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Solakoglu T, Kucukmetin NT, Akar M, Koseoglu H. Acute peripancreatic fluid collection in acute pancreatitis: Incidence, outcome, and association with inflammatory markers. Saudi J Gastroenterol 2023; 29:225-232. [PMID: 37470666 PMCID: PMC10445500 DOI: 10.4103/sjg.sjg_443_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 07/21/2023] Open
Abstract
Background The hospital outcomes and predictors of acute peripancreatic fluid collection (APFC) have not been well-characterized. In this study, we aimed to investigate the clinical outcomes of APFC in patients with acute pancreatitis (AP) and the role of the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and C-reactive protein (CRP) level in predicting the occurrence of APFC. Methods In this retrospective study, the complicated group (patients with APFC) and the uncomplicated group (patients without APFC) were compared for their clinical characteristics, hospital outcomes (mortality rate, intensive care unit admission rate, and length of hospital stay), pseudocyst formation, CRP levels, SII, and SIRI on admission and at 48 hours. Results Of 132 patients with AP, 51 (38.6%) had APFC and eight (6.1%) had pancreatic pseudocysts. Of 51 patients with APFC, 15.7% had pancreatic pseudocysts. Pseudocyst did not develop in the uncomplicated group. SII value at 48 h [median 859 (541-1740) x 109/L vs. 610 (343-1259) x 109/L, P = 0.01] and CRP level at 48 h [89 (40-237) mg/L vs. 38 (12-122) mg/L, P = 0.01] were higher in the complicated group than in the uncomplicated group. The length of hospital stay was longer in the complicated group, compared with the uncomplicated group [median 8 days (5-15), vs. 4 days (3-7), P < 0.001, respectively]. No significant difference was detected between the two study groups' mortality rates and intensive care unit admission rates. Conclusions While 38.6% of the AP patients had APFC, 6.1% of all patients and 15.7% of the patients with APFC had pancreatic pseudocysts. APFC was found to lengthen the hospital stay and to be associated with the SII value and CRP level measured at 48 h.
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Affiliation(s)
- Tevfik Solakoglu
- Department of Gastroenterology, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Nurten Turkel Kucukmetin
- Department of Gastroenterology, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Mustafa Akar
- Department of Gastroenterology, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Hüseyin Koseoglu
- Department of Gastroenterology, Faculty of Medicine, Hitit University, Çorum, Turkey
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Hamada S, Masamune A, Shimosegawa T. Management of acute pancreatitis in Japan: Analysis of nationwide epidemiological survey. World J Gastroenterol 2016; 22:6335-6344. [PMID: 27605870 PMCID: PMC4968116 DOI: 10.3748/wjg.v22.i28.6335] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/22/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In Japan, nationwide epidemiological surveys have been conducted every 4 to 5 years by the Research Committee of Intractable Pancreatic Diseases, under the support of the Ministry of Health, Labour, and Welfare of Japan. We reviewed the results of the nationwide surveys focusing on the severity assessment and changes in the therapeutic strategy for walled-off necrosis. The severity assessment system currently used in Japan consists of 9 prognostic factors and the imaging grade on contrast-enhanced computed tomography. By univariate analysis, all of the 9 prognostic factors were associated with AP-related death. A multivariate analysis identified 4 out of the 9 prognostic factors (base excess or shock, renal failure, systemic inflammatory response syndrome criteria, and age) that were associated with AP-related death. Receiver-operating characteristics curve analysis showed that the area under the curve was 0.82 for these 4 prognostic factors and 0.84 for the 9 prognostic factors, suggesting the comparable utility of these 4 factors in the severity assessment. We also examined the temporal changes in treatment strategy for walled-off necrosis in Japan according to the 2003, 2007, and 2011 surveys. Step-up approaches and less-invasive endoscopic therapies were uncommon in 2003 and 2007, but became popular in 2011. Mortality has been decreasing in patients who require intervention for walled-off necrosis. In conclusion, the nationwide survey revealed the comparable utility of 4 prognostic factors in the severity assessment and the increased use of less-invasive, step-up approaches with improved clinical outcomes in the management of walled-off necrosis.
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Nitsche U, Siveke J, Friess H, Kleeff J. [Delayed complications after pancreatic surgery: Pancreatic insufficiency, malabsorption syndrome, pancreoprivic diabetes mellitus and pseudocysts]. Chirurg 2015; 86:533-9. [PMID: 25997699 DOI: 10.1007/s00104-015-0006-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Benign and malignant pathologies of the pancreas can result in a relevant chronic disease burden. This is aggravated by morbidities resulting from surgical resections as well as from progression of the underlying condition. OBJECTIVE The aim was to summarize the current evidence regarding epidemiology, pathophysiology, diagnosis and treatment of endocrine and exocrine pancreatic insufficiency, as well as of pancreatic pseudocysts. MATERIAL AND METHODS A selective literature search was performed and a summary of the currently available data on the surgical sequelae after pancreatic resection is given. RESULTS Reduction of healthy pancreatic parenchyma down to 10-15 % leads to exocrine insufficiency with malabsorption and gastrointestinal complaints. Orally substituted pancreatic enzymes are the therapy of choice. Loss of pancreatic islets and/or islet function leads to endocrine insufficiency and pancreoprivic diabetes mellitus. Inflammatory, traumatic and iatrogenic injuries of the pancreas can lead to pancreatic pseudocysts, which require endoscopic, interventional or surgical drainage if symptomatic. Finally, pancreatic surgery harbors the long-term risk of gastrointestinal anastomotic ulcers, bile duct stenosis, portal vein thrombosis and chronic pain syndrome. CONCLUSION As the evidence is limited, an interdisciplinary and individually tailored approach for delayed pancreatic morbidity is recommended.
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Affiliation(s)
- U Nitsche
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Graversen M, Mortensen MB. [Diagnosis and treatment of pancreatic cysts]. Ugeskr Laeger 2015; 177:941-945. [PMID: 26535432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential, whereas pseudocysts and serous cystadenomas are benign, the distinction is of key clinical importance. Current recommendations advocate the use of multiple imaging modalities (CT/MRI/endoscopic US/endoscopic US & fine-needle aspiration) during evaluation and follow-up. This review describes the most frequent cystic lesions of the pancreas and suggests a simple investigation and treatment algorithm.
