Strictures, stones and cysts: an unusual cause of pancreatitis in a 20-month-old female child

2020 ◽  
Vol 13 (7) ◽  
pp. e234966
Author(s):  
Alina Zufall ◽  
Jeremy P Middleton ◽  
Sara Rasmussen ◽  
Reza J Daugherty
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Clinical Symptoms ◽  
Stone Formation ◽  
Abdominal Mass ◽  
Biliary Tree ◽  
Female Child ◽  
Choledochal Cysts ◽  
Patient Morbidity ◽  
Duct Stricture

Choledochal cysts are dilations of the biliary tree that cause a variety of clinical symptoms and can lead to several types of complications. Choledochal cysts are most commonly diagnosed in childhood and frequently present with abdominal pain, jaundice and, in infants, an abdominal mass. Although the most concerning complication is malignant transformation of the cyst epithelium, other complications such as stone formation, acute pancreatitis and stricture can also occur and lead to patient morbidity. Treatment is aimed at not only relieving patient symptoms, but also decreasing a long-term cancer risk. We present a case of a child presenting with abdominal pain and vomiting secondary to a type IVa choledochal cyst complicated by acute pancreatitis, a common bile duct stricture and cystolithiasis.

scholarly journals Insights into Acute Pancreatitis Associated COVID-19: Literature Review

2021 ◽  
Vol 10 (24) ◽  
pp. 5902
Author(s):  
Yasameen E. Muzahim ◽  
David C. Parish ◽  
Hemant Goyal
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Respiratory Symptoms ◽  
Clinical Symptoms ◽  
Pancreatic Injury ◽  
Insufficient Data ◽  
Converting Enzyme ◽  
Serum Lipase ◽  
Asymptomatic Patients ◽  
Organ Systems

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) primarily affects the lungs, causing respiratory symptoms. However, the infection clearly affects all organ systems including the gastrointestinal system. Acute pancreatitis associated with coronavirus disease 2019 (COVID-19) has been widely reported Recent studies have discussed pancreatic compromise incidentally in asymptomatic patients, or in a form of clinical symptoms such as abdominal pain, nausea, or vomiting, which is further reflected in some cases with abnormal serum lipase and amylase levels It was suggested that upregulation of angiotensin-converting enzyme II cell receptors or inflammatory cytokines play a major role in predisposing pancreatic injury in SARS-CoV-2 positive patients To date, there is insufficient data to establish the causality of acute pancreatitis in SARS-CoV-2 infected cases. In this paper, we organize recent studies conducted to observe the frequency of acute pancreatitis associated with COVID-19 cases while highlighting present hypotheses, predisposing factors, and their effect on the outcome, and point to gaps in our knowledge.

Scarlet Fever with Hydrops of the Gallbladder

PEDIATRICS ◽  
1969 ◽  
Vol 44 (5) ◽  
pp. 741-745
Author(s):  
Ronald G. Strauss
Keyword(s):  
Abdominal Pain ◽  
Scarlet Fever ◽  
Case Reports ◽  
Abdominal Mass ◽  
Biliary Tree

A 69/12-year-old white boy with acute distension of the gallbladder during an episode of scarlet fever is reported. Case reports of nine children with acute distention of the gallblader are reviewed. This condition is found in both boys and girls at many ages. Abdominal pain is invariably present, while fever, jaundice, or an abdominal mass are less frequently seen. The pathogenesis is obscure, but mesenteric adenopathy has been noted and these nodes may obstruct the biliary tree. It is important to recognize acute distention of the gallbladder because the therapy is simple aspiration or cholecystostomy.

scholarly journals Clinical Profile of Acute Pancreatitis in Children in a Tertiary Level Hospital of Bangladesh

2017 ◽  
Vol 40 (3) ◽  
pp. 160-165
Author(s):  
Nadira Musabbir ◽  
ASM Bazlul Karim ◽  
Md Wahiduzzaman Mazumder ◽  
Kaniz Sultana ◽  
Syeda Afria Anwar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Serum Amylase ◽  
Abdominal Mass ◽  
Elevated Serum ◽  
Clinical Feature ◽  
Cross Sectional ◽  
Female Ratio ◽  
Epigastric Region ◽  
Common Location

