Multiple Pseudocysts Research Articles

Multiple giant pancreatic pseudocysts, a rare complication of acute pancreatitis – A case report

A 34-year-old alcoholic male presented to our outpatient department with a complaint of persistent epigastric pain, radiating to the back with a swelling in the upper abdomen. He had 2 similar episodes in the past for which he was conservatively managed along the lines of acute pancreatitis. Now on physical examination, the patient had a massive lump in the upper abdomen reaching below the umbilicus. Examination findings were confirmed by computed tomography - abdomen (Plain and Contrast), two 13×10×09 cm and 9×8×7.8 cm, cystic lesions (Noncommunicating) were seen abutting the posterior wall of the stomach and into each other, suggestive of mature pseudocysts of the pancreas. The patient was admitted and after necessary investigations, surgical cystogastrostomy was done for the lower pseudocyst and cystocystostomy for the upper pseudocyst. The patient was discharged 5 days later with no complications. This case shows that multiple pseudocysts, a relatively rare complication of acute pancreatitis, are one of the differentials of acute abdomen. The treatment is a therapeutic challenge that depends on location, size, number as well as their relation to one another. Good drainage prevents resection procedures and further complications (exocrine and endocrine insufficiency).

Duodenal perforation and multiple pseudocyst complicated with hypertriglyceridemia-induced acute necrotizing pancreatitis in kidney transplant patient

Duodenal perforation and multiple pseudocyst complicated with hypertriglyceridemia-induced acute necrotizing pancreatitis in kidney transplant patient

Large or multiple pseudocysts can impede or complicate the nonsurgical treatment of pancreatolithiasis.

We aimed to determine when a coexisting pseudocyst was likely to complicate the nonsurgical treatment of pancreatolithiasis. We treated 165 patients with pancreatolithiasis nonsurgically between 1992 and 2020, including 21 with pseudocysts. Twelve patients had a single pseudocyst less than 60mm in diameter. Pseudocysts in the other nine patients had diameters of at least 60mm or were multiple. The locations of pseudocysts along the length of the pancreas varied from the area with stone involvement to the pancreatic tail. We compared the outcomes in these groups. We found no significant differences in pain relief, stone clearance, stone recurrence, or the likelihood of adverse events between pseudocyst groups or between patients with vs without pseudocysts. However, 4 of 9 patients with large or multiple pseudocysts required transition to surgical treatment (44%) compared with 13 of 144 patients with pancreatolithiasis and no pseudocyst (9.0%) (P=0.006). Patients with smaller pseudocysts typically underwent nonsurgical stone clearance successfully with few adverse events, similar to findings in patients with pancreatolithiasis and no pseudocysts. Pancreatolithiasis complicated by large or multiple pseudocysts did not cause more adverse events but was more likely to require transition to surgery compared with pancreatolithiasis without pseudocysts. In patients with large or multiple pseudocysts, early transition to surgery should be considered when nonsurgical treatment is ineffective.

Unusual presentation of subcapsular renal pseudocyst as page kidney – A case report

Page kidney is a rare but potentially curable cause of secondary hypertension. While the pancreatic pseudocyst is a completely different and unrelated entity. Here, we report a case of a 45-year-old female, diagnosed with idiopathic acute pancreatitis with multiple pseudocysts. After successful ultrasound -guided drainage of her left subcapsular renal pseudocyst, she became normotensive again, confirming the diagnosis of page kidney. This case highlights dual reasons that prompted us to report the case. The first being such remotely located subcapsular renal pseudocyst as itself a rare entity and the second, its unusual presentation as page kidney. The case emphasizes on the early management of such patients so as to salvage renal function.

Large ciliary body melanocytoma with pseudocysts: a case report

BackgroundTo describe the correlation between standardized A-scan echography and histopathology in a ciliary body melanocytoma.Case presentationWe present a case of a large ciliary body melanocytoma with significant growth, vision loss, and elevated intraocular pressure that was diagnosed clinically as a melanoma, but the standardized A-scan findings correlated to the histopathological description of a melanocytoma with multiple pseudocysts.ConclusionsThe reflectivity of this melanocytoma by standardized A-scan was consistent with multiple pseudocysts on pathological evaluation. This echographic pattern guided the differential diagnosis. Standardized A-scan is an important diagnostic tool in the differentiation of ciliary body melanocytomas from melanomas.

