Treatment of Pancreatic Pseudocysts

2005 ◽  
Vol 94 (2) ◽  
pp. 165-175 ◽  
Author(s):  
Å. Andrén-Sandberg ◽  
C. Ansorge ◽  
K. Eiriksson ◽  
T. Glomsaker ◽  
A. Maleckas
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
Pancreatic Juice ◽  
Granulation Tissue ◽  
Spontaneous Resolution ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Pancreatic Trauma ◽  
Choice Of Procedure ◽  
Substantial Risk

According to the Atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of acute pancreatitis or pancreatic trauma, whereas a chronic pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of chronic pancreatitis and lack an antecedent episode of acute pancreatitis. It is generally agreed that acute and chronic pseudocysts have a different natural history, though many reports do not differentiate between pseudocysts that complicate acute pancreatitis and those that complicate chronic disease. Observation — “conservative treatment” — of a patient with a pseudocyst is preponderantly based on the knowledge that spontaneous resolution can occur. It must, however, be admitted that there is substantial risk of complications or even death; first of all due to bleeding. There are no randomized studies for the management protocols for pancreatic pseudocysts. Therefore, today we have to rely on best clinical practice, but still certain advice may be given. First of all it is important to differentiate acute from chronic pseudocysts for management, but at the same time not miss cystic neoplasias. Conservative treatment should always be considered the first option (pseudocysts should not be treated just because they are there). However, if intervention is needed, a procedure that is well known should always be considered first. The results of percutaneous or endoscopic drainage are probably more dependent on the experience of the interventionist than the choice of procedure and if surgery is needed, an intern anastomosis can hold sutures not until several weeks (if possible 6 weeks).

Pancreatic pseudocysts: Prognostic factors for their development and their spontaneous resolution in the setting of acute pancreatitis

Pancreatology ◽  
2012 ◽  
Vol 12 (2) ◽  
pp. 85-90 ◽  
Author(s):  
Paul Georg Lankisch ◽  
Bettina Weber-Dany ◽  
Patrick Maisonneuve ◽  
Albert B. Lowenfels
Keyword(s):  
Acute Pancreatitis ◽  
Prognostic Factors ◽  
Spontaneous Resolution ◽  
Pancreatic Pseudocysts

Infeasibility of endoscopic transmural drainage due to pancreatic pseudocyst wall calcifications - case report

2017 ◽  
Vol 89 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Andrzej Krajewski ◽  
Gustaw Lech ◽  
Marcin Makiewicz ◽  
Andrzej Kluciński ◽  
Monika Wojtasik ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Cyst Wall ◽  
Pancreatic Pseudocyst ◽  
Histopathological Examination ◽  
Epigastric Pain ◽  
Gastrointestinal Transit ◽  
The Body ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Transmural Drainage

Postinflammatory pancreatic pseudocysts are one of the most common complications of acute pancreatitis. In most cases, pseudocysts self-absorb in the course of treatment of pancreatitis. In some patients, pancreatic pseudocysts are symptomatic and cause pain, problems with gastrointestinal transit, and other complications. In such cases, drainage or resection should be performed. Among the invasive methods, mini invasive procedures like endoscopic transmural drainage through the wall of the stomach or duodenum play an important role. For endoscopic transmural drainage, it is necessary that the cyst wall adheres to the stomach or duodenum, making a visible impression. We present a very rare case of infeasibility of endoscopic drainage of a postinflammatory pancreatic pseudocyst, impressing the stomach, due to cyst wall calcifications. A 55-year-old man after acute pancreatitis presented with a 1-year history of epigastric pain and was admitted due to a postinflammatory pseudocyst in the body and tail of pancreas. On admission, blood tests, including CA 19-9 and CEA, were normal. An ultrasound examination revealed a 100-mm pseudocyst in the tail of pancreas, which was confirmed on CT and EUS. Acoustic shadowing caused by cyst wall calcifications made the cyst unavailable to ultrasound assessment and percutaneous drainage. Gastroscopy revealed an impression on the stomach wall from the outside. The patient was scheduled for endoscopic transmural drainage. After insufflation of the stomach, a large mass protruding from the wall was observed. The stomach mucosa was punctured with a cystotome needle knife, and the pancreatic cyst wall was reached. Due to cyst wall calcifications, endoscopic drainage of the cyst was unfeasible. Profuse submucosal bleeding at the puncture site was stopped by placing clips. The patient was scheduled for open surgery, and distal pancreatectomy with splenectomy was performed. The histopathological examination confirmed the initial diagnosis of postinflammatory pancreatic pseudocyst. Endoscopic transmural drainage is a highly effective procedure for treating postinflammatory pancreatic pseudocysts. In some patents, especially with large pseudocysts, pseudocysts with calcified walls, and cysts of primary origin, resection should be performed.