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MESH Headings
- Algorithms
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/epidemiology
- Carcinoma, Pancreatic Ductal/therapy
- Cystadenocarcinoma, Mucinous/diagnosis
- Cystadenocarcinoma, Mucinous/epidemiology
- Cystadenocarcinoma, Mucinous/therapy
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/epidemiology
- Cystadenoma, Serous/pathology
- Cystadenoma, Serous/therapy
- Humans
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/epidemiology
- Pancreatic Cyst/pathology
- Pancreatic Cyst/therapy
- Pancreatic Pseudocyst/diagnosis
- Pancreatic Pseudocyst/epidemiology
- Pancreatic Pseudocyst/therapy
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Graversen M, Mortensen MB. [Diagnosis and treatment of pancreatic cysts]. Ugeskr Laeger 2014; 176:V06140359. [PMID: 25394925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential, whereas pseudocysts and serous cystadenomas are benign, the distinction is of key clinical importance. Current recommendations advocate the use of multiple imaging modalities (CT/MRI/endoscopic US/endoscopic US & fine-needle aspiration) during evaluation and follow-up. This review describes the most frequent cystic lesions of the pancreas and suggests a simple investigation and treatment algorithm.
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MESH Headings
- Algorithms
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/epidemiology
- Carcinoma, Pancreatic Ductal/therapy
- Cystadenocarcinoma, Mucinous/diagnosis
- Cystadenocarcinoma, Mucinous/epidemiology
- Cystadenocarcinoma, Mucinous/therapy
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/epidemiology
- Cystadenoma, Serous/pathology
- Cystadenoma, Serous/therapy
- Humans
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/epidemiology
- Pancreatic Cyst/pathology
- Pancreatic Cyst/therapy
- Pancreatic Pseudocyst/diagnosis
- Pancreatic Pseudocyst/epidemiology
- Pancreatic Pseudocyst/therapy
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Affiliation(s)
- Martin Graversen
- Kirurgisk Afdeling A, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense. /
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Guardado-Bermúdez F, Azuara-Turrubiates AJ, Ardisson-Zamora FJ, Guerrero-Silva LA, Villanueva-Rodríguez E, Gómez-de Leija NA. [Pancreatic pseudocyst. Case report and literature review]. CIR CIR 2014; 82:425-431. [PMID: 25167354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The most frequent etiology of pancreatic pseudocyst is acute pancreatitis and exacerbations of chronic pancreatitis, presenting spontaneous resolution in 50% of the cases. Treatment is indicated in symptomatic or complicated persistent pseudocysts. The OBJECTIVE of this article is to present a case and management options of pancreatic pseudocyst defined as a collection of fluid in the omental bursa. CLINICAL CASE We present the case of a 59-year-old female patient with a history of laparoscopic cholecystectomy and necrotizing pancreatitis. She presented abdominal pain, early satiety, and nausea during the previous 2 months. Presence of pancreatic pseudocysts of 92 and 62 mm was demonstrated by computed tomography. The patient was submitted to a laparoscopic cyst-gastric anastomosis. CONCLUSIONS Laparoscopic cyst-gastric anastomosis is the ideal treatment for pancreatic pseudocyst management because it offers continuous drainage, low rate of recurrence and few complications, exceeding the RESULTS of endoscopic management and imaging-guided drainage along with the benefits of a minimally invasive procedure.
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Affiliation(s)
- Fernando Guardado-Bermúdez
- Servicio de Cirugía General, Departamento de Cirugía del Hospital Regional de Ciudad Madero (PEMEX), Tamaulipas, México.
| | | | | | - Luis Alberto Guerrero-Silva
- Servicio de Cirugía General, Departamento de Cirugía del Hospital Regional de Ciudad Madero (PEMEX), Tamaulipas, México
| | - Estefanie Villanueva-Rodríguez
- Servicio de Medicina Interna, Departamento de Cirugía del Hospital Regional de Ciudad Madero (PEMEX), Tamaulipas, México
| | - Nubia Alondra Gómez-de Leija
- Servicio de Medicina General, Departamento de Cirugía del Hospital Regional de Ciudad Madero (PEMEX), Tamaulipas, México
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Rana SS, Bhasin DK. Should all fluid collections in delayed phase of acute necrotizing pancreatitis labeled as walled-off pancreatic necrosis? Dig Dis Sci 2014; 59:1338-9. [PMID: 24795039 DOI: 10.1007/s10620-014-3183-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/20/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India,
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Talar-Wojnarowska R, Woźniak B, Pazurek M, Małecka-Panas E. Outcome of pseudocysts complicating chronic pancreatitis. Hepatogastroenterology 2010; 57:631-634. [PMID: 20698240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND/AIMS Pancreatic pseudocysts are frequent complication of chronic pancreatitis with incidence rate from 20 to 40%. The aim of our study was to establish a possible correlation between clinical features and outcome of pseudocysts complicating chronic pancreatitis. METHODOLOGY We included in the study 37 patients with chronic pancreatitis and pancreatic pseudocysts treated at the Department of Digestive Tract Diseases of Lodz Medical University between 2003-2008. For each patients the following parameters were recorded: number and location of pseudocysts, diameter, kind of treatment, recurrence rate and time of hospitalisation. RESULTS The mean size of pancreatic pseudocysts was 7.8 cm (range 2-16 cm). Spontaneous regression was observed in 7 pseudocysts (18.9%), persistence without symptoms and without size enlargement in 9 patients (24.3%). Twenty one (56.8%) pseudocysts required therapeutic intervention: endoscopic procedures (27.1%), surgical treatment (18,.9%) or percutaneous drainage (10.8%). Mean pseudocyst size for conservative treated patients was 4.2 compared to 9.6 for patients with interventional treatment (p < 0.05). The overall recurrence rate was 33.3%. The mean hospital stay of patients treated endoscopically was significantly shorter than those treated surgically (p < 0.01) and shorter than those of percutaneous drainage (p < 0.01). CONCLUSION Pseudocysts treatment in chronic pancreatitis may be effectively achieved by both endoscopic and surgical means. Nonetheless, the endoscopic drainage, with lower hospitalization period, should be considered for initial therapy in each appropriate patients.
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Dronov OI, Kriuchyna IA, Horlach AI, Skomarovs'kyĭ OA. [Surgical approach to pancreatic pseudocysts complicated with hemorrhages]. Klin Khir 2009:25-27. [PMID: 20218363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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10
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Grubnik VV, Diuzhev AS, Vododiuk RI. [Laparoscopy interventions for pancreatic pseudocysts]. Klin Khir 2009:18-20. [PMID: 20218360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Nychytaĭlo MI, Ohorodnyk PV, Kondratiuk OP, Deĭnychenko AH. [Endoscopic treatment of pancreatic pseudocysts]. Klin Khir 2009:5-8. [PMID: 19957739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The results of endoscopic treatment of 42 patients for pancreatic pseudocysts, including 8 (19%) women and 34 (81%) men, were analyzed. In 7 (16.7%) patients the complications had occurred and the pancreatic cyst recurrence after its endoscopic treatment--in 3 (7.1%).
