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Pancreatic pseudocysts develop following acute or chronic pancreatitis. Majority of the cases resolve spontaneously but some persist beyond six weeks. Active management of pancreatic pseudocysts involves draining of the fluid collection through open surgery, endoscopically, laparoscopically or percutaneously. In our setup, drainage has traditionally been done through open surgery. In this article we present a case of a 61 year old male who developed pancreatic pseudocysts secondary to chronic pancreatitis. Laparoscopic cystogastrostomy was performed and there was no recurrence after three months of follow up. The case presentation highlights the need to offer laparoscopic cystogastrostomy as a method of managing pancreatic pseudocysts in our setup.

Introduction: Pancreatic pseudocysts are frequent complications after acute and chronic pancreatitis. They are diagnosed in 6–18% of patients with the history of acute pancreatitis and in 20–40% cases with chronic pancreatitis. The aim of the study was to analyse early results of surgical treatment of pancreatic acute and chronic pseudocysts based on our experience. Material and methods: The retrospective analysis was based on early results of surgical treatment of 46 patients aged between 20 and 78 (33 males and 13 females) who underwent treatment of acute (n = 26) and chronic (n = 20) pancreatic pseudocysts from November 2005 to July 2011 at the Second Department of General and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract in Lublin. Results: The choice of a surgical method of treatment depended on the size, localisation, thickness of pseudocystic wall and changes in the main pancreatic duct. We used the following surgical methods: cystogastrostomy (Jurasz procedure) was conducted in 22 patients (47.8%), Roux-en-Y cystojejunostomy was performed in 19 cases (41.3%), complete excision of the pseudocyst was possible in two patients (4.3%) and cystoduodenostomy – in one case (2.1%). Also, in single cases external drainage (2.1%) and cystopancreaticojejunostomy of Puestow (2.1%) were applied. Forty-four patients (95.6%) were cured. Early postoperative complications were observed in 2 patients (4.4%). Two reoperations (4.4%) were required. Early postoperative mortality was 0%. Conclusions: Classic internal drainage procedures, known since the 19th century, are still effective methods of treatment in acute and chronic pancreatic pseudocysts.

Pancreatic pseudocysts persisting beyond six weeks needs decompression, specially when they are larger than 6cm and symptomatic. Cysto-gastrostomy is the treatment of choice. This may be done by open, laparoscopic or endoscopic methods. Endoscopic cystogastrostomy has the least morbidity. Ultrasound guided aspiration causes lesser morbidity but has a higher incidence of recurrence. We compare six patients with pseudocysts treated by aspiration and cystogastrostomy; open, laparoscopic and endoscopic

Solid-pseudopapillary tumor (SPPT) of the pancreas is an uncommon low-grade exocrine pancreatic malignancy. An 11-year-old male child presented with pain in the abdomen. He had a history of fall 1-week back for which a computerized tomography (CT) scan was advised. A pancreatic mass was incidentally detected on CT scan and diagnosed as pancreatic pseudocyst. Explorative surgery was performed that revealed a solid-cystic tumor in the tail of the pancreas. The histopathological examination reported the features of pancreatic SPPT which was also the final diagnosis.

Background Congenital pancreatic cyst is very rare in infants and children. The majority of pancreatic cysts in children are pseudocysts resulting from trauma, acute pancreatitis or infection. Patients and methods Three children with true congenital pancreatic cyst were treated. Their medical charts were reviewed for age at presentation, sex, clinical features, diagnosis and management. Results Three children (1 male and 2 females) with a mean age of 23 months (4 months-4 years) were treated for congenital pancreatic cyst. One of them presented with an abdominal mass while another presented with non-bile stained vomiting and abdominal distension. The third was diagnosed to have left sided Wilms tumor and during investigation was found to have congenital pancreatic cyst. CT-scan and MRI were helpful in confirming the diagnosis. All were treated surgically. One had total surgical excision while the other two had cystojejunostomy. Conclusions Congenital pancreatic cyst is very rare in the pediatric age group and should be considered in the differential diagnosis of cystic lesions of the pancreas in infants and children. Preoperative diagnosis is important to plan surgical intervention. Complete surgical excision is the treatment of choice but if this is not feasible a form of internal drainage, a cystoduodenostomy or a Roux-in-Y cystojejunostomy should be done. [ABSTRACT FROM AUTHOR]

