1
|
Watanabe S, Toki M, Kambayashi K, Kitada S, Nosaka T, Ochiai K, Gondo K, Shibahara J, Hisamatsu T. Successful treatment of mediastinal pancreatic pseudocyst and pancreatic pleural effusion with endoscopic pancreatic duct drainage: A case report. DEN OPEN 2023; 3:e133. [PMID: 35898838 PMCID: PMC9307726 DOI: 10.1002/deo2.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 01/16/2023]
Abstract
An 81‐year‐old man with chronic pancreatitis was being treated with a protease inhibitor. He developed an acute exacerbation of chronic pancreatitis and dyspnea. Contrast‐enhanced computed tomography showed disruption of the main pancreatic duct, a cystic lesion connecting the mediastinum to the main pancreatic duct, and left pleural effusion. We diagnosed a pancreatic pseudocyst, mediastinal pancreatic pseudocyst, and pancreatic pleural effusion. Endoscopic retrograde pancreatography showed leakage of contrast medium from the pancreatic body; furthermore, a cystic cavity extending to the mediastinum through a pancreatic duct fistula was visualized. An endoscopic transpapillary nasopancreatic drainage tube was placed in the cystic cavity. Computed tomography showed that the mediastinal pseudocyst and pleural effusion had disappeared. Endoscopic transpapillary pancreatic duct drainage may be useful when a connection between the main pancreatic duct and a mediastinal pseudocyst is confirmed by imaging.
Collapse
Affiliation(s)
- Shunsuke Watanabe
- Department of Gastroenterology and Hepatology Kyorin University School of Medicine Tokyo Japan
| | - Masao Toki
- Department of Gastroenterology and Hepatology Kyorin University School of Medicine Tokyo Japan
| | - Komei Kambayashi
- Department of Gastroenterology and Hepatology Kyorin University School of Medicine Tokyo Japan
| | - Shuichi Kitada
- Department of Gastroenterology and Hepatology Kyorin University School of Medicine Tokyo Japan
| | - Takeshi Nosaka
- Department of Gastroenterology and Hepatology Kyorin University School of Medicine Tokyo Japan
| | - Kazushige Ochiai
- Department of Gastroenterology and Hepatology Kyorin University School of Medicine Tokyo Japan
| | - Koichi Gondo
- Department of Gastroenterology and Hepatology Kyorin University School of Medicine Tokyo Japan
| | - Junji Shibahara
- Department of Pathology Kyorin University School of Medicine Tokyo Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology Kyorin University School of Medicine Tokyo Japan
| |
Collapse
|
2
|
Clark HL, Illipparambil LC, Khurana S. Mediastinal pancreatic pseudocyst masquerading as diffuse alveolar haemorrhage. BMJ Case Rep 2021; 14:14/7/e240677. [PMID: 34210696 DOI: 10.1136/bcr-2020-240677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pancreatic pseudocyst formation with extension into the mediastinum is an uncommon complication of pancreatitis that can result in numerous pulmonary and cardiac complications. We present a case of a 56-year-old man with a history of recurrent pancreatitis who presented with haemoptysis. His initial workup was consistent with diffuse alveolar haemorrhage for which he was treated with glucocorticoids. After failure to improve, further imaging demonstrated a complex fluid collection in the mediastinum consistent with extension of his pre-existing pancreatic pseudocyst, leading to erosion into the right lower lobe of the lung. This case highlights a rare pulmonary complication of pancreatitis and underscores the importance of proper identification of this condition to guide successful management.
Collapse
Affiliation(s)
- Heather Lynn Clark
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Lijo C Illipparambil
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Sandhya Khurana
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
3
|
Nagarajan K, Sunilkumar D, Ramakrishnaiah VPN, Amuthabarathi M. Left Gastric Pseudoaneurysm in a Case of Chronic Pancreatitis: A Case Report With Review of Literature. Vasc Endovascular Surg 2020; 55:73-76. [PMID: 32869730 DOI: 10.1177/1538574420954309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Visceral artery pseudoaneurysms are common complications of pancreatitis that carry a high mortality rate. Early detection and treatment of the pseudoaneurysms should be done as they carry high mortality following rupture. The splenic artery is the commonest artery involved followed by gastroduodenal and pancreaticoduodenal arteries. Gastric artery pseudoaneurysms are less common with less than 50 cases reported in the literature till now. We describe a case of gastric artery pseudoaneurysm secondary to chronic pancreatitis in a patient who presented with intermittent GI bleeding and also describe the role of endovascular management in the treatment of the same.
