Cases reported "Pancreatitis, Chronic"

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1/3. Lymphoplasmacytic sclerosing pancreatitis presenting as a pancreatic head mass in a child: case report and management recommendations.

    Lymphoplasmacytic sclerosing pancreatitis (LPSP) is an autoimmune form of chronic pancreatitis found most commonly in elderly men and only rarely in children. A 10-year-old boy presented with a 3-week history of obstructive jaundice. Imaging studies showed a pancreatic head mass, hepatic ductal dilatation, and involvement of the portal vein. A preliminary diagnosis of malignancy was based on endoscopic ultrasound characteristics and fine-needle aspiration cytology. The patient underwent a pancreaticoduodenectomy. The patient recovered uneventfully and was discharged home on postoperative day 6. The final pathological diagnosis was LPSP. Lymphoplasmacytic sclerosing pancreatitis is a rare form of chronic pancreatitis in children that is difficult to distinguish from malignancy preoperatively. We discuss the diagnosis and treatment of LPSP. Determination of elevated IgG4 levels in children with pancreatic head masses may allow for the medical treatment of LPSP.
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2/3. Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting.

    A 41-year old alchoholic male with a history of chronic pancreatitis was admitted for nausea, vomiting and weight loss. Angiogram was performed and demonstrated an aneurysmal sac with a narrow neck originating from the inferior aspect of the distal portion of the proper hepatic artery. The origin of the pseudoaneurysm was covered with a 5 mm multiply 2.5 cm Viabahn cover stent (Gore). A repeat angiogram showed some leak and a second stent (6 mm multiply 2.3 cm) was deployed and overlapped with the first stent by 3 mm. Contrast was injected and a repeat angiogram demonstrated complete exclusion of the aneurysm. A repeat computerized axial tomography (CAT) scan of the abdomen after 24 h showed successful stenting. The patient had an uneventful post-operative course.
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3/3. Sinistral portal hypertension. A case report.

    Sinistral portal hypertension is a clinical syndrome of gastric variceal hemorrhage in the setting of splenic vein thrombosis due to a primary pancreatic pathology. The distinguishing features from other forms of portal hypertension are preserved liver function and a patent extrahepatic portal vein. The important causes include acute and chronic pancreatitis, pancreatic pseudocysts and pancreatic carcinomas. Benign pancreatic neoplasms only rarely cause sinistral portal hypertension. splenic vein thrombosis complicates 7-20% of patients having pancreatitis or a pancreatic pseudocyst; however, bleeding occurs in only approximately 5% of patients. The diagnosis of sinistral portal hypertension is achieved by a combination of gastroscopy, liver function tests, ultrasound examination (with Doppler) and/or contrast-enhanced CT scan of the abdomen. A mere demonstration of sinistral portal hypertension does not warrant intervention. An expectant management is justifiable in asymptomatic patients with pancreatitis. However, concomitant splenectomy may be considered in patients undergoing operative treatment of symptomatic chronic pancreatitis if sinistral portal hypertension and gastroesophageal varices are present. In patients presenting with gastric variceal hemorrhage, splenectomy (with treatment for the primary pancreatic pathology, e.g. distal pancreatectomy) is curative with excellent long term results.
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