Rare Complication Of Pancreatitis Research Articles

Mediastinal pancreatic cysts: review and own clinical observations

To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC). There were 5 patients with MPC. Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide. MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.

Intrahepatic Pancreatic Pseudocyst; a Rare Complication of Pancreatitis

Intrahepatic Pancreatic Pseudocyst; a Rare Complication of Pancreatitis

PANCREATIC-PLEURAL FISTULA PRESENTING AS RECURRENT UNILATERAL PLEURAL EFFUSION

SESSION TITLE: Critical Care 3 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Pancreatic-pleural fistula (PPF) is a rare complication of pancreatitis. Pleural effusion seen with pancreatitis is usually clinically insignificant but PPF can produce recurrent and large volume pleural effusions. CASE PRESENTATION: A 58-year-old male with a medical history significant for alcohol abuse and recurrent alcoholic pancreatitis presented to our institute with worsening shortness of breath for 2 days.He was recently admitted for the third time to the hospital with similar presentation and was diagnosed with massive left-sided pleural effusion requiring drainage for symptom relief. He started feeling short of breath the very next day after discharge, more on exertion. On admission, his vitals were: HR 118, BP 140/97, RR 22, Temp 98.2F. Physical examination was remarkable for dullness to percussion with reduced air entry up to the left 5th intercostal space.Laboratory workup revealed a serum lipase level of > 600 U/L, serum amylase of 459 U/L mm/hr.Chest x-ray showed opacification of left hemithorax. CT chest confirmed large left-sided pleural effusion with compression collapse of the left lower lung.Pleural fluid analysis showed an exudative effusion with an amylase level of 17675 U/L. MRCP of the abdomen revealed diffusely dilated pancreatic ducts.Despite repeated aspiration, recurrent accumulation of pleural effusion was seen, so a chest tube was inserted.An ERCP was performed for the concern of pancreatic-pleural fistula which was consistent with moderate ductal stenosis and contrast extravasation from the ventral pancreatic duct in the head of the pancreas but did not demonstrate a clearcut fistulous tract. A stent was placed in the stenotic duct. The pleural fluid drainage from the tube decreased markedly, the chest tube was removed next day and a follow-up chest X-ray after 2 weeks revealed no evidence of recurrent pleural effusion. DISCUSSION: Although uncommon, pancreatic-pleural fistula can present with recurrent unilateral clinically significant pleural effusion. Although there is no cutoff level to establish the diagnosis, pleural fluid amylase is usually greater than 1000U/L, with levels of> 50,000U/L highly suggestive of a PPF.ERCP is essential in both the diagnosis and treatment of PPF; it does not only show the site of the leak but also reveals the ductal morphology, it demonstrates the fistulous tract in 59% to 74% of the cases. In our patient, the diagnosis was initially suggested by the very high level of pleuritic fluid amylase level and was confirmed by imaging and ERCP. Treatment was successful after a stent was placed at the site of leakage. CONCLUSIONS: Pancreatic-pleural fistula (PPF) should be included in the differential diagnosis of recurrent and large pleural effusions especially in middle-aged men with a history of alcohol consumption and recurrent pancreatitis. Reference #1: A. R. Dhebri and N. Ferran, “Nonsurgical management of pancreaticopleural fistula,” Journal of the Pancreas, vol. 6, no. 2, pp. 152–161, 2005. Reference #2: R. Materne, P. Vranckx, C. Pauls, E. E. Coche, P. Deprez, and B. E. Van Beers, “Pancreaticopleural fistula: diagnosis with magnetic resonance pancreatography,” Chest, vol. 117, no. 3, pp. 912–914, 2000. Reference #3: E. W. Pottmeyer, C. F. Frey, and S. Matsuno, “Pancreaticopleural fistulas,” Archives of Surgery, vol. 122, no. 6, pp. 648–654, 1987. DISCLOSURES: No relevant relationships by Taha Ahmed, source=Web Response No relevant relationships by TALHA AHMED, source=Web Response No relevant relationships by Basma Ricaurte, source=Web Response

Spontaneous gastric fistulation during the course of acute necrotizing pancreatitis: a case report

