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.

Laparoscopic Transgastric versus Endoscopic Drainage of a Large Pancreatic Pseudocyst. A Case Report

2016 ◽  
Vol 25 (2) ◽  
pp. 243-247 ◽  
Author(s):  
Mircea Beuran ◽  
Ionut Negoi ◽  
Fausto Catena ◽  
Massimo Sartelli ◽  
Sorin Hostiuc ◽  
...  
Keyword(s):  
Case Report ◽  
Pancreatic Pseudocyst ◽  
Clinical Course ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Large Tumor ◽  
Specific Patient ◽  
Invasive Approach ◽  
Feasible Option ◽  
Tailored Approach

Case report: A 37 year-old woman was admitted three months after an episode of severe acute pancreatitis with a large tumor mass located in her left abdomen, abdominal tenderness and asthenia. Abdominal Computed Tomography (CT) revealed a giant pancreatic pseudocyst of 23/15/12 centimeters. We performed an anterior laparoscopic transgastric cystogastrostomy. The postoperative clinical course was uneventful, and she was discharged nine days later. After another month she was re-admitted for general malaise and fever. We performed endoscopic evaluation of the cystogastrostomy patency followed by lavage of the pseudocyst cavity. After five days of broad spectrum antibiotic therapy the clinical course started to improve and the patient was discharged after another eight days. One- and two-year follow-ups revealed no remnant cavity. Conclusions: Laparoscopic transgastric cystogastrostomy is a feasible option for selected patients with pancreatic pseudocysts. Careful patients’ evaluation in a multidisciplinary team, including imaging specialists, dedicated gastroenterologists with experience in advanced interventional techniques and pancreatic surgeons, balancing between watchful waiting and step-up minimally invasive approach offers the best tailored approach for a specific patient.

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 Pancreatic Pseudocyst with Splenic Artery Erosion, Retroperitoneal and Splenic Hematoma

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Petre V. H. Botianu ◽  
Adrian S. Dobre ◽  
Ana-Maria V. Botianu ◽  
Danusia Onisor
Keyword(s):  
Elevated Level ◽  
Splenic Artery ◽  
Pancreatic Pseudocyst ◽  
Postoperative Morbidity ◽  
Hemodynamic Instability ◽  
Pancreatic Pseudocysts ◽  
Emergency Laparotomy ◽  
Vascular Structures ◽  
Splenic Hematoma

The erosion of the peripancreatic vascular structures is a rare but life-endangering complication of pancreatic diseases. We report a female patient with a multicompartmentalized pancreatic pseudocyst that eroded the splenic artery resulting in a retroperitoneal and splenic hematoma with hemodynamic instability which required emergency laparotomy with splenectomy, partial cystectomy, ligation of the splenic artery at the level of the vascular erosion, cholecystectomy (lithiasis), and multiple drainage. The postoperative course was difficult (elevated level of platelets, pancreatic fistula) but eventually favourable, with no abdominal complaints and no recurrence at 2-year follow-up. The case shows that the pancreatic pseudocysts may present with acute hemorrhagic complications with life-endangering potential and significant postoperative morbidity.

scholarly journals Liver Cirrhosis and Hepatocellular Carcinoma Diagnosed from Chylothorax: A Case Report

2021 ◽  
Vol 11 (3) ◽  
pp. 582-586
Author(s):  
Kenta Ito ◽  
Yoshimasa Hachisu ◽  
Mitsuhiko Shibasaki ◽  
Kazuma Ezawa ◽  
Hiroshi Iwashita ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Case Report ◽  
Pleural Effusion ◽  
Malignant Lymphoma ◽  
Review Of The Literature ◽  
Left Pleural Effusion ◽  
History Of

A 71-year-old man visited our hospital with dyspnea and left pleural effusion. Left pleural effusion was diagnosed as chylothorax by thoracentesis. He had no history of trauma or surgery, and there were no findings of malignant lymphoma or thrombosis. Furthermore, he was diagnosed with liver cirrhosis and hepatocellular carcinoma by computed tomography and hematological examinations, and the chylothorax was considered to be caused by liver cirrhosis. We report a review of the literature with this case since it is relatively rare for cirrhosis and hepatocellular carcinoma diagnosed from chylothorax.

scholarly journals Endoscopic Drainage of Giant Pancreatic Pseudocysts Using Both Lumen-Apposing Metal Stent and Plastic Stent: A Report of Two Cases and Review of the Current Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hussam I. A. Alzeerelhouseini ◽  
Muawiyah Elqadi ◽  
Mohammad N. Elqadi ◽  
Sadi A. Abukhalaf ◽  
Hazem A. Ashhab
Keyword(s):  
Pancreatic Pseudocyst ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Metal Stent ◽  
Case Presentation ◽  
Plastic Stent ◽  
History Of ◽  
Giant Pseudocyst ◽  
The Ideal

