scholarly journals Pancreatic Pseudocyst Ruptured due to Acute Intracystic Hemorrhage

2017 ◽  
Vol 11 (3) ◽  
pp. 755-762 ◽  
Author(s):  
Kunishige Okamura ◽  
Masanori Ohara ◽  
Tsukasa Kaneko ◽  
Tomohide Shirosaki ◽  
Aki Fujiwara ◽  
...  
Keyword(s):  
Pancreatic Pseudocyst ◽  
Left Kidney ◽  
Abdominal Cavity ◽  
Fluid Collection ◽  
Renal Tumors ◽  
Pancreatic Tail ◽  
Pancreatic Stump ◽  
Medical Interventions ◽  
Appropriate Treatment ◽  
Intracystic Hemorrhage

Rupture of pancreatic pseudocyst is one of the rare complications and usually results in high mortality. The present case was a rupture of pancreatic pseudocyst that could be treated by surgical intervention. A 74-year-old man developed abdominal pain, vomiting, and diarrhea, and he was diagnosed with cholecystitis and pneumonia. Three days later, acute pancreatitis occurred and computed tomography (CT) showed slight hemorrhage in the cyst of the pancreatic tail. After another 10 days, CT showed pancreatic cyst ruptured due to intracystic hemorrhage. Endoscopic retrograde cholangiopancreatography revealed leakage of contrast agent from pancreatic tail cyst to enclosed abdominal cavity. His left hypochondrial pain was increasing, and CT showed rupture of the cyst of the pancreatic tail into the peritoneal cavity was increased in 10 days. CT showed also two left renal tumors. Therefore we performed distal pancreatectomy with concomitant resection of transverse colon and left kidney. We histopathologically diagnosed pancreatic pseudocyst ruptured due to intracystic hemorrhage and renal cell carcinoma. Despite postoperative paralytic ileus and fluid collection at pancreatic stump, they improved by conservative management and he could be discharged on postoperative day 29. He has achieved relapse-free survival for 6 months postoperatively. The mortality of pancreatic pseudocyst rupture is very high if some effective medical interventions cannot be performed. It should be necessary to plan appropriate treatment strategy depending on each patient.

scholarly journals Splenic injury following endoscopic drainage of a large pancreatic pseudocyst: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Krittin J. Supapannachart ◽  
Christopher R. Funk ◽  
Lauren M. Gensler ◽  
Matthew P. Butters
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Pancreatic Pseudocyst ◽  
Left Kidney ◽  
Fluid Collection ◽  
Mass Effect ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Left Pleural Effusion ◽  
Splenic Hematoma

Abstract Background Many pancreatic pseudocysts spontaneously resolve, but larger or symptomatic pseudocysts may require procedural management. Though endoscopic ultrasound guided approaches are standard of care and have high success rates, complications can include bleeding, infection, and splenic perforation. This patient case report details an unusual series of complications of endoscopic cystogastrostomy that should encourage clinicians to evaluate for anatomic disruptions caused by mass effects of pancreatic pseudocysts prior to endoscopic pseudocyst drainage. Case presentation A 53-year-old African American male with a past medical history notable for alcohol use disorder, chronic pancreatitis, and insulin dependent diabetes presented with a 4-day history of left upper quadrant abdominal pain. Computed tomography imaging with contrast revealed enlargement of a known pancreatic pseudocyst to 15.9 × 10.4 cm. Due to pseudocyst size and the patient’s symptoms, endoscopic cystogastrostomy stent placement was performed. However, postprocedurally, he developed leukocytosis to 19,800 cells/m3 (from 14,100 cells/m3 preoperatively) as well as acute hypoxemic respiratory failure with a large left pleural effusion. Postprocedural computed tomography with contrast demonstrated a new large subcapsular splenic hematoma in communication with a new subdiaphragmatic fluid collection. Due to suspicion of endoscopic procedural complication, he underwent open laparotomy which revealed grade 4 splenic laceration, septic splenic hematoma, and a subdiaphragmatic abscess. Conclusions While endoscopic drainage of pancreatic pseudocyst was technically successful, this case demonstrates complications from mass effect of a large pancreatic pseudocyst which putatively tore the splenorenal ligament, leading to excessive separation of the left kidney and spleen. If anatomic disruptions caused by mass effect from a pancreatic pseudocyst are recognized through preprocedural abdominal imaging, such cases may be considered for early open repair versus cystogastrostomy.

