A Clinical Analysis of Pancreatic Pseudocysts

BACKGROUND: Pancreatic pseudocysts are localized collections of pancreatic secretions in a cystic structure that lack an epithelial lining and occur as a result of surrounding tissues walling off and containing a pancreatic duct disruption. METHODS: This is paper presents a clinical analysis of 32 cases of pancreatic pseudocysts treated from January 1987 to July 1997 at Pusan Medical Center. RESULTS: The results are summarized briefly as follows: 1) The age and the sex distributions of these patients showed that 19 cases occurred between the 3rd and the 4th decades and the male-to-female ratio was 10.3:1. 2) Pancreatitis was most frequently associated with pancreatic pseudocysts (75%). 3) Common clinical manifestations were abdominal pain (89%), abdominal tenderness (78%), nausea and vomiting (56%), abdominal mass (32%), abdominal distension (31%). 4) Abdominal CT and ultrasound were major diagnostic methods. 5) The location of the peudocysts were the body (41%), head and tail (31%), the tail (22%), and others (6%). 6) The sizes of the pseudocysts were as follows less than 5 cm (5 cases), 5-10 cm (19 cases), above 11 cm (8 cases) in 32 cases. 7) Valuable laboratory data for a pancreatic pseudocyst were blood WBC count (above 10,000/mm in 78%), serum amylase (above 160 unit/L in 62%), urine amylase (above 300 unit/L in 56%), blood glucose (above 110 mg/L in 50%), serum alkaline phosphatase (above 250/L in 44%). 8) The surgical methods in 29 cases were excision (1 case), external drainage (4 cases), cystogastrostomy (7 cases), cystojejunostomy (16 cases), cystoduodenostomy (1 case). 9) Postoperative complications were encountered in 13 cases, and many of the cases involved pulmonary complications and wound infections. CONCLUSIONS: Currently, treatment of patients with pancreatic pseudocysts is based on the clinical setting, the presence or absence of symptoms, the age and size of the pseudocyst, and the presence or absence of complications. In the most common clinical settings, a pseudocyst is discovered after an episode of acute alcoholic pancreatitis.

Clinical Analysis of Post-Operative Enterocutaneous Fistulas

Despite recent advances in nutritional support, patient monitoring, and surgical intensive care, as well as some improvement in surgical techniques, post-operative fistulas have been regarded as one of the most serious complications in abdominal surgery. The present study was undertaken to evaluate the effectiveness of treatment with total parenteral nutrition (TPN) alone (group A, n=26) or with TPN combined with octreotide, a long-acting analog of somatostatin (group B, n=20) in post-operative enterocutaneous fistulas. In group A, we treated 2 biliary, 10 pancreatic and 14 intestinal cutaneous fistulas with total parenteral nutrition. In group B, we treated 6 biliary, 8 pancreatic and 6 intestinal cutaneous fistulas with octreotide. The results obtained from the analysis are as follows: 1) The spontaneous closure of the fistulas was 69.2% in group A and 75.0% in group B. 2) The mean interval of time to achieve the healing of the fistula was 30.44 days in group A and 14.53 days in group B. 3) The mean interval of time to achieve a fistula output reduction of 50% was 6.44 days in group A and 2.44 days in group B. 4) In patients with low-output fistulas, the spontaneous closure of the fistula was 81.8% in group A and 80.0% in group B. In patients with high-output fistulas, the spontaneous closure of the fistula was 60.0% in group A and 73.3% in group B. 5) In patients with low albumin ( or = 3.0 g/dl), the spontaneous closure of the fistula was 80.0% in group A and 85.7% in group B. 6) In patients with an abdominal abscess, the spontaneous closure of the fistula was 40.0% in group A and 40.0% in group B. In patients without an abdominal abscess, the spontaneous closure of the fistula was 87.5% in group A and 86.7% in group B. 7) As compared with TPN, the spontaneous closure of the fistulas treated with octreotide was increased in the gastroduodenum and the external biliary system, was similar in the small bowel and the pancreas, but was decreased in the colon. We conclude that octreotide is a useful therapeutic complement in the conservative treatment of selected patients with post-operative cutaneous fistulas, especially fistulas in the external biliary system and the gastroduodenum.