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Early endoscopic management of an infected acute necrotic collection misdiagnosed as a pancreatic pseudocyst: A case report

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 609-615页

作者： Hong-Ying Zhang Chen-Cong He Department of Gastroenterology Jinhua People's HospitalJinhua 321000Zhejiang ProvinceChina Department of General Medicine Jinhua Guangfu HospitalJinhua 321001Zhejiang ProvinceChina

BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and *** plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be *** SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst *** wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic ***,the final diagnosis of ANC in-fection was *** necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and *** weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully *** repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after *** Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.

关键词： Infected acute necrotic collection pancreatic pseudocyst Endoscopic ultrasonography Endoscopic retrograde cholangiopancreatography Endoscopic ultrasound-guided fine-needle aspiration Case report

pancreatic pseudocyst

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World Journal of Gastroenterology 2009年第1期15卷 38-47页

作者： Samir Habashi Peter V Draganov Department of Gastroenterology Hepatology and Nutrition University of FloridaGainesville Florida 32610 United States

pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications. The main two indications for some type of invasive drainage procedure are persistent patient symptoms or the presence of complications (infection, gastric outlet or biliary obstruction, bleeding). Three different strategies for pancreatic pseudocysts drainage are available: endoscopic (transpapillary or transmural) drainage, percutaneous catheter drainage, or open surgery. To date, no prospective controlled studies have compared directly these approaches. As a result, the management varies based on local expertise, but in general, endoscopic drainage is becoming the preferred approach because it is less invasive than surgery, avoids the need for external drain, and has a high long-term success rate. A tailored therapeutic approach taking into consideration patient preferences and involving multidisciplinary team of therapeutic endoscopist, interventional radiologist and pancreatic surgeon should be considered in all cases.

关键词： pancreatic pseudocyst Cyst Pancreatititis Endoscopic ultrasound Therapy

pancreatic pseudocyst filled with semisolid lipids mimicking solid mass on endoscopic ultrasound

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World Journal of Gastroenterology 2010年第8期16卷 1034-1038页

作者： Sang-Woo Cha Sae Hee Kim Hyang Ie Lee Yun Jung Lee Hyeon Woong Yang Sung Hee Jung Anna Kim Min Koo Lee Hyun Young Han Dong Wook Kang Division of Gastroenterology Department of Internal Medicine Eulji University College of Medicine Eulji University Hospital Division of Gastroenterology Department of Surgery Eulji University College of Medicine Eulji University Hospital Division of Gastroenterology Department of Radiology Eulji University College of Medicine Eulji University Hospital Division of Gastroenterology Department of Pathology Eulji University College of Medicine Eulji University Hospital

pancreatic pseudocysts,which account for 70%-90% of pancreatic cystic lesions,characteristically are non-epithelially lined cystic cavities that are contiguous with the pancreas. pancreatic pseudocysts can be caused by acute,chronic or traumatic pancreatitis and should be differentiated from other pancreatic diseases with cystic appearances,especially cystic neoplasms. We report a unique case of a pancreatic pseudocyst filled with semisolid lipids,which appeared by endoscopic ultrasound as a solid mass,and was therefore resected.

关键词： pancreatic pseudocyst Lipids Endosonog-raphy

Percutaneous drainage in the treatment of intrahepatic pancreatic pseudocyst with Budd-Chiari syndrome:A case report

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World Journal of Clinical Cases 2021年第28期9卷 8476-8481页

作者： Gang Zhu Yi-Sheng Peng Cheng Fang Xiao-Li Yang Bo Li Department of General Surgery(Hepatobiliary Surgery) Academician(Expert)Workstation of Sichuan ProvinceThe Affiliated Hospital of Southwest Medical UniversityLuzhou 646000Sichuan ProvinceChina

