Pseudocyst of Abdomen Presenting as a Huge Abdominal Mass after Ventriculoperitoneal Shunt: A Case Report

A ventriculoperitoneal shunt is a major surgical modality to relieve intracranial pressure in patients with hydrocephalus. Shunt obstruction and infection are the most common complications following shunt surgery whereas VP shunt-associated pseudocyst formation is a rare complication. These are the cystic space without the epithelial lining, filled with fluid around the distal tip of the catheter. In this case report, we present you a 47-year-old male who underwent VP shunt placed a year back presented with huge abdominal swelling, headache, and weight loss. CT scan of the abdomen showed abdominal pseudocyst with the peritoneal end of the shunt within the cyst. Though the exact mechanism is not known, abdominal adhesion, multiple revisions, obstruction, or dislodgement are thought to predispose to the formation of a pseudocyst.

Ep.Fri.329 Severe Acute Pancreatitis in Pregnancy Secondary to Hypertriglyceridemia – A Case Report and Literature Review

Background Hypertriglyceridemia is a common and well characterized physiological phenomenon in pregnancy. Rarely does it complicate the pregnancy causing acute pancreatitis (APIP). The majority of APIP cases arise secondary to gallstones. Hyperlipidaemia induced pancreatitis is a rarer cause with relatively worse outcomes with increased incidences of preterm delivery and pseudocyst formation. Case Report A 38-years-old woman at 29 weeks gestation presented with epigastric pain. The initial investigations revealed raised inflammatory markers, elevated amylase and hypertriglyceridemia. A diagnosis of APIP was made, prompting transfer to ITU. Foetal compromise necessitated an emergency Caesarean delivery. Post-partum, her clinical condition improved with NG feeding, bezafibrates and IV antibiotics. Her baby was transferred to a nearby tertiary neonatal unit with no immediate complications. Discussion Hyperlipidemia induced APIP requires intensive treatment. Various medical treatments for hypertriglyceridemia, such as fibrates and insulin infusions, have been described. Plasmapheresis in severe cases may benefit reducing the triglycerides level. Considering maternal and foetal morbidity and mortality, early diagnosis and multidisciplinary input is required to treat and reduce complications. Conclusion APIP is a serious and rare complication of pregnancy. The current lack of consensus on treatment of APIP warrants further inquiry, to minimise poor neonatal outcomes. The merits of routine screening for gestational hypertriglyceridemia are yet to be elucidated; the morbidity associated with APIP, coupled with its rising incidence justify a targeted screening programme. Keywords Pancreatitis, Pregnancy, Hypertriglyceridemia.

Intra-Peritoneal Pseudocyst as a Rare Complication After Peritoneal Dialysis: The Use of a Staged Surgical Approach in Management

Despite its numerous benefits, peritoneal dialysis (PD) can rarely result in dangerous and even life-threatening complications, including peritonitis, hernias, encapsulating peritoneal sclerosis (EPS), and rarely peritoneal pseudocysts. Herein, we present a rare case of a giant intra-peritoneal pseudocyst that presented four months following the discontinuation of a 5-year course of complicated PD. Despite the initially successful drainages, the patient’s symptoms continued to recur, and the imaging findings were concerning for underlying neoplastic processes. As such, a staged surgical approach was performed, starting with a diagnostic laparoscopy and was subsequently followed with cyst excision and marsupialization to the peritoneal cavity. While previous reports of such rare pseudocyst have been documented in the literature as a complication of PD, to our knowledge, this is the second case of pseudocyst formation to occur months after the discontinuation of PD therapy. This case emphasizes the importance of close follow-up in PD patients and showcases how a staged surgical approach can be utilized to accurately diagnose and manage such complicated cases.

Pseudocyst in Neck: A Case Report on Rare Complication of Ventriculoperitoneal Shunt

Introduction. Ventriculoperitoneal shunt is a common neurosurgical procedure, for the definitive management of hydrocephalus. Shunt failures may occur due to various causes but are usually due to infections in adults and catheter occlusion in the paediatric population. Case Report. The 13-year-old girl presented with a right lateral neck swelling. In detailed history, she was found to be an old case of ventriculoperitoneal shunt. The clinical examination and radiological investigation revealed proximal dislodgment of the stent from the cranium, causing persistent cerebrospinal fluid (CSF) leak and pseudocyst formation in the neck. Conclusion. The case highlights CSF pseudocyst formation as a rare differential for lateral neck swellings.