Introduction: Acute pancreatitis is a common surgical condition with significant morbidity and mortality. Pancreatic pseudocysts and walled off pancreatic necrosis (WOPN) are late sequele of pancreatitis. Spontaneous perforation or fistulation of such collections into a hollow viscus is a rare complication of pancreatitis. The most commonly reported site is the transverse colon, though such fistulation can involve all levels of the alimentary tract. Method: We describe a rare case of spontaneous gastric fistulation of a WOPN with subsequent improvement in the patient's clinical condition and successful conservative management. Case report: A 52 year old Chinese male presented on day 29 after a bout of severe necrotizing alcoholic pancreatitis with worsening pain and sepsis. Imaging confirmed the presence of an infected walled off pancreatic necrosis abutting and inseperable from the posterior gastric wall and duodenum. The patient was treated initially with percutaneous drainage and a step wise approach with an aim for VARDS. On day 38 of pancreatitis, there was a sudden change in drain fluid character to copious amounts of clear gastric fluid. CT and fluoroscopic imaging confirmed the presence of spontaneous fistulation into the stomach. Patient was treated conservatively for as a controlled fistula with rapid clinical improvement, hence avoiding any further surgical intervention. Conclusion: Though prompt surgical intervention may be required in cases of infected necrotic collections, the rare instances of spontaneous perforation into the duodenum or stomach results in transient drainage of the infected collection and subsequent clinical improvement.

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.

Isolated Mediastinal Pseudocyst of the Pancreas

Mediastinal pancreatic pseudocyst is a rare complication of pancreatitis. An 8-year-old boy with chest pain and shortness of breath. Computed tomography of chest showed a cystic mass in the mediastinum. The cyst aspirate revealed high amylase and lipase levels, suggestive of pancreatic pseudocyst. The patient gradually recovered after Roux-en-Y cystojejunostomy. Cysto-jejunostomy is a viable treatment option for mediastinal pancreatic pseudocyst, especially with failure of medical therapy.

A Rare Complication of Pancreatitis

A Rare Complication of Pancreatitis

A Case Report of Pancreaticopleural Fistula That was Treated Conservatively

Introduction: Pancreaticopleural fistula(PPF) is a rare complication of pancreatitis. It has been reported to occur in about 0.4% cases of pancreatitis mainly in chronic cases. It's defined as an abnormal connection between the pancreas and the adjacent pleural cavity. It's difficult to demonstrate the fistula tract on imaging like CT or MRCP but amylase-rich pleural fluid (greater than the upper limits of normal for serum amylase) is highly suggestive of the diagnosis. There's no guidelines for treatment and we are presenting a case of PPF that was treated conservatively. Case Report: 49-year-old female with a past medical history of alcoholic pancreatitis who presented with worsening dyspnea, orthopnea and right-sided chest pain. She had been recently admitted for an episode of alcoholic pancreatitis 4 weeks ago. Patient was found to be tachypneic, tachycardic and with no breath sounds on the ride side of the chest. Labs were notable for a leukocytosis of 19.1 and lipase 16,232. CXR showed a white-out of the right hemithorax (Fig. 1). CT abdomen and pelvis showed multiple subdiaphramatic fluid collections, atrophic pancreas and no significant PD dilation. 9 liters of fluid was drained and fluid analysis showed an amylase of >50,000. PPF diagnosis was made and she was started on octreotide drip and kept NPO on TPN. Patient had multiple ERCPs, but Pancreatic duct (PD) cannulation/stenting was unsuccessful despite using different sphincterotomes and wires. Patient remained asymptomatic and eventually started on diet which she tolerated well. Repeat CT prior to discharge showed partially loculated right pleural effusion and interval decrease of fluids collection in the upper abdomen (Fig. 2). Patient was followed closely after discharged.3 months after her presentation, she remains asymptomatic, repeat images (Fig. 4). showed stable loculated pleural effusion and no intervention is planned.FigureFigureConclusion: Pancreaticopleural fistula is a serious complication of acute or chronic pancreatitis. Modalities of treatment are endoscopic stenting of the disrupted PD, conservative management with octreotide and chest tube drainage for extended period, or surgical intervention. We present a case who has been successfully treated with a limited period of octreotide and no indwelling chest drain.This supports the prior limited data that interventions may not be needed for PPF especially in case of loculated effusion and no evidence of PD disruption.Figure

