A COMPARATIVE STUDY OF PANCREATIC PSEUDOCYST TREATED WITH ULTRASOUND GUIDED ASPIRATION VERSUS CONVENTIONAL SURGERY

Background: Pancreatic pseudocysts belong to a large and hetero-geneous group of cystic pancreatic lesions and represent a complication of acute or chronic pancreatitis. This is a prospect Material and Methods: ive study conducted in the department of General surgery, at darbhanga medical college and Hospital, Darbhanga, Laheriasarai, Bihar. Study duration on One year. Conclusion: Ultrasound guided aspiration is equally safe compared to conventional surgery, It not only cures but provides palliation of symptoms and gives enough time needed for maturation of the cyst.

MR Imaging of Pancreatic Lesions

Aim: The aim of this work was to evaluate the role of MRI in differentiating between benign and malignant pancreatic lesions and its correlation with histopathological results as the reference standard. Patients and Methods: This MRI study included 30 patients, 17 females and 13 males with a mean age 50 years. Sixteen patients had malignant masses (14 patients were adenocarcinoma, one patient was lymphoma and one patient was metastasis) and 14 patients had benign masses (7 patients were pancreatic pseudocysts, two patients were pancreatic abscesses, three patients were simple cysts and two patients were focal pancreatitis). The main clinical symptom was abdominal pain and most of masses were located in the head of the pancreas. Results: In our study, 25 cases of the 30 patients showed increased intensity at T2-weighted images. Most of malignant cases showed low or equal intensity on T1- and high intensity on T2-weighted images compared to normal pancreatic parenchyma. In our study, DW-MRI was performed on all subjects at b-values of 500 and 1000 s/mm2. Benign pancreatic masses as pancreatic pseudocyst, simple cyst and abscess show low signal intensities on DWI, however malignant pancreatic masses as adenocarcinoma, lymphoma and metastasis show high signal intensities on DWI with a cut-off value of 1.5 x10-3 s/mm2 for the differentiation of benign from malignant pancreatic masses by b-value 1000 s/mm2 with the sensitivity, specificity, PPV, NPV& p value were 100%, 83.33%, 100%, 88.88% and <0.001 respectively. Conclusion: MRI plays an important role in the diagnosis of different pancreatic lesions and can assess the neoplastic pancreatic lesions with accurate detection of extension, nodal involvement and hepatic metastatic lesions. It also has a major role in differentiation between benign and malignant pancreatic lesions by the aids of DWI.

O-BN05 The management of pancreatitis and complications that require intervention in a Benign Specialist Surgical Unit

Background Acute pancreatitis or inflammation of the pancreas is a common surgical pathology that presents with a spectrum of severity. The condition itself ranges from a mild/moderate self-limiting pathology to one associated with a systemic inflammatory response that can lead to organ dysfunction and death. We aim to investigate the aetiology/management and outcomes of patients presenting with pancreatitis in a benign specialist surgical unit with dedicated upper GI surgical care. Methods A retrospective analysis of all patients presenting and falling under surgical care with biochemical/radiological pancreatitis was conducted, using hospital archiving systems, reviewing operative notes and follow up events was conducted over an 8-year period. Results Within our benign specialist centre, 1393 patients were treated over an 8-year period. 73% of patients presenting with acute pancreatitis were male, whereas only 37% were female. The age range of patients presenting was 12 to 100 years, with the median age being 44 years. Within our population, 36.8% of acute pancreatitis was caused by gallstones, and 29.6% caused by alcohol and 33.6% other causes. 81% of patients seen had mild/moderate self-resolving pancreatitis requiring only fluids and analgesia. 19% had complicated pancreatitis requiring complex medical/surgical treatment.4.8% patients developed pancreatic necrosis, and 3.7% developed pancreatic pseudocysts. 8 patients required necrosectomy, 19 patients required cystogastrostomy and 1 patient required distal pancreatectomy with no 90-day mortality. Conclusions Our specialist unit with the support of gastroenterology, nutrition team, radiology and ITU have managed a large cohort of pancreatitic patients, the small number patients who require a surgical intervention have had good outcomes.

