ABSTRACT
Abstract Introduction: The pancreatic pseudocyst is one of the late local complications of acute pancreatitis. For managing a giant pancreatic pseudocyst, there are multiple strategies. Aim: To present the case of a patient with a giant pancreatic pseudocyst managed by endoscopic cystogastrostomy. Clinical case: A 41-year-old woman developed a giant pancreatic pseudocyst as a complication of acute pancreatitis that was managed by endoscopic cystogastrostomy without endoscopic ultrasound guidance, with good evolution. Conclusions: Endoscopic cystogastrostomy, with or without the help of ultrasound endoscopy or lumen-apposing metal stent (LAMS), is a viable, safe, effective, and economical therapeutic option for selected patients with a giant pancreatic pseudocyst.
Resumen Introducción: el pseudoquiste pancreático es una de las complicaciones locales tardías de la pancreatitis aguda. Para el manejo del pseudoquiste pancreático gigante existen múltiples estrategias. Objetivo: presentar el caso de una paciente con pseudoquiste pancreático gigante manejado mediante cistogastrostomía endoscópica. Caso clínico: mujer de 41 años que desarrolló un pseudoquiste pancreático gigante como complicación de una pancreatitis aguda y se manejó mediante cistogastrostomía endoscópica sin guía ecoendoscópica, con una adecuada evolución. Conclusiones: la cistogastrostomía endoscópica, con la ayuda o no de ecoendoscopia ni stent de aposición luminal (LAMS), es una opción terapéutica viable, segura, efectiva y económica para pacientes seleccionados con pseudoquiste pancreático gigante.
Subject(s)
Humans , Female , Adult , Pancreatic Pseudocyst/surgery , Pancreatitis/complications , Drainage/methods , Endoscopy, Digestive System/methods , Pancreatic Pseudocyst/etiology , Pancreatic Pseudocyst/diagnostic imagingABSTRACT
Resumen Un pseudoquiste pancreático es una acumulación de líquido casi siempre estéril, rico en enzimas digestivas y jugo pancreático encapsulado en una pared de tejido fibroso y de granulación sin revestimiento epitelial, generalmente de forma ovalada o redondeada. Los pseudoquistes se pueden desarrollar por complicaciones en el páncreas que generan obstrucción o ruptura de un conducto pancreático. Se presenta el caso de un paciente masculino de 9 años con diagnóstico de pseudoquiste pancreático con crecimiento progresivo, debido a trauma abdominal cerrado. Se realizó un manejo multidisciplinario para determinar el tratamiento. Por las características del pseudoquiste, se definió realizar un drenaje endoscópico transgástrico. El procedimiento llevado a cabo es descrito en el presente texto. El paciente evolucionó satisfactoriamente.
Abstract A pancreatic pseudocyst is an accumulation of fluid that is almost always sterile and is rich in digestive enzymes and pancreatic juice that is encapsulated in a wall of fibrous tissue and granulation tissue without an epithelial lining. They are generally oval or rounded. Pseudocysts can develop from complications in the pancreas that lead to obstruction or rupture of a pancreatic duct. We present the case of a 9-year-old male patient diagnosed with a pancreatic pseudocyst with progressive growth due to closed abdominal trauma. Multidisciplinary management determined treatment. Due to the characteristics of the pseudocyst, transgastric endoscopic drainage was used, and the procedure was carried out as described herein. The patient evolved satisfactorily.
Subject(s)
Humans , Male , Child , Pancreatic Ducts , Pancreatic Pseudocyst , Drainage , Pancreas , Patients , Therapeutics , MethodsABSTRACT
Tras el Symposium de Atlanta (1992), existe acuerdo en definir un pseudoquiste pancreático (PQP) como una colección de jugo pancreático, rico en amilasa, rodeado por una pared no epitelial, producido como consecuencia de una pancreatitis aguda, pancreatitis crónica o traumatismo pancreático. Se estima que se necesitan al menos cuatro semanas para que constituya la pared definida que distingue un PQP de una colección líquida. Caso Clínico. Presentamos el caso de un paciente de 29 años de edad, con antecedentes de pancreatitis aguda de etiología biliar. Se realizó colecistectomía laparoscópica una vez resuelta la pancreatitis y egresó a domicilio. 40 días después refiere dolor abdominal, saciedad precoz progresiva hasta intolerancia a la vía oral, nausea y vómito, hechos que motivaron la reinternación. La tomografía computada revela un PQP gigante de 19.18 por 19.55 centímetros. Se plantea abordaje laparoscópico, realizándose cisto-gastroanastomosis con sutura mecánica por vía laparoscópica. CONCLUSIÓN: La cisto-gastroanastomosis laparoscópica es una opción terapéutica para el tratamiento del pseudoquiste pancreático porque ofrece: drenaje continuo, bajo índice de recidiva y pocas complicaciones que superan al tratamiento endoscópico y al drenaje guiado por imagenología, junto con las ventajas de mínima invasión.
