Intrahepatic Pancreatic Pseudocyst Research Articles

S1603 Intrahepatic Pancreatic Pseudocyst: A Rare Complication of Acute Pancreatitis

S1603 Intrahepatic Pancreatic Pseudocyst: A Rare Complication of Acute Pancreatitis

Infected intrahepatic pancreatic pseudocyst: a surprising misdiagnosis.

Infected intrahepatic pancreatic pseudocyst: a surprising misdiagnosis.

A case of intrahepatic pancreatic pseudocyst developed as a complication of pancreatitis

Introduction: Pancreatic pseudocyst is located usually in lesser sac and peripancreatic space and is rarely developed in the liver. The intrahepatic pancreatic pseudocyst(IHPP) following acute pancreatitis is extremely rare with very limited number of clinical reports about IHPP. Methods: A 70-year-old woman was referred because of upper abdominal pain of 3 days' duration. An abdominal CT scan revealed 11x10 cm sized cystic mass in the left lateral section of liver. On EUS findings, a huge hypoechoic lesion with internal echogenicity was noted in the lesser sac. EUS-guided gastrocystostomy was performed and analysis of cystic fluid showed a high level of amylase (21,200 U/L). After the endoscopic procedure, severe abdominal pain developed and physical examination showed peritoneal irritation sign. An emergency operation was performed. Results: On operation findings, a huge cystic tumor was located in the left lateral section of liver without direct communication with pancreas. However, mass-like necrotic tissue was filled with in the hepatoduodenal ligament, hepatogastric ligament, and Glisson sheath of the left hepatic lobe. Left lateral sectionectomy was performed. Pathologic examination confirmed the pseudocyst with findings of non-epithelialized granulation tissue of the cystic wall. Conclusion: IHPP should be considered when a huge intrahepatic cystic lesion is found in patients with recent episodes of pancreatitis. The high level of amylase on cystic fluid analysis plays a key role in the diagnosis of IHPP. Drainage procedure or surgical resection can be considered, if necessary, for the treatment of IHPP.

Intrahepatic Pancreatic Pseudocyst; a Rare Complication of Pancreatitis

Intrahepatic Pancreatic Pseudocyst; a Rare Complication of Pancreatitis

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.

Intrahepatic pancreatic pseudocyst; a rare complication of pancreatitis

Introduction: Pancreatic pseudocyst is located usually in lesser sac and peripancreatic space and is rarely developed in the liver. The intrahepatic pancreatic pseudocyst(IHPP) following acute pancreatitis is extremely rare with very limited number of clinical reports about IHPP. Methods: A 70-year-old woman was referred because of upper abdominal pain of 3 days' duration. An abdominal CT scan revealed 11x10 cm sized cystic mass in the left lateral section of liver. On EUS findings, a huge hypoechoic lesion with internal echogenicity was noted in the lesser sac. EUS-guided gastrocystostomy was performed and analysis of cystic fluid showed a high level of amylase (21,200 U/L). After the endoscopic procedure, severe abdominal pain developed and physical examination showed peritoneal irritation sign. An emergency operation was performed. Results: On operation findings, a huge cystic tumor was located in the left lateral section of liver without direct communication with pancreas. However, mass-like necrotic tissue was filled with in the hepatoduodenal ligament, hepatogastric ligament, and Glisson sheath of the left hepatic lobe. Left lateral sectionectomy was performed. Pathologic examination confirmed the pseudocyst with findings of non-epithelialized granulation tissue of the cystic wall. Conclusion: IHPP should be considered when a huge intrahepatic cystic lesion is found in patients with recent episodes of pancreatitis. The high level of amylase on cystic fluid analysis plays a key role in the diagnosis of IHPP. Drainage procedure or surgical resection can be considered, if necessary, for the treatment of IHPP.

PANCREATIC PSEUDOCYSTS AT UNUSUAL SITES: A CASE REPORT

A pseudocyst is a well-circumscribed fluid collection surrounded by a non-epithelialized wall of granulation tissue and fibrosis with no associated tissue necrosis that is present for 4 or more weeks after disease onset. Pseudocyst as a complication of acute pancreatitis can occur at any site in the abdomen and even in the mediastinum, but the intrahepatic location of a pancreatic pseudocyst is a very uncommon event. In the literature, only 36 such cases have been described. Computed tomography and high amylase levels obtained by the aspiration of the fluid play an important role in diagnosing this complication. There are no definite guidelines for the management of hepatic subcapsular pseudocyst. We present a case of a 32-year-old male who presented with acute pancreatitis, and radiological imaging was diagnosed with disrupted pancreatic duct and intrahepatic pancreatic pseudocyst in communication with a collection in the anterior abdominal wall.