scholarly journals Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis

2021 ◽  
Vol 8 (1) ◽  
pp. e000501
Author(s):  
Manu K Nayar ◽  
Noor L H Bekkali ◽  
David Bourne ◽  
Sophie Young ◽  
John S Leeds ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Secondary Care ◽  
Multiorgan Failure ◽  
Tertiary Care ◽  
Endoscopic Drainage ◽  
Hub And Spoke ◽  
Specialist Nurse ◽  
Icu Stay

ObjectiveSevere acute pancreatitis (SAP) is associated with high mortality (15%–30%). Current guidelines recommend these patients are best managed in a multidisciplinary team setting. This study reports experience in the management of SAP within the UK’s first reported hub-and-spoke pancreatitis network.DesignAll patients with SAP referred to the remote care pancreatitis network between 2015 and 2017 were prospectively entered onto a database by a dedicated pancreatitis specialist nurse. Baseline characteristics, aetiology, intensive care unit (ICU) stay, interventions, complications, mortality and follow-up were analysed.Results285 patients admitted with SAP to secondary care hospitals during the study period were discussed with the dedicated pancreatitis specialist nurse and referred to the regional service. 83/285 patients (29%; 37 male) were transferred to the specialist centre mainly for drainage of infected pancreatic fluid collections (PFC) in 95% (n=79) of patients. Among the patients transferred; 29 (35%) patients developed multiorgan failure with an inpatient mortality of 14% (n=12/83). The median follow-up was 18.2 months (IQR=11.25–35.51). Multivariate analysis showed that transferred patients had statistically significant longer overall hospital stay (p<0.001) but less ICU stay (p<0.012).ConclusionThis hub-and-spoke model facilitates the management of the majority of patients with SAP in secondary care setting. 29% warranted transfer to our tertiary centre, predominantly for endoscopic drainage of PFCs. An evidence-based approach with a low threshold for transfer to tertiary care centre can result in lower mortality for SAP and fewer days in ICU.

Iatrogenic fetal goiter. Conservative management and spontaneous resolution

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Margarita Alvarez de la Rosa ◽  
Olga Rosales Aedo ◽  
Ricardo Darias Garzón ◽  
Ana Isabel Padilla Pérez ◽  
Juan Mario Troyano Luque
Keyword(s):  
Conservative Treatment ◽  
Perinatal Asphyxia ◽  
Mass Effect ◽  
Neck Mass ◽  
Spontaneous Resolution ◽  
Anterior Neck ◽  
Case Presentation ◽  
Fetal Goiter ◽  
Fetal Thyroid ◽  
Intrauterine Treatment

AbstractObjectivesWe aim to report a case of a fetal goiter with postpartum spontaneous resolution. Fetal goiter can be secondary to maternal treatment and range from clinically asymptomatic or cause alterations in the fetus, from impaired swallowing to difficulty in vaginal delivery and even perinatal asphyxia due to the mass effect. The need for intrauterine treatment remains controversial.Case presentationWe present a case of fetal goiter with postpartum resolution. A 34-year-old multigravida presented to the emergency department with hiperemesis gravidarum at 10 weeks’ gestation. During evaluation for severe vomiting, Graves disease was diagnosed and treated with propylthiouracil. A routine ultrasound scan at 28 weeks gestation revealed a fetal anterior neck mass suggesting a fetal goiter. Cordocentesis showed fetal iatrogenic hypothyroidism. Conservative treatment was decided. Pregnancy concluded uneventful and the mass resolved spontaneously in the newborn.ConclusionsThe fetal thyroid gland is a structure that usually goes unnoticed during the process of prenatal diagnosis. In cases of maternal Graves diseases, fetal thyroid needs monitoring during pregnancy and conservative treatment is an option. Fetal goiter should be searched for secondary to thyroid alterations of the gravida, and in selected cases it can be managed without intrauterine treatment.

scholarly journals Comparison of early and delayed EUS-guided drainage of pancreatic fluid collection

2018 ◽  
Vol 06 (12) ◽  
pp. E1398-E1405 ◽  
Author(s):  
Tanyaporn Chantarojanasiri ◽  
Natsuyo Yamamoto ◽  
Yousuke Nakai ◽  
Tomotaka Saito ◽  
Kei Saito ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Gastrointestinal Tract ◽  
Fluid Collection ◽  
Adverse Event Rate ◽  
Plastic Stents ◽  
Endoscopic Drainage ◽  
Metallic Stent ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid ◽  
Covered Metallic Stent