Fenestration of Peritoneal Catheter to Avoid Abdominal Pseudocyst Formation after Ventriculoperitoneal Shunts: A Technical Note

Ventriculoperitoneal shunt (VPS) is a well-known procedure in the neurosurgical field. However, it has high complication and reoperation rates. Abdominal pseudocyst (APC) formation is a rare complication of VPS with reports in the literature varying from 4 to 10%. In this article, we report a simple and effective technique, with no additional cost, to avoid APC formation by making small multiple slits along the length of the peritoneal catheter.

Effectiveness of Endoscopic Pancreatic Stenting for Pancreatic Pseudocyst-Portal Vein Fistula

Pancreatic pseudocyst-portal vein (PP-PV) fistula, mostly occurring after pseudocyst formation following acute/chronic pancreatitis, is a rare but life-threatening condition. The majority of treatments are based on conservative or surgical interventions. We report the case of a 70-year-old man with a PP-PV fistula and PV thrombosis. We adopted conservative treatment at first due to his mild symptoms. However, after resuming food intake, the patient had severe abdominal pain. Following endoscopic retrograde cholangiopancreatography, we found that the pseudocyst was connected with the PV through the fistula. Subsequently, an endoscopic nasopancreatic drainage (ENPD) catheter was inserted into the main pancreatic duct to establish pancreatic drainage, which resulted in a decrease in the abdominal pain. After the ENPD tube had been exchanged for endoscopic pancreatic stenting, his abdominal pain did not recur. Therefore, this case demonstrated endoscopic treatment as an effective treatment option for PP-PV fistula.

Angiotensin-Converting Enzyme (ACE) Inhibitors and Pancreatitis: A Potential Dose-dependent Relationship

Acute pancreatitis (AP) remains one of the most common causes of emergency department visits in the USA. The literature supports an association between angiotensin-converting enzyme inhibitors (ACEi), mainly at steady-state doses, and AP. We present a case of recurrent AP and pseudocyst formation following multiple ACEi dose adjustments after a steady-state period lasting for over a decade. Previous reports have rarely described ACEi-induced pancreatitis and pseudocyst development. ACEi can cause significant ductal obstruction and fluid retention due to its angioedema effects. Consequently, it may trigger AP complicated by pseudocyst formation. Therefore, ACEi administration must be considered in the appropriate clinical context.

POST CYSTOGASTROSTOMY BLEEDING-COMMON COMPLICATION UNUSUAL CAUSE: A CASE REPORT

Pseudoaneurysms of gastroduodenal artery are rare and mostly associated with pancreatitis. We report a case of a ruptured GDA aneurysm in a patient who underwent cystogastrostomy for pancreatic pseudocyst and this has rarely been reported in the literature. Our patient presented with hematemesis 2 week postoperatively. CT angiogram showed pseudoaneurysm of the GDA and which was embolised. Our case highlights that GDA aneurysm must be considered in the differential for a patient who presents with upper GI tract bleed after drainage of pancreatic pseudocyst and that it can be managed with angioembolization. A 30 year old male presented to our surgery department with a four-month history of pain & swelling over upper abdomen with associated vomiting. CT scan showed large thicked walled cystic lesion in lesser sac abutting the uncinate process with atrophy of body and tail of pancrease s/o chronic pancreatitis with pseudocyst formation. We performed cystogastrostomy for pancreatic pseudocyst. Two week later, he presented with the complains of hematemesis. Patient was resuscitated initially and then CT angiogram was planned that showed pseudoaneurysm of the GDA. The pseudoaneurysm was embolised and patient was sent home later on. Gastroduodenal artery aneurysm shoud be suspected in a patient with GI hemorrhage after surgery for Pancreatic pseudocyst. The investigation of choice is CT angiography and endovascular angioembolisation is the treatment modality of choice.