Introduction. A pancreatic pseudocyst (PP) with major diameter equal to 10 cm or more is called a giant pseudocyst. The ideal management for giant PPs is controversial. Endoscopic drainage is an alternative nonsurgical approach for PP management. Only a few cases of giant PPs were reported to be managed by endoscopic drainage. Case Presentation. We reported two cases of giant PPs following an episode of acute pancreatitis. Both were resolved following endoscopic cystogastrostomy using metallic and double-pigtail stents with excellent outcomes. There was no history of recurrence or complications on follow-up. In addition, we extensively reviewed all available literature studies of giant pancreatic pseudocyst presentation, management, and complications. We summarized all reported cases and presented them in a comprehensive table. Conclusion. The endoscopic cystogastrostomy approach is cost saving, can avoid surgical complications, and offers an early hospital discharge.

scholarly journals The results of endosonography-assisted internal drainage of pancreatic pseudocyst

2019 ◽  
Vol 24 (1) ◽  
pp. 43-52
Author(s):  
Yu. G. Starkov ◽  
R. D. Zamolodchikov ◽  
S. V. Dzhantukhanova ◽  
M. I. Vyborniy ◽  
K. V. Lukich ◽  
...  
Keyword(s):  
Success Rate ◽  
Pancreatic Pseudocyst ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Internal Drainage

Aim.To compare immediate and long-term results of internal drainage of pancreatic pseudocyst by using of endosonography-assisted and open surgical approaches.Material and methods.EUS-assisted internal drainage of pancreatic pseudocyst was performed in 32 patients in 2011–2016. Open drainage procedures were carried out on the other 32 patients.Results.In the group of endoscopic drainage, technical success rate, clinical success rate and complication rate were 97%, 85% and 26%, respectively. There were no recurrent pseudocysts in long-term period. Comparison with open surgery confirmed advantages of endoscopic technique regarding time of operation (p< 0.01), intraoperative blood loss (p< 0.01) and length of hospital-stay (p< 0.01).Conclusion.EUS-assisted internal drainage of pancreatic pseudocysts in the treatment of chronic pancreatitis is characterized by high rate of technical and clinical success, small postoperative morbidity and low incidence of longterm recurrences.

Somatostatine analogue in nonoperative treatment of posttraumatic pancreatic pseudocyst in a child: a case report

Open Medicine ◽  
2012 ◽  
Vol 7 (1) ◽  
pp. 34-37
Author(s):  
Vesna Marjanovic ◽  
Andjelka Slavkovic ◽  
Miroslav Stojanovic ◽  
Vladisav Stefanovic ◽  
Goran Marjanovic ◽  
...  
Keyword(s):  
Case Report ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Pancreatic Pseudocyst ◽  
Nonoperative Treatment ◽  
Pancreatic Pseudocysts ◽  
Somatostatin Analogue ◽  
Pancreatic Trauma ◽  
Octreotide Acetate ◽  
Analogue Octreotide

AbstractPancreatic pseudocyst is a complication of pancreatic trauma. We describe improved nonoperative treatment of patient with posttraumatic pancreatic pseudocyst with somatostatin analogue. A 9-year-old girl was admitted to our hospital after blunt abdominal trauma with handlebar. Three weeks after abdominal trauma, pancreatic pseudocyst developed. Nonoperative treatment of posttraumatic pancreatic pseudocyst (the largest dimensions 70 × 55 × 65 mm) with somatostatin analogue, octreotide acetate, was applied for the next 52 days. The patient was followed up for 24 months after the discontinuation of octreotide and there were no recurrence of pancreatic pseudocyst. Somatostatin analogue could be usefull in the nonoperative treatment of posttraumatic pancreatic pseudocysts in children.

scholarly journals Pancreatic Pseudocyst with Fistula to the Common Bile Duct Resolved by Combined Biliary and Pancreatic Stenting – A Case Report and Literature Review

2009 ◽  
Vol 23 (8) ◽  
pp. 557-559 ◽  
Author(s):  
Jaber A Al Ali ◽  
Henry Chung ◽  
Peter L Munk ◽  
Michael F Byrne
Keyword(s):  
Case Report ◽  
Chronic Pancreatitis ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Literature Review ◽  
Pancreatic Pseudocyst ◽  
Unusual Case ◽  
Present Report ◽  
Pancreatic Pseudocysts ◽  
The Common

Pancreatic pseudocysts develop in 10% to 20% of patients with chronic pancreatitis, and can cause a variety of complications such as infection, bleeding or development of fistulae. However, fistulous communication with the common bile duct is very rare. The present report describes an unusual case of a patient with a large, symptomatic pancreatic pseudocyst with a fistula to the common bile duct that was treated successfully by combined biliary and pancreatic stenting.

scholarly journals Current treatment of pancreatic pseudocysts: a systematic review

2021 ◽  
Vol 28 (4) ◽  
pp. 85-99
Author(s):  
V. M. Durleshter ◽  
S. R. Genrikh ◽  
A. V. Makarenko ◽  
D. S. Kirakosyan
Keyword(s):  
Pancreatic Pseudocyst ◽  
Current Treatment ◽  
Pancreatic Pseudocysts ◽  
Journal Title ◽  
Endoscopic Drainage ◽  
Surgical Drainage ◽  
Ultrasound Guided ◽  
Advantages And Disadvantages ◽  
Large Patient ◽  
Surgical Methods