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12
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Rabinovich A, Rescorla FJ, Howard TJ, Grosfeld J, Lillemoe KD. Pancreatic disorders in children: relationship of postoperative morbidity and the indication for surgery. Am Surg 2006; 72:641-3. [PMID: 16875089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pancreatic surgery in children is a rare occurrence, and this unfamiliarity can be associated with the assumption of significant morbidity and mortality. The indication for pediatric pancreatic surgery and its relationship to postoperative complications and mortality was evaluated. Patients with pancreatic disease requiring surgical intervention from 1992 to 2004 at a tertiary referral center were retrospectively reviewed. Disorders were divided into 3 categories: 1) pancreatitis, 2) trauma, and 3) tumors. Sixty-two patients (28 males and 34 females), average age was 9.5 years (range, 1 week-18 years), underwent 72 operations. Thirty-seven procedures in 30 category I patients, 18 procedures in 15 category II, and 17 operations in 17 category III. There was only one death. A total of 33.9 per cent of the patients had postoperative complications that included: infection (11%), pseudocyst (6%), diabetes mellitus (5.6%), pancreatic fistula (3%), bowel obstruction (1.3%), extracellular fluid (1.3%), pleural effusion (1.3%), and recurrent abdominal pain (13%) (all in category I patients). There was equivalent morbidity between all 3 groups but unique differences with in the categories. Recurrent abdominal pain characterized category I patients, fistulas were more common in category II, and diabetes mellitus was primarily related to near total excisions in category III. Pancreatic surgery in children is associated with a very low mortality (1.6%) and morbidity equal to that of adult patients. Unique types of morbidities occur with each category of disease state.
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Affiliation(s)
- Aaron Rabinovich
- Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, Indiana 46202-5125, USA
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Jiang CY, Han TQ, Feng FL, Kong L, Cai XX, Zhang SD. Clinical characteristics of acute pancreatitis patients with elevated serum triglyceride concentration. ACTA ACUST UNITED AC 2005; 6:43-6. [PMID: 15667558 DOI: 10.1111/j.1443-9573.2005.00187.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the clinical characteristics of acute pancreatitis (AP) patients with elevated serum triglyceride (TG) concentration. METHODS Ninety-nine cases of AP admitted from January 2000 to January 2002 were analyzed: 28 cases comprised the TG-elevated group (serum TG >1.7 mmol/L) and 71 cases were the TG-normal group (serum TG </=1.7 mmol/L). RESULTS The AP patients with elevated serum TG accounted for 11.3% (9/80) of all AP cases during the study period. Pulmonary, cardiovascular and renal dysfunction within 72 h of onset of AP were all higher in the TG-elevated group than in the group with normal TG (25.0% vs 1.4%; 17.9% vs 1.4%; 14.3% vs 1.4%, respectively; P < 0.05). The incidence of pancreatic pseudocyst was 53.6% and 4.2%, respectively, in the group with elevated TG and in the group with normal TG (P < 0.05). CONCLUSIONS Patients with AP and elevated serum TG concentration have organ dysfunction at an earlier stage and increased local complications. Non-surgical therapy was common for the majority of these patients.
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Affiliation(s)
- Chong Yi Jiang
- Department of Surgery, Ruijin Hospital, Shanghai Second Medical University, Shanghai Institute of Digestive Surgery, Shanghai, China
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Diculescu M, Ciocîrlan M, Ciocîrlan M, Stănescu D, Ciprut T, Marinescu T. Predictive factors for pseudocysts and peripancreatic collections in acute pancreatitis. Rom J Gastroenterol 2005; 14:129-34. [PMID: 15990931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) is a proteiform disease which may lead to various complications. Pancreatic pseudocysts and fluid collections are among the most frequent of them. The aim of our study was to find predictive factors of their occurrence. METHODS We carried out a retrospective cohort study comprising one year patients admitted to our department with AP. Fisher's exact and U Mann Whitney tests were used for correlations, with a probability of error < 5% (p<0.05). RESULTS We included 62 patients with a mean age of 49 years; 77.4% were males. AP etiology was due to alcohol (58.1%), biliary disorders (22.6%), hyper-triglycerides (8.1%) and post-ERCP (3.2%). Pancreatic cancer was revealed in (6.5%) patients. From the whole group 2 patients (3.2%) died. There were 22 patients with pseudocysts (35.5%) and 13 patients with acute fluid collections (21%). Multiple pseudocysts were present in 12 cases (54.5%), mean diameter was 39.5 mm. Pancreatic head localization was most frequent (63.6%). Alcoholic etiology was associated with acute pseudocysts formation (p=0.007) as well as lower values of alkaline phosphatase (96 U/L versus 286 U/L, p = 0.016). The area under the receiver operating characteristics curve demonstrated values of alkaline phosphatase < 2 x upper normal values were predicting pseudocyst occurrence with > 90% specificity. Presence of ascites predicted formation of acute fluid collections, (p < 0.001). CONCLUSIONS Alcoholic etiology and low values of serum alkaline phosphatase seem to predict pseudocysts formation in acute pancreatitis, while ascites forecast acute fluid collections occurrence.
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Affiliation(s)
- Mircea Diculescu
- Department of Hepatology, Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Str. Fundeni no. 258, 72437 Bucharest, Romania.
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Agbakwuru EA, Asaleye CM, Ogunrombi AB, Akinola DO. Pancreatic pseudocyst in Ile-Ife revisited: 5 more cases. Niger J Med 2005; 14:77-82. [PMID: 15832648 DOI: 10.4314/njm.v14i1.37140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pancreatic pseudocyst is a major health problem in the developed countries and its incidence is noted to be getting higher among the Caucasians as a result of better diagnostic techniques. This retrospective study was done to review the cases of pancreatic pseudocyst seen between 1991 and 1999 at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria. The 5 cases seen over this period of study were used to illustrate its rarity. METHOD The case notes of the patients managed for pancreatic pseudocyst during the period under review were studied and analysed to evaluate the different modes of presentation, investigations done and the modes of treatment. RESULTS The age range of the patients varied between 23 and 70 years with three of them being male while two were female. The most common presenting symptom and sign were abdominal pain and abdominal mass. Abdominal ultrasonography, chest X-ray, upper gastrointestinal endoscopy and laboratory blood tests were the investigative procedures carried out. The treatment modalities were either conservative or surgical (operative). One patient had spontaneous resolution of the pseudocyst, 2 had external drainage while the remaining 2 had cystogastrostomy. Two of the patients responded well to treatment and were being followed up in the Surgical Out Patient Clinic, one died within 24 hours of surgery while the other developed diabetes mellitus 3 months post surgery and was referred to the physicians for follow-up. CONCLUSION Though pancreatic pseudocyst remains uncommon in Nigeria, ultrasonography can play an essential role in assisting diagnosis while successful management of this condition is still possible in the absence of current endoscopic techniques of drainage.
