Pseudoquiste mesentérico: reporte de un caso

Introducción: Los quistes mesentéricos se pueden encontrar a lo largo de todo el mesenterio del intestino. Los pseudoquistes de mesenterio se caracterizan por carecer de revestimiento endotelial. Generalmente son asintomáticos y el diagnóstico se realiza mediante estudios de imagen. Material y Método: Reporte de un caso clínico Resultados: Presentamos el caso de una mujer de 50 años sana que consulta por tumoración indolora en flanco izquierdo. Se solicita TC y RNM donde se visualiza tumoración quistica de paredes finas, homogenea de 88mm de diámetro mayor con septos y tabiques. Se realiza abordaje laparoscópico identificando masa de 12cm que se protruye a nivel del mesenterio de la segunda asa yeyunal, se reseca in incidentes. La anatomía patológica informó pseudoquiste mesentérico, sin elementos de malignidad. Buena evolución posterior. Conclusiones: Los quistes mesentéricos son extremadamente infrecuentes. General-mente se localizan en el mesenterio del intestino delgado como en el caso presentado. Teniendo en cuenta las características histopatológicas, se clasifican en seis grupos. Si bien es excepcional su transformación maligna, el tratamiento consiste siempre en su resección quirúrgica. Se prefiere la laparoscopía por sus conocidos beneficios.

Introduction: Mesenteric cysts can be found throughout the entire intestine mesentery. Mesenteric pseudocysts are characterized by lack of endothelial lining. They are generally asymptomatic and the diagnosis can be made by imaging studies. Material and Method: Report of a clinical case Results: We present the case of a healthy 50-year-old woman consulted for a painless tumor on the left flank. She requested a CT and MRI where a thin-walled, homogeneous cystic tumor of 88mm in greatest diameter with septa and partitions was visualized. A laparoscopic approach was performed identifying a 12cm mass that protruded at the level of the mesentery of the second jejunal loop, it was resected without incident. The pathological anatomy reported a mesenteric pseudocyst, without elements of malignancy. Good subsequent evolution. Conclusions: Mesenteric cysts are extremely rare. They are generally located in the mesentery of the small intestine, as in the case presented. Taking into account the histopathological characteristics, they are classified into six groups. Although its malignant transformation is exceptional, the treatment always consists of its surgical resection. Laparoscopy is preferred for its well-known benefits.

Drainage of Pancreatic Pseudocysts Using Lumen-apposing Metal Stents (LAMS): Experience in Two Referral Centers in Colombia

Introduction: Endoscopic ultrasound (EUS)-guided drainage and luminal-apposing metal stents (LAMS) are the options for managing symptomatic pancreatic pseudocysts. Aim: To evaluate the effectiveness and safety of LAMS for EUS-guided drainage of symptomatic pancreatic pseudocysts in two referral centers in Colombia. Materials and methods: A multicenter prospective cohort study between June 2019 and December 2021 included 13 patients diagnosed with symptomatic pancreatic pseudocysts who underwent EUS-guided drainage with LAMS. Technical success, clinical success, and successful stent removal were evaluated as outcomes. Safety outcomes included stent-related adverse events and general adverse events. Follow-up was carried out for eight weeks, collecting data on stent removal. Results: The average age was 53.4 years; 8/13 were men. The mean size of the pseudocyst was 9.56 ± 2.3 cm. Technical success was 100%, and clinical success was 92.3%. The stents were removed on average after 8 ± 2 weeks. The mean procedural time from puncture to stent deployment was 3.2 ± 2.4 minutes. In the imaging check-up, the collections had adequate drainage in all cases. There was a low frequency of complications; bleeding was documented in one case requiring surgery. Conclusions: LAMS is safe and effective in managing symptomatic pancreatic pseudocysts, reducing hospital stay and cost overruns. Clinical symptomatology prevails in the surgery decision.

Introducción: el drenaje guiado por ultrasonido endoscópico (USE) y el uso de stent metálico luminal de aposición (LAMS) son de elección en el manejo de los pseudoquistes pancreáticos sintomáticos. Objetivo: evaluar la efectividad y seguridad del LAMS para el drenaje por USE de pseudoquistes pancreáticos sintomáticos en dos centros de referencia en Colombia. Materiales y métodos: estudio de cohorte prospectivo multicéntrico entre junio de 2019 y diciembre de 2021, se incluyeron a 13 pacientes con diagnóstico de pseudoquistes pancreáticos sintomáticos sometidos a drenaje por USE con LAMS. Se evaluaron como desenlaces el éxito técnico, el éxito clínico y la extracción exitosa del stent. Y los desenlaces de seguridad incluyeron eventos adversos relacionados con el stent y los eventos adversos generales. Se realizó seguimiento a 8 semanas, en las que se recopilaron datos relacionados con el retiro del stent. Resultados: la edad promedio fue 53,4 años, 8/13 fueron hombres. El tamaño medio del pseudoquiste fue de 9,56 ± 2,3 cm. El éxito técnico fue del 100% y el éxito clínico fue 92,3%. Los stents fueron retirados en promedio a las 8 ± 2 semanas. El tiempo medio del procedimiento desde la punción hasta el despliegue del stent fue 3,2 ± 2,4 minutos. En el control imagenológico hubo un adecuado drenaje de las colecciones en todos los casos. Hubo baja frecuencia de complicaciones, se documentó sangrado en 1 caso con requerimiento quirúrgico. Conclusiones: el uso de LAMS es seguro y efectivo en el manejo de pseudoquistes pancreáticos sintomáticos, disminuye la estancia hospitalaria y sobrecostos. La sintomatología clínica prima en la decisión de intervención.

