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Objective To study the clinical features,diagnosis and treatment of pancreatic pseudocysts in children.Methods A retrospective study was conducted on 50 children with pancreatic pseudocysts diagnosed and treated in the Children's Hospital of Chongqing Medical University from September 2006 to August 2017.36 of these 50 children were treated with external drainage (including 2 patients after conservative treatment),5 internal drainage (including 2 patients after external drainage),and 13 conservative treatment.Results 47 patients were diagnosed by clinical symptoms,amylase examinations,ultrasound and CT scans;and 3 patients by surgical exploration.Of the 36 patients who were treated with external drainage,29 recovered and 5 improved.Two patients relapsed and underwent internal drainage.Five patients who were treated with internal drainage recovered.Of 13 patients who were treated with conservation treatment,10 were cured,1 recovered well,and the remaining 2 developed relapse and underwent external drainage.Conclusions The incidence of pancreatic pseudocyst in children was low.The diagnosis depended on clinical symptoms,biochemical and radiological examinations.For patients with small cysts,no complications and asymptomatic,conservative treatment is suggested.There were no obvious differences in the treatment results between internal and external drainage,and external drainage is advocated because of its advantages.Differences in the etiology play a vital role in the choice of treatment.In elective surgery for a pancreatic pseudocyst caused by trauma,external drainage is preferred.For those who developed after pancreatitis,internal drainage is advocated.
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Objective To discuss how to preven wrong absorption of pancreatic pseudocyst using guided transmural drainage under endoscopic ultrasonography.Methods Retrospectively analyzed the clinical data of patients with pancreatic pseudocysts underwent operations of Endoscopic ultrasonography guided transmural drainage.Results 16 cases of pancreatic pseudocysts were finished with guided transmural drainage under endoscopic ultrasonography using needling to place bypass grafting with successful rate 100.0% of guided transmural drainage by needling. After needling, 2 cased happened regurgitation which led to wrongly absorbed, rate of occurrence is 12.5%. Generally, pancreatic pseudocysts of 16 cases disappeared completely with cure rate 100.0%. From above, stents were pulled out by endoscope in 3 cases while stents were removed voluntarily in another 13 cases.Conclusion Dorsal elevated position, detailed operation and esophageal annular tubes can effectively prevent wrong absorption of guided transmural drainage under endoscopic ultrasonography of pancreatic pseudocysts.
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Objective To investigate the value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of pancreatic pseudocysts,cystadenomas and cystadenocarcinomas,so as to improve diagnostic accuracy of the condition.Methods The results of CEUS and conventional ultrasound for 71 patients with pancreatic cystic lesions were analyzed retrospectively,and compared with the finally obtained surgical-pathological examination to assess the ability of qualitative diagnosis between two methods.Results In 71 pancreatic cystic lesions,there were 32 pancreatic pseudocysts,24 cystadenomas and 15 cystadenocarcinomas.The sensitivity and accuracy of CEUS for pancreatic pseudocysts and cystadenocarcinomas were 84.4％,93.0％ and 86.7％,88.7％,which were higher than those of conventional ultrasound 56.3 ％,80.3 ％ and 53.3 ％,74.6％ (x2 =6.06,4.92,3.97,4.71,all P ＜ 0.05).Conclusion There are some similarities in terms of imaging manifestations among pancreatic pseudocysts,cystadenomas and cystadenocarcinomas.Combining conventional ultrasound with CEUS can help the differential diagnosis of pancreatic cystic lesions.
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Reportamos el caso de un paciente con pseudoquiste pancreático como complicación de un episodio de pancreatitis aguda, el cual se manifestó con dolor abdominal epigástrico, vómito y sensación de plenitud posprandial. El paciente no presentó mejoría clínica después de realizar manejo expectante durante más de 12 meses y en el seguimiento con tomografías de abdomen se evidenció persistencia de la lesión con aumento en el tamaño hasta 4 cm de diámetro mayor. El paciente fue remitido para manejo a nuestra institución. En imagen de colangiopancreatografía por resonancia magnética se encontró que el pseudoquiste estaba comunicado con el ducto pancreático proximal. Se realizó manejo endoscópico con drenaje por vía transpapilar con inserción de stent pancreático, el cual fue realizado con resultado exitoso, observando desaparición de la lesión a los 30 días después del drenaje sin recurrencia de los síntomas a los 60 días de seguimiento.