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Affiliation(s)
- E A Agbakwuru
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Osun State, Nigeria
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Oruc N, Lamb J, Kutlu OC, Barmada MM, Money ME, Slivka A, Whitcomb DC. The functional angiotensin converting enzyme gene I/D polymorphism does not alter susceptibility to chronic pancreatitis. JOP 2004; 5:457-63. [PMID: 15536282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
CONTEXT Alterations of the renin-angiotensin system have been implicated in the pathogenesis of various diseases. The angiotensin converting enzyme is a key enzyme in the renin-angiotensin system. A deletion polymorphism of a 287-bp fragment of intron 16 of the angiotensin converting enzyme gene allele results in higher levels of circulating enzyme. ACE deletion genotype has been linked to heart diseases, sarcoidosis and liver fibrosis. The pancreatic renin-angiotensin system plays a role in the development of pancreatic fibrosis and ACE inhibitors decrease pancreatic fibrosis in experimental models. OBJECTIVES We investigated the frequency of the ACE gene insertion/deletion polymorphism in chronic pancreatitis patients and controls. PATIENTS Subjects with familial pancreatitis (n=51), sporadic chronic pancreatitis (n=104), and healthy controls (n=163) were evaluated. MAIN OUTCOME MEASURE The presence of ACE insertion/deletion polymorphism. RESULTS The frequency of the ACE gene deletion allele was similar in familial pancreatitis (49.0%) sporadic pancreatitis (51.0%) and controls (55.8%). Furthermore, there was no significant difference in clinical features between patients with ACE-insertion or insertion/deletion genotypes vs. patients with ACE-deletion genotype. CONCLUSION We conclude that the ACE deletion genotype does not make a significant contribution to the pathogenesis and the progression of chronic pancreatitis.
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Affiliation(s)
- Nevin Oruc
- Department of Medicine, Division of Gastroenterology, and the Center for Genomic Sciences, University of Pittsburgh. Pittsburgh, PA, USA
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Soliani P, Franzini C, Ziegler S, Del Rio P, Dell'Abate P, Piccolo D, Japichino GG, Cavestro GM, Di Mario F, Sianesi M. Pancreatic pseudocysts following acute pancreatitis: risk factors influencing therapeutic outcomes. JOP 2004; 5:338-47. [PMID: 15365200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
CONTEXT The natural history of pancreatic pseudocysts has become well known in recent years, but the choice of a proper treatment still remains controversial. OBJECTIVE This study aims at establishing whether predictive factors influencing therapeutic outcomes exist. SETTING Patients with pancreatic pseudocysts following an episode of acute pancreatitis treated from January 1980 to December 2001 at the Department of General Surgery and Organ Transplantation of the University of Parma, Italy. PATIENTS Seventy-four patients were studied: 12 had a spontaneous resolution, 37 patients were treated surgically, 15 were treated endoscopically and in 10, percutaneous drainage was used. MAIN OUTCOME MEASURES Epidemiological, clinical and pathological characteristics of patients with pancreatic pseudocysts were related to morbidity, recurrence rates and hospital stay. RESULTS At univariate logistic regression, our data reveal a significant increase in morbidity related to age (P=0.013), etiology (alcoholic vs. biliary, P=0.024), Ranson score of previous pancreatitis (P=0.006), nutritional assessment (P=0.001), residual necrosis (P<0.001) and modality of treatment (P=0.009), whereas none of these parameters has been shown to be significantly correlated to recurrence. At multivariate logistic regression, only residual necrosis was significantly related to morbidity. CONCLUSIONS Some factors, such as epidemiological (age, etiology), clinical (severity of previous pancreatitis, malnourishment), pathological (residual necrosis), and therapeutical factors (emergency/urgency treatment) are predictive of worse outcomes for invasive treatment of pseudocysts. In particular residual necrosis appeared to be the most important factor influencing invasive treatment outcomes, confirming that this pathological aspect deserves particular attention from surgeons. No risk factors predicting pancreatic pseudocyst recurrence emerged.
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Affiliation(s)
- Paolo Soliani
- Department of General Surgery and Organ Transplantation, University of Parma, Parma, Italy.
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Rosso E, Alexakis N, Ghaneh P, Lombard M, Smart HL, Evans J, Neoptolemos JP. Pancreatic pseudocyst in chronic pancreatitis: endoscopic and surgical treatment. Dig Surg 2004; 20:397-406. [PMID: 12900529 DOI: 10.1159/000072706] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Edoardo Rosso
- Department of Surgery, Royal Liverpool University Hospital, Liverpool, UK
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19
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Peacock P, Lovett PB. Clinicopathological conference: massive hematemesis following blunt abdominal trauma. Acad Emerg Med 2003; 10:1086-95. [PMID: 14525742 DOI: 10.1111/j.1553-2712.2003.tb00579.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Peter Peacock
- Kings County Hospital Center and the State University of New York, New York, NY, USA.
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20
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Abstract
BACKGROUND Pancreatic pseudocyst in pregnancy is a rare condition whose management is not standardized. STUDY DESIGN We combine one case report with nine others published in the literature since 1980. The cases are compiled to provide a descriptive review of this condition. RESULTS The natural history of pancreatic pseudocysts in pregnancy appears similar to that in nongravid patients. Hyperlipidemia is overrepresented as a cause of pancreatic pseudocysts in pregnancy, causing more cases than alcoholic and biliary pancreatitis combined. Seventy-five percent of cases of known parity was primaparous. While in some cases percutaneous or endoscopic drainage was performed antepartum, most patients were conservatively managed until delivery. Despite two cases of successful vaginal delivery, cesarian section may be preferable for large pseudocysts to avert rupture.
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Affiliation(s)
- Jennifer J Eddy
- Department of Family Practice, University of Wisconsin Medical School, 807 South Farwell Street, Eau Claire, USA
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21
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Tinto A, Lloyd DAJ, Kang JY, Majeed A, Ellis C, Williamson RCN, Maxwell JD. Acute and chronic pancreatitis--diseases on the rise: a study of hospital admissions in England 1989/90-1999/2000. Aliment Pharmacol Ther 2002; 16:2097-105. [PMID: 12452943 DOI: 10.1046/j.1365-2036.2002.01367.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The number of hospital admissions for acute and chronic pancreatitis increased in Britain from the 1960s to the 1980s. AIMS To determine time trends in acute and chronic pancreatitis for hospital admissions from 1989/90 to 1999/2000, mortality from 1979 to 1999, and various indices of alcohol consumption. METHODS Hospital Episode Statistics for admissions were obtained from the Department of Health and mortality data from the Office for National Statistics. Alcohol consumption data were obtained from the General Household Survey. RESULTS Between 1989/90 and 1999/2000, age-standardized hospital admission rates for acute pancreatitis increased by 43%, whilst those for chronic pancreatitis rose by 100%. The proportions of admissions requiring surgical operations increased for acute pancreatitis, but declined for chronic pancreatitis. Case fatality rates for acute pancreatitis declined, but mortality statistics showed no significant change. The proportion of women who drank more than 14 units of alcohol a week also increased. CONCLUSIONS There has been a steady increase in admission rates for both acute and chronic pancreatitis over the study period, and these conditions will become an increasingly important part of the workload of the gastroenterologist.