Abstract Background and study aims While endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collection (PFC) is recommended to be performed ≥ 4 weeks after onset of acute pancreatitis (AP), early (< 4 weeks) interventions are needed in some symptomatic cases. Despite feasibility of early percutaneous drainage, there have been few studies about early EUS-guided drainage of PFC. Patients and methods Consecutive patients who received EUS-guided drainage (EUS-PCD) of infected or symptomatic PFC at the University of Tokyo were retrospectively studied. Contraindications for EUS-PCD are lack of encapsulation or adhesion to the gastrointestinal tract. Safety and effectiveness of early vs delayed (≥ 4 weeks) EUS-PCD were compared. Results A total of 35 patients underwent EUS-PCD (12 early and 23 delayed) using 19 large-bore fully-covered metallic stent and 16 plastic stents. The median diameter of PFC was 110 mm (40 – 180) and 122 mm (17 – 250) in the early and delayed drainage groups, respectively. Median time from onset of AP to drainage was 23 and 85 days for early and delayed drainage, respectively. The technical success rate of EUS-guided drainage was 100 %. Endoscopic necrosectomy was performed in six early and 16 cases of delayed drainage. The adverse event rate was 25 % (3 bleeding) and 13 % (2 perforations and 1 CO2 retention) in the early and delayed drainage groups, respectively. Two patients died (1 early and 1 delayed) due to multiorgan failure. Conclusion Endoscopic drainage and subsequent necrosectomy of symptomatic PFC within 4 weeks after onset of acute pancreatitis was feasible, given that the collection was encapsulated and attached to the gastrointestinal tract.

scholarly journals Spontaneous resolution of large non-traumatic bilateral acute-on-chronic subdural hematoma

2017 ◽  
Vol 31 (1) ◽  
pp. 8-16
Author(s):  
D. Adam ◽  
D. Iftimie ◽  
Gina Burduşa ◽  
Cristiana Moisescu
Keyword(s):  
Conservative Treatment ◽  
Subdural Hematoma ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neurological Status ◽  
Spontaneous Resolution ◽  
Subdural Hematomas ◽  
Gcs Score

Abstract Background and importance: Chronic subdural hematomas are a frequently encountered neurosurgical pathology, especially in the elderly. They often require surgical evacuation, but recent studies have shown good results with conservative treatment in selected cases. Clinical presentation: We report the case of a 72-year old patient that developed large, non-traumatic, bilateral, acute-on-chronic subdural hematoma after repeated abdominal surgery for appendicular carcinoma. He presented an abdominal wound infection and good neurological status (GCS score of 14 points), factors that indicated the delay of surgical intervention. Subsequent clinical and radiological improvement forestalled the operation altogether and he presented complete spontaneous resolution of subdural hematomas at only 5 months after diagnosis. Conclusion: Although surgical treatment is performed in the majority of chronic subdural hematomas, in clinically and radiologically selected cases, the operation can be avoided. The hematoma can present resolution, either spontaneously or with the help of conservative treatment.

scholarly journals CT Image Changes of Severe Acute Pancreatitis Based on Smart Electronic Medical Augmented Reality in Nursing Practice

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Defen Zhang ◽  
Shifang Mao ◽  
Siyou Lan ◽  
Chengli Zhou ◽  
Xiaoyan Liu
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Juice ◽  
Nursing Practice ◽  
Imaging System ◽  
Pancreatic Tissue ◽  
Ct Imaging ◽  
Pancreatic Ducts ◽  
Ct Image ◽  
Internal Drainage

Severe acute pancreatitis (SAP) is traditionally treated with chemical analysis. Faced with the increasing maturity of CT imaging technology, it is necessary to use more advantageous CT imaging to treat SAP. In this article, 72 SAP patients admitted to the Affiliated Hospital of Southwest Medical University were selected for study, of which 62 were severely ill, 8 were exacerbated, and 2 changed from severe to mild. This article combines the patient’s case records and related CT images during treatment from the perspective of nursing and conducts nursing research on the application of CT image changes in severe acute pancreatitis in nursing practice. CT image processing uses CT imaging system workstation (DICOM). The results of the study showed that, in the care of patients, 21 cases had recurrence after internal drainage, and the cure rate was 91.1%. Internal drainage is an effective way to treat SAP. The higher the incidence of pancreatitis, the more likely it is to relapse after SAP internal drainage, which may be related to repeated episodes of pancreatitis and repeated inflammation of the pancreas and pancreatic duct damage. 4 of the relapsed cases in this article are postchronic pancreatitis SAP, and the relapsed cases account for 50% of the chronic pancreatic cases. This may be due to chronic fibrosis of the branched and main pancreatic ducts, continuous abnormal pancreatic juice drainage. Therefore, it is necessary to further explore the prognosis of different causes of SAP. In terms of complication care, the overall complication rate was 16.6%. One patient died of postoperative hemorrhage. Analysis of the causes of cyst recurrence and complications may be closely related to the mechanism of the occurrence and development of SAP. The initiating factor of SAP is that the pancreatic tissue is damaged due to inflammation, trauma, or microcirculation disorder, and then the pancreatic juice leaks out of the pancreas, wrapping the pancreatic juice; it takes a certain time for the capsule of fibrous knot tissue to form and strengthen.

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