Infected Pancreatic Pseudocyst Research Articles

The Strategic Management of Infected Pancreatic Pseudocyst in the Postpartum Period After Cesarean Delivery in a Pregnancy Complicated by Preeclampsia/Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome and Shock

The Strategic Management of Infected Pancreatic Pseudocyst in the Postpartum Period After Cesarean Delivery in a Pregnancy Complicated by Preeclampsia/Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome and Shock

S2569 Navigating Diagnostic and Therapeutic Hurdles in Infected Pancreatic Pseudocysts

S2569 Navigating Diagnostic and Therapeutic Hurdles in Infected Pancreatic Pseudocysts

Pancreatic pseudocyst mimicking a left kidney abscess: a case report

BackgroundPancreatic pseudocyst are fluid filled sacs that develop as a result of dissection of pancreatic enzyme tissue. While most commonly found near the pancreas, they can also rarely occur in other areas such as the perirenal region.Case presentationThis study reports a new case of an infected perirenal pancreatic pseudocyst mimicking a left kidney abscess in a 46-year-old North African patient with history of recurrent acute pancreatitis, who presented with left lumbar region pain and fever. Computed tomography revealed a left perirenal collection that turned out to be an infected pancreatic pseudocyst, The diagnostic was first suspected based on the medical history of the patient and confirmed by biochemical examination detecting a high level of pancreatic enzymes in the computed tomography-guided percutaneous drainage fluid. The patient evolved well after early resuscitation, rapid and effective antibiotic therapy, and computed tomography-guided percutaneous drainage of renal collection.ConclusionPancreatic pseudocyst is an uncommon disorder, which may present at a complicated stage and that must be considered in patients with a history of pancreatitis.

Minimally invasive treatment of a giant pancreatic pseudocyst

The authors present minimally invasive treatment of a giant infected pancreatic pseudocyst. Throughout in-hospital period, the patient underwent endosonography-guided transgastric drainage of the pseudocyst, 7 endoscopic debridement of the cavity with sequestrectomy, laparoscopy for enzymatic peritonitis and external percutaneous drainage of the pseudocyst. Effectiveness of minimally invasive treatment was assessed considering laboratory data (CRP, white blood cell count), clinical data (hyperthermia, complaints) and follow-up ultrasound and computed tomography data (cyst dimension, sequestration). We observed with positive dynamics with decrease of intoxication syndrome, serum CRP and white blood cell count after two debridement procedures. After the seventh endoscopic debridement and sequestrectomy, granulations occurred in the cyst cavity and there was no further sequestration. At discharge, CT revealed dry residual small cavity 1.5×3 cm. There were no any complaints.

An uncommon mediastinitis from infected pancreatic pseudocyst

A 48-year-old man with a history of alcoholism and recurrent abdominal pain developed acute alcohol-induced pancreatitis

Gastric inflammatory change due to infected pancreatic pseudocyst mimicking malignant gastroepithelial tumor.

Gastric inflammatory change due to infected pancreatic pseudocyst mimicking malignant gastroepithelial tumor.

High risk of complications and mortality in cirrhotic patients with acute pancreatitis

High risk of complications and mortality in cirrhotic patients with acute pancreatitis

Infected intrahepatic pancreatic pseudocyst: a surprising misdiagnosis.

Infected intrahepatic pancreatic pseudocyst: a surprising misdiagnosis.

Treatment of mycotic superior mesenteric vein pseudoaneurysm via placement of covered endovascular stent.

Vascular pseudoaneurysms are a rare yet life-threatening complication of untreated pancreatic pseudocysts related to their high risk of rupture and bleeding. Several studies and reports have established endovascular approaches as a successful first-line therapy in the management of arterial pancreatic pseudoaneurysms. However, no reports have been published describing endovascular repair of a venous pseudoaneurysm that developed after infection of a chronically stable pancreatic pseudocyst, most likely due to its rare occurrence. We report in this technical note the treatment of a superior mesenteric vein pseudoaneurysm that developed as a result of an infected small pancreatic pseudocyst, by radiologic placement of a covered endovascular stent.