After the Atlanta Symposium (1992), there's an agreement to define a pancreatic pseudocyst (PPC) as a collection of pancreatic juice, therefore rich in amylase, surrounded by a non-epithelial wall, produced as a consequence of an acute pancreatitis, chronic pancreatitis or pancreatic trauma. It is estimated that it takes at least four weeks for it to constitute the defined wall that distinguishes a PPQ from a fluid collection. Clinical case. We present the case of a 29-year-old patient with a history of acute pancreatitis of biliary etiology. Laparoscopic cholecystectomy was performed once the pancreatitis resolved and was outpatient. 40 days later he presents severe abdominal pain, early satiety and finally intolerance to the oral intake, nausea and vomiting, reasons for readmission. The computed tomography revealed a giant PPC of 19.18 by 19.55 centimeters which was resolved by laparoscopic cysto-gastrostomy with stapler. CONCLUSION: Laparoscopic cysto-gastrostomy is a therapeutic option for the treatment of pancreatic pseudocyst because it offers: continuous drainage, low rate of recurrence and few complications that overcome endoscopic treatment and drainage guided by imaging, with the advantages of minimal invasion.
Subject(s)
Humans , Pancreatic Cyst , Pancreatic Pseudocyst , LaparoscopyABSTRACT
Pseudocysts of pancreas is collection of fluid in the lesser sac enclosed by a wall of fibrous or granulation tissue as a consequence of acute pancreatitis, pancreatic trauma or chronic pancreatitis. Invasive drainage procedures are currently indicated in those patients with symptoms or complications. We present our experience of 26 cases of pseudocyst of pancreas managed laparoscopically between Nov-2014 to March-2016 using different techniques of anastomosis using Vicryl 2-0 continues sutures as well as using Titanium clips for creating stoma between anterior wall of pancreatic pseudocyst and posterior wall of stomach. Laparoscopic cysto-gastrostomy appears to be safe and effective approach for internal drainage of pancreatic pseudocyst. It also facilitates the debridement of the necrotic tissue from the cyst cavity. Use of Titanium clips can be an alternative to conventional sutured cystogastrostomy and stapled cystogastrostomy, as it is less time consuming, easy to perform and cost effective
ABSTRACT
Drainage of pseudocyst and walled-off pancreatic necrosis has traditionally been achieved by surgical means. Recently, there has been a progressive shift in paradigm to performing endoscopic drainage for these conditions. Endoscopic ultrasound (EUS)-guided drainage is the preferred approach for drainage of pancreatic pseudocyst. However, many controversies still exist on the optimal management and wide variations in techniques exist. There is a pressing need for establishment of a consensus for safe practices in EUS-guided pseudocyst drainage.
Subject(s)
Humans , Asian People , Consensus , Drainage , Necrosis , Pancreatic Pseudocyst , UltrasonographyABSTRACT
Objetivo: Reportar la técnica mínimamente invasiva para tratar un pseudoquiste pancreático. Sede: Hospital General de Zona Núm. 4, IMSS. Diseño: Reporte de caso. Descripción del caso: Reportamos el caso de una mujer de 48 años con una historia de 8 meses de evolución con pseudoquiste pancreático secundario a pancreatitis biliar, con una cistogastrostomía laparoscópica exitosa. Siete días después de la cirugía, la paciente fue egresada del hospital por mejoría. La paciente ha tenido un seguimiento por más de 6 meses después de la cirugía sin síntomas, y la TAC realizada 90 días después del tratamiento reveló que el pseudoquiste desapareció. Conclusión: Nuestra experiencia inicial sugiere que la cirugía laparoscópica es segura, reproducible y una técnica mínimamente invasiva para el tratamiento del pseudoquiste pancreático. Ésta es efectiva cuando no se puede realizar el drenaje por ultrasonido endoscópico.
Objective: To report a minimally invasive technique to treat a pancreatic pseudocyst. Setting: General Hospital No. 4 of the Mexican Institute of Social Security. Design: Case report. Case description: We report the case of a 48-year-old woman with an 8-month history of a pancreactic pseudocyst secondary to biliary pancreatitis with a successful laparoscopic cystograstrostomy. Seven days after surgery, the patient was discharged from the hospital. The patient has been followed for more than 6 months after surgery without symptoms. The CAT scan performed 90 days after treatment revealed the disappearance of the pseudocyst. Conclusion: Our initial experience suggests that laparoscopic surgery is safe, reproducible, and a minimally invasive technique for the treatment of a pancreatic pseudocyst. It is effective when no drainage can be performed through endoscopic ultrasound.