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Affiliation(s)
- A Tinto
- Office for National Statistics, London, UK
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22
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Abstract
The diminished role of surgery and increased role of nonoperative interventional therapy for pancreatic pseudocysts is discussed. The natural history supports prolonged observation for most asymptomatic pseudocysts.
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23
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Klöppel G. Pseudocysts and other non-neoplastic cysts of the pancreas. Semin Diagn Pathol 2000; 17:7-15. [PMID: 10721803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Among the cystic lesions of the pancreas, pseudocysts are most common. This article summarizes the current state of knowledge on the morphology and pathogenesis of pseudocysts. Specifically, the pathogenetic relationship between pancreatic pseudocysts and acute and chronic pancreatitis and the natural history of pseudocysts will be discussed. In addition, this article gives a brief description of a few non-neoplastic pancreatic cysts, including retention cysts, congenital cysts, cystic acinar transformation, para-ampullary duodenal wall cysts, enterogenous cysts, endometrial cysts, and parasitic cysts.
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Affiliation(s)
- G Klöppel
- Department of Pathology, University of Kiel, Germany.
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24
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Duvnjak M, Duvnjak L, Dodig M, Simicevic VN, Troskot B, Supanc V. Factors predictive of the healing of pancreatic pseudocysts treated by percutaneous evacuation. Hepatogastroenterology 1998; 45:536-40. [PMID: 9638445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS Pseudocyst formation is a well-known complication of pancreatitis which develops over 1 to 4 weeks in approximately 15% of patients. Nearly one-third of pancreatic pseudocysts resolve spontaneously; however, if there is no resolution within six weeks, evacuation must be performed. The aim of this study was to prospectively assess the reliability of the following: etiology; location; amount of pseudocyst liquid; and concentrations of certain biochemical parameters (LDH, glucose, proteins, sodium, potassium, bilirubin, lipase and amylase) in the pseudocyst content and patients' serum, in terms of the efficacy of ultrasound-guided percutaneous evacuation as a therapeutic approach. METHODOLOGY Pseudocyst fluid was obtained by ultrasound-guided percutaneous evacuation in 67 patients, with a history of pancreatitis and pancreatic pseudocysts larger than five centimeters in diameter, with a matured membraneous wall that persisted for more than six weeks. RESULTS There is a prognostic value associated with the location of the pseudocyst, the amount of pseudocyst liquid and the concentration of proteins, potassium, lipase and amylase in the evacuated material. CONCLUSION Analysis of the aforementioned parameters provides an early forecast of the outcome of percutaneous evacuation.
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Affiliation(s)
- M Duvnjak
- Department of Gastroenterology, University Hospital Sestre Milosrdnice, Zagreb, Croatia
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25
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Abstract
PURPOSE The safety and efficacy of nonoperative management of pancreatic contusions and transections was examined by reviewing the case histories of 35 consecutive children with pancreatic injuries treated over the past 10 years. METHODS/RESULTS Surgical exploration was performed for the management of associated injuries only. The diagnosis of pancreatic trauma was suspected in children with abdominal pain, tenderness, elevated serum amylase levels and findings consistent with pancreatic injury on abdominal ultrasound scan or computerized tomography (CT) examination. After children were diagnosed with pancreatic injury, enteral feedings were withheld and total parenteral nutrition administered until abdominal pain resolved and serum amylase levels and radiographic findings improved. Twenty-three children received diagnosis within 24 hours of injury, and in 12, the diagnosis was delayed 2 to 14 days. Hyperamylasemia was found in 27 of 35 children. Twenty-eight children sustaining pancreatic injuries were treated nonoperatively. Abdominal imaging in these children demonstrated pancreatic contusion in 14, transection in 11, and pseudocyst in three. Enteral feeding resumed an average of 15 days after injury. The average hospital stay was 21 days. Pseudocysts formed in 10 children (2 of 14 with contusion; 5 of 11 with transection; three children presented late, and the type of pancreatic injury could not be determined), whose average hospital stay was 25 days. All pseudocysts were successfully managed nonoperatively, although percutaneous aspiration or drainage was required in six children. Children underwent follow-up for an average of 10 months after injury (range, 1 to 144 months). Abdominal pain and radiological abnormalities resolved in all children before discharge from the clinic. CONCLUSIONS Nonoperative management of pancreatic contusion and transection diagnosed radiologically is effective and safe. Pseudocysts may form after pancreatic injury, and if large or symptomatic, can be managed successfully by percutaneous drainage.
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Affiliation(s)
- J Shilyansky
- Department of Surgery, University of Toronto, Hospital for Sick Children, Ontario, Canada
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26
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Abstract
Today pancreatitis is classified only as acute or chronic. In pediatric surgery it seems more practical to distinguish traumatic from non-traumatic cases. To show whether there is also a difference in the management of these two groups we analysed all patients treated between 1977 and 1991 for pancreatitis. It was most impressive that traumatic cases were operated on in 86% and the rate of pseudocysts reached 61.5% whereas non-traumatic pancreatitis required surgical intervention in 50% and developed pseudocysts in 17%. Following trauma elevation of serum enzyme concentration lasted longer in a significant number of patients but became normal without any hint of further complications. In non-traumatic pancreatitis it is recommended that surgery should be avoided and reserved for complications. Exceptions are obstructions of the pancreaticobiliary ducts which need early removal to prevent chronicity of the disease and functional loss of the organ.
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Affiliation(s)
- P P Schmittenbecher
- Department of Pediatric Surgery, Dr. von Hauner's Childrens Hospital, University of Munich, Germany
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27
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Gumaste VV, Pitchumoni CS. Pancreatic pseudocyst. Gastroenterologist 1996; 4:33-43. [PMID: 8689144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pseudocyst formation is a well-known complication of pancreatitis. Pseudocysts of the pancreas are localized collections of fluid occurring within the pancreatic mass or the peripancreatic spaces often following acute pancreatitis or in a patient with chronic pancreatitis without any previous history of an acute episode. The pathogenesis depends on the etiology: in acute pancreatitis, enzyme-rich fluid and products of autodegradation accumulate; in chronic pancreatitis, the cyst results from an obstructed duct. The natural history of the diseases has become clearer with the advent of ultrasound and computed tomographic scanning. The incidence of pseudocysts is noted to be higher as a result of better diagnostic techniques. Pseudocysts must be suspected in patients who have persistent abdominal pain or consistently elevated levels of pancreatic enzymes. Nearly one third of pancreatic pseudocysts resolve spontaneously. Some, however, require intervention. Surgery was the only option available for many years. Recently, newer methods, such as percutaneous drainage and endoscopic cystenterostomy, have been used. Percutaneous drainage is inexpensive, has a low complication rate, and is done under local anesthesia. The recurrence rate is high with a one-time needle aspiration; this rate can be reduced to less than 10% by using an indwelling catheter. On the basis of a review of literature and our own experience, we believe that percutaneous continuous catheter drainage should be the first choice in the management of pseudocysts that require intervention. Experience with the endoscopic technique is increasing, and it may prove to be a viable alternative in skilled hands in the future.