S2362 Colopancreatic Fistula: The OTSC Connection Closure

INTRODUCTION: Enteric fistulas are a rare complication of necrotizing pancreatitis typically connecting with a pancreatic pseudocyst or abscess. Colopancreatic fistulas (CPFs) are very uncommon and have a complicated course as they are unlikely to close spontaneously and can lead to peritonitis and death. Colectomy with fistula repair is commonly performed with unclear data on endoscopic management. We present a case of CPF managed endoscopically with an over-the-scope clip (OTSC) system. CASE DESCRIPTION/METHODS: Our patient is a 57 year old male who initially presented with severe necrotizing pancreatitis and two months later developed a large infected pancreatic pseudocyst measuring 17 cm × 15 cm x 27cm occupying the peripancreatic, abdominal, and pelvic space. EUS-guided cystogastrostomy was unable to be performed and IR-guided drainage was performed. Over the next several months, the patient had recurrent IR guided drainage with improvement over time; however, on one drainage change, a CPF was noted with enterococcus faecium noted on drainage culture. ERCP showed no evidence of pancreatic duct disruption. Resolution of the pseudocyst was observed on CT; however, there was persistent CPF noted on repeat imaging (Figure 1). There was subsequent development of a retroperitoneal fluid collection and a percutaneous IR guided drain was placed. Throughout his course, the patient was symptomatic with abdominal pain, nausea, and vomiting. We made the decision to perform colonoscopic ablation with OTSC closure. Methylene blue was injected through the percutaneous drain into the colon to confirm the fistula site (Figure 2). The fistula site was ablated for de-epithelialization with APC and an 11/6T OTSC was placed (Figure 3). Further injection of methylene blue did not enter the colon. Subsequent sinogram 2 weeks later showed fistula resolution and the fluid collection had resolved with symptom improvement. DISCUSSION: CPF is a rare complication of necrotizing pancreatitis that is difficult to manage and typically requires surgical intervention. Endoscopic clipping for CPF has been previously noted in the literature. There is one prior case report of CPF managed with the OTSC system noted. This case highlighted the persistence and morbidity associated with CPFs. This patient was able to avoid surgical intervention. The OTSC system appears to be effective in the management of CPFs and should be further investigated.Figure 1.: Methylene blue injection showing persistent CPF.Figure 2.: APC ablation for de-epithelialization of CPF.Figure 3.: Deployed OTSC at the de-epithelialized site.

Nephroscopic Management of Giant Infected Pancreatic Pseudocyst After Drainage

We describe a successful simple, hitherto not described but may have been performed somewhere in the world a nephroscopic technique for the treatment of pancreatic pseudocyst (PP) in urgent or high-risk cases. Endoscopic drainage is recognized as preferred management for patients with PP. However, external drainage ought to be a valuable management in exceptional cases. Nephroscopic management is a minimally invasive approach (MIA) commonly conducted in patient with acute infected pancreatic necrosis (IPN) after percutaneous catheter drainage (PCD). It is frequently operated in our institution. We present a case of large infected PP in an 81-year Chinese woman successfully treated by nephroscopic drainage management after urgent PCD. However, it is considered a technically specialized procedure and often requires rich experience.

