Pancreatic pseudocyst, pancreatitis, and incomplete pancreas divisum in a child treated with endotherapy: a case report

Pancreatic divisum (PD) is caused by the lack of fusion of the pancreatic duct during the embryonic period. Considering the incidence rate of PD, clinicians lack an understanding of the disease, which is usually asymptomatic. Some patients with PD may experience recurrent pancreatitis and progress to chronic pancreatitis. Recently, a 13-year-old boy presented with pancreatic pseudocyst, recurrent pancreatitis, and incomplete PD, and we report this patient’s clinical data regarding the diagnosis, medical imagining, and treatment. The patient had a history of recurrent pancreatitis and abdominal pain. Magnetic resonance cholangiopancreatography was chosen for diagnosis of PD, pancreatitis, and pancreatic pseudocyst, followed by endoscopic retrograde cholangiopancreatography, minor papillotomy, pancreatic pseudocyst drainage, and stent implantation. In the follow-up, the pseudocyst lesions were completely resolved, and no recurrent pancreatitis has been observed.

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Rare cause of chronic abdominal pain: left paraduodenal hernia and its surgical management

BMJ Case Reports ◽

10.1136/bcr-2021-245024 ◽

2021 ◽

Vol 14 (12) ◽

pp. e245024

Author(s):

Ajay Chikara ◽

Sasidhar Reddy Karnati ◽

Kailash Chand Kurdia ◽

Yashwant Sakaray

Keyword(s):

Abdominal Pain ◽

Stable Condition ◽

Paraduodenal Hernia ◽

Inferior Mesenteric Vein ◽

Anterior Border ◽

Initial Reduction ◽

Contrast Enhanced ◽

History Of ◽

Enhanced Computed Tomography

A 30-year-old man presented with colicky abdominal pain for 2 months, associated with occasional episodes of bilious vomiting. He had a history of similar complaints at the age of 16 and 26 years. Contrast-enhanced computed tomography abdomen was consistent with a diagnosis of left paraduodenal hernia. On laparoscopy a 3 × 3 cm hernial defect was identified in the left paraduodenal fossa (fossa of Landzert). Contents were jejunal, and proximal ileal loops which were dilated and edematous. Anterior border of the sac was formed by the inferior mesenteric vein and left branch of the left colic artery. Initial reduction of contents was easy. However, complete reduction proved to be difficult due to adhesions with the sac opening, the hernial sac instead laid open by dividing the Inferior Mesentric Vein (IMV) (anterior border of defect) using a vascular stapler. The patient was discharged on postoperative day 3 in a stable condition. On follow-up the patient is doing well.

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Case 5.6

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0134 ◽

2014 ◽

pp. 253-253

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Abdominal Pain ◽

Equilibrium Phase ◽

Arterial Phase ◽

Recurrent Pancreatitis ◽

Portal Venous Phase ◽

History Of ◽

Venous Phase ◽

Delayed Phase

37-year-old woman with a history of recurrent pancreatitis and abdominal pain Arterial phase (Figure 5.6.1A), portal venous phase (Figure 5.6.1B), equilibrium phase (Figure 5.6.1C), and 8-minute delayed phase (Figure 5.6.1D) postgadolinium 3D SPGR images show multiple splenic lesions that are initially hypoenhancing relative to adjacent spleen and become hyperintense on delayed images....

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Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

Case Reports in Surgery ◽

10.1155/2019/1072821 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Oluwatobi Onafowokan ◽

Dabanjan Bandyopadhyay ◽

Dale Johnson ◽

Hugo J. R. Bonatti

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Ct Scan ◽

Late Complication ◽

Abdominal Hernia ◽

Emergency Laparotomy ◽

Incisional Hernias ◽

History Of ◽

The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

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Outcome of Conservative Management in Biliary Ascariasis - A Study of 98 Cases

Journal of Dhaka Medical College ◽

10.3329/jdmc.v19i1.6247 ◽

1970 ◽

Vol 19 (1) ◽

pp. 25-28 ◽

Cited By ~ 2

Author(s):