A rare case of chronic calcificpancreatitis with intrahepatic andsplenic pseudocysts

Pancreatic pseudocyst is a well-defined collection of fluid rich in pancreatic enzymes which occurs as a complication of pancreatitis. They are mostly located in the head and body of the pancreas while few are found in extra-pancreatic locations like mediastinum, liver, pelvis, pleura and spleen. However intrahepatic pseudocyst is a rare complication of pancreatitis with only 34 such cases being reported in English literature till the year 2009. Around 1 in 100 cases of pancreatic pseudocyst show extension into spleen.

Large Subcapsular Splenic Hematoma with a Large Pancreatic Pseudocyst Was Successfully Treated with Splenic Arterial Embolization and Ultrasound-Guided Percutaneous Drainage of Pancreatic Pseudocyst

Subcapsular splenic hematoma is a rare complication of pancreatitis. The management for subcapsular splenic hematoma remains controversial. We herein report a case of a large subcapsular splenic hematoma with a large pancreatic pseudocyst, which was successfully treated with splenic arterial embolization and ultrasound- (US-) guided percutaneous drainage of pancreatic pseudocyst, for the first time. A 44-year-old male suffered from recurrent abdominal pain for more than two years. He had previous 3 episodes of pancreatitis. A subcapsular splenic hematoma (16.0 × 16.0 × 7.6 cm) with pancreatic pseudocyst (13.5 × 10.0 × 8.0 cm) was shown on abdominal computed tomography (CT). He underwent splenic arterial embolization to decrease the blood supply of the spleen and then ultrasound-guided percutaneous drainage of the large pancreatic pseudocyst. After 2 weeks, the repeated CT-Abdomen showed the disappearance of pancreatic pseudocyst and multiple areas of infarction on the spleen, while the splenic subcapsular hematoma had also significantly reduced. The patient was discharged after almost a month of his hospital admission with the drainage tube attached, and about 2 weeks later the drainage tube was removed upon CT scan confirmation of decrease in the volume of the subcapsular hematoma. Patient had no abdominal symptoms at the 1.5-year follow-up.

Large Bowel Obstruction, a Delayed Complication of Severe Gallstone Pancreatitis.

Colonic complications are rare after acute pancreatitis but are associated with a high mortality. Possible complications include mechanical obstruction, ischaemic necrosis, haemorrhage, and fistula. We report a case of large bowel obstruction in a 31-year-old postpartum female, secondary to severe gallstone pancreatitis. The patient required emergency laparotomy and segmental bowel resection, as well as cholecystectomy. Presentation of obstruction occurs during the acute episode or can be delayed for several weeks. The most common site is the splenic flexure owing to its proximity to the pancreas. Initial management may be conservative, stenting, or surgical. CT is an acceptable baseline investigation in all cases of new onset bowel obstruction. Although bowel obstruction is a rare complication of pancreatitis, clinicians should be aware of it due to its high mortality. Obstruction can occur after a significant delay following the resolution of pancreatitis. Those patients with evidence of colonic involvement on pancreatic imaging warrant further large bowel evaluation. Bowel resection may be required electively or acutely. Colonic stenting has an increasing role in the management of large bowel obstruction but is a modality of treatment that needs further evaluation in this setting.

Osteomyelitis: A rare complication of pancreatitis and PPP-syndrome

Pancreatic diseases can be accompanied by periarthritis with bone necrosis and panniculitis (PPP-syndrome). It is postulated that this is caused by systemic activity of pancreatic enzymes leading to microcirculatory disturbances and fat necrosis. The morbidity and mortality of the PPP-syndrome is high. Successful treatment of pancreatitis can lead to resolution of accompanying panniculitis and periarthritis without adverse sequelae, but weeks or months after pancreatitis, asymptomatic necrosis of the bone may become symptomatic by fracturing spontaneously. In this report, we also describe osteomyelitis as a severe septic complication of bone necrosis caused by pancreatitis, in one case as acute tissue necrosis and in another case months after pancreatitis spread haematogenously.