scholarly journals Wrapping the pancreas with a polyglycolic acid sheet before stapling reduces the risk of fluid collection on the pancreatic stump after distal pancreatectomy

2021 ◽  
Author(s):  
Ji Su Kim ◽  
Seoung Yoon Rho ◽  
Dong Min Shin ◽  
Munseok Choi ◽  
Chang Moo Kang ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Fluid Collection ◽  
International Study ◽  
Polyglycolic Acid ◽  
Previous Method ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Pancreatic Stump ◽  
Resection Line

Abstract Background Postoperative pancreatic fistula (POPF) and postoperative fluid collection (POFC) are common complications after distal pancreatectomy (DP). The previous method of reducing the risk of POPF was the application of a polyglycolic acid (PGA) sheet to the pancreatic stump after cutting the pancreas with a stapler (After-stapling); the new method involves wrapping the pancreatic resection line with a PGA sheet before stapling (Before-stapling). The study aimed to compare the incidence of POPF and POFC between two methods. Methods Data of patients who underwent open or laparoscopic DPs by a single surgeon from October 2010 to February 2020 in a tertiary referral hospital were retrospectively analyzed. POPF was defined according to the updated International Study Group of Pancreatic Fistula criteria. POFC was measured by postoperative computed tomography (CT). Results Altogether, 182 patients were enrolled (After-stapling group, n = 138; Before-stapling group, n = 44). Clinicopathologic and intraoperative findings between the two groups were similar. Clinically relevant POPF rates were similar between both groups (4.3% vs. 4.5%, p = 0.989). POFC was significantly lesser in the Before-stapling group on postoperative day 7 (p < 0.001). Conclusions Wrapping the pancreas with PGA sheet before stapling was a simple and effective way to reduce POFC.

scholarly journals Nephrectomy for Metastatic Kidney Tumor in Patients with Differentiated Thyroid Cancer: A Report of Two Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Haruhiko Yamazaki ◽  
Takeshi Kishida ◽  
Go Noguchi ◽  
Hiroyuki Iwasaki ◽  
Nobuyasu Suganuma ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Follicular Thyroid Carcinoma ◽  
Left Kidney ◽  
Renal Tumors ◽  
Kidney Tumor ◽  
Papillary Thyroid ◽  
Renal Metastasis ◽  
Initial Surgery ◽  
Renal Metastases

The occurrence of renal tumors originating from thyroid cancer is extremely rare with a few effective treatments for renal metastases. Here, we report the cases of two patients with differentiated thyroid cancer who underwent nephrectomy for a metastatic kidney tumor. Case 1 was a 74-year-old man who was diagnosed with right kidney tumor 10 years after initial surgery for papillary thyroid cancer (PTC). Right nephrectomy was performed, and the pathology was metastatic PTC. Case 2 was a 68-year-old woman who was diagnosed with left kidney tumor 24 years after surgery for follicular thyroid carcinoma (FTC). Left nephrectomy was performed, and the pathology was metastatic FTC. Nephrectomy for single renal metastasis could be considered a treatment option if the patients’ general condition is positive.

scholarly journals Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Digestion ◽  
2022 ◽  
pp. 1-9
Author(s):  
Daxin Guo ◽  
Wei Dai ◽  
Jingyi Shen ◽  
Mengting Zhang ◽  
Yetan Shi ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Pseudocyst ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Cochrane Library ◽  
Intensive Care Unit Treatment ◽  
Significant Difference ◽  
And Control