This paper discusses variations of laparoscopic transgastric cystogastrostomy in management of retrogastric pancreatic pseudocysts for 8 patients with symptom or pseudocysts (larger than 6 cm) companied with clinical manifestations. Using a Harmonic scalpel, two 3-5-cm incisions were made in the anterior and posterior gastric wall respectively. In the last step, the anterior gastrotomy was closed with an Endo-GIA stapler. All cases were successfully treated without large blood loss and without conversion to open surgery. The mean operative time was 114.29±19.24 min, blood loss was 157.14±78.70 mL, and mean hospital stay was 8.29±2.98 days. Gastric fistula occurred in one case on the postoperative day 7, and closed 1 month later. No bleeding was seen in all patients during the perioperative follow-up period. CT scans, given one month after the surgeries, displayed that the pancreatic pseudocysts disappeared or decreased in size, and ultrasounds showed no fluid or food residue in stomas at the third and fifth month following surgery. No patient experienced a recurrence during the follow-up period. Transgastric laparoscopic cystogastrostomy is a minimally invasive surgical procedure with a high rate of success and a low rate of recurrence, accompanied by rapid recovery. It is easy to master, safe to perform and may be the preferred option to treat retrogastric pancreatic pseudocysts. [ABSTRACT FROM AUTHOR]

Background: Trauma is the main cause of morbidity and mortality in the pediatric population. Blunt trauma to the abdomen accounts for the majority of abdominal injuries in children. Pancreatic injury, although uncommon (2 to 9%), is the fourth most common solid organ injury. Unlike other solid organ injuries, pancreatic trauma may be subtle and difficult to diagnose. Computed tomography currently is the imaging modality of choice. As the incidence of pancreatic injury in children sustaining blunt abdominal trauma is low, management remains a challenge.Case Presentation: We present a 7-year-old Bahraini boy who sustained blunt trauma to his abdomen. He presented with abdominal pain and vomiting. His examination revealed abdominal distension and an epigastric bruise. Contrast-enhanced computed tomography reported grade III liver injury, grade I bilateral renal injury, a suspicion of splenic injury, and a grade III to IV pancreatic injury. He was admitted to Pediatric Intensive Care Unit and was treated conservatively. Because he was stable, he was discharged to the surgical ward at day 3. At day 18 he developed a pancreatic pseudocyst that was aspirated and recurred at day 25 when a pigtail catheter was inserted. He was kept on total parenteral nutrition through a peripherally inserted central catheter. The pigtail catheter was removed on day 36 and a low fat diet was started by day 44. He was discharged home at day 55 in good health. Out-patient follow-up and serial abdominal ultrasound showed resolution of the cyst and normalization of blood tests.Conclusion: Non-operative management of pancreatic injury is effective and safe in hemodynamically stable patients with no other indication for surgery. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of laparoscopic internal drainage of pancreatic pseudocyst ( LIDP) versus open surgical internal drainage of pancreatic pseudocyst ( OSIDP) and the feasibility, safety, and superiority of LIDP. Methods A retrospective analysis was performed for the clinical data of 46 patients with pancreatic pseudocyst ( PPG) who underwent internal drainage in China - Japan Union Hospital of Jilin University and The Second Hospital of Jilin University from June 2011 to August 2016, and among these patients, 22 underwent LIDP ( LIDP group) and 24 underwent OSIDP (OSIDP group). The two groups were compared in terms of preoperative general status ( sex, age, and size of the cyst), intraoperative conditions (time of operation and intraoperative blood loss), and postoperative conditions (time to first flatus, time to first meal, length of postoperative hospital stay, hospital cost, and complications). The t - test was used for comparison of normally distributed continuous data with homogeneity of variance between groups, and the t' test was used for continuous data with heterogeneity of variance; the Pearson chi - square test or the Fisher's exact test was used for comparison of categorical data between groups. Results There were significant differences between the two groups in intraoperative blood loss (87. 72 ±24.48 ml vs 103. 75 ± 26. 83 ml, P <0.05 ), time to first flatus after surgery (3.00 ±1.02 d vs 3. 79 ±1. 10 d, t = -2.517, P - 0. 016), time to first meal after surgery (3.09 ± 0.97 d vs 3.87 ±0. 99 d, t = -2. 705, P =0.010), length of postoperative hospital stay (4. 90 ± 1.54 d vs 8.66 ± 3.71 d, t= -4.548, P <0.001 ), and hospital cost (43 402.06 ±6424.47 yuan vs 37 668.45 ±11 249.01 yuan, t = 2.097, P = 0.042). Of all 22 patients in the LIDP group, 2 (9. 09% ) experienced the postoperative complication of biochemical leakage; of all 24 patients in the OSIDP group, 4 (16.67% ) experienced postoperative complications (2 patients with biochemical leakage and 2 with grade B pancreatic fistula), among whom 2 patients were complicated by bleeding. Conclusion LJDP has the advantages of small trauma, clear visual field, low intraoperative blood loss, fast postoperative recovery, short length of hospital stay, and low incidence of complications. Compared with OSIDP. LIDP does not increase the time of operation. but it leads to a significant increase in average hospital cost. This surgical procedure is simple and easy and does not have high requirements for surgical equipment, and therefore, it holds promise for clinical application. [ABSTRACT FROM AUTHOR]