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Affiliation(s)
- V V Gumaste
- Division of Gastroenterology, Mount Sinai Services at Elmhurst, New York, NY 11373, USA
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28
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Abstract
BACKGROUND Complete disruption of the main pancreatic duct is an unusual event in the course of acute or chronic pancreatitis. Endoscopic management has already proven effective in the treatment of partial ruptures. METHODS Thirteen patients presented over a 7-year period with acute (9 patients) or chronic (4 patients) pancreatitis complicated by complete disruption of the main pancreatic duct and cyst formation. Endoscopic treatment was attempted in 12. Treatment varied depending on the site of the rupture and accessibility of the pseudocyst and consisted either of transpapillary drainage (3), cystogastrostomy (3), cystoduodenostomy (2), or combined procedures (4) when one of these procedures did not induce significant decrease in collection size. Long-term results were obtained by observing the patients with ultrasound, CT, ERCP, and clinical evaluation. RESULTS Short-term results were excellent with complete cyst resolution and clinical recovery in all but one patient treated by endoscopy. Two patients had pseudocyst infection successfully treated by drainage and antibiotics. Long-term follow-up was available for 11 patients (mean duration, 30.2 months; range, 12 to 72 months) without relapsing clinical symptoms or pseudocyst. CONCLUSIONS Endoscopic management is effective and safe for treating patients with complete main pancreatic duct disruption. A double drainage combining transpapillary drainage and cystoenterostomy must be done in selected instances, especially when rupture occurs in the setting of chronic pancreatitis with stricture or stone distal to the rupture.
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Affiliation(s)
- J Devière
- Mediosurgical Department of Gastroenterology, Hopital Erasme, Université Libre de Bruxelles, Belgium
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29
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Abstract
To evaluate the frequency of multiple pancreatic cysts, the likelihood of preoperative diagnosis, and therapeutic outcome, we retrospectively reviewed the records of 157 patients who underwent operation for pancreatic pseudocysts at 2 institutions between 1970 and 1992. Multiple pseudocysts were found in 29 (18.5%). The 8 women and 21 men ranged in age from 21 to 79 years. The etiology was alcohol abuse in 15 (52%), biliary tract disease in 6 (21%), alcohol abuse and biliary tract disease in 3 (10%), and a variety of other causes in the remaining 5 (17%). There was no difference in age, sex, race, etiology, or presenting signs and symptoms between patients with single pseudocysts and those with multiple cysts. Serum amylase levels were significantly higher in patients with multiple cysts compared to those with single cysts (P < 0.05). Computed tomography accurately demonstrated the extent of disease in 20 of 25 patients (80%), while 1 or more cysts were missed in 5 (20%). The mean number of cysts per patient was 2.7, with a range of 2 to 5. Average pseudocyst diameter was 7.8 cm, with a range from 3 to 20 cm. Multiple internal drainage procedures were performed in 19 patients, a combination of internal and external drainage in 6, external drainage in 1, and resection of multiple cysts in the tail in 2. There was no operative mortality. With a mean follow up of 38.5 months, only 1 recurrent pseudocyst has been found. There were six attempts at percutaneous drainage in six patients. Two of these patients were referred to our institution following failure of percutaneous drainage at other hospitals. Three other patients had residual symptomatic pseudocysts following percutaneous drainage at our hospitals and then underwent multiple internal drainage. The sixth patient refused operative drainage despite the persistence of residual symptomatic pseudocysts after attempted percutaneous drainage. The incidence of multiple pseudocysts (18.5%) is higher than previously reported. There is no difference in the clinical features of patients with single versus multiple pseudocysts. Patients with multiple cysts have higher serum amylase levels. Preoperative computed tomography underestimated the number of cysts in 20% of patients. Careful intraoperative exploration is still needed to avoid missing multiple pseudocysts. Internal drainage is the preferred therapy. A thorough search for multiple cysts at the initial operation should eliminate one potential cause for pseudocyst recurrence.
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Affiliation(s)
- I J Fedorak
- Department of Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
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30
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Sperti C, Pasquali C, Di Prima F, Rugge M, Petrin P, Costantino V, Canton A, Pedrazzoli S. Percutaneous CT-guided fine needle aspiration cytology in the differential diagnosis of pancreatic lesions. Ital J Gastroenterol 1994; 26:126-31. [PMID: 8061338 DOI: pmid/8061338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cytologic results were retrospectively evaluated in 83 patients who underwent CT-guided fine-needle aspiration of pancreatic lesions during a 5-year period. Sixty seven patients had malignant disease and 16 benign disease. The sensitivity, specificity, positive and negative predictive values, and diagnostic efficiency of fine-needle aspiration (FNA) cytology in detecting malignancy were 91%, 100%, 100%, 73%, and 93%, respectively. In solid pancreatic masses the sensitivity of FNA cytology rose to 98%, while in cystic pancreatic masses sensitivity fell to 62%. In 18 patients with cystic lesions (12 benign and 6 malignant), the cystic fluid was analyzed for amylase, CEA and CA 19-9 content. Amylase levels were high in pseudocysts and in 4/6 malignant cysts. CEA levels were low in benign cysts, and high in all malignant cysts. CA 19-9 levels were high in one pseudocyst and in all malignant cysts. Tumour marker content analysis enhanced the sensitivity of the cytologic diagnosis of malignant cysts to 92%. FNA cytology is a simple and highly accurate method in the differential diagnosis of solid pancreatic lesions. In cystic lesions, tumour marker fluid content determination increases the sensitivity of FNA cytology.
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Affiliation(s)
- C Sperti
- Instituto di Semeiotica Chirurgica, Università di Padova, Italy
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31
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Pérez GA, Valera R, Navas NC, Mora C. [Pancreatic pseudocyst. A review of 10 years]. G E N 1994; 48:29-33. [PMID: 7926617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In the hope of finding those patients whose pancreas pseudocyst resolution were spontaneous, we undertook a retrospective review of such cases admitted at the Hospital Central de San Cristobal y Hospital Patrocinio Peñuela Ruiz (from IVSS), with the diagnosis of acute pancreatitis. From 619 patients with pancreatitis, 40 developed a pseudocyst (5.78%). The most frequent ethiology was biliary disease (47.5%) and abdominal pain in 87.5%, the most common symptom. Abdominal ultrasonography was the best diagnostic aid. Spontaneous resolution occur in 24 cases (60%) in juntion with the normalization of seric and urinary amylases values, the size of the cyst in these patients was less than 5 cms. Sixteen patients needed surgery, in 8 of them the seric amylase value remained high and in 3 cases this value was normal but with a cyst size more than five cms. Internal drainage in 11, external in 4 and surgical resection in one. There was no deaths in this review.