<b><i>Background:</i></b> The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. <b><i>Methods:</i></b> This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. <b><i>Results:</i></b> Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; <i>p</i> = 0.03) and complications (OR: 0.48; <i>p</i> = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; <i>p</i> = 0.24), mortality (OR: 0.69; <i>p</i> = 0.17), extrapancreatic infection (OR: 0.64, <i>p</i> = 0.54), pulmonary infection (OR: 1.23; <i>p</i> = 0.69), blood infection (OR: 0.60; <i>p</i> = 0.35), urinary tract infection (OR: 0.97; <i>p</i> = 0.97), pancreatic pseudocyst (OR: 0.59; <i>p</i> = 0.28), fluid collection (OR: 0.91; <i>p</i> = 0.76), organ failure (OR: 0.63; <i>p</i> = 0.19), acute respiratory distress syndrome (OR: 0.80; <i>p</i> = 0.61), surgical intervention (OR: 0.97; <i>p</i> = 0.93), dialysis (OR: 2.34; <i>p</i> = 0.57), use of respirator or ventilator (OR: 1.90; <i>p</i> = 0.40), intensive care unit treatment (OR: 2.97; <i>p</i> = 0.18), and additional antibiotics (OR: 0.59; <i>p</i> = 0.28) between the experimental and control groups. <b><i>Conclusions:</i></b> It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

scholarly journals Importance of Laparoscopy to Solve the Diagnostic Dilemma of Abdominal Tuberculosis

KYAMC Journal ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 14-17
Author(s):  
Md Saiful Islam ◽  
Md Masudar Rahman ◽  
M Fardil Hossain Faisal ◽  
Md Alamgir Jalil Pramanik ◽  
Muhammad Abdur Rouf
Keyword(s):  
Minimally Invasive ◽  
Diagnostic Laparoscopy ◽  
Abdominal Cavity ◽  
Correct Diagnosis ◽  
Abdominal Tuberculosis ◽  
Diagnostic Dilemma ◽  
Peritoneal Tissue ◽  
Appropriate Treatment ◽  
Liver Surface ◽  
Minimally Invasive Access

Background: Diagnosis of abdominal tuberculosis as well as histopathological confirmation is difficult because of suboptimal access to the intraperitoneal pathology. Laparoscopy provides minimally invasive access to the peritoneal cavity and materials can be collected for confirmation of diagnosis. Objectives: To study the importance of laparoscopy as a tool for the diagnosis of abdominal tuberculosis and initiation of appropriate treatment without delay. Materials & Methods: In this study 25 patients with suspected abdominal tuberculosis were selected within the period of May, 2014 to October, 2014. Diagnostic laparoscopy performed on all patients with biopsy of tissue from accessible sites. Results: Diagnostic laparoscopy with biopsy confirmed the diagnosis in 24 (96%) patients, 23 of these patients (96%) had nodules at different site of abdominal cavity and 19 of these patients (76%) had ascites. In two cases there were nodules over liver surface; biopsy was taken also from both liver nodules. One nodule revealed fibrosis and another nodule revealed tuberculosis. Conclusion: Imaging and culture of ascitic fluid may fail to confirm or exclude abdominal tuberculosis in clinically suspected cases. Laparoscopy with peritoneal tissue biopsy provided rapid and correct diagnosis of abdominal tuberculosis and should be performed early in suspected cases. KYAMC Journal.2021;12(01): 14-17

scholarly journals ANALYSIS AND INTERPRETATION OF ULTRASOUND SIGNS OF THICKENING OF THE GALLBLADDER WALL

2019 ◽  
Vol 21 (4) ◽  
pp. 241-245
Author(s):  
I. V. Dvoryakovsky ◽  
S. A. Ivleva
Keyword(s):  
Infectious Diseases ◽  
Ultrasound Examination ◽  
Abdominal Cavity ◽  
Gallbladder Wall ◽  
Healthy Children ◽  
Dynamic Studies ◽  
Pathological Conditions ◽  
Appropriate Treatment ◽  
Wide Range ◽  
And Function

An overview of the data on features of ultrasound examination of the gallbladder with various forms of pathology in children is presented. We examined 650 conditionally healthy children and 840 children with diseases of the abdominal cavity organs, cardiovascular system, and some infectious diseases. The diffuse thickening of the gallbladder wall was established to be the possible result of a wide range of pathological conditions, both of surgical and non-surgical origin. It is shown that sometimes it is necessary to conduct frequent dynamic studies, especially in cases where the primary disease of the gallbladder cannot be ruled out. As a rule, the recognition of the cause of the response of the gallbladder wall and its exclusion as a result of appropriate treatment leads to a normalization of the morphology and function of the gallbladder.