Pseudoquiste de páncreas y hernia interna complicada. Presentación de un caso

Las hernias internas en su mayoría son de causas congénitas. Constituyen entidades nosológicas poco frecuentes. El cuadro abdominal agudo secundario a la complicación de estas se relaciona con oclusión intestinal y necrosis. En ocasiones, algunas enfermedades que anteceden o se descubren en el transcurso del padecimiento clínico, como el pseudoquiste pancreático, pueden dificultar el diagnóstico positivo. En este informe se describe el caso clínico de un paciente con diagnóstico de pseudoquiste de páncreas, que en el transcurso de la enfermedad presentó complicación de hernia interna. El paciente, de 45 años y con diagnóstico de pseudoquiste pancreático, presentó durante su ingreso cuadro de dolor abdominal acompañado de vómitos, lo que dio lugar a la sospecha de ruptura del pseudoquiste. Fue operado de urgencia, y se obtuvo entonces la evidencia de hernia interna (no diagnosticada de forma preoperatoria) complicada con necrosis de segmento de intestino delgado. No se observó ruptura del pseudoquiste pancreático. Las manifestaciones clínicas de la hernia interna complicada y la ruptura del pseudoquiste de páncreas son difíciles de discernir entre sí. El tratamiento quirúrgico de urgencia es el pilar fundamental ante la duda diagnóstica o el empeoramiento clínico del paciente.

Internal hernias are mostly congenital causes. They constitute rare nosological entities. The acute abdominal picture secondary to the complication of these is related to intestinal occlusion and necrosis. Sometimes, some diseases that precede or are discovered during the clinical condition, such as pancreatic pseudocyst, can make a positive diagnosis difficult. The clinical case of a patient diagnosed with a pancreatic pseudocyst, who presented a complication of internal hernia during the course of the disease it is described in this report. The 45-years-old patient with a pancreatic pseudocyst diagnosis presented symptoms of abdominal pain accompanied by vomiting during his admission, which led to suspicion of rupture of the pseudocyst. He underwent emergency surgery, and evidence of an internal hernia (not diagnosed preoperatively) complicated with small bowel segment necrosis was then obtained. No rupture of the pancreatic pseudocyst was observed. The clinical manifestations of complicated internal hernia and pancreatic pseudocyst rupture are difficult to distinguish from each other. Emergency surgical treatment is the fundamental pillar in the face of diagnostic doubt or clinical worsening of the patient.

Factores pronósticos de complicaciones en pacientes con pseudoquiste pancreático

Fundamento los pseudoquistes del páncreas se presentan como complicación en pancreatitis aguda y crónica, así como en el trauma pancreático. En ocasiones pasan inadvertidos, por su carácter asintomático en algunos casos, además del cuadro clínico poco definido. Los estudios orientados a esta temática permiten un manejo satisfactorio de los pacientes con diagnóstico de dicha entidad. Objetivo determinar los factores pronósticos de complicaciones en pacientes con pseudoquiste pancreático. Métodos se realizó un estudio descriptivo longitudinal, en pacientes con pseudoquistes pancreáticos atendidos en el Hospital Arnaldo Milián Castro, de Villa Clara, durante el período enero/2013-diciembre/2020. La muestra quedó definitivamente conformada por 45 pacientes. Resultados predominaron los pacientes con edades de 40-59 años (57,8 %), y del sexo masculino (62,2 %). La causa fundamental fue la pancreatitis aguda (51,1 %), y la localización más frecuente el cuerpo pancreático (37,8 %). El síntoma más observado fue el dolor abdominal (82,2 %). El manejo fue médico en la mayoría de los pacientes (75,6 %) y se realizó cistogastrostomía en el 13,3 %. Evolucionaron sin complicación el 68,9 %. Solo 3 pacientes fallecieron (6,7 %). La edad mayor de 52 años, el tiempo de formación mayor de seis semanas, el tamaño menor de 6 centímetros y la persistencia tuvieron valores de Odds Ratio: 1,214- IC(0,211-6,985); 7,250- IC(0,786-66,842); 4,688- IC(0,489-44,904); y 2,875- IC(0,479-17,239), respectivamente. Conclusiones la edad mayor de 52 años, la formación después de seis semanas, el tamaño menor de seis cm y la persistencia mayor de tres semanas constituyen factores de riesgo de complicaciones del pseudoquiste pancreático.