1261 Chylous Ascites in the Setting of a Pancreatic Pseudocsyt: A Rare Cause of an Even Rarer Condition

INTRODUCTION: Chylous ascites is a rare entity. It is formed when triglyceride-rich fluid enters the peritoneal cavity. Although the most common cause of the same is trauma to the lymphatic ducts, rarer causes still exist for the same. CASE DESCRIPTION/METHODS: Our case is a 63-year-old lady who was admitted with a provisional diagnosis of severe pancreatitis with multiorgan failure. On admission, her lab results were significant for a WBC count of 23.7 and a lipase level of over 30,000. While in the hospital she had also developed acute kidney injury, requiring hemodialysis and a pulmonary embolism. On being managed for th aforementioned, she also subsequently developed an infected pancreatic pseudocyst with culture results being positive for Enterococcus spp. and Staphylococcus epidermidis. A few weeks later, the patient underwent repeat abdominal imaging to assess for the interval change in the pancreatic pseudocyst. CT of the Abdomen revealed the presence of ascites. It was initially thought to be a gynecological malignancy, but Ascitic fluid analysis revealed elevated triglyceride levels and was unremarkable for the presence of any malignant cytological cells. A diagnosis of chylous ascites was made, which had resolved on drainage of the pseudocyst. The CT of the abdomen also revealed the presence of necrotizing pancreatitis, which appeared to have resolved after the draiange of the pseudocyst. DISCUSSION: In summary, although the most common causes of chylous ascites are either malignancy or iatrogenic trauma, our case presents itself to be somewhat of an enigma. Our working hypothesis is that the pseudocyst may have potentially expanded to cause traumatic injury to the lymphatic channels. Although exceptionally rare, there have been a total of 13 cases of chylous ascites associated with pancreatitis, of which 7 of them happen to be chronic. This is the first case of an association with a pancreatic pseudocyst. Further, even though chylous ascites due to necrotizing pancreatitis has been reported, the fact that her symptoms resolved on drainage of the pseudocyst favours the latter as the etiological agent for the ascites.

3029 Complications from Hypertriglyceridemia-Induced Acute Pancreatitis

INTRODUCTION: Pancreatitis accounts for 275,000 hospital admissions annually. While alcohol consumption and gallstones are responsible for the majority of cases, hypertriglyceridemia accounts for only 7%. Most are treated successfully with intravenous hydration, pain control and triglyceride-lowering agents but complications do occur 15% of the time. We present a case of one such complication. CASE DESCRIPTION/METHODS: A 40-year-old previously healthy female presented with a 12-hour history of nausea and severe LUQ abdominal pain. She was admitted with acute pancreatitis secondary to hypertriglyceridemia. Labs revealed a lipase of 3653 U/L and triglycerides of 6160 mg/dL. Abdominal CT scan confirmed acute pancreatitis. She was treated supportively with aggressive IV hydration. Repeat imaging 5 days later showed a large fluid collection inferior to the gastric antrum, an extensive amount of free fluid layering the abdomen and a small to moderate left pleural effusion. Eventually her symptoms due to the evolving pseudocyst improved and she was discharged on day 22 with Fenofibrate and Omega-3-Acid Ethyl Esters. Six days later she was admitted for sepsis secondary to infected pancreatic pseudocyst. CT showed an extensive multi-locular fluid collection and worsening left pleural effusion. Ultrasound-guided drainage was performed and cultures reported E. coli. Antibiotics were tailored but patient remained hypotensive and tachycardic. At that point the patient underwent a diagnostic laparoscopy, which was converted to Roux En Y pancreatic cystjejunostomy for continuous drainage. Repeat imaging on post-op day one demonstrated an interval decrease in size of fluid collection. Eventually the patient was discharged home in stable condition. DISCUSSION: While pancreatitis due to hypertriglyceridemia remains common, life threatening complications are rare. Aggressive supportive care is the mainstay of therapy with early surgical intervention as needed.