scholarly journals Irrigation and passive drainage of pancreatic stump after distal pancreatectomy in high-risk patients: an innovative approach to reduce pancreatic fistula

2020 ◽  
Vol 405 (8) ◽  
pp. 1233-1241
Author(s):  
Olga Adamenko ◽  
Carlo Ferrari ◽  
Jan Schmidt
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Surgical Complication ◽  
Fluid Collection ◽  
Ringer Solution ◽  
Pancreatic Stump ◽  
High Risk Patients ◽  
Risk Patients ◽  
Drain Amylase

Abstract Introduction Postoperative pancreatic fistula (POPF) represents the most common form of morbidity after distal pancreatectomy (DP). The aim of this study was to illustrate an innovative technique of irrigation and passive drainage to reduce clinically relevant POPF (CR-POPF) incidence in high-risk patients undergoing DP. Material and methods Twelve consecutive high-risk patients received irrigation and passive drainage of the pancreatic stump with a Salem sump drainage after DP. The Salem sump was irrigated with 100 ml/h of Ringer solution for 2 postoperative days (POD). In the case of low-drain amylase and lipase levels on POD 3, the irrigation was reduced to 50 ml/h. Persistence of low-drain pancreatic enzymes on POD 4 allowed for interruption of irrigation and subsequent removal of drainage from POD 7 onward in the absence of evidence of any pancreatic fistula. Results Overall, 16.6% of the patients experienced a grade 3 or higher surgical complication. We experienced only one case of POPF: the fistula was classified as grade B and it was managed with radiologic drainage of the fluid collection. We did not experience any case of re-operation nor in-hospital mortality. Conclusions Irrigation with passive drainage of the pancreatic stump after DP is an interesting approach for CR-POPF prevention in high-risk patients.

scholarly journals A case of duodenal duplication cyst mimicking a pancreatic pseudocyst with intracystic hemorrhage

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Sotaro Fukuhara ◽  
Saburo Fukuda ◽  
Hiroyuki Sawada ◽  
Masayuki Shishida ◽  
Sho Ishikawa ◽  
...  
Keyword(s):  
Pancreatic Pseudocyst ◽  
Duplication Cyst ◽  
Duodenal Duplication ◽  
Intracystic Hemorrhage ◽  
Duodenal Duplication Cyst

scholarly journals Renal Tumors of Childhood—A Histopathologic Pattern-Based Diagnostic Approach

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 729 ◽  
Author(s):  
Ariadne H.A.G. Ooms ◽  
Gordan M. Vujanić ◽  
Ellen D’Hooghe ◽  
Paola Collini ◽  
Aurore L’Herminé-Coulomb ◽  
...  
Keyword(s):  
Molecular Characterization ◽  
Molecular Analysis ◽  
Pediatric Oncology ◽  
Correct Diagnosis ◽  
Renal Tumors ◽  
Pediatric Tumors ◽  
Cell Type ◽  
Appropriate Treatment ◽  
Histologic Pattern

Renal tumors comprise approximately 7% of all malignant pediatric tumors. This is a highly heterogeneous group of tumors, each with its own therapeutic management, outcome, and association with germline predispositions. Histopathology is the key in establishing the correct diagnosis, and therefore pathologists with expertise in pediatric oncology are needed for dealing with these rare tumors. While each tumor shows different histologic features, they do have considerable overlap in cell type and histologic pattern, making the diagnosis difficult to establish, if based on routine histology alone. To this end, ancillary techniques, such as immunohistochemistry and molecular analysis, can be of great importance for the correct diagnosis, resulting in appropriate treatment. To use ancillary techniques cost-effectively, we propose a pattern-based approach and provide recommendations to aid in deciding which panel of antibodies, supplemented by molecular characterization of a subset of genes, are required.

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