Background: Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. The incidence of acute pancreatitis in children has increased significantly in the past two decades. It can be associated with severe morbidity and mortality. It should be considered in every child with unexplained acute abdominal pain.Objectives: To observe the clinical, biochemical and imaging profiles of acute pancreatitis in children.Methods: It was a cross-sectional study conducted at the Department of Pediatric Gastroenterology & Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2014 through June 2015. A total of 50 cases of acute pancreatitis were included in this study. The diagnosis of acute pancreatitis was based on diagnostic criteria of acute pancreatitis made by INSPPIRE group (If a child had any 2 of the 3 criteria: the abdominal pain compatible with acute pancreatitis, elevated serum amylase and /or lipase level more than three times of upper limit of normal, imaging findings compatible with acute pancreatitis). Clinical characteristics, laboratory and imaging profile of the cases, complications were studied.Results: Among 50 cases, male were 46% and male female ratio was 0.8:1. Mean age at presentation was 10.2 ± 3.2 years. Forty eight (96%) patients had abdominal pain which was severe agonizing in 81.3% cases. The common location of pain was in epigastric region (77%). Pain radiating to back in 22.9% patients. Mean duration of pain was 6.6 ± 4.4 days before hospital admission. Vomiting was present in 72% patients followed by fever (30%). Two (4%) patients had jaundice. Ascites was noted in 12% patients and abdominal mass in 6% patients. Out of 50 cases of AP, biliary sludge was associated in 6% patients, biliary ascariasis in 4%, choledochal cyst in 2% and gallbladder stone in 2% patients. But in this study, 4% patients had Wilson disease. Laboratory tests showed leukocytosis in 28% patients, high serum amylase and lipase level in 56% and 58% patients respectively. Postive findings in ultrasonogram were present in 66% patients. In the present study, hypocalcemia was found in 38% patients, pseudocyst in 6% and pancreatic necrosis in 2% patients.Conclusion: Although acute pancreatitis may present with varieties of clinical feature, the most common one is abdominal pain and common location of pain is in epigastric region. For confirmation of clinically diagnosed pancreatitis, both serum amylase and lipase level and abdominal ultrasound are useful tools.Bangladesh J Child Health 2016; VOL 40 (3) :160-165

scholarly journals A Review of Clinicopathological Characteristics and Treatment of Solid Pseudopapillary Tumor of the Pancreas with 2450 Cases in Chinese Population

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Jihang Yao ◽  
He Song
Keyword(s):  
Abdominal Pain ◽  
Chinese Population ◽  
Clinical Symptoms ◽  
Chinese Literature ◽  
Abdominal Mass ◽  
Average Diameter ◽  
Clinicopathological Characteristics ◽  
The Body ◽  
Solid Pseudopapillary Tumor ◽  
Upper Abdominal

Background. Solid pseudopapillary tumor of the pancreas (SPTP) has been reported as a rare disease with low malignant potential. The aim of this study was to summarize experiences of the diagnosis and treatment for the patients reported in the Chinese population. Method. 2450 SPTP cases reported in English and Chinese literature before Jan 2020 were for our review and analysis retrospectively. Result. There are 389 male cases and 2061 female cases, and the ratio of male/female was 1 : 5.3. The average age was 29.3 years. The main clinical symptoms were upper abdominal pain and bloating discomfort in 51.6% of the cases and epigastric mass. 38.6% of the tumor was located at the head of the pancreas and 55.4% at the body and tail of the pancreas. The most frequent operative styles were tumor enucleation (38.4%). Pathology showed that the average diameter of the tumor was 8.2 cm and 12.3% of SPTP was malignant. 98.3% of cases had favorable survival. Conclusions. SPTP is a rare indolent tumor occurring mainly in young women, and the main clinical performances are abdominal mass and abdominal pain; most tumors are distributed at the head and the tail of the pancreas; the prognosis after complete resection is excellent.

scholarly journals Clinical and imaging findings of walled-off pancreatic necrosis misdiagnosed as an intra-abdominal neoplasia in a Schnauzer dog: A case report

2021 ◽  
Vol 66 (No. 1) ◽  
pp. 32-39
Author(s):  
J Kim ◽  
J Ko ◽  
H Yoon ◽  
H Kim ◽  
J Hwang ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Report ◽  
Soft Tissue ◽  
Pancreatic Necrosis ◽  
Abdominal Mass ◽  
Imaging Findings ◽  
Diagnostic Modality ◽  
Surgical Exploration ◽  
Cystic Masses

A 10-year-old Schnauzer presented with a 1-month history of vomiting, anorexia, and abdominal pain, and a recently detected intra-abdominal mass. The round, soft-tissue opacity masses identified on the radiography in the left mid-abdomen were confirmed as multifocal, cystic masses via ultrasonography. The necrotic masses mimicked an intra-abdominal neoplasia on the initial imaging examinations. The computed tomography (CT) clearly showed encapsulated masses with a necrotic fluid arising from the left limb of the pancreas and extending to the peripancreatic, paracolic, and perigastric regions. Based on the multimodal imaging, surgical exploration, and histopathology, the mass was diagnosed as a walled-off pancreatic necrosis (WOPN). CT is an effective diagnostic modality for diagnosing acute pancreatitis in WOPN.

