scholarly journals Diagnostic Pitfalls and Therapeutic Strategies in the Treatment of Pancreatic Duct Haemorrhage

HPB Surgery ◽  
1997 ◽  
Vol 10 (5) ◽  
pp. 293-297 ◽  
Author(s):  
P. J. Gallagher ◽  
G. Mclauchlin ◽  
P. C. Bornman ◽  
J. E. J. Krige ◽  
J. Thomson ◽  
...  
Keyword(s):  
Alcohol Abuse ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Splenic Artery ◽  
Epigastric Pain ◽  
Gastroduodenal Artery ◽  
Diagnostic Dilemma ◽  
Artery Ligation ◽  
Men 2 ◽  
History Of

Haemorrhage via the pancreatic duct, a rare cause of upper gastrointestinal bleeding (GIB), often poses a diagnostic dilemma. We analysed our experience with 10 patients (8 men, 2 women; mean age 44 years, range 34 – 62) treated during a 12 year period. All had a history of alcohol abuse and presented with major upper GIB requiring a median of 8 units (range 2 – 40) blood, transfusion. Nine had upper abdominal pain at the time of admission and nine had a history of pancreatitis. Upper gastroduodenal endoscopy (median 4; range 1 – 9), was diagnostic in only one. Side-viewing endoscopy showed bleeding from the pancreatic duct in 7 of 8 patients. Visceral aneurysms were demonstrated in 7 of 9 patients in whom coeliac angiography was carried out: (splenic artery 4, gastroduodenal artery 2, and pancreaticoduodenal artery 1). Two of 4 selective embolisations were successful. Six patients underwent distal pancreatectomy, 1 had gastroduodenal artery ligation and 1 died of coagulopathy following a total pancreatectomy. Pancreatic duct haemorrhage should be considered in patients with unexplained recurrent upper GIB, alcohol abuse and epigastric pain, particularly in those with established chronic pancreatitis. Selective angiography is essential for diagnosis and management. For bleeding sites in the head of the pancreas, embolisation should be attempted to avoid major resection. Distal pancreatectomy is preferred for splenic artery lesions.

scholarly journals Gastrointestinal Hemorrhage Due to Splenic Artery Aneurysm Pancreatic Duct Fistula in Chronic Pancreatitis

HPB Surgery ◽  
1993 ◽  
Vol 7 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Christian Seiler ◽  
Leslie H. Blumgart
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Gastrointestinal Hemorrhage ◽  
Splenic Artery ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Artery Aneurysm ◽  
Splenic Artery Aneurysm ◽  
Life Threatening ◽  
Threatening Situation

Gastrointestinal hemorrhage due to splenic artery aneurysm pancreatic duct fistula in chronic pancreatitis is rare. It is, however, important to diagnose this condition particularly in patients having chronic pancreatitis, since it may result in a life-threatening situation. The diagnosis is usually difficult to establish and it may take repeated admissions for intermittent gastrointestinal bleeding until the real source is recognized. Clinical attacks of epigastric pain followed by GI-bleeding 30–40 minutes later are characteristic. Occasionally these attacks are followed by transient jaundice. The present case report describes this rare complication and reviews the current literature.

Pancreatic Cyst: Pseudocyst or Neoplasm? Pitfalls in Endoscopic Retrograde Cholangiopancreatography Diagnosis

2010 ◽  
Vol 76 (7) ◽  
pp. 725-730
Author(s):  
Clayton Tyler Ellis ◽  
John R. Barbour ◽  
Thomas M. Shary ◽  
David B. Adams
Keyword(s):  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Main Pancreatic Duct ◽  
Pancreatic Cyst ◽  
Mucinous Cystadenoma ◽  
Cystic Lesions ◽  
Endoscopic Retrograde ◽  
Pancreatic Tail ◽  
History Of