S1678 Gastric Ectopic Pancreas With Pseudocyst Formation Causing Gastric Outlet Obstruction

Introduction: Ectopic pancreas (EP) is a rare entity referring to the presence of pancreatic tissue at an anatomic location distinct from the pancreas which is commonly asymptomatic and found incidentally. EP can become symptomatic due to similar pathologic changes found in the anatomic pancreas including pancreatitis, bleeding, or pseudocyst formation. Gastric EP lesions present a diagnostic challenge as they lack distinguishing imaging and endoscopic features from other types of gastric submucosal tumors. This case report describes a rare case of EP presenting as a gastric antral mass with a unique combination of complications: chronic pancreatitis and pseudocyst formation causing gastric outlet obstruction. Case Description/Methods: A 59-year-old man presented to the hospital with nausea, vomiting, weight loss, and epigastric pain for 5 days. Exam was notable for epigastric tenderness, and labs were unremarkable. Computed tomography (CT) and index upper endoscopy showed a 4.4 x 3.5 cm multiloculated cystic mass in the gastric antrum (Figure). Endoscopic ultrasound (EUS) showed that the lesion originated from the submucosa, and fine needle aspiration (FNA) demonstrated histiocytes and epithelial cells with a high amylase level. On repeat endoscopy, interval growth of the cystic gastric mass was observed, and repeat CT abdomen/pelvis again showed the mass now with multiple cystic collections causing mass effect on a distended stomach suggesting gastric outlet obstruction. The lesion was surgically resected and determined to be EP with histologic changes of chronic pancreatitis and multiple pseudocysts. Patient did well after surgical resection and had no recurrence on repeat upper endoscopy. Discussion: EP can occur anywhere in the GI tract but most commonly are found in the duodenum or stomach. Symptoms are associated with the location, size, and pathology of the tissue. Lesions greater than 1.5 cm are more likely to be symptomatic with non-specific symptoms such as epigastric pain, abdominal fullness, nausea, diarrhea or melena. Diagnosis can be challenging, and in this case, multiple diagnostic modalities (imaging, endoscopy, EUS with FNA biopsy and surgical resection) were needed to reach a definitive diagnosis. EP is often found incidentally, and the combination of pseudocyst formation and gastric outlet obstruction in this case has been rarely reported in the literature. Prompt recognition of ectopic pancreas can facilitate the management of these complications.Figure 1.: A: Computed tomography of abdomen and pelvis from initial presentation, showing a multiloculated cystic mass (noted by *) and thickening of the gastric antral wall. B: Esophagogastroduodenoscopy (EGD) image showing a submucosal mass in the gastric antrum. C: Endoscopic ultrasound of gastric antrum with multicystic lesion appearing to originate from the submucosa.

Pseudotumoral Auto-Immun Pancreatitis with Multiple Pancreatic Pseudo-Cysts: A Diagnosis Pitfall

Introduction: The autoimmune pancreatitis (AIP) is a chronic inflammatory disease secondary to autoimmune disorders. Its s considered as a manifestation of IgG4 related disease. Case Report: We report an exceptional case of AIP of a patient who presented with nonspecific symptoms leading to an MRI-diagnosis of a pancreatic tale tumor with strong presumption of cystadenocarcinoma rather than adenocarcinoma. Histopathological study revealed a tense lymphoplasmacytic infiltrate associated with storiform fibrosis and collagenization. Furthermore; many pseudocysts were associated lesions immunohistochemical tests revealed a diffuse staining of plasma cells by IgG and IgG4 antibodies. The diagnosis of an AIP with multiple pseudocysts mimicking a pancreatic tale tumor was made. Conclusion: These, all criterions considered together made our case, a rare entity that may be a challenging diagnosis leading sometimes, as the current case, to a massive surgery

Wirsung atraumatic rupture in patient with pancreatic pseudocysts: a case presentation