Infected Pancreatic Pseudocysts: Surgical Treatment

Introduction. The incidence of pancreatic pseudocysts (PPC) amounts to 0.5–1 per 100,000 adults per year. In all the pancreatic disorders the incidence of PPC amounts to 1.6-4.5%. Designing an individually tailored treatment programme using minimally invasive techniques to ensure the longest lasting treatment effect combined with the reduction of surgical trauma is an important issue of today’s surgery.Materials and methods. This paper presents a retrospective analysis of surgeries performed on 101 patients with infected PPC treated in the period from 2000 to 2015 at surgical wards of the Centre for Emergency and Disaster Medicine of the Regional Teaching Hospital, Kharkiv, Ukraine and the Department of Pancreatic and Bile Duct Surgery of A. A. Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine. Of these, 74 patients (73.3%) were male and 27 (26.7%) — female, aged 21 to 79, average age of patients was 43.3±1.2 years.Results. Percutaneous drainage was administered to patients with type I infected PPC with the onset of multiple organ failure in order to make the wait-and-see strategy possible and to alleviate the patient’s general condition and improve the course of sepsis. For patients with type II and III infected PPC percutaneous punctures were the final stage of treatment in 80% of cases. Whether radical surgical procedures were performed depended on the severity of the patient’s condition, degree of pancreatic necrosis or chronic pancreatitis spread, PC localisation, duct system condition and complications involving neighbouring organs.Conclusion. When treating patients with PPC one has to use an individually tailored treatment strategy based on state of the art minimally invasive treatment techniques. When treating infected PPC both minimally invasive and traditional open access procedures have to be considered as mutually complementing, presenting a broad range of diagnostic and treatment options.

ERCP-associated infected intrahepatic pancreatic pseudocyst.

IntroductionPancreatic pseudocysts are abnormal mature collections of pancreatic fluid that can develop in association with acute or chronic pancreatitis. Here, we share the discovery of an infected hepatic subcapsular pseudocyst of the pancreas causing septic shock following endoscopic retrograde cholangiopancreatography (ERCP).Presentation of CaseA 55-year-old woman with ethanol-related chronic pancreatitis and biliary stricture was transferred to the ICU for hypotension 8 hours following ERCP. Examination revealed mild right upper quadrant tenderness without sign of peritonitis. Laboratory studies were notable for leukocytosis (14.6 k/L) and slightly elevated serum lipase (489 U/L). Abdominal CT scan revealed a previously undescribed subcapsular fluid collection. She underwent CT-guided percutaneous subcapsular drainage with return of opaque yellowish fluid. Fluid analysis showed elevated lipase of 62,901 U/L with cultures positive for ESBL Escherichia coli, Streptococcus constellatus, and Enterococcus faecium.DiscussionA majority of pancreatic pseudocysts develop in peripancreatic regions, while, in a recent study, over a quarter of cases were found in usual sites. The management of subcapsular pseudocysts has not been standardized and often involves endoscopic or percutaneous drainage. Operative intervention is reserved for severe infection or rupture in patients with intrahepatic pseudocysts. Rarely do subcapsular pseudocysts become infected. In this case, we postulate the pseudocyst became seeded by bacteria during ERCP resulting in infection and then sepsis.ConclusionThis case report highlights an atypical presentation of pancreatic pseudocyst as well as a rare septic complication of ERCP.

Fungal Infections in Patients With Infected Pancreatic Necrosis and Pseudocysts: Risk Factors and Outcome.

Fungal infections in patients with acute pancreatitis are common and potentially life threatening. Data on fungal pancreatic infections are inconsistent. Therefore, the aim of this study was to identify risk factors for fungal infection and to determine their impact on survival. This was a retrospective analysis of pathogen spectrum and outcome of infected pancreatic necrosis or pseudocysts from 3 German hospitals from 2002 to 2016. A total of 187 fine-needle aspirations were performed in 113 patients. Fungal pancreatic infections, predominantly caused by Candida species, were identified in 52 patients (46%). Antibiotic treatment before fine-needle aspiration (84.6% vs 49.2%, P = 0.003) and the duration of therapy (9 vs 2 days, P = 0.024) identified patients at an increased risk of fungal infection. Patients with fungal pancreatic infections had a longer hospital stay (34 vs 14 days, P < 0.001), received intensive care treatment more often (55.8% vs 27.9%, P = 0.002), and had a lower 365-day survival (78.4 [SE, 6.6%] vs 95.0 [SE, 2.0%], P = 0.035) than patients with bacterial pancreatic infections only. Fungal infections are common in patients with infected pancreatic necrosis and pseudocysts and indicate patients with a higher risk of mortality in the long term.