AS Khan ◽

B Bhowmik ◽

HAN Hakim ◽

MA Islam

Keyword(s):

Abdominal Pain ◽

Conservative Management ◽

Diagnostic Tools ◽

Biliary Disease ◽

Common Presentation ◽

Biliary Ascariasis ◽

Clinical Presentations ◽

History Of ◽

Upper Abdominal

Objectives: History of ascariasis is very old. One quarter of the world's population is known to be infected by ascariasis. It is endemic in various parts of Bangladesh. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis. Materials and Methods: Ninty eight cases of hepatobiliary ascariasis were studied over a period of 2 years (April 03 - April 05). All the patients were aged between 12 and 73 years and all were admitted with acute right upper abdominal pain. Ultrasound was the diagnostic tool of choice with 100% results. Results: In this study, biliary ascariasis was found to be more common in females 64.29% (64 patients). The most common presentation was upper abdominal pain in 100% of the patients (98 patients). Complications observed were obstructive jaundice in 08.16% (8 patients), cholangitis in 74.49% (73 patients). History of worm emesis was present in 21.42% (21 patients). Conservative management was successful in 96.94% (95 patients). During follow-up, worm reinvasion of the biliary system occurred in 7.1% (three patients). Conclusion: In endemic countries, biliary ascariasis should be suspected in patients with biliary disease. Most of the patients respond to conservative management. Keywords: Acute upper abdominal pain; biliary ascariasis; Ultrasonography DOI: 10.3329/jdmc.v19i1.6247 J Dhaka Med Coll. 2010; 19(1) : 25-28.

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Intussusception in a pregnant woman

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa554 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Ana Cristina Silva ◽

Pedro Soares Moreira ◽

Vitor Costa Simões ◽

Mónica Sampaio ◽

Marisa Domingues Santos

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Pregnant Woman ◽

Pregnant Patient ◽

Computed Tomography Scan ◽

Intestinal Necrosis ◽

History Of ◽

Emergent Laparotomy ◽

Tomography Scan

Abstract Abdominal pain in a pregnant woman with a history of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the emergency department is challenging. Intussusception is a rare cause of small bowel obstruction after LRYGB and can lead to intestinal necrosis, perforation, sepsis and death. The authors report a case of a 34-week pregnant patient, previously submitted to LRYGB, presenting to the emergency department with abdominal pain and vomiting. A computed tomography scan suggested the presence of ileoileal intussusception. So, an emergent laparotomy was performed with invagination reduction. The postoperative period was uneventful, as well as pregnancy and caesarian performed 4 weeks after surgery. At the 45-month follow-up, there was no recurrence of intussusception.

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Use of methylene blue in the prevention of recurrent intra-abdominal postoperative adhesions

Journal of International Medical Research ◽

10.1177/0300060517727694 ◽

2017 ◽

Vol 46 (1) ◽

pp. 504-510 ◽

Cited By ~ 2

Author(s):

Octavian C. Neagoe ◽

Mihaela Ionica ◽

Octavian Mazilu

Keyword(s):

Methylene Blue ◽

Abdominal Pain ◽

Abdominal Surgery ◽

Beneficial Effect ◽

Adhesion Formation ◽

Chronic Abdominal Pain ◽

Postoperative Adhesions ◽

Similar Time ◽

History Of

Objective To evaluate the efficacy of methylene blue in preventing recurrent symptomatic postoperative adhesions. Methods Patients with a history of >2 surgeries for intra-abdominal adhesion-related complications were selected for this study. Adhesiolysis surgery was subsequently performed using administration of 1% methylene blue. The follow-up period was 28.5 ± 11.1 months. Results Data were available from 20 patients (seven men and 13 women) whose mean ± SD age was 51.2 ± 11.4 years. Adhesions took longer to become symptomatic after the first abdominal surgery when the initial pathology was malignant compared with benign. However, the recurrence of adhesions after a previous adhesiolysis surgery had a similar time onset regardless of the initial disease. Following adhesiolysis surgery with methylene blue, the majority of patients did not present with symptoms associated with adhesion complications (i.e., chronic abdominal pain, bowel obstruction) for the length of the follow-up period. Conclusions The use of methylene blue during adhesiolysis surgery appears to reduce the recurrence of adhesion-related symptoms, suggesting a beneficial effect in the prevention of adhesion formation.