BackgroundPancreatic duct disruption is a challenging condition leading to pancreatic juice leakage and consequently to pancreatic fluid collections. The manifestations of pancreatic main duct leak include pseudocysts, walled-off necrosis, pancreatic fistulas, ascites, pleural and pericardial effusions. Pseudocyst formation is the most frequent outcome of a pancreatic duct leak.Case presentationWe describe a case of a 64-year old man with large multiple pancreatic cysts discovered for progressive jaundice and significant weight loss in the absence of a previous episode of acute pancreatitis. Computed tomography scan showed lesion with thick enhancing walls. The main cyst dislocated the stomach and the duodenum inducing intra and extrahepatic bile ducts enlargement. Magnetic resonance cholangiopancreatography revealed a communication between the main pancreatic duct and the cystic lesions due to Wirsung duct rupture. Endoscopic ultrasound guided fine needle aspiration cytology did not show neoplastic cells and cyst fluid analysis revealed high amylase concentration. Preoperative exams were suggestive but not conclusive for a benign lesion. Laparotomy was necessary to confirm the presence of large communicating pseudocysts whose drainage was performed by cystogastrostomy. Histology confirmed the inflammatory nature of the cyst wall. Subsequently, the patient had progressive jaundice resolution.ConclusionPancreatic cystic masses include several pathological entities, ranging from benign to malignant lesions. Rarely pseudocysts present as complex cystic pancreatic lesions with biliary compression in absence of history of acute pancreatitis. We describe the rare case of multiple pancreatic pseudocysts due to Wirsung duct rupture in absence of previous trauma or acute pancreatitis. Magnetic resonance showed the presence of communication with the main pancreatic duct and endoscopic ultrasound fine needle aspiration suggested the benign nature of the lesion.

Purinergic enzymatic activities in lymphocytes and cardiomyocytes of mice acutely infected by Trypanosoma cruzi modulating the inflammatory responses

The aim of this study was to evaluate the activity of purinergic enzymes in lymphocytes and cardiac tissue of mice experimentally infected by Trypanosoma cruzi. Twelve female mice were used, divided into two groups (n = 6): uninfected and infected. On day 12 post-infection (PI), the animals were anesthetized and after euthanized, and samples were collected for analyses. Infected mice showed reduction in erythrocyte counts, hematocrit and hemoglobin concentration, as well as reduced number of total leukocytes in consequence of neutrophilia (P < 0.01). The number of monocytes increased in infected mice (P < 0.001), however the number of lymphocytes and eosinophils did not differ between groups (P > 0.05). The E-NTPDase (ATP and ADP substrate) and E-ADA activities in lymphocytes increased significantly in mice infected by T. cruzi (P < 0.01). In the heart, multiple pseudocysts containing amastigotes within cardiomyocytes were observed, as well as focally extensive severe necrosis associated with diffuse moderate to severe inflammatory infiltrate of lymphocytes. Although, the NTPDase activity (ATP and ADP substrate) in the cardiac homogenate did not differ between groups, a reduction on 5'-nucleotidase activity (P < 0.001) and an increase in the ADA activity in infected animals (P < 0.05) were observed. Thus, animals infected by T. cruzi experienced the disease, i.e., showed anemia, leucopenia, and heart lesions. Associated with this, purinergic enzymes showed altered activities, which might be related to the modulation of the inflammatory response.

A curious case of pancreatic pseudo cyst masquerading as hydratid cyst: A case report

We report a curious case of pseudo pancreatic cyst with retro peritonial pancreatico pleural fistula, with masquerading giant hydratid cyst. A 24 year old man, known alcoholic with history of recurrent pleural effusion was referred to our hospital with complaints of cough, breathless, right sided chest pain , fever and weight loss. Abdomino thoracic computed tomography showed thick walled fluid cyst in right hemithorax with multiple pseudo cysts of pancreas and calcified hydratid cyst in right lobe of liver. Patient had history of resection of hydratid cyst (20 x20cm) from liver 15 years ago. For present symptoms, patient had undergone multiple pleural fluid aspirations, which were inconclusive. The computer tomography scan could not confirm any pancreatico pleural fistula. The diagnosis was masked in view of no history of pancreatitis, history of hydratid cyst, and the computer tomography finding of thick walled fluid collection in right hemithorax.

Morphological and molecular genetic characterization of two Kudoa spp., K. musculoliquefaciens, and K. pleurogrammi n. sp. (Myxosporea: Multivalvulida), causing myoliquefaction of commercial marine fish.