A Case of Chronic Pancreatitis With Pancreatic Pseudocysts Complicated by a Rare Candida albicans Infection

Introduction: Pancreatic pseudocysts are known complications of acute and chronic pancreatitis. However, subsequent infection of pseudocyst is uncommon. We present a rare case of chronic pancreatitis with pancreatic pseudocyst complicated by a candida infection. Case report: A 42-year old African American female with alcoholic chronic pancreatitis, presented with complaints of abdominal pain, nausea and vomiting over 2 weeks. Computed tomography (CT) scan of abdomen revealed an acute on chronic pancreatitis with a large (91x48 mm) multiloculated pancreatic pseudocyst involving body and tail of the pancreas without signs of necrotizing pancreatitis. Initially she was managed conservatively, she began to spike fevers with worsening abdominal pain. She was therefore started on IV Meropenem but showed no clinical improvement. Given the lack of an endoscopic ultrasound in our institution, she underwent CT guided percutaneous drainage and aspirate cultures grew Candida albicans and antibiotics were switched to IV Fluconazole. Her fevers and poor appetite persisted. Repeat CT abdomen showed no change in the size of her pseudocyst. Subsequently, she again underwent percutaneous drainage; this time, a drainage catheter was left in place, and again, the fluid cultures grew C. albicans. Meropenem was resumed to cover for common pathogens. Despite all this, her condition did not improve. She therefore underwent exploratory laparotomy and several pockets of pus with significant amount of necrotic tissue were found. These pockets were debrided and her abdomen was left open with wound-vac drainage. Meropenem and Fluconazole were continued and underwent several peritoneal washings until eventually her abdomen was closed. She was later discharged with close outpatient follow up. Conclusion: Although most pancreactic pseudocysts are managed expectantly and resolve on their own, 10% of pseudocysts can get infected and carry a high morbidity and mortality. The most common pathogens isolated from pancreatic pseudocysts are bacterial including Escherichia coli, Klebsiella pneumonia, Enterococcus faecalis, Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis. Isolation of Candida albicans is extremely rare and only a few cases are reported in literature. Aggressive therapy is necessary with surgical drainage and antimicrobials. We suggest a high level of suspicion for Candida infected Pancreatic Pseudocyst for patients with persistent or worsening symptoms.

Mo2017 Direct Endoscopic Fenestration for Infected Pancreatic Pseudocyst

Mo2017 Direct Endoscopic Fenestration for Infected Pancreatic Pseudocyst

The staged combined endoscopic treatment of a patient presenting with giant infected pancreatic pseudocysts with sequestration

The staged combined endoscopic treatment of a patient presenting with giant infected pancreatic pseudocysts with sequestration

各種ドレナージを組み合わせた治療が有用であった膵仮性囊胞の1例

A 68-year-old man was admitted because of an infected pancreatic pseudocyst after alcoholic pancreatitis. Computed tomography revealed multiple pancreatic duct stones and multilocular pancreatic pseudocysts in his pancreatic tail. We performed endoscopic ultrasonography-guided transmural drainage of the pancreatic pseudocyst adjacent to the fundus of the stomach. It was effective for the punctured cyst, but not for the distant cysts. Therefore, we additionally performed transcutaneous drainage. Although the size of the cysts decreased, the drainage tube could not be removed because of continuous drainage of pancreatic juice. Then, we performed trans-papillary drainage by using a pancreatic duct stent. After that, the amount of pancreatic juice drained from the transcutaneous tube decreased and was successfully removed. Combined drainage from various routes is effective for treating multilocular pancreatic pseudocysts, not only when the cysts do not communicate with each other but also when they communicate with an obstructed pancreatic duct.