Background. Pancreatic pseudocysts stand among current challenges in modern medicine. Their treatment uses variant instrumental techniques and implies a multispecialty approach. Trials in surgery and gastroenterology have aimed to identify an optimal strategy to tackle pancreatic pseudocysts for reducing complications and the recurrence rate, suggesting ultrasound-guided percutaneous, laparoscopic and flexible endoscopic drainage as promising treatment choices.Objectives. A summarising review of diagnostic and therapeutic methods for pancreatic pseudocyst treatment and comparison of ultrasound-guided percutaneous vs. surgical and endoscopic drainage techniques.Methods. The review examines the classification, epidemiology and methods for diagnosis and treatment of pancreatic pseudocysts. Only comparative full-text studies published within 2014–2021, as well as selected impactive publications within 2002–2013, have been included. The eLibrary, Elsevier and PubMed resources were queried for the article or journal title fields against the keywords (separate or combined) “pancreatic pseudocyst” [псевдокиста поджелудочной железы], “pseudocyst drainage” [дренирование псевдокисты], “surgical drainage” [хирургическое дренирование], “endoscopic drainage” [эндоскопическое дренирование], cystogastrostomy [цистогастростомия], gastrojejunostomy [гастроеюностомия], “duodenal-cystic anastomosis” [цистодуоденоанастомоз], “transpapillary drainage” [транспапиллярное дренирование], “transmural drainage and esophagogastroduodenoscopy” [трансмуральное дренирование и эзофагогастродуоденоскопия]. Records have been selected for topic-related scientific value.Results. The review systematically surveys 68 scientific papers in the focus area and summarises the most common surgical methods for pancreatic pseudocyst treatment. Based on the main principle, the methods are classified into three categories, ultrasound-guided percutaneous drainage, surgical drainage and flexible endoscopic drainage. The major classifications and treatment techniques are highlighted for their advantages and disadvantages.Conclusion. There exist no generally adopted strategy for pancreatic pseudocyst treatment in current clinical practice and no evidence on a particular method application in a large patient cohort. The publication survey identifies the techniques of percutaneous, surgical and endoscopic drainage with ultrasound control as highly effective overall among other surgical treatments.

scholarly journals Endoscopic management of pancreatic pseudocyst

2017 ◽  
Vol 4 (8) ◽  
pp. 2577
Author(s):  
Wormi Sharon
Keyword(s):  
Pancreatic Pseudocyst ◽  
High Sensitivity ◽  
Cost Effective ◽  
Good Alternative ◽  
Venous Occlusion ◽  
Diagnostic Tools ◽  
Endoscopic Management ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Cystic Neoplasms

Background: Pancreatic pseudocyst is a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter. It represents 80-90% of cystic lesions of the pancreas. Benign and malignant cystic neoplasms constitute 10-13%, congenital and retention cysts comprising the remainder. Diagnosis is accomplished most often by computed tomographic scanning, by endoscopic retrograde cholangiopancreatography, or by ultrasound, and a rapid progress in the improvement of diagnostic tools enables detection with high sensitivity and specificity. Endoscopic drainage provides a good alternative or supplement to a surgical treatment of pancreatic pseudocysts.Methods: This is a prospective study of 26 patients diagnosed to have Pancreatic Pseudocyst and treated by endoscopic drainage from 1st June 2008 to 30th September 2010 in St. John’s Medical College and Hospital, Bangalore. Transabdominal and endoscopic ultrasound, CT scan were used to determine the number, size, volume, wall thickness, location of pancreatic pseudocysts, the extent of pancreatic parenchymal disease, the nature of the main pancreatic duct and its relationship to the cyst, the presence of portal hypertension, venous occlusion, arterial anomalies and pseudoaneurysm. The indications for endoscopic drainage were symptomatic and/or bigger than 6 cm in major diameter pancreatic pseudocysts with a close opposition to the gastric or duodenal wall.Results: There were 26 patients with pancreatic pseudocyst and all of them are located in lesser sac. It mainly affects the middle-aged males with alcohol as the main etiology. Out of 26 patients 24 underwent endoscopic drainage and 2 patients were abandoned in view of vessel between the cyst wall and stomach which was picked up by EUS. Out of 26 patients, 5 developed infection which was proven by culture. Endoscopic cystogastrostomy was performed in 21 patients (80.8%), endoscopic cystogastrostomy with nasocystic drainage performed in 3 patients (11.5%), and abandoned in 2 patients. 2 patients developed bleeding, and managed conservatively. No intervention done. 5 patients underwent re-procedure (3 underwent nasocystic drainage, 1 aspiration, and the other cystogastrostomy), in view of recollection.Conclusions: Endoscopic drainage is safe and effective in experienced hand, less morbidity, cost effective, short hospital stay, can be repeated.

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