The syndromes of pancreatic pseudocysts and fluid collections

A nomogram to predict the occurrence of pseudocyst in patients with acute pancreatitis

BACKGROUND

Pseudocyst formation is common in many patients with acute pancreatitis during follow-up. Many risk factors have been proposed to be associated with the development of PP, but the predictive factors are still underexplored. The focus of this study was to investigate whether early laboratory indicators could effectively predict the occurrence of PP.

METHODS

2811 AP patients hospitalized in the Second Affiliated Hospital of Soochow University between November 2008 and September 2020 were retrospectively studied. Univariate and multivariate analyses were used to screen the risk variables. The nomograms of those risk factors were validated and evaluated by logistic analysis.

RESULTS

AP patients had a 6.1 % (172/2811) incidence of PP. In a univariate analysis, the development of PP was correlated with serum lactate dehydrogenase (LDH), albumin (ALB), calcium (Ca), hemoglobin (Hb), organ dysfunction, CT severity index (CTSI), etiology, age, etc. Further logistic regression analysis showed that the risk factors were different between hyperlipidemic pancreatitis patients (LDH, ALB and Ca) and non-hyperlipidemic pancreatitis patients (LDH, Hb, ALB and Ca). A nomogram based on the identified risk factors was developed. Our model showed good discrimination ability, with a boostrap - corrected C index of 0.905 (95 % CI = 0.875-0.935), and had well-fitted calibration curves. The area under the curve (AUC) of the nomogram were 0.905 (95 % CI = 0.875-0.935) and 0.933 (95 % CI = 0.890-0.975) in the training and validation groups, respectively. The results of DCA indicated that the nomogram may have clinic usefulness.

CONCLUSIONS

The nomogram that incorporates early laboratory data (LDH, Hb, ALB, and Ca) in AP patients is able to predict the incidence of PP with greater accuracy than the CTSI and AP severity.

Imaging assessment of acute pancreatitis: a review

Acute pancreatitis is one of the more commonly encountered etiologies in the emergency setting. While in the majority of cases it is a self-limiting disease which responds rapidly to conservative management, in some cases acute pancreatitis may present with a more pronounced, sometimes dramatic, clinical picture and requires immediate medical care to avoid fatal complication. In this context, imaging plays a significant role because it enables identification of the development of the disease and local/systemic complications. The purpose of this article is to offer an overview of the disease and a spectrum of imaging findings in patients with acute pancreatitis, emphasizing the role of ultrasound, computed tomography, and magnetic resonance imaging according to the appropriate clinical context and advantages and limitations of each imaging modality are examined.

The efficacy of endoscopic treatment of pancreatic pseudocysts

BACKGROUND

Endoscopic drainage of pancreatic pseudocysts is a new nonsurgical treatment modality. We retrospectively studied the efficacy of endoscopic drainage of pseudocysts in 37 patients with chronic pancreatitis.

METHODS

Endoscopic retrograde pancreatic drainage was performed in 12 patients, endoscopic cystogastrostomy in 10 patients, and endoscopic cystoduodenostomy in 7 patients. In the remaining 8 patients, combinations of drainage routes were used.

RESULTS

ECG failed in 3 patients. Procedure-related complications were seen in 6 patients: bleeding in 3, perforation in 2, and apnea in 1 patient. There was no procedure-related mortality. Seven patients had complications in relation to stents or drains: pseudocyst infection due to stent clogging in 2, stent migration in 4, and kinking of the drain in 1 patient. Twenty-four patients had complete resolution of pseudocysts, 7 had partial resolution, and 6 had no resolution. Three patients had pseudocyst recurrences. Mean follow-up was 32 months. Finally, 10 patients underwent surgery.

CONCLUSIONS

Endoscopic drainage was technically feasible in 92% of the patients. Procedure-related morbidity was 16% and mortality was 0%. Endoscopic drainage was a definitive treatment for two thirds of the patients (65%). Surgery can be reserved for those patients in whom endoscopic therapy fails.

Proteolytic activity in pancreatic pseudocyst fluid

Pancreatic pseudocyst fluids from 15 patients were biochemically analyzed, especially concerning proteolytic activity and protease inhibitors, and correlated to the clinical course. The pseudocyst fluid was a mixture of pancreatic juice and plasma possessing a high proteolytic activity against high- as well against low-mol-wt proteins. There was practically no functional protease inhibitory capacity left, although immunoreactive inhibitors were present. No distinct biochemical findings differed between fluids from "acute" or from "chronic" pseudocysts. It is concluded, that high proteolytic activity within a pancreatic pseudocyst could well explain symptoms as well as complications caused by the pseudocyst. Biochemical analysis of the pseudocyst fluid cannot, however, be used to differentiate between pseudocysts with a harmless or a complicated course.

Subcutaneous soft tissue densities: a computed tomography indicator of severe pancreatitis

Twenty patients with known acute pancreatitis had 50 computed tomography studies. Those with severe pancreatitis showed streaky and fluffy soft tissue densities in the flanks and some in the gluteal regions. The appearance and disappearance of this finding correlates with the extravascular movement of fluid due to severe pancreatic inflammation.

Rupture of a pancreatic pseudocyst following blunt abdominal trauma

This report describes a case of intraperitoneal rupture of a pancreatic pseudocyst (PPC) following blunt abdominal trauma. Cause of the pseudocyst was likely alcoholic pancreatitis. Peritoneal aspiration of hemorrhagic fluid prompted laparotomy and led to diagnosis. Trauma-induced intraperitoneal rupture of a preexisting PPC has been rarely reported.

Pancreatic pseudocysts: a biochemical evaluation of proteases and protease inhibitors in plasma

A biochemical evaluation was performed on plasma from eight patients developing a pancreatic pseudocyst during acute pancreatitis attacks and from six patients with a known pseudocyst. Patients developing an acute pancreatic pseudocyst had high levels of activated trypsin in complex with alpha 1-protease inhibitor, together with a probable activation of the kinin, complement, coagulation and fibrinolytic systems. Profound changes were also seen in several protease inhibitors, indicating consumption of the inhibitors. The changes did, however, not differ from those seen in severe acute pancreatitis attacks in which no pseudocyst developed. Patients with chronic pancreatic pseudocysts had biochemical changes similar to those seen in moderate pancreatitis attacks, without any overt cascade system activation. At convalescence, however, these patients had biochemical signs of leakage from the pancreas and an ongoing proteolytic activity.