Background/Aims: Options for the endoscopic management of symptomatic pancreatic fluid collections (PFCs) include transmural drainage (TM) alone, transpapillary drainage (TP) alone, or a combination of both drainage method (CD). There have been conflicting reports about the best method. This study performed a meta-analysis to determine whether CD presents an added clinical benefit over TM. Methods: The included studies compared TM with CD and reported clinical success for both methods. A random-effects model was used to determine the pooled odds ratios (ORs) and the 95% confidence intervals (CIs) for the following outcomes: technical success, clinical success, complications, and recurrence. Results: Nine studies involving a combined total of 604 drainage procedures--373 TMs (62%) and 231 CDs (38%)--were included. CD showed no additional benefit over TM in terms of technical success (OR, 1.12; 95% CI, 0.37-3.37; p=0.85), clinical success (OR, 1.11; 95% CI, 0.65-1.89; p=0.70), recurrence (OR, 1.49; 95% CI, 0.53-4.21; p=0.45), or complications (OR, 1.15; 95% CI, 0.61-2.18; p=0.67). Conclusions: Pancreatic duct (PD) stenting provides no additional clinical benefit for the TM of PFCs (particularly pseudocysts). Patients undergoing the TM of symptomatic pseudocysts may not require endoscopic retrograde pancreatography (ERP). [ABSTRACT FROM AUTHOR]

Chronic pancreatitis is a disease that leads to irreversible changes in the pancreatic morphology and function. The loss of function can lead to diabetes mellitus and exocrine pancreatic insufficiency. The inflammation and fibrosis can also lead to other complications including a chronic abdominal pain syndrome, metabolic bone disease, and pancretic cancer. This article reviews our current understanding of the mechanisms and management of these complications of chronic pancreatitis. [ABSTRACT FROM AUTHOR]

Background and Aim Pancreatic pseudocyst is a common complication of chronic pancreatitis. The identification of risk factors and development of a nomogram for pancreatic pseudocysts in chronic pancreatitis patients may contribute to the early diagnosis and intervention of pancreatic pseudocysts. Methods Patients with chronic pancreatitis admitted to our center from January 2000 to December 2013 were enrolled. Cumulative rates of pancreatic pseudocysts after the onset of chronic pancreatitis and after the diagnosis of chronic pancreatitis were calculated. Patients were randomly assigned, in a 2:1 ratio, to the training and validation cohort. Based on the training cohort, risk factors were identified through Cox proportional hazards regression model, and nomogram was developed. Internal and external validations were performed based on the training and validation cohort, respectively. Results With a total of 1998 patients, pancreatic pseudocysts were detected in 228 (11.41%) patients. Age at the onset of chronic pancreatitis, smoking, and severe acute pancreatitis were identified risk factors for pancreatic pseudocysts development while steatorrhea and pancreatic stones were protective factors. Incorporating these five factors, the nomogram achieved good concordance indexes of 0.735 and 0.628 in the training and validation cohorts, respectively, with well-fitted calibration curves. Conclusion The nomogram achieved an individualized prediction of pancreatic pseudocysts development in chronic pancreatitis. It may help the early diagnosis and management of pancreatic pseudocysts. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound (EUS) is being used increasingly in the management of pancreatic fluid collection, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of the gallbladder, and other conditions. The role of interventional EUS is rapidly expanding and new interventions are continuously emerging. The development of devices could be a major breakthrough in the field of interventional EUS. New devices would enable the expansion of its role even further and prompt its widespread use in clinical practice. This review focuses on the current status of interventional EUS, especially highlighting the topics that are presently drawing the interest of endoscopists. [ABSTRACT FROM AUTHOR]

Purpose To evaluate clinical and imaging features of pancreatic pseudocyst-portal vein fistula (PPVF). Methods Patients with evidence of PPVF on CT/MRI were included. Clinical presentation, outcomes, imaging appearance of the portal vein were recorded. Results 75% of patients developed portal hypertension, 62% cavernous transformation of the portal vein and 25% portal biliopathy. PPVF presented on CT as fluid-attenuated portal vein, and on MRI as T2-weighted hyperintense fluid-filled portal vein. PPVF was misdiagnosed as portal vein thrombosis in all patients who underwent CT as initial examination. Conclusions Whenever PPVF is suspected on CT, MRI can be helpful to achieve accurate diagnosis and avoid unnecessary interventions. [ABSTRACT FROM AUTHOR]