Background pseudocysts of the pancreas appear as a complication in acute and chronic pancreatitis, as well as in pancreatic trauma. Sometimes they go unnoticed, due to their asymptomatic nature in some cases, in addition to the poorly defined clinical picture. The studies oriented to this subject allow a satisfactory management of the patients diagnosed with said entity. Objective to determine the prognostic factors for complications in patients with pancreatic pseudocyst. Methods a longitudinal descriptive study was carried out in patients with pancreatic pseudocysts treated at the Arnaldo Milián Castro Hospital, in Villa Clara, from January/2013 to December/2020, 45 patients were the sample. Results patients aged 40-59 years old (57.8%), and males (62.2%) predominated. The fundamental cause was acute pancreatitis (51.1%), and the most frequent location was the pancreatic body (37.8%). The most observed symptom was abdominal pain (82.2%). Medical management was performed in most of the patients (75.6%) and cystogastrostomy in 13.3%. 68.9% evolved without complications. Only 3 patients died (6.7%). Age greater than 52 years old, formation time greater than six weeks, size less than 6 centimeters, and persistence had Odds Ratio values: 1.214- IC(0.211-6.985); 7,250- CI(0,786-66,842); 4.688-CI(0.489-44.904); and 2.875-CI(0.479-17.239), respectively. Conclusions age greater than 52 years old, formation after six weeks, size less than six cm, and persistence greater than three weeks are risk factors for complications of pancreatic pseudocyst.

ASPIRATION VERSUS SURGICAL DEROOFING TECHNIQUE IN MANAGEMENT OF PRIMARY PSEUDOCYST OF PINNA: A RANDOMIZED CONTROL STUDY.

Introduction: Pseudocyst or seroma is an uncommon asymptomatic, non-in?ammatory swelling of the pinna, characterized by endochondral cyst formation. Pseudocyst commonly occur as a post trauma sequela. The objective of our study is to compare and analyse the outcomes of aspiration and window technique in treating auricular seroma. Randomized control study. This study comprised of 20 patients who presented with Study Design: Setting: auricular seroma to the Department of ENT, HSK Hospital, Bagalkot from August 2020 to December 2022. The Methods: diagnosis of the auricular pseudocyst was made clinically. Out of 20 patients, 10 patients were taken up for wide bore needle aspiration followed by contour pressure dressing, and 10 patients underwent the window procedure. Patients were followed up for a period of 6 months. In the 10 cases primarily taken up for needle aspiration, there was a recurrence in 8 out of the Results: 10 cases; while 2 patients showed successful outcome during the 6 months of follow-up. Of the 10 cases taken up primarily for the window procedure, no recurrences were noted as compared to aspiration group, which was statistically signi?cant (p=0.0003) Considering the rate of success and minimal complications encountered in our study, we would . Conclusion: advocate the use of deroo?ng technique for achieving better outcome in the management of pinna pseudocysts.

ASPIRATION VERSUS SURGICAL DEROOFING TECHNIQUE IN MANAGEMENT OF PRIMARY PSEUDOCYST OF PINNA: A RANDOMIZED CONTROL STUDY.

Introduction: Pseudocyst or seroma is an uncommon asymptomatic, non-in?ammatory swelling of the pinna, characterized by endochondral cyst formation. Pseudocyst commonly occur as a post trauma sequela. The objective of our study is to compare and analyse the outcomes of aspiration and window technique in treating auricular seroma. Randomized control study. This study comprised of 20 patients who presented with Study Design: Setting: auricular seroma to the Department of ENT, HSK Hospital, Bagalkot from August 2020 to December 2022. The Methods: diagnosis of the auricular pseudocyst was made clinically. Out of 20 patients, 10 patients were taken up for wide bore needle aspiration followed by contour pressure dressing, and 10 patients underwent the window procedure. Patients were followed up for a period of 6 months. In the 10 cases primarily taken up for needle aspiration, there was a recurrence in 8 out of the Results: 10 cases; while 2 patients showed successful outcome during the 6 months of follow-up. Of the 10 cases taken up primarily for the window procedure, no recurrences were noted as compared to aspiration group, which was statistically signi?cant (p=0.0003) Considering the rate of success and minimal complications encountered in our study, we would . Conclusion: advocate the use of deroo?ng technique for achieving better outcome in the management of pinna pseudocysts.

A meta-analysis on the comparison between endoscopic ultrasound-guided drainage and percutaneous drainