Comparison of Surgical Treatment with Percutaneous Catheter Drainage of a Pancreatic Pseudocyst

A pancreatic pseudocyst is a relatively rare complication of pancreatitis. Various factors, such as inflammatory process or trauma, are among the possible cause of pancreatitis. A pancreatic pseudocyst is often defined as a localized collection of pancreatic juice in the retroperitoneal area surrounded by a fibrous membrane devoid of an epithelial lining. The hospital records of 52 cases of pancreatic pseudocyst treated at Kyungpook National University Hospital from 1976 through 1994 were reviewed and analysed. The results are as follows : 1) The age distribution of these cases showed that 57.7% occurred in the 3rd and the 4th decades. The male to female ratio was 3.7 : 1 2) The etiology of the pseudocysts was pancreatitis in 46.2% of the cases and trauma, unknown etiology, pancreatic cancer and hyperlipidemia, in that order, in the other cases. 3) Abdominal pain was the most common symptom (86.4%); a palpable mass (65.4%), abdominal tenderness (65.3%) also occurred. 4) Abdominal C.T. and Ultrasonogram has a diagnostic accuracy as 100%, and U.G.I. showed a diagnostic accuracy of 76.5%. 5) Among the 52 cases, 30 cases received surgical treatment 13 cases were treated by percutaneous catheter drainage. 6) With respect to the operative procedure, internal drainage was performed in 18 cases (60%), external drainage in 8 cases (26.7%), excision in 3 cases (10.0%), and O & C in 1 case (3.3%). 7) Thirteen percutaneous catheter drainage procedures were performed, and the success rate was 92.3%.

Clinicopathological Significance for Polypoid Lesions of the Gallbladder: The Adenoma-carcinoma sequence

Twenty cases of polypoid lesions of the gallbladder were reviewed. Seven were benign lesions. Among them, there were 4 (20%) adenomas and 3 (15%) adenomatous hyperplasias. All of the benign lesions were less than 1 cm in diameter. Thirteen cases involved a carcinoma of the gallbladder, of which 92% were more than 1 cm in diameter, 76.9% were over 60 years of age, and 38.5% were associated with gallstones. The accuracy of the preoperative ultrasonographic diagnosis of the polypoid lesions of the gallbladder was 80%. The spread and the size of the tumor showed a close correlation. Therefore, the size of the tumor is a vital indicator for the treatment of polypoid lesions of the gallbladder; lesions between 0.6~1 cm in diameter should be followed up by ultrasonography. An operation may be considered if stones are present. Lesions bigger than 1 cm should be resected since malignancy can not be excluded.