Pancreatic pseudocysts represent the majority of cystic lesions, and can usually be differentiated from cystic neoplasms, which have malignant potential. Endoscopic retrograde cholangiopancreatography (ERCP) can help in solving diagnostic dilemmas. When ERCP demonstrates cyst communication with the pancreatic duct, the diagnosis of pseudocyst is usually secure. There are exceptions, however, as reported in these two case reports. A retrospective chart review was conducted of two patients undergoing distal pancreatectomy in 2008 to 2009 for cystic lesions communicating with the main pancreatic duct on ERCP. Both patients were women (ages 37 and 42) with a history of chronic abdominal pain and pancreatitis. Radiologic imaging showed cystic lesions in the pancreatic tail. ERCP demonstrated main pancreatic duct communication. When endoscopic management failed, surgical therapy was undertaken. Both patients underwent distal pancreatectomy with splenectomy. Pathologic findings were mucinous cystadenoma. The conventional wisdom that a pancreatic cyst communicating with the main pancreatic duct is a benign pseudocyst is not always wise. As seen in this series, mucinous cystadenomas can erode into the main pancreatic duct. Women in the fourth and fifth decade with symptomatic cysts in the pancreatic tail with a history of pancreatitis should undergo distal pancreatectomy, regardless of ductal communication on ERCP.

scholarly journals Black ascitic fluid in a patient with history of alcohol abuse: report of an unusual case and literature review

2020 ◽  
Vol 2020 (4-5) ◽  
Author(s):  
José Martín Alanís Naranjo ◽  
María de Lourdes Alanís Naranjo
Keyword(s):  
Alcohol Abuse ◽  
Ascitic Fluid ◽  
Unusual Case ◽  
Pancreatic Necrosis ◽  
Epigastric Pain ◽  
Abdominal Distension ◽  
Fluid Analysis ◽  
History Of ◽  
Bowel Rest ◽  
Tomography Scan

Abstract The differential diagnosis for black ascites include pancreatic ascites (PA). In majority of cases described the ascitic fluid as amber or black-colored. We report the case of a 33-year-old man with a history of alcohol abuse who presented with 24 h of epigastric pain and abdominal distension. Laboratory results showed lipase of 1270 U/l, amylase of 442 U/l and albumin of 2 g/dl. A contrast computed tomography scan of the abdomen showed pancreatic necrosis with atrophy and free abdominal fluid. Paracentesis was performed, yielding opaque black ascitic fluid. An ascitic fluid analysis demonstrated amylase of 2769 U/l, albumin of 1.6 g/dl, was negative for malignant cells and tuberculosis. Serum-Ascites Albumin Gradient was resulted in 0.4. The diagnosis of chronic pancreatitis was suspected, and he received supportive care with pain medication and bowel rest. He was discharged with symptom free on Day 14 after admission.

scholarly journals Hydatid cyst of the pancreas

2004 ◽  
Vol 132 (11-12) ◽  
pp. 435-437
Author(s):  
Radoje Colovic ◽  
Nikica Grubor ◽  
Vladimir Radak ◽  
Natasa Colovic ◽  
Mirjana Stojkovic
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Case Report ◽  
Hydatid Cyst ◽  
Pancreatic Duct ◽  
Epigastric Pain ◽  
The Body ◽  
Cystic Lesions ◽  
History Of ◽  
Endemic Areas

Hydatid cyst of the pancreas is rare. During the last 30 years, less than 40 cases have been reported in journals on Medline. This is a case report of a 35-year old woman with 2-year history of epigastric pain in whom an ultrasound and computed tomography showed the cyst of the body and tail of the pancreas 6x7 cm in diameters, which was supposed to be hydatid one. During surgery, an isolated hydatid cyst of the pancreas was found without communication with the pancreatic duct. The content of the cyst was removed, and pericyst was partially excised and drained. The recovery was uneventful and the patient has remained symptom free so far. Although rare, hydatid cyst should be considered in the differential diagnosis of the cystic lesions of the pancreas, particularly in patients coming from endemic areas and without history of pancreatitis.

scholarly journals Pancreatic ductal adenocarcinoma in a patient with pancreas divisum and gastrointestinal duplication cyst: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naoto Takahashi ◽  
Hiroyuki Nitta ◽  
Akira Umemura ◽  
Hirokatsu Katagiri ◽  
Shoji Kanno ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Pancreas Divisum ◽  
Duplication Cyst ◽  
Ductal Adenocarcinoma ◽  
Ct Examination ◽  
History Of