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Affiliation(s)
- G A Pérez
- Departamento de Cirugía, Hospital Central de San Cristóbal
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32
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Sperti C, Cappellazzo F, Pasquali C, Militello C, Catalini S, Bonadimani B, Pedrazzoli S. Cystic neoplasms of the pancreas: problems in differential diagnosis. Am Surg 1993; 59:740-5. [PMID: 7694532 DOI: pmid/7694532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
From 1970 to 1990 we observed 18 patients with histologically proven pancreatic cystic tumors. The average duration of symptoms prior to diagnosis was 14.1 months. A presumptive diagnosis was made preoperatively in nine patients. CT-guided fine needle cytology performed in three cases correctly showed a benign lesion in one patient and malignancy in two patients. Amylase and tumoral marker levels (CEA, CA19-9) were low in cystic fluid of two patients with cystadenomas who underwent preoperative percutaneous aspiration. Intraoperative biopsy of the cystic wall failed to detect epithelial lining in two cases; one patient had internal drainage for cystadenocarcinoma mistaken for pancreatic pseudocyst. Sixteen patients underwent surgery, two of whom died. Of the seven patients with a malignant condition, resection for cure was performed on three. The preoperative diagnosis of these very rare tumors remains difficult. Fine-needle cytology and cystic fluid examination may be a promising technique, but resection of all suspected lesions, whenever possible, is the procedure of choice for diagnosis and treatment.
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Affiliation(s)
- C Sperti
- Department of Surgery, University of Padua, Italy
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33
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Huizinga WK, Baker LW. Surgical intervention for regional complications of chronic pancreatitis. Int Surg 1993; 78:315-9. [PMID: 8175259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In a five year review of 648 patients with chronic pancreatitis, 446 (68.8%) were documented with regional complications consisting of biliary, duodenal or colonic obstruction, pseudocysts, haemorrhage, pancreatic ascites and gastric varices. Although the majority could be treated conservatively, surgical intervention was needed in 129 patients (28.9%). The commonest operations were choledocho-duodenostomy for distal bile duct obstruction, gastro-enterostomy for duodenal obstruction, local resection for colon obstruction, cyst-gastrostomy for pseudocysts, duct-enteric anastomosis for pancreatic ascites and splenectomy for gastric varices. Operative mortality was 8.5% and morbidity 27.9%. During 1-5 year follow-up, re-admission for pancreatitis was needed in 24%. No secondary biliary cirrhosis was encountered in long standing bile duct obstruction, but fibrosis was present in 73% of liver biopsies. Cholangitis occurred in 14%. Angiographic embolisation was useful in the control of massive bleeding from peri-pancreatic visceral arteries. Although relief of pain in chronic pancreatitis has generally been disappointing, regional complications, occurring in the majority of patients, can be corrected satisfactorily by surgical intervention.
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Affiliation(s)
- W K Huizinga
- Department of Surgery, Natal University Medical School, Durban, South Africa
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34
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Abstract
Seventeen patients with pancreatic pseudocysts were treated by endoscopic drainage. In nine cases we performed endoscopic retrograde pancreatic drainage (ERPD) by inserting 7-Fr pigtail catheters via the papilla into the cyst or into the main pancreatic duct. In two cases transduodenal cystotomy (ECD) and in eight cases transgastral cystotomy (ECG) are performed by using coagulator and papillotome. In five cases of ECG an endoprosthesis was inserted into the cyst. In two cases combination therapy of ERPD and ECG was performed. All patients reported reduction of continuous pain and postprandial epigastralgia after placement of endoprosthesis. After disappearance of symptoms and abnormal endoscopic findings within a period of 2-12 months the drainage tubes were removed. In one case postoperative dislocation of the prosthesis was observed; no serious complication was not encountered. The period of observation varied from 5 to 40 months. Two patients are presently under treatment with endoprostheses. Endoscopic drainage yielded good results in the treatment of pancreatic pseudocysts.
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Affiliation(s)
- M Dohmoto
- Chirurgische Endoskopie, Klinik für Chirurgie, Medizinischen Universität zu Lübeck, Federal Republic of Germany
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35
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Zamudio Ochoa S, Roesch Dietlen F, Compagn García F, Hernández Espinoza R, Pérez Morales A. [The treatment of pancreatic pseudocyst]. Rev Gastroenterol Mex 1992; 57:105-7. [PMID: 1308612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- S Zamudio Ochoa
- División de Cirugía, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Veracruz
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36
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Ahearne PM, Baillie JM, Cotton PB, Baker ME, Meyers WC, Pappas TN. An endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm for the management of pancreatic pseudocysts. Am J Surg 1992; 163:111-5; discussion 115-6. [PMID: 1733357 DOI: 10.1016/0002-9610(92)90262-p] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In the treatment of pancreatic pseudocysts, percutaneous and endoscopic drainage have, in certain cases, become alternatives to surgery. However, each treatment modality carries risks of complications and recurrences that may be minimized by the appropriate allocation of therapy. This article proposes the use of an endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm as a means to allocate pseudocyst therapy based on the findings of pancreatic duct obstruction or pseudocyst communication. To evaluate this algorithm, the records of a series of patients with pancreatic pseudocysts seen at Duke University Medical Center from 1984 to 1990 were reviewed. Of 102 patients, 73 had symptomatic pseudocysts that required treatment. Forty of the 69 elective interventions were preceded by ERCPs and retrospectively applied to the algorithm. The number of adverse outcomes (treatment failures + complications) of the group that followed the algorithm was 3 of 26 (12%), while the number of adverse outcomes of the group that did not follow the algorithm was 6 of 14 (43%) (p less than 0.04 by Fisher's exact test). These two subgroups were similar in all other characteristics examined. Therefore, this ERCP-based algorithm may be used to allocate pseudocyst treatment; however, a prospective trial is necessary to prove its efficacy.