scholarly journals Choledochal cyst type I-A: a case report

2021 ◽  
Vol 1 (3) ◽  
pp. 6-11
Author(s):  
Tiago Magalhães Cardoso ◽  
Érica Paulinne Pereira Brandão ◽  
Fernando Fernandes Rodrigues ◽  
Luíz Felipe Lima Ceccato
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Abdominal Mass ◽  
Biliary Tree ◽  
Liver Cyst ◽  
Multiple Form ◽  
Type I ◽  
The Right ◽  
Palpable Abdominal Mass ◽  
Mass Form

Choledocal cysts are cystic dilations that can occur in a single or multiple form in the biliary tree. Cysts can be congenital or acquired and are associated with numerous anatomical abnormalities. The presence of pain in the upper right quadrant of the abdomen, jaundice and palpable abdominal mass form the classic triad that is present in 15% to 45% of patients. We report the case of a 19-year-old woman patient, who she was admitted with abdominal pain in the right hypochondrium, nausea and vomiting, which evolved into  jaundice. When seeking medical care, a large liver cyst and cholelithiasis. Imaging exams revealed liver cyst in segments IV-B,V and VI, lithiasis and biliary polyp.

scholarly journals Choledochal Cyst in Adults: Etiopathogenesis, Presentation, Management, and Outcome—Case Series and Review

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Norman Oneil Machado ◽  
Pradeep J. Chopra ◽  
Adil Al-Zadjali ◽  
Shahzad Younas
Keyword(s):  
Abdominal Pain ◽  
Choledochal Cyst ◽  
Past History ◽  
Abdominal Mass ◽  
Case Series ◽  
Biliary Tree ◽  
Type I ◽  
Type Ii ◽  
Complete Excision ◽  
Type Iii

Background. Choledochal cyst, a rare congenital cystic dilatation of biliary tree, is uncommon in adults. Their presentations differ from children and surgical management has evolved.Methods. A retrospective review of the records of all the patients above 15 years, who underwent therapeutic intervention in our hospital, was carried out.Results. Ten cases of choledochal cyst were found; 8 female, with mean age 31 years. These included 8 cases of Todani type I and one case each of type II and type III. The predominant symptoms were abdominal pain and jaundice. Abdominal mass and past history of cholangitis and pancreatitis were seen in 2 patients. Investigations included ultrasound in 8 patients, CT in 7, ERCP in 3, and MRCP in 5. Surgical intervention included complete excision of the cyst with hepaticojejunostomy and cholecystectomy (type I), excision of the diverticulum (type II), and ERCP sphincterotomy (type III). Malignancy was not seen in any patients. The long-term postoperative complications included cholangitis in two patients.Conclusion. Choledochal cyst is rare in adults. The typical triad of abdominal pain, jaundice, and mass is uncommon in adults. The surgical strategy aims for single stage complete excision of the cyst with hepaticojejunostomy.

Spontaneous intramural duodenal hematoma in a young woman

2021 ◽  
Vol 75 (6) ◽  
pp. 535-539
Author(s):  
Petra Vrbová ◽  
Tomáš Koller
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Report ◽  
Key Words ◽  
Clinical Symptoms ◽  
Supportive Therapy ◽  
Gastrointestinal Obstruction ◽  
History Of ◽  
Duodenal Hematoma ◽  
Upper Abdominal

Summary: Non-traumatic spontaneous intramural duodenal hematoma is a rare cause of proximal gastrointestinal obstruction which may present with hemorrhage, jaundice and pancreatitis. In this case report we present a case of spontaneous duodenal hematoma in a 28-year-old female with a history of acute pancreatitis, admitted to hospital for convulsive upper abdominal pain with vomiting as suspected pancreatitis. An MRI examination of the abdomen confi rmed intraluminal bleeding into the duodenum. Following supportive therapy the clinical symptoms spontaneously subsided and laboratory parameters improved. Due to early dia gnosis and therapy the patient had a good outcome, without requiring surgery. Repeated imaging showed hematoma resorption. Key words: abdominal pain – vomitus – duodenal hematoma – hemorrhage

Thrombotic Thrombocytopenic Purpura INDUCED PANCREATITIS– A Rare Complication

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4683-4683
Author(s):  
Vladimir K. Gotlieb ◽  
Vaibhav erma ◽  
Robin Jacob ◽  
Padi Reddy ◽  
Hesham Taha ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Clinical Symptoms ◽  
Conflicts Of Interest ◽  
Rare Complication ◽  
Clinical Status ◽  
African American Female ◽  
Thrombocytopenic Purpura ◽  
Clinical Disorder