Abstract Background The complication of duplication of alimentary tracts and pancreas divisum (PD) is a rare malformation and the development of pancreatic ductal adenocarcinoma (PDAC) in this malformation is also extremely rare. There have been some reports of complication of malignancy in a gastric duplication cyst (GDC) and PD. However, there have been no reports of complication of PDAC in cases with GDC and PD. Case presentation A 54-year-old woman was followed up at the previous hospital due to a history of ovarian endometrial adenocarcinoma. She also had a surgical history of partial excision for a GDC and pancreatic tail of PD in her childhood. A gynecological follow-up computed tomography (CT) examination revealed the pancreatic body tumor and the bifurcated main pancreatic duct dilatation. Furthermore, magnetic resonance cholangiopancreatography also revealed that the ventral main pancreatic duct communicated with the GDC. The initial levels of tumor markers were high, but we could not achieve preoperative histopathological diagnosis. The preoperative diagnosis was PDAC occurring in a case with PD and GDC. She received two courses of neoadjuvant chemotherapy with gemcitabine and nab-paclitaxel. A CT examination after neoadjuvant chemotherapy revealed the shrinkage of the tumor, and then we performed distal pancreatectomy with splenectomy and GDC resection. A histopathological examination revealed invasive PDAC and lymph node metastases; pathological staging was T1N1M0, stage III. Furthermore, PD and GDC were also histopathologically detected. The postoperative course was uneventful, and she was discharged on the postoperative day 25. She received S-1 monotherapy for 6 months, and no recurrence has been detected at 1 year after radical resection. Conclusions We herein presented an extremely rare combined case of PD, GDC and PDAC. We successfully treated it by neoadjuvant chemotherapy and distal pancreatectomy with GDC resection, and postoperative chemotherapy.

scholarly journals P-P56 Successful endovascular embolisation of a recurrent gastroduodenal artery aneurysm in a patient presenting with acute on chronic pancreatitis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Dheepa Nair ◽  
Katie Jones ◽  
Rajeev Parameswaran
Keyword(s):  
Chronic Pancreatitis ◽  
Epigastric Pain ◽  
Contrast Material ◽  
Pancreatic Head ◽  
Artery Aneurysm ◽  
Gastroduodenal Artery ◽  
Visceral Artery ◽  
Pseudoaneurysm Formation ◽  
Visceral Artery Aneurysms ◽  
History Of

Abstract Background Pseudoaneurysms are recognised to be a serious complication of chronic pancreatitis.  Visceral artery aneurysms (VAA) can be difficult to determine and most commonly occur in the splenic or hepatic artery. Gastroduodenal artery pseudoaneurysms (GDA) have been reported to be the most common VAA following pancreatic surgery. We aim to outline the successful management of a patient with a recurrent 5.5cm GDA pseudoaneurysm following previous embolisation 2 years prior. Methods The 59yr old patient had a history of alcohol related necrotic pancreatitis with pseudocyst formation requiring percutaneous drainage in 2019. This was complicated by pseudoaneurysm formation requiring embolisation of the inferior pancreatico-duodenal artery and GDA.  In April 2021 they were readmitted with recurrent abdominal pain thought to be secondary to chronic pancreatitis and one episode of haematemesis. Results Endoscopy revealed inflammation of D1 with signs of recent mucosal bleeding with a recent abdominal ultrasound showing a 4.7x4.6cm apparent pseudocyst. A CT pancreas was performed to assess the pseudocyst however an incidental pseudoaneurysm at the pancreatic head with a sac measuring 5.5cm in diameter and contrast material measuring 3cm in diameter was present. Peripancreatic and retroperitoneal inflammation indicative of acute on chronic pancreatitis. The patient underwent embolisation of the recurrent GDA pseudoaneurysm successfully with no more filling of the previously seen pseudoaneurysm and was safely discharged. Conclusions Recurrent GDA pseudoaneurysms are a very rare complication of recurrent pancreatitis, however should be considered in patients presenting severe epigastric pain with a history of previous pseudoaneurysms.  

Physiologic Measures In Patients with PTSD with and Without A Recent History of Alcohol Abuse

2007 ◽  
Author(s):  
Eileen Ahearn ◽  
Mary Mussey ◽  
Catherine Johnson ◽  
Amy Krohn ◽  
Timothy Juergens ◽  
...  
Keyword(s):  
Alcohol Abuse ◽  
Recent History ◽  
History Of

An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

2019 ◽  
Vol 98 (8) ◽  
pp. 326-327 ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Epigastric Pain ◽  
Umbilical Vein ◽  
History Of ◽  
Clinically Significant ◽  
Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

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