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Liver Segmentectomy by Intrahepatic Lithiasis

Case Reports in Gastroenterology ◽

10.1159/000511005 ◽

2021 ◽

pp. 305-311

Author(s):

Fadi Rayya ◽

Ehab Alhasan

Keyword(s):

Hepatic Duct ◽

Preoperative Evaluation ◽

Magnetic Resonance Cholangiopancreatography ◽

Abdominal Ultrasound ◽

Biliary Pancreatitis ◽

Liver Segment ◽

Intrahepatic Lithiasis ◽

History Of ◽

Normal Gallbladder

Intrahepatic cholelithiasis, which is defined as stones proximal to the confluence of the hepatic ducts, is considered endemic in Southeast Asia. Its pathogenesis is not completely understood yet. A 19-year-old female was admitted to the hospital with a history of recurrent biliary pancreatitis. Abdominal ultrasound detected normal gallbladder while magnetic resonance cholangiopancreatography revealed lithiasis at the hepatic duct of liver segment V. After preoperative evaluation a typical segmentectomy was done. The postoperative period was uneventful and the patient was well at 6-month follow-up.

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2935 Efficacy, Safety and Long-Term Follow-Up of a Single 7 Fr Double Pigtail Plastic Stent for EUS-Guided Pancreatic Pseudocyst Drainage

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000601272.21469.c5 ◽

2019 ◽

Vol 114 (1) ◽

pp. S1598-S1599

Author(s):

Manus Rugivarodom ◽

Nonthalee Pausawasdi ◽

Tanyaporn Chantarojanasiri ◽

Arunchai Chang ◽

Yongyut Sirivatanauksorn

Keyword(s):

Pancreatic Pseudocyst ◽

Plastic Stent ◽

Long Term Follow Up ◽

Pseudocyst Drainage

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Laparoscopic Transgastric Endoscopy after Roux-en-Y Gastric Bypass: Case Series and Review of the Literature

The American Surgeon ◽

10.1177/000313481207801037 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1182-1186 ◽

Cited By ~ 18

Author(s):

Jason F. Richardson ◽

John G. Lee ◽

Brian R. Smith ◽

Brian Nguyen ◽

Kathleen P. Pham ◽

...

Keyword(s):

Gastric Bypass ◽

Case Series ◽

Biliary Tree ◽

Gastric Remnant ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Medical Centers ◽

Excluded Stomach ◽

History Of

Endoscopic access to the gastric remnant and pancreatobiliary tree is technically difficult after Roux-en-Y gastric bypass even when facilitated by the use of specialized techniques such as balloon enteroscopy and the use of overtubes. Furthermore, such techniques are not universally available at all medical centers. We describe a case series of 13 patients with a history of Roux-en-Y gastric bypass for the treatment of morbid obesity who underwent laparoscopic transgastric endoscopy through the gastric remnant to access the duodenum or biliary tree. Charts of these patients were reviewed for demographics, indications for procedure, length of stay, morbidity, and mortality. Four of the patients had failed prior attempts to access the excluded anatomy through traditional transoral endoscopy. Two patients underwent transgastric endoscopy for evaluation of gastrointestinal bleeding. Of the 11 patients for whom endoscopic retrograde cholangiopancreatography was planned, all underwent successful biliary cannulation and sphincterotomy. There were no conversions to an open procedure or complications during the follow-up period. Laparoscopic transgastric endoscopy is a safe and reliable method to access the excluded stomach and biliary tree in patients with a history of Roux-en-Y gastric bypass.

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