ABSTRACT
Objective To evaluate the clinical value of laparoscopic cystogastrostomy for retrogastric pancreatic pseudocysts.Methods Five patients suffering from retrogastric pancreatic pseudocysts caused by severe acute biliary pancreatitis received conservative management for 2 ～ 6 months,and the sizes of pseudocysts were 8,10,12,14,15 cm.All the 5 patients received laparoscopic cystogastrostomy,and 4 ports methods was applied,through anterior gastric wall,the posterior gastric wall and pancreatic pseudocysts were incised by using harmonic scalpel,then cystogastrostomy was performed to drain the pseudocysts.Results Laparoscopic cystogastrostomy for retrogastric pancreatic pseudocysts was successful in all patients,theoperation time was 90,105,115,120,150 minutes.The blood loss was 100,150,150,200,300 ml.No intra-gastric bleeding occurred.After 1 month follow-up,all the pseudocysts disappeared,and there was no acute pancreatitis and local infection recurrence.Gastric leakage occurred 7 d after operation in one patient,and was healed after one month of conservative management.Conclusions Laparoscopic cystogastrostomy through gastric cavity for retrogastric pancreatic pseudocysts is simple and effective,mini-invasive,and it can be an alternative therapeutic method for pancreatic pseudocysts.
ABSTRACT
A large symptomatic and unresolved pancreatic pseudocyst is treated surgically by internal drainage to a neighboring adherent viscus. Recently the various minimal invasive approaches have been used to treat this condition. A 30- year-old man who had been in clinical follow-up for a chronic pancreatitis. For the necrotizing pancreatitis, the patient had undergone surgical debridement and external drainage 5 years, and 3 years ago, respectively. Abdominal ultrasonography and computed tomography revealed 8.2x7.7 cm sized pseudocyst in the body of pancreas. Endoscopic internal fistula formation was tried, but it was failed due to bleeding. We underwent adhesiotomy and cystogastrostomy totally with laparoscopic techniques. The patient started a diet on the 5th postoperative day and discharged on the 11th postoperative day. There was no postoperative complicationand no recurrence during 6 months. Laparoscopic cystogastrostomy is safe and feasible method in the pancreatic pseudocyst even in case of severe abdominal adhesion.
Subject(s)
Humans , Debridement , Diet , Drainage , Fistula , Follow-Up Studies , Hemorrhage , Pancreas , Pancreatic Pseudocyst , Pancreatitis , Pancreatitis, Chronic , Recurrence , UltrasonographyABSTRACT
The purpose of this study was to investigate clinical feasibility of treatment of pancreatic pseudocyst by endoscopy. We reported here one case of large pancreatic psuedocyst that was treated by endoscopic ultrasonography guided cystogastrostomy.The patient's symptoms resolved on the same day of operation. And one week later, the pancreatic pseudocyst decreased by more than 50% in size. Pancreatic psuedocyst resolved and didn't relapse after 6 months. So endoscopic ultrasonography guided cystogastrostomy is a safe, reliable, effective therapy for pancreatic pseudocyst with few complications.
ABSTRACT
Laparoscopic surgery on the pancreas is carefully attempted because the pancreas is a retroperitoneal organ and because the tissue is very fragile and composed of abundant small vessels. Recently, the authors experienced one case of a laparoscopic cystogastrostomy for a pancreatic pseudocyst. The patient was a 43-year-old man and a chronic alcoholic. He visited the emergency room for severe abdominal pain which had lasted for 2 weeks. Ultrasonography revealed a huge pseudocyst in the retroperitoneum. The size of the pseudocyst was 10 cm 9 cm, and it was located at the pancreatic tail in the abdominal CT. Through four 10 mm ports, the gastric anterior wall was longitudinally incised about 4 cm; then, a communicating window between the stomach and the pseudocyst was made with endoscopic cautery after using needle aspiration to recognize the cyst. The pseudocyst was completely gone in the follow up CT, and the man was discharged without complication on the postoperative 10 th day. The laparo scopic cystogastrostomy is not only a feasible operation but also a minimally invasive and effective method for treating huge, maturated pancreatic pseudocysts.
Subject(s)
Adult , Humans , Abdominal Pain , Alcoholics , Cautery , Emergency Service, Hospital , Follow-Up Studies , Laparoscopy , Needles , Pancreas , Pancreatic Pseudocyst , Stomach , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Pancreatic pseudocysts were complicated in 10-27% of acute pancreatitis and 11-41% of chronic pancreatitis. Asymptomatic pseudocysts require no treatment, but symptomatic pseudocysts should be decompressed. Surgical management had been the traditional approach to treating pancreatic pseudocysts. Endoscopic transpapillary or transduodenal cystoenterostomy were recently suggested as an alternative to surgery in order to avoid surgical complications. The success rates of endoscopic treatment was 65-94%, procedure related morbidity was 6-21% and mortality was 0-5%. We reported two cases of patients with pancreatic pseudocysts which were treated with endoscopic cystogastrostomy and proceeded to drain through stent and ENPD catheter.