EUS guided drainage of intrahepatic pancreatic pseudocyst

EUS guided drainage of intrahepatic pancreatic pseudocyst

Rare Case of Intrahepatic Pancreatic Pseudocyst misdiagnosed as Hepatic Abscess

ABSTRACT Introduction Pseudocyst formation is a well known complication of pancreatitis. Intrahepatic pancreatic pseudocyst is very rare event and only about 30 cases have been reported in literature. We report here a case of 32-year-old male who was previously diagnosed as a case of hepatic abscess. He was referred to our department for ultrasonography (USG) and contrast enhanced computed tomography (CECT) abdomen with complaint of recurrent pain in upper abdomen. On the basis of findings of CECT Abdomen, diagnosis of large intrahepatic pancreatic pseudocyst in left lobe of liver is made. Conclusion Intrahepatic pseudocyst should be considered a differential diagnosis of cystic hepatic lesions in the patients with chronic or recent episode of acute pancreatitis. Computed tomography and high level of amylase in the collection plays an important role for diagnosing this complication. How to cite this article Hans P, Tyagi S, Sinha P, Kumar L, Gupta D, Singh R. Rare Case of Intrahepatic Pancreatic Pseudocyst misdiagnosed as Hepatic Abscess. Int J Adv Integ Med Sci 2016;1(4):191-193.

Intrahepatic pancreatic pseudocyst: A review of the world literature.

AIMTo investigate and summarize the literature regarding the diagnosis and management of intrahepatic pancreatic pseudocysts (IHPP).METHODSA literature search was performed using PubMed (MEDLINE) and Google Scholar databases, followed by a manual review of reference lists to ensure that no articles were missed. All articles, case reports, systematic reviews, letters to editors, and abstracts were analyzed and tabulated. Bivariate analyses were performed, with significance accepted at P < 0.05. Articles included were primarily in the English language, and articles in other languages were reviewed with native speakers or, if none available, were translated with electronic software when possible.RESULTSWe found 41 published articles describing 54 cases since the 1970s, with a fairly steady rate of publication. Patients were predominantly male, with a mean age of 49 years. In 42% of published cases, the IHPP was the only reported pseudocyst, but 58% also had concurrent pseudocysts in other extrapancreatic locations. Average IHPP size was 9.5 cm and they occurred most commonly (48%) in the left hemiliver. Nearly every reported case was managed with an intervention, most with a single intervention, but some required up to three interventions. Percutaneous treatment with either simple aspiration or with an indwelling drain were the most common interventions, frequently performed along with stenting of the pancreatic duct. The size of the IHPP correlated significantly with both the duration of treatment (P = 0.006) and with the number of interventions required (P = 0.031). The duration of therapy also correlated with the initial white blood cell (WBC) count (P = 0.048).CONCLUSIONDiagnosis of IHPP is difficult and often missed. Initial size and WBC are predictive of the treatment required. With appropriate intervention, most patients achieve resolution.

Intrahepatic Pancreatic Pseudocyst Complicating Chronic Calcific Pancreatitis - a rare cause for a cystic liver lesion

Intrahepatic pancreatic pseudocyst is a very rare differential for a hepatic space occupying cystic lesion. Though pseudocysts complicating chronic calcific pancreatitis are well described , an isolated intrahepatic location is extremely rare. Moreover , Intrahepatic pancreatic pseudocysts are usually described following acute pancreatitis. In this case report we describe the case of a 60 year old male presenting with epigastric pain and abdominal distension, in whom computed tomography showed features of an intrahepatic pancreatic pseudocyst complicating chronic calcific pancreatitis, which was subsequently confirmed on surgery. The etiopathogenesis and the types of intrahepatic pancreatic pseudocysts are discussed in addition to describing the imaging differentials.

EUS–guided diagnosis and successful endoscopic transpapillary management of an intrahepatic pancreatic pseudocyst masquerading as a metastatic pancreatic adenocarcinoma (with videos)

EUS–guided diagnosis and successful endoscopic transpapillary management of an intrahepatic pancreatic pseudocyst masquerading as a metastatic pancreatic adenocarcinoma (with videos)