BACKGROUND Intrahepatic pancreatic pseudocyst(IHPP)is an extremely rare complication of acute pancreatitis,with only a few cases previously described in the *** the best of our knowledge,IHPP with Budd-Chiari syndrome(BCS)has not yet been *** SUMMARY A 35-year-old male presented with abdominal pain,vomiting and anorexia,followed by severe swelling of the lower body after 4 *** morphological assessment(using computed tomography revealed the presence of a huge cyst of 18.28 cm×10.34 cm under the liver capsule accompanied by a large amount of *** puncture allowed us to detect a high level of amylase in the collection,confirming the diagnosis of *** cyst was treated by percu-taneous drainage,producing complete resolution of the *** IHPP can be treated with percutaneous drainage,endoscopic drainage,surgery or even conservative treatment,depending on the specific *** recommend percutaneous drainage as the first choice of treatment when IHPP with secondary BCS.

关键词： Intrahepatic pancreatic pseudocyst pancreatic pseudocyst Pancreatitis Budd�Chiari syndrome Percutaneous drainage Case report

Massive gastric bleeding-perforation of pancreatic pseudocyst into the stomach: A case report and review of literature

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World Journal of Clinical Cases 2021年第2期9卷 389-395页

作者： Zhe Jin Yi-Wei Xiang Qiu-Shi Liao Xiao-Xu Yang Hui-Chao Wu Bi-Guang Tuo Rui Xie Department of Gastroenterology Affiliated Hospital of Zunyi Medical UniversityZunyi 563003Guizhou ProvinceChina

BACKGROUND pancreatic pseudocyst may cause serious gastrointestinal complications including necrosis,infection,and perforation of the gastrointestinal tract wall,but massive gastric bleeding is very *** We report a rare case of a 49-year-old man with life-threatening gastric bleeding from a pseudoaneurysm of the splenic artery perforating the stomach induced by pancreatic *** hospitalization,gastroscopy revealed a bare blood vessel in an ulcer-like depression of the greater gastric curvature,and computed tomography scan confirmed a pancreatic pseudocyst invading part of the spleen and gastric wall of the greater *** showed that the bare blood vessel originated from a pseudoaneurysm of the splenic *** bleeding was controlled by the trans-arterial embolization,the patient’s recovery was rapid and *** Massive gastrointestinal bleeding could be a rare complication of pancreatic pseudo aneurysm.

关键词： Gastric bleeding Pseudoaneurysm of the arteria lienalis pancreatic pseudocyst Trans-arterial embolization Case report

pancreatic pseudocyst Rupture: Cause of Acute Abdomen

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Case Reports in Clinical Medicine 2023年第8期12卷 324-331页

作者： Joel Iván Cruz-González Miguel Ángel Miranda-Del Olmo Benito Antonio García-Ramón Brenda Hernández-García Crystell Guadalupe Guzmán-Priego Alejandro Jiménez-Sastré Social Security Institute of the State of Tabasco Villahermosa Mexico Cardiometabolism Laboratory Academic Division of Health Sciences Juarez Autonomous University of Tabasco Villahermosa Mexico

Case report of a 23-year-old male patient with a pancreatic pseudocyst, initially was treated by the Interventional Radiology service by placing percutaneous drainage with poor evolution, abruptly presented abdominal pain, Systemic Inflammatory Response Syndrome and peritoneal irritation, so an urgent exploratory laparotomy was performed with a finding of rupture of the pancreatic pseudocyst into the abdominal cavity. He presented septic shock and died in the immediate postoperative period. Computerized Axial Tomography represents the ideal diagnostic method. Spontaneous rupture is extremely rare and requires urgent surgical intervention.

关键词： Rupture pancreatic pseudocyst Acute Abdomen

Endoscopic intramural cystogastrostomy for treatment of peripancreatic fluid collection: A viewpoint from a surgeon

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World Journal of Gastroenterology 2024年第6期30卷 610-613页

作者： Chen-Guo Ker Department of General Surgery E-Da HospitalI-Shou UniversityKaohsiung 824Taiwan

Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic *** transgastric fenestration(ETGF)was first reported for the management of pancreatic pseu-docysts of 20 patients in *** a surgeon’s viewpoint,ETGF is a similar procedure to cystogastrostomy in that they both produce a wide outlet orifice for the drainage of fluid and necrotic *** can be performed at least 4 wk after the initial onset of acute pancreatitis and it has a high priority over the surgical ***,the surgical approach usually has a better success rate because surgical cystogastrostomy has a wider outlet(>6 cm vs 2 cm)than ***,percutaneous or endoscopic drainage,ETGF,and surgical approach offer various treatment options for peripancreatic fluid collection patients based on their conditions.