We report on the case of a patient with pancreatic pseudocysts. They presented as complications of an episode of acute pancreatitis which had manifested as epigastric pain, vomiting, and a postprandial sensation of fullness. After 12 months of watchful waiting the patient had not improved. Instead, an abdominal CAT scans revealed that the lesion persisted and had grown an additional 4 cm in diameter. The patient was referred to our institution for treatment. A magnetic resonance cholangiopancreatography (MRCP) image revealed that the pseudocyst passed through the proximal pancreatic duct. Endoscopic transpapillary drainage was successfully performed with the insertion of a pancreatic stent. The lesion had disappeared 30 days after drainage. Symptoms had not recurred 60 days after drainage.
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Humans , Male , Adult , Pancreatic Pseudocyst , Pancreatitis , Pancreatitis, Acute NecrotizingABSTRACT
Objective To investigate the early risk factors of the formation of pancreatic pseudocysts after severe acute pancreatitis. Methods One hundred patients with severe acute pancreatitis admitted from Jul. 2005 to Mar. 2007 were included. Clinical and laboratory data within 24 hours of admission and radiological tests of chest, abdominal dynamic contrast-enhanced computed tomography and abdominal ultrasound within 3 days after admission were analyzed and multiple stepwise logistic regression analysis was performed. Results 30 patients developed pancreatic pseudocysts and the incidence of pancreatic pseudocysts in the clinical course of severe acute pancreatitis was 30%. There were significant difference between group A (pancreatic pseudocyst group) and group B (non-pancreatic pseudocyst group) in serum albumin[(33.23±4.810g/L vs (36.07±4.92)g/L], CT severity index (CTSI) (3~6 vs 2~4 points) ,length of hospital stay[(26.83±19.760) day vs (14.51±7.71) days, (P<0.05)]. Meanwhile, there were no significant differences between the two groups in age, gender proportion, body temperature, heart rate, breath rate and mean arterial pressure in admission,urine volume within 24 hours, early defaecation within 24 hours after admission, blood routine, liver function, kidney function, electrolytes, blood cholesterol and triglycerol, PT, APTr, arterial blood gas analysis, blood amylase, C-reaction protein, APACHE Ⅱ, RANSON scoring, early ascites and pleural effusion. But multiple stepwise logistic regression analysis showed that the serum albumin and CTSI were associated with the formation of pancreatic pseudocysts after severe acute pancreatids. Conclusions The serum albumin and CTSI were the independent risk factors of the formation of pancreatic pseudocysts after severe acute pancreatitis.
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Objective To evaluate the efficacy and clinical application value of endoscopic transpapillary cyst drainage(ETCD)on huge pancreatic pseudocysts(HPP)and pancreatic abscess.Methods According to unification standard from 2003 Jun to 2006 Jun,to select 10 disquisitive cases,in which patients with uninfected HPP were 8 cases and that with infected HPP was 1 case,and pancreatic abscess was 1 case.ETCD was adopted in all cases.The clinical treatment process and the change of relative investigation subjects were retrospectively studied.Results Endoscopic transpapillary treatment failed in 1 case,postoperative infection of HPP occurred in 2 cases and acute pancreatitis was found in 1 case.Mean follow-up was 16.5 months in 8 cases.Finally,four patients had complete resolution of HPP,3 cases had partial resolution,and the remains cavity of HPP was formed in 1 caes.Acute grave pancreatitis were cured in 2 cases and Chronic pancreatitis had resolution in 6 cases.Conclusion ETCD was safe and efficient in HPP and pancreatic abscess.Postoperative infection of HPP was the familiar complication,and obstruction of drainage path of HPP was major cause.So the crux of complications precaution and treatment was that the drainage path of HPP was unhindered.
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A case of pancreatic pseudocysts and bloody pancreatic ascites as complications of chronic pancreatitis in eleven-year-old girl was reported. She was admitted to the pediatric ward with chief complaints of abdominal distension and bloody ascites. About nine months prior to admission, when she was stuck by a bicycle, she had sustained a blow on her abdomen. She has been apparently well until four months prior to admission, when she began to feel colidy and intermittent abdominal pain and her appetits became poor. About a week prior to admission, her mother noticed that the girl's abdomen was distended. One day prior to admission, bloody ascites was revealed by paracenteis at a local clinic. Clinical and laboratory pictures were observed for 3 months. Ascites amylase at preoperative state were 496~705 u/dl and 740~772 u/dl Protein in ascites was 2,390mg%~4,820mg%. On the fifty fifth hospital day, an exploratory laparotomy was performed. About 7,000cc of bloody ascites was drained. A 30 x 20cm sized pseudocyst with thin wall was found between stomach and transverse colon. The portion of disrupted pancreatic duct was drained with sump tube. Abdomen distension and pain was markedly relieved after operation. On the 60 th postoperative day, ultrasonography of abdomen revealed no cysts. So sump tube was removed. A brief review of the literature was done.