P-P25 Hot Axios stent removal following endoscopic pancreatic necrosectomy

Background Symptomatic pancreatic pseudocysts or walled off necrosis following pancreatitis can be drained via a stoma from the collection to the GI tract, this is typically facilitated by endoscopic stents. These stents are left in-situ until the area has drained, this can take several months. The stent is then ideally removed endoscopically. Little is known about the consequences of failed endoscopic stent removal or factors contributing to this failure. Methods Retrospective analysis of prospective data at LUHFT between 1st January 2018 and 31st December 2019 of patients receiving at least one Hot Axios stent for management of pancreatic collection. Normally distributed data were compared using Student’s two tailed T test, with non-parametric data compared using Mann-Witney U test, categorical data were analysed using Chi2 test Results 131 patients were included in analysis, of which 74 were male with a median age of 56 years (IQR 46-66.5). Failure of endoscopic removal (14 patients) was associated with a longer time to removal; 101 days (IQR 78-121) to first attempt vs. 49 days (IQR 19-104) to first endoscopic attempt where the stent was successfully retrieved endoscopically (p &lt; 0.01). Surgical removal was undertaken in 6 patients, with significant morbidity in 2 of 6 patients. Overall 90-day mortality in patients undergoing Hot Axios stent placement was 8 of 131 (6%). Conclusions Endoscopic stent removal fails more frequently in patients where the stent has remained in situ for a long time before removal is attempted. Surgical removal of Hot Axios Stents is associated with significant morbidity, and this should be balanced against the as yet unknown consequences of leaving Hot Axios stent in-situ permanently.

Mediastinal Extension of a Pancreatic Pseudocyst: A Rare Intrathoracic Complication of Pancreatitis

Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.

The Role of EUS-Guided Drainage in the Management of Postoperative Fluid Collections after Pancreatobiliary Surgery

Postoperative fluid collection (POFC) is a challenging complication following pancreatobiliary surgery. Traditional treatment with surgical drainage is associated with significant morbidity, while percutaneous drainage is associated with a higher rate of recurrence and the need for repeated interventions. Studies have shown that endoscopic ultrasound (EUS)-guided drainage may offer a promising solution to this problem. There are limited data on the ideal therapeutic protocol for EUS-guided drainage of POFC including the timing for drainage; type, size, and number of stents to use; and the need for endoscopic debridement and irrigation. Current practices extrapolated from the treatment of pancreatic pseudocysts and walled-off necrosis may not be applicable to POFC. There are increasing data to suggest that drainage procedures may be performed within two weeks after surgery. While most authors advocate the use of double pigtail plastic stents (DPPSs), there have been a number of reports on the use of novel lumen-apposing metal stents (LAMSs), although no direct comparisons have been made between the two.

Gastrointestinal Intramural Pancreatic Pseudocysts in a Dog: A Case Report and Human Literature Review

ABSTRACT A 9.5 yr old Yorkshire terrier presented with chronic intermittent vomiting and lethargy of 1.5 yr duration that progressed to generalized weakness. Insulin:glucose ratio was consistent with an insulinoma. Triple-phase computed tomography revealed a mid-body pancreatic nodule. The mid-body pancreatic nodule was enucleated; histopathology was consistent with an insulinoma. Two weeks after the operation, the dog presented for anorexia and diarrhea. Abdominal ultrasound revealed a thick-walled cystic lesion along the dorsal stomach wall. An intramural gastric pseudocyst was diagnosed via exploratory laparotomy and intraoperative gastroscopy. Comparison of amylase and lipase levels of the cystic fluid with that of concurrent blood serum samples confirmed the lesion was of pancreatic pseudocyst origin. The gastric pseudocyst was omentalized. Two weeks after the operation, the dog re-presented for anorexia, regurgitation, and diarrhea. An intramural duodenal pseudocyst was identified and treated with a duodenal resection and anastomosis. The dog has remained asymptomatic and recurrence free based on serial abdominal ultrasounds 22 mo following insulinoma removal. To our knowledge, this phenomenon of pancreatic pseudocysts forming in organs other than the pancreas has not been reported in dogs. This case report and comprehensive human literature review purpose is to raise awareness of this disease process in dogs.