关键词： Pancreatitis pancreatic pseudocyst Endoscopic cystogastrostomy Surgical cystogastrostomy Peripancreatic fluid collection Fenestration for pancreatic cyst

Totally laparoscopic Roux-en-Y cystojejunostomy as a sole treatment option for pancreatic pseudocysts： a report of four cases

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Chinese Medical Journal 2010年第15期123卷 2142-2144页

作者： SUN Yue-ming CAI Hui-hua BAI Jian-feng ZHAO Han-lin FU Zan MIAO Yi Department of Minimally Invasive Surgery First Affiliated Hospital Nanjing Medical University Nanjing Jiangsu 210029China

pancreatic pseudocyst （PPC） is one of the most common complications of acute pancreatitis,pancreatic injury or *** the pseudocyst exceeds 6 cm in diameter and sustains over 6 weeks,1patients may suffer from abdominal pain, co-morbid illness, or the presence of abdominal *** such large pseudocyst is unlikely to resolve spontaneously, surgical treatment is necessary.

关键词： laparoscopy Roux-en- Y pancreatic pseudocyst

Differential treatment and early outcome in the interventional endoscopic management of pancreatic pseudocysts in 27 patients

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World Journal of Gastroenterology 2006年第26期12卷 4175-4178页

作者： Uwe Will Conrad Wegener Kai-Ivo Graf Igor Wanzar Thomas Manger Frank Meyer Department of Gastroenterology Municipal Hospital D-07548 GeraGermany Department of Surgery Municipal Hospital D-07548 GeraGermany Department of Surgery University Hospital D-39120 MagdeburgGermany

AIM： pancreatic pseudocysts （PPC） as a complication of pancreatitis are approached only in the case of abdominal pain, infection, bleeding, and compression onto the gastrointestinal tract or biliary tree. METHODS： From 02/01/2002 to 05/31/2004, all con- secutive patients with symptomatic PPC who underwent an interventional endoscopic approach were evaluated in this pilot case-series study： Group （Gr.） Ⅰ-Primary percutaneous （external）, ultrasound-guided drainage. Gr. Ⅱ- Primary EUS-guided cystogastrostomy. Gr. Ⅲ-EUS-guided cystogastrostomy including intracystic necrosectomy. RESULTS：（=＂follow up＂： n = 27）： Gr. Ⅰ （n = 9; 33.3%）： No complaints （n = 3）; change of an external into an internal drainage （n = 4）; complications：（a） bleeding （n = 1） followed by 3 d at ICU, discharge after 40 d; （b） septic shock （n = 1） followed by ICU and several laparotomies for programmed lavage and necrosectomy, death after 74 d. Gr. Ⅱ （n = 13; 48.1%）： No complaints （n = 11）; external drainage （n = 2）; complications/problems out of the 13 cases： 2nd separate pseudocyst （n = 1） with external drainage （since no communication with primary internal drainage）; infection of the residual cyst （n = 1）＋ following external drainage; spontaneous PPC perforation （n = 1）＋ following closure of the opening of the cystogastrostomy using clips and subsequently ICU for 2 d. Gr. Ⅲ （n = 5; 18.5%）： No complaints in all patients, in average two endoscopic procedures required （range, 2-6）. CONCLUSION： Interventional endoscopic management of pancreatic pseudocysts is a reasonable alternative treatment option with low invasiveness compared to surgery and an acceptable outcome with regard to the complication rate （11.1%） and mortality （3.7%）, as shown by these initial study results.

关键词： pancreatic pseudocyst Pancreatitis Interventional endoscopic approach