Surgical intervention for mediastinal pancreatic pseudocysts. A case series and review of the literature.

Development of mediastinal pancreatic pseudocysts is a rare complication of pancreatitis. There is currently no consensus on the optimal management of this condition, options for which include conservative management with somatostatin analogues, endoscopic drainage procedures and surgery. Here we present two patients with mediastinal pancreatic pseudocysts which were initially managed endoscopically. However, in both cases, this led to complications secondary to the endoscopic procedures, recurrence or non-resolution of symptoms, requiring surgical cystogastrostomy and/or cystojejunostomy. These cases suggest that surgery may be ultimately necessary for mediastinal pancreatic pseudocysts where endoscopic procedures might have a high likelihood of failure.

Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia.

Acute pancreatitis (AP) is a condition characterised by the activation of the normally inactive digestive enzymes due to an etiological factor and digestion of the pancreatic tissues, resulting in extensive inflammation and leading to local, regional, and systemic complications in the organism. It may vary from the mild edematous to the hemorrhagic and severely necrotising form. The most common causes are biliary stones and alcohol abuse. In this case study, we would like to present a patient with AP due to hypertriglyceridemia (HPTG), which is a rare cause of pancreatitis, and splenic vein thrombosis, which is a rare complication of pancreatitis.

Idiopathic pancreatitis with splenic artery pseudoaneurysm in a child: a rare presentation

Splenic artery pseudoaneurysms are a rare complication of pancreatitis and abdominal trauma in children. We report a case of splenic artery pseudoaneurysm complicating pancreatitis (idiopathic) that was managed by transcatheter angioembolization.

Pylephlebitis With Pyogenic Liver Abscesses: A Rare Complication of Pancreatitis

Pylephlebitis With Pyogenic Liver Abscesses: A Rare Complication of Pancreatitis

Postpartum Pancreatic Encephalopathy -A Rare Case

A young female of postpartum pancreatic encephalopathy is described who presented with convulsions and coma . She had deranged lipase levels in blood, and cerebrospinal fluid along with abnormal white matter signals in MRI brain . As the patient improved with medical management, deranged blood lipase levels and abnormal MRI signals also improved. Pancreatic encephalopathy is a rare complication of pancreatitis in the setting of postpartum period. In any atypical neuropsychiatric condition with abdominal symptoms the possibility of pancreatic encephalopathy should be considered after certain exclusions.

Intramural Duodenal Hematoma Caused by Acute Gallstone Pancreatitis

Intramural duodenal hematoma (IDH) is a rare complication of pancreatitis. We report a unique case of IDH caused by acute gallstone pancreatitis in a 37-year-old man. The patient presented with hematemesis and sudden exacerbation of upper abdominal pancreatic pain. An abdominal computed tomography scan showed an intramural hyperdense hematoma and symmetric thickening of the duodenal wall along with peripancreatic inflammation and gallbladder stones. A duodenoscopy also revealed a bloody edematous duodenal wall with a narrow lumen due to IDH. The patient recovered fully from the acute pancreatitis and IDH without pancreaticoduodenectomy using conservative management and a subsequent cholecystectomy. (Korean J Med 2013; 84:551-555)

Su1386 Clinical Presentation, Radiological Features & Endoscopic Management of Mediastinal Pseudocysts: Experience of a Decade

Mediastinal pseudocyst is a very rare complication of pancreatitis. There is paucity of data on its clinical as well as imaging features. Also surgery has been the conventional treatment with limited experience with endoscopic drainage. Patients &

Percutaneous retropleural drainage of a posttraumatic pancreatic mediastinal pseudocyst in a child

Pancreatic mediastinal pseudocyst is a rare complication of pancreatitis in children. These children usually present with abdominal pain, anorexia, vomiting, and dysphagia. Computed tomography not only is essential in defining the extent of the pseudocyst but also can guide percutaneous external drainage. We present the case of a 4-year-old child with a mediastinal pseudocyst secondary to pancreatic trauma, which was successfully treated with computed tomography–guided percutaneous drainage via a posterior, extrapleural approach.