Cases reported "Pancreatitis"

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1/27. Haemosuccus pancreaticus: a clinical challenge.

    BACKGROUND: Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25-year-old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow-up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss.
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2/27. Laparoscopic cystogastrostomy for pancreatic pseudocyst is safe and effective.

    Between March 1997 and March 1998, three consecutive patients underwent laparoscopic cystogastrostomy for persistent giant retrogastric pancreatic pseudocyst complicating an attack of acute pancreatitis. The mean cyst diameter was 15 /- 1 cm (range 14-16). The procedure was performed with four trocars. The anterior wall of the stomach was opened longitudinally. The pseudocyst was entered through the posterior wall of the stomach. A cystogastrostomy was created by suturing the margins of the communication by interrupted nonabsorbable sutures. The mean operative time was 123 /- 15 min, and there were no postoperative complications. The mean postoperative hospital stay was 4 /- 1 days. Computed tomography demonstrated complete resolution of the pseudocyst. Laparoscopic cystogastrostomy represents a good therapeutic option for persistent retrogastric pancreatic pseudocyst.
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3/27. alstrom syndrome with acute pancreatitis: a case report.

    We report the case of a 21-year-old female with alstrom syndrome who also suffered from acute pancreatitis of obscure manifestation. The patient had underlying cone-rod dystrophy of the retinas, nystagmus, obesity, progressive sensorineural hearing impairment, diabetes mellitus, and hypertriglyceridemia, compatible with the clinical diagnosis of alstrom syndrome. Serial examinations showed liver dysfunction and pancreatitis. In treating a patient with poor communication (i.e. cone-rod dystrophy and hearing impairment) suffering from acute illness, understanding the underlying disease and the potential for pancreatitis with hypertriglyceridemia is necessary. It is also a challenge to treat a patient with multiple system involvement. In conclusion, alstrom syndrome is a disease of systemic multi-organ involvement, and hepatic disease and pancreatitis, possibly due to dyslipidemia, appear to be manifestations of alstrom syndrome.
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4/27. Intrasplenic pancreatic pseudocyst: a case report.

    An intrasplenic pseudocyst associated with the acute relapsing phase of chronic pancreatitis in a 51-year-old woman is reported, with a review of the Japanese literature. The patient was admitted with a complaint of left lateral and back pain. Abdominal US and CT revealed communicating cysts at the pancreatic tail and the subcapsule of the spleen. A repeat US and CT 1 month after admission demonstrated enlargement of the cyst at the pancreatic tail. ERCP revealed a dilated main pancreatic duct without any definite evidence of stenosis, and direct communication with the cyst at the pancreatic tail. Percutaneous cystography revealed that the subcapsular cyst of the spleen, the cyst of the pancreatic tail, and the main pancreatic duct communicated with each other. The cyst contained serous fluid with an amylase content of 57,500 IU/I. Distal pancreatectomy and splenectomy was performed. Histologically, there was a nonepithelial lining on the inner surface of the cysts at the pancreatic tail and the subcapsule of the spleen. Severe chronic inflammatory changes were present in the resected tail of the pancreas. Timely surgical treatment is advocated to reduce the mortality and morbidity associated with complications of intrasplenic pseudocysts.
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5/27. Intrapancreatic duodenal duplication associated with pancreatic pseudocysts.

    A rare case of intrapancreatic duodenal duplication causing pancreatitis is reported. At 2 years of age, the patient presented with a recurrent pancreatic pseudocyst. Intraoperative pancreatogram showed the presence of cystic duodenal duplication in the aberrant lobe of the pancreas communication with the pancreatic duct. Since the resection of the duplication, she has been free from recurrence of pancreatitis. In this case, intraoperative pancreatography was of great value.
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6/27. Mucinous cystic neoplasms of the pancreas.

    Mucinous cystic neoplasms of the pancreas (MCNP) are rare tumors with presentation and findings that differ in most cases from pancreatic pseudocysts. A simple pancreatic cystic lesion in a younger-aged patient with a history of pancreatitis and endoscopic retrograde cholangiopancreatography (ERCP) demonstration of ductal communication with the cyst strongly suggests the diagnosis of a benign pseudocyst. MCNP may have extensive areas without an epithelial lining, adding histologic sampling error to the potential for confusing these two entities. Pancreatic pseudocysts are benign lesions treated by enteric drainage procedures, while MCNP have significant malignant potential, and resection is advised. Even when clinical presentation and imaging are persuasive for a benign cyst, MCNP of the pancreas should be considered in planning, evaluation, and treatment.
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7/27. Mediastinal pancreatic pseudocyst with recurrent pleural effusion. Demonstration by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan.

    Mediastinal pseudocysts of internal pancreatic fistulas are rare as a cause of bilateral pleural effusions even in relapsing pancreatitis. We describe a 38-year-old man with recurrent bilateral pleural effusion as a complication of a pancreatic pseudocyst. Extension of a pancreatic pseudocyst into the posterior mediastinum was clearly identified by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan of the abdomen and chest, and the complication was successfully treated by surgical management. We stress the importance of definite assessment of the communication of pancreatic pseudocyst with mediastinum in patients with pancreatitis who develop recurrent pleural effusions.
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8/27. Successful resolution of a mediastinal pseudocyst and pancreatic pleural effusion by endoscopic nasopancreatic drainage.

    CONTEXT: A mediastinal pseudocyst is an unusual complication of acute and chronic pancreatitis. The ideal form of management is controversial, and various successful therapeutic interventions including surgical resection, internal or external drainage, and non-operative radiological drainage techniques have been described. Successful resolution of a mediastinal pseudocyst with endoscopic transpapillary stent placement has been described in fewer than five cases. CASE REPORT: We report a case of chronic pancreatitis with complete pancreas divisum together with a mediastinal pseudocyst and pancreatic pleural effusion in which magnetic resonance imaging and endoscopic retrograde pancreatography demonstrated communication of the abdominal pseudocyst with the posterior mediastinum through the diaphragmatic hiatus. This case was successfully treated with endoscopic transpapillary nasopancreatic drain placement alone. CONCLUSION: A communicating mediastinal pseudocyst can be successfully treated by endoscopic transpapillary nasopancreatic drainage alone.
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9/27. Spontaneous internal drainage of pancreatic pseudocysts.

    Six cases are reported in which spontaneous internal drainage between a pancreatic pseudocyst and the alimentary tract became established. In each instance the communication was demonstrated radiologically. The clinical circumstances and radiographic features of these cases are described, and the existing literature pertaining to this phenomenon is reviewed.
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10/27. Metastasis-induced acute pancreatitis in small cell bronchogenic carcinoma.

    Despite frequent metastatic involvement of the pancreas at postmortem examination in patients with small cell lung cancer, clinically observed pancreatitis due to metastatic pancreatic tumor rarely has been reported. This communication describes three cases of clinical acute pancreatitis occurring in a consecutive series of 40 patients with oat cell lung cancer. This complication may appear either as the initial manifestation of the neoplasm or during a recrudescent phase of the malignant growth. The diagnosis should be suspected in the presence of the clinical, laboratory, and radiologic features of acute pancreatitis in patients with known small cell carcinoma of the lung, especially if there is evidence of progression of the neoplastic disease elsewhere and no response to conservative medical management. Aggressive treatment with polychemotherapy can produce rapid clinical improvement and useful prolongation of survival.
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