Genetic characterization of myxosporean species, including members of the genus Kudoa, has advanced dramatically throughout the last decade. This is in stark contrast to those species described further back in time. Kudoa musculoliquefaciens described from the jellied muscle of swordfish, Xiphias gladius, in the western Pacific Ocean off the Sanriku Coast, northern Japan, is one such species. In the present study, multiple pseudocysts (0.66-1.35mm average length and 0.06-0.10mm average width) containing K. musculoliquefaciens spores were collected from three host groups: muscle blocks of swordfish caught in the western Pacific Ocean off the Sanriku Coast, or the northern Indian Ocean, and Indo-Pacific sailfish, Istiophorus platypterus, in the western Pacific Ocean off Kochi, western Japan. Subspherical K. musculoliquefaciens spores, 8.0-10.3μm in width, 7.3-10.0μm in thickness, 6.4-7.9μm in sutural thickness, and 5.5-8.1μm in length, had four subspherical polar capsules, 2.8-4.0μm in length by 2.2-3.2μm in width. The kudoid spores found in the different host groups showed morphometric variations to some extent but had essentially identical nucleotide sequences of the ribosomal RNA gene (rDNA), closest to those of Kudoa hemiscylli or Kudoa carcharhini recorded from elasmobranchs in the Indo-Pacific Ocean. Another kudoid species, Kudoa pleurogrammi n. sp., was recorded from the jellied and normal muscles of Atka mackerel, Pleurogrammus monopterygius and Pleurogrammus azonus, fished in the northern Pacific Ocean or northern Sea of Japan. Subquadrate spores found in round-ended pseudocysts (1.15-3.85mm in length and 0.11-0.26mm in width) in myofibers were 8.2-9.1μm in width, 7.1-8.2μm in thickness, 5.4-7.7μm in sutural thickness, and 5.6-6.8μm in length, with four ovoid polar capsules, 2.7-2.9μm in length by 1.4-2.0μm in width. Kudoid spores from both jellied and normal muscles or different host fish species had identical 18S or 28S rDNA nucleotide sequences. Thus, molecular genetic characterization of kudoid species with the potential to induce post-mortem myoliquefaction will facilitate the reliable and specific identification of myxosporeans found in either jellied or normal muscles of important commercial fish.

Surgical drainage of multiple pancreatic pseudocyst

Surgical drainage of multiple pancreatic pseudocyst

Multiple Pancreatic Pseudocysts Treated with Endoscopic Transpapillary Drainage

Management of a solitary pancreatic pseudocyst with endoscopic transpapillary stent drainage is a well recognized treatment modality. Endoscopic options are however limited in the presence of multiple pancreatic pseudocysts. Conventionally surgery has been the mainstay of treatment in this situation. In this case report, we present a patient with multiple pancreatic pseudocysts who was successfully treated via transpapillary placement of pancreatic duct stent.

Groove pancreatitis: A case series and review of the literature

Groove pancreatitis is a form of chronic pancreatitis affecting the space surrounded by the pancreatic head, duodenum and common bile duct. The clinical findings can conflict with pancreatic cancer causing diagnostic dilemma preoperatively. We describe two patients with a history of alcohol excess, who presented with a few months history of upper abdominal pain associated with weight loss and vomiting. Endoscopic and radiological investigations related duodenal narrowing, biliary dilatation and multiple pseudocysts around the head of the pancreas and duodenum. A Whipple's pancreaticoduodenectomy was carried out in both patients. Histopathology report demonstrated cystic areas in both medial and lateral walls of the duodenum microscopically consistent with groove pancreatitis. The diagnosis of groove pancreatitis should be considered in patients with duodenal stenosis and cystic lesions around the head of the pancreas associated with history of alcohol excess. Differentiation from pancreatic cancer is difficult preoperatively.

Multiple Giant Pancreatic Pseudocysts: A Case Report

Multiple Giant Pancreatic Pseudocysts: A Case Report

A Case of Autoimmune Pancreatitis Manifested by a Pseudocyst and IgG4-Associated Cholangitis

Autoimmune pancreatitis (AIP) is a benign disorder and a unique form of chronic pancreatitis with several characteristic features. A cystic formation that mimics a pseudocyst is a rare finding. There have been a few reports of AIP complicated by pancreatic cysts. We present a case of AIP with multiple pseudocysts and obstructive jaundice caused by IgG4-associated cholangitis. We initially missed the diagnosis due to the pseudocyst. Based on the computed tomography images, laboratory findings and the therapeutic response to steroids, the case was diagnosed as AIP with pseudocysts and associated cholangiopathy.

Multiple Pseudocysts. A Potential Complication Following Progressive Tension Sutures.