Abstract Abstract 4683 Thrombotic Thrombocytopenic Purpura (TTP) is a rare clinical disorder characterized by clinical combination of fever, microangiopathic hemolytic anemia, thrombocytopenia, renal failure and neurological changes. Pancreatitis may occur as a result of TTP or may rarely trigger TTP. We present a case of acute Pancreatitis as a complication of TTP. A 29 year-old African-American female with history of alcohol abuse presented with three days of nausea, vomiting, diarrhea, headache and fever. Vitals: BP-120/80mmHg, HR-75/min, Temp-98F, and RR-14/min. Examination was remarkable for lethargy and mild epigastric tenderness. Pertinent laboratory: Hgb-12.4g/dL (Day1) - 8.5g/dL (Day3), reticulocyte count-3.35, Platelets-13,000mm3, BUN/Cr-69/6.3 (mg/dL), LDH-1523U/L, indirect hyperbilrubinemia-3.6mg/dL, Amylase/Lipase-117/87(U/L), fibrinogen-462, D-dimer-15.39, PT/PTT-normal and Haptoglobulin<8mg/dL. Peripheral smear showed 3+ schistocytes. Imaging: CXR, CT Head and CT Abdomen were unremarkable. Work-up for various infections and autoimmune diseases was negative. TTP was diagnosed and patient was admitted to ICU. Plasmapheresis was initiated with clinical improvement by day 3 with subsequent deterioration by day 7. On day 10, patient developed severe abdominal pain with increase in Amylase (145U/L) and lipase (281U/L). Repeat CT Abdomen showed acute pancreatitis. Day 13 - Rapid worsening in clinical status with death of the patient. Autopsy revealed micothrombi and infarcts in multiple organs including kidney, pancreas, and heart. Acute Pancreatitis is a rare complication of TTP suggested to occur in 2% of cases of TTP but no case has ever been reported in the literature. There are cases that have been reported where Acute Pancreatitis have triggered TTP-HUS syndrome and chronic relapsing TTP. Idiopathic cases of TTP have a deficiency of ADAMS 13, a metalloprotease enzyme that cleaves von Willebrand factor (vWF) resulting in abnormal vWF multimers causing hyaline thrombi formation with end-organ damage due to ischemia. Pancreatic inflammation in TTP has been regarded as ischemic in nature, due to microthrombi of pancreatic small vessels. It is common to see the inflammation of pancreas in the histological specimens on autopsy, but very rare to develop pancreatitis with clinical symptoms, increase in pancreatic enzymes and CT findings of Pancreatitis. Prognosis of Patients with Acute Pancreatitis in TTP is guarded. Patient should be closely monitored in ICU setting aiming to control TTP by Plasmapheresis and Immunosuppressive therapy (Rituximab) in refractory cases. Acute Pancreatitis is a rare complication of TTP and carries a worse prognosis. In patients developing abdominal pain during the course of TTP, Acute Pancreatitis should always be considered in the differential diagnosis. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Management of Choledochal Cysts

HPB Surgery ◽  
1997 ◽  
Vol 10 (4) ◽  
pp. 211-219 ◽  
Author(s):  
Hikmet Akkiz ◽  
Salih O. Çolakoğlu ◽  
Yilmaz Ergün ◽  
Haluk Demiryürek ◽  
Alper Akinoğlu ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biliary Stricture ◽  
Clinical Symptoms ◽  
Imaging Technique ◽  
Hepatic Abscess ◽  
Biliary Tree ◽  
Choledochal Cysts ◽  
Cystic Dilatation ◽  
Endoscopic Retrograde ◽  
Recurrent Acute Pancreatitis

Choledochal cysts are an uncommon anomaly of the biliary system manifested by cystic dilatation of the extra or intrahepatic biliary tree or both. It is most frequently found in Orientals and in females. Endoscopic retrograde cholangiopancreatography is a valuable imaging technique in the diagnosis of choledochal cysts in adults. Additionaly, in selected cases, a choledochocele may be effectively managed by endoscopic sphincterotomy. We present clinical and endoscopic findings of six adult patients with choledochal cysts. Clinical symptoms were characterized by abdominal pain, jaundice and cholangitis. Associated hepatobiliary pathologic findings included cholelithiasis, recurrent acute pancreatitis, gallbladder carcinoma, Cystolithiasis, choledocholithiasis, biliary stricture and hepatic abscess.

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