Collapse
Affiliation(s)
- Krishnan Nagarajan
- Department of Radio-Diagnosis, 29988Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Devaraj Sunilkumar
- Department of Radio-Diagnosis, 29988Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | | | - Mohan Amuthabarathi
- Department of Radio-Diagnosis, 29988Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| |
Collapse
|
4
|
Taniguchi Y, Osakabe Y, Terada Y. Atypical extensive pancreatic pseudocyst with hemorrhage in a hemodialysis patient. Radiol Case Rep 2020; 15:1415-1418. [PMID: 32642008 PMCID: PMC7334557 DOI: 10.1016/j.radcr.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 11/27/2022] Open
Abstract
Pancreatic pseudocysts are a common complication of both acute and chronic pancreatitis. The complications of pancreatic pseudocysts include compression of abdominal great vessels, gastric or duodenal stenosis, cholestasis due to stenosis of common bile duct, infection, and hemorrhage into the cyst. Moreover, pancreatic pseudocysts most commonly occur around the pancreas; however, extension into the adjacent viscera including spleen, liver, transverse colon, anterior or posterior pararenal space, retroperitoneum and mediastinum does occur infrequently. Here, we report a rare case of atypical extensive pancreatic pseudocyst with hemorrhage in a hemodialysis patient.
Collapse
|
5
|
Kotb M, Oshiba A, Ashour K. Pseudopancreatic Cyst Extending into the Mediastinum in a 7-Year-Old Child. European J Pediatr Surg Rep 2019; 7:e24-e27. [PMID: 31214482 PMCID: PMC6579729 DOI: 10.1055/s-0039-1688802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/31/2019] [Indexed: 01/23/2023] Open
Abstract
Mediastinal pseudopancreatic cyst (MPP) is the extension of a pancreatic pseudocyst through esophageal or aortic hiatus into the posterior mediastinum. It can produce a range of manifestations caused by compression by the cyst, for instance, odynophagia, dysphagia, pericardial, or pleural effusion. Here we report a case of MPP in a 7-year-old child who was presented with repeated chest infections and left pleural effusion. It was successfully drained by cystogastrostomy.
Collapse
Affiliation(s)
- Mostafa Kotb
- Department of Pediatric Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Ahmed Oshiba
- Department of Pediatric Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Khaled Ashour
- Department of Pediatric Surgery, Alexandria University Faculty of Medicine, Alexandria, Egypt
| |
Collapse
|
6
|
Urbonas T, Damaskos D, Braden B, Gilmour J. Pancreatic pseudocyst extending into mediastinum and causing complete dysphagia. ANZ J Surg 2017; 88:E799-E800. [PMID: 28118675 DOI: 10.1111/ans.13858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/08/2016] [Accepted: 10/27/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Tomas Urbonas
- Department of Emergency Surgery, Oxford University Hospitals Foundation Trust, Oxford, UK.,Department of Gastroenterology, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Dimitrios Damaskos
- Department of Emergency Surgery, Oxford University Hospitals Foundation Trust, Oxford, UK.,Department of Gastroenterology, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Barbara Braden
- Department of Emergency Surgery, Oxford University Hospitals Foundation Trust, Oxford, UK.,Department of Gastroenterology, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Jeffrey Gilmour
- Department of Emergency Surgery, Oxford University Hospitals Foundation Trust, Oxford, UK.,Department of Gastroenterology, Oxford University Hospitals Foundation Trust, Oxford, UK
| |
Collapse
|
7
|
Matsusue E, Fujihara Y, Maeda K, Okamoto M, Yanagitani A, Tanaka K, Nakamura K, Ogawa T. Three cases of mediastinal pancreatic pseudocysts. Acta Radiol Open 2016; 5:2058460116647213. [PMID: 27330827 PMCID: PMC4900332 DOI: 10.1177/2058460116647213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/09/2016] [Indexed: 01/10/2023] Open
Abstract
A rare complication of acute or chronic pancreatitis is the formation of a mediastinal pancreatic pseudocyst (MPP), which is caused by tracking of pancreatic fluids through anatomical openings of the diaphragm into the mediastinum. Herein, we report the imaging characteristics of three cases of this condition. Our results revealed three features in common: (i) the connection between the mediastinum and the pancreatic cystic lesion; (ii) the presence of pleural effusions; and (iii) imaging findings consistent with chronic pancreatitis, such as pancreatic atrophy and calcifications and dilatation and/or stricture of main pancreatic duct (MPD). Serial diameter changes of the MPD and of the adjacent pseudocysts were necessary for the determination of the therapeutic strategy used in each case.
Collapse
Affiliation(s)
- Eiji Matsusue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Yoshio Fujihara
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kazunori Maeda
- Department of Gastroenterology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Masaru Okamoto
- Department of General Medicine, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Atsushi Yanagitani
- Department of Gastroenterology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kiwamu Tanaka
- Department of Gastroenterology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kazuhiko Nakamura
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological Therapeutic Science, Tottori University, Tottori, Japan
| |
Collapse
|