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Affiliation(s)
- P M Ahearne
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710
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37
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Sayed S, Kaabar N, Ben Attia M, Nouri A, Houissa T, Hentati M, Aloulou T, el Mufti N. [Pancreatic pseudocyst in the child]. Tunis Med 1991; 69:633-7. [PMID: 1808773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Sayed
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant, Bab Saadoun, Tunis
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38
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Kourtesis G, Wilson SE, Williams RA. The clinical significance of fluid collections in acute pancreatitis. Am Surg 1990; 56:796-9. [PMID: 2268109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Computed tomography (CT) displays fluid collections in patients with acute pancreatitis as well defined intra- or extrapancreatic homogeneous areas with low attenuation numbers. We followed, prospectively, the clinical courses of 128 patients who had CT during an episode of acute pancreatitis, to determine the natural history and clinical significance of any fluid collections that developed. Fluid collections were found in 48 (37%) of the 128 patients with pancreatitis. Thirty-eight developed in the 86 (44%) patients with alcoholic pancreatitis, five in the 33 (15%) with biliary pancreatitis and five in the nine (55%) with other causes of pancreatitis (excluding chronic pancreatitis, trauma, or malignancy). On clinical follow-up of the 48 patients with fluid collections, 21 patients required operation; two died before an operation was done and 25 did not require operation. Operations were done to treat pseudocysts (14), abscess (5), and necrosis (3). One patient had an operation for a pseudocyst and an abscess. All 14 patients requiring operation for pseudocyst had collections greater than 7 cm and 13 of these patients had alcoholic pancreatitis. Of the 25 patients not requiring operation, five were lost to follow-up, and 19 of the 20 who had spontaneous resolution of their fluid collection(s) had collections less than 6 cm in diameter. The eight patients who required operative pancreatic debridement for abscess or necrosis had multiple small fluid collections. In summary, fluid collections were found in one-third of patients with acute pancreatitis and were often associated with the development of local complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Kourtesis
- Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509
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39
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Ford EG, Hardin WD, Mahour GH, Woolley MM. Pseudocysts of the pancreas in children. Am Surg 1990; 56:384-7. [PMID: 2350109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sixteen children with pancreatic pseudocysts were treated from 1965-1988. Blunt trauma was the etiology of pseudocyst formation in 69 per cent of children with 50 per cent resulting from the abdomen impacting bicycle handlebars. Chronic pancreatitis is an uncommon cause of pseudocyst formation in children. Medical therapy is directed towards reduction of pancreatic stimulation and nutritional support, which are maintained through pseudocyst resolution or maturation. Pseudocysts spontaneously resolved in 25 per cent of patients. Complications occurred in 25 per cent during nonoperative management. Children may safely undergo internal drainage earlier than adults (3-4 weeks vs 6 weeks). Internal drainage by cystoenterostomy was curative in eight patients. Persistent fistula drainage developed for five weeks in one patient who had surgical external pseudocyst drainage. One patient required distal pancreatectomy for a transected pancreatic duct. Spontaneous resolution of psseudocysts while on medical therapy is more frequent in children than in adults, and major complications (abscess formation, hemorrhage, and fistula formation) are usually not encountered. Pseudocyst rupture is the major complication of conservative management. We had no pseudocyst recurrences and 11 of 12 children treated surgically were discharged home within ten days of operation.
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Affiliation(s)
- E G Ford
- Division of Pediatric Surgery, Childrens Hospital of Los Angeles, CA 90027
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40
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Abstract
The usefulness of computed tomography (CT) in guiding the management of 43 patients who had a complicated clinical course of acute pancreatitis was retrospectively studied. The CT scans were performed when patients had persistent fever, leucocytosis, hyperamylasaemia, palpable abdominal masses or when there was organ failure. The CT scans showed normal findings in six patients, features of pancreatic abscess in three patients, pseudocysts in three patients and inflammatory masses (a mixture of sterile inflammation and necrosis) in 31 patients. Patients with pancreatic abscesses underwent emergency laparotomy, drainage and debridement; patients with pseudocysts had delayed drainage unless complication occurred; patients with normal CT scan or findings of inflammatory masses were managed conservatively. For patients undergoing conservative management, repeated CT scanning and percutaneous aspiration of the inflammatory mass was performed when pancreatic sepsis was strongly suspected. By this approach, basing on careful clinical and CT scan surveillance, five patients with pancreatic sepsis (pancreatic abscess and localized abscess collection in pseudocyst) underwent emergency surgery and four survived, while 25 patients with inflammatory masses were successfully managed conservatively and some who may have been operated on clinical grounds were spared unnecessary early debridement surgery.
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Affiliation(s)
- S T Fan
- Department of Surgery, University of Hong Kong
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41
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Montalto G, Carroccio A, Soresi M, Ficano L, Notarbartolo A. Chronic pancreatitis in Sicily. Preliminary reports. Ital J Gastroenterol 1990; 22:33-5. [PMID: 2131926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aetiology and clinical characteristics of 42 patients affected with chronic calcifying pancreatitis in a Sicilian population were investigated and compared with a series of other Italian and foreign reports. It was found that the aetiology was 62% alcoholics and 38% idiopathic in origin and that the M/F ratio was 2.5:1. Clinical features as pain, weight loss, pancreatic calcifications, steatorrhea, pseudocysts and associated cirrhosis are significantly more frequent in the group of alcoholics, while cholelithiasis was more frequent in the non-alcoholic group. Two aspects are worth noting in comparison to the north of Italy: a) the lesser frequency of alcoholic forms and b) the high incidence of women.
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Affiliation(s)
- G Montalto
- Cattedra di Patologia Medica II, Università di Palermo, Italy
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42
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Abstract
Ten children ranging in age from 15 months to 16 years were operated on for pancreatic pseudocysts in Zaria. Four of the cysts were traumatic in origin but the cause of the others was obscure: perhaps some of the patients had juvenile tropical pancreatitis syndrome (JTPS). Since these were all chronic pseudocysts with thick walls, internal drainage was performed in eight and resection in one; the inadvertent opening into an anterior pseudocyst was converted into an external drainage porta. In the absence of modern abdominal imaging facilities, it is possible that pancreatic pseudocysts are under-reported in most parts of Africa.
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Affiliation(s)
- O A Mabogunje
- Department of Surgery, Ahmadu Bello University Hospital, Zaria, Nigeria
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43
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Bragg LE, Thompson JS, Burnett DA, Hodgson PE, Rikkers LF. Increased incidence of pancreas-related complications in patients with postoperative pancreatitis. Am J Surg 1985; 150:694-7. [PMID: 4073361 DOI: 10.1016/0002-9610(85)90411-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The incidence and significance of pancreas-related complications (pseudocysts, abscesses, and fistulas) were evaluated in 100 patients with acute pancreatitis. Alcoholic (40 percent), biliary (20 percent), and postoperative (15 percent) pancreatitis were seen most frequently. Eighteen patients had severe pancreatitis (3 or more Ranson's criteria). The overall mortality rate was 8 percent, and there were 16 pancreas-related complications. Pancreas-related complications developed in eight patients (53 percent), including two pseudocysts, four abscesses, and two fistulas. The incidence of pancreas-related complications was significantly greater in the postoperative group than in the overall 9 percent incidence in the other groups (p less than 0.005). Half of these patients required operation for their complications. Patients with postoperative pancreatitis are at a markedly increased risk of pancreas-related complications. Since these complications occur even in apparently mild cases of pancreatitis, these patients should be followed closely to detect pancreas-related complications.
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44
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Ogunbiyi OA, Akingbehin NA. Pancreatic pseudocysts in childhood. Report of 2 cases from Ibadan, Nigeria. East Afr Med J 1983; 60:108-12. [PMID: 6617544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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