Pseudocyst formation after abdominoplasty is a rare complication. The pathogenesis of these cysts is due to theencapsulation of the potential dead space resulting after undermining of the abdominal flap. The potential incidence of these cysts is likely to be enhanced if liposuction is performed together wit abdominoplasty. Lymphaticdraining system is overwhelmed with the overload of lymph, blood, fat, extravasated fluid and wetting solutionused as infiltrate. Two raw surfaces created as a direct result of undermining result in shearing and rubbing, theprocess further exacerbates extravasation of fluid. To reduce friction between two raw surfaces of abdominoplasty flap and anterior abdominal musculature, progressive tension sutures are used. These sutures compartmentalized and stabilized the raw surfaces. Progressively enlarging multiple pseudo cysts arising from these compartments following the use of progressive tension is described as a case report.Key Words: Seroma, Progressive tension sutures, Abdominoplasty complications, Pseudo cyst, Quilting, Liposuction.

Su1466 Multiple Pseudocysts Managed With Transpapillary Drainage

Su1466 Multiple Pseudocysts Managed With Transpapillary Drainage

P33.18: Evolution of sonographic findings in patent urachus with an allantoic cyst of the cord: third trimester development of pseudocysts and cord edema

Allantoic cysts of the umbilical cord are rare anomalies in which a patent urachus links the bladder to a true cyst of the cord. Characteristic features include location close to the abdominal wall and splaying of the umbilical vessels around the cyst. Communication with the bladder via a patent urachus may be seen. Patent urachus can cause cord edema and pseudocysts. Here, we present serial ultrasound findings in a case of a 3 cm allantoic cyst diagnosed at 21 weeks and followed through pregnancy, with increase to 6 × 3 cm and development of cord edema and pseudocysts at 36 weeks. The neonate was otherwise normal and had an uneventful surgical repair. Allantoic cysts of the cord must be distinguished from omphalocele and cord pseudocysts; allantoic cysts are associated with urinary tract abnormalities but are not strongly linked to aneuploidy. Fetal compromise due to compression of cord vessels by increasing size of an allantoic cyst has been reported. In this pregnancy, antenatal testing remained reassuring despite the changes in cord appearance delivery was uneventful. Pathology confirmed a true cyst and ‘massive edema’ of the cord. Supporting information can be found in the online version of this abstract. Upper row: 2D and 3D images at 21 weeks. The cord cyst was unilocular. Lower row: 36 week scan showing cord edema and multiple pseudocysts. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Successful Diagnosis and Management of an Unusual Cause of Upper GI Bleeding

Purpose: A 48 year old woman was admitted with severe epigastric abdominal pain for 3 days. She was previously healthy and had had no similar previous episodes. Her initial abdominal exam was benign with minimal tenderness to palpation. Laboratory studies revealed amylase and lipase levels greater than three times the upper limit of normal. A CT scan of the abdomen showed peripancreatic edema and inflammatory changes consistent with acute pancreatitis, as well as multiple pseudocysts in the tail. A 2.9 cm partially thrombosed pseudoaneurysm arising from the proximal splenic artery was incidentally noticed. Within the initial 24 hours of admission she developed melena with a three gram drop in hemoglobin. Upper endoscopy did not reveal evidence of recent bleeding. Mesenteric angiography did not show active bleeding from the splenic artery pseudoaneurysm, however due to the high risk for subsequent rupture the pseudoaneurysm sac was coil embolized. There was satisfactory thrombosis and normal splenic perfusion at the conclusion of the procedure. Hemodynamics and stool patterns returned to normal prior to hospital dismissal. Three weeks later, she developed recurrent abdominal pain and hematochezia. A colonoscopy showed blood coming from the small bowel into ileum. Upper endoscopy revealed blood in the second portion of the duodenum. A side-viewing scope was utilized, and blood was seen oozing from the papilla. Angiography demonstrated a recurrent pseudoaneurysm, so covered stent exclusion of the proximal splenic artery was performed. She has had no recurrent bleeding at four months of followup. Hemosuccus pancreaticus refers to GI bleeding from the papilla of Vater via the pancreatic duct. It is a rare cause of upper GI bleeding, and most commonly occurs as a complication of chronic pancreatitis. Bleeding occurs when a pseudocyst or tumor erodes into a vessel, forming a direct communication with the pancreatic duct. The most commonly involved vessel is the splenic artery, as seen in this case. This diagnosis should be clinically suspected when upper GI bleeding occurs in the setting of chronic pancreatitis. Unfortunately blood exiting the ampulla of Vater is rarely identified at endoscopy, so angiography should be pursued early if this diagnosis is considered. Mesenteric arteriography with coil embolization or stent placement may be used to control acute bleeding, however recurrent bleeding can occur. Surgical exploration may be required if the lesion is not amenable to an angiography or the patient is hemodynamically unstable, and definitive surgical management may be required if there is recurrent bleeding.