Background Pancreatic pseudocysts (PPC) are collections of fluid encapsulated within a well-defined inflammatory wall that develop during pancreatic inflammation. Internal drainage represents the standard of care in lesions that persist and lead to symptoms and complications. Only limited data are available on long-term results and recurrence of PPC after drainage procedures. Thus, the aim of the present study was to analyse the long-term outcome after endoscopic drainage of PPC. Material and methods Patient data were retrospectively collected by review of clinical records of the University Medical Center Mannheim. We assessed the clinical short-term outcome (results in the first 30 days after initial drainage procedure), medium-term outcome (results 6 months after initial drainage procedure) and long-term outcome (results after stent removal). We performed statistical analysis to identify possible risk factors for recurrence of PPC. Results We identified 51 patients with initially successful endoscopic drainage of the PPC (n = 51/53, 96%). Among this cohort, 43 patients were available for assessment of medium-term results. In 82.9% of these 43 patients the drainage could be removed after successful treatment of the PPC. Thirty patients were available for long term follow-up with a mean observation period of 42.2 months (SD 32.8 months). Among these patients, seven (n = 7/30, 23.3%) had recurrent PPC. Approximately half of the recurrent cysts arose in different anatomical regions and most patients with recurrence had chronic pancreatitis. Conclusion Endoscopic drainage represents an effective treatment for PPC. Approximately one quarter of the patients developed recurrent PPC. Half of recurrent PPC developed in different pancreatic regions than the initial PPC. [ABSTRACT FROM AUTHOR]

We report a 7-year-old Taiwanese girl with acute pancreatitis (AP) complicated with pseudocyst (PC). The girl was found to have a PC by ultrasonograpgy (USG) and magnetic resonance imaging 14 days after the onset of AP. The girl was discharged 21 days after management with an asymptomatic PC. The diagnostic criteria of AP included abdominal pain, serum amylase or lipase level, and imaging findings. Transabdominal USG after appropriate preparation with adequate fasting, intake of some liquids during the scanning, and right decubitus position enhance the demonstration of pancreas and peripancreatic structures. PC could be seen in up to 38% of pediatric AP patients. It can form within 2 weeks after the onset of symptoms, although most are late complications. Pancreatic PCs have to be differentiated from other intra-abdominal cysts on USG according to their image character and anatomic location. A well-prepared USG examination in combination with liquid intake and right decubitus position is of value in the diagnosis and follow-up of PC. [ABSTRACT FROM AUTHOR]

Background: We evaluated short- and long-term results of endoscopic drainage (a minimally invasive nonsurgical treatment) of pancreatic pseudocysts (PPCs) and factors associated with its success at a multilevel teaching hospital in Northern India, as such data are scanty from India. Patients and Methods: Retrospective review of records of consecutive patients undergoing endoscopic drainage of PPC from January 2002 to June 2013 was undertaken. Results: Seventy-seven patients (56 males), median age 36 years (range, 15-73), underwent endoscopic drainage of PPC with 98% technical success. Pseudocysts drained were symptomatic (duration 11 weeks, range, 8-68), large (volume 582 mL [range, 80-2706]), located in head (n = 32, 46%), body and tail (n = 37, 54%), and infected (n = 39, 49%). Drainage procedures included cystogastrostomy (n = 54, 78%), cystoduodenostomy (n = 9, 13%), transpapillary drainage (n = 2, 3%), and multiple route (n = 4, 6%), with additional endoscopic nasocystic drainage (ENCD) in 41 (59%). Sixty-nine patients were followed up (median 28 months, range 2-156; other eight lost to follow-up). Complications (n = 21, 30%) included stent occlusion and migration (13), bleeding (5), perforation (2), and death (1). Endoscopic procedure had to be repeated in 19 patients (28%; 16 for sepsis, 3 for recurrence). The reasons for additional nonendoscopic treatment (n = 8, 12%) included incomplete cyst resolution (3), recurrence (2), bleeding (1), and perforation (2). Overall success rate of endoscopic drainage was 88%. Whereas infected pseudocysts were associated with poorer outcome (odds ratio [OR] 0.016; 95% confidence interval [CI] 0.001-0.037), placement of ENCD led to better results (OR 11.85; 95% CI 1.03-135.95). Conclusion: Endoscopic drainage is safe and effective for PPC. [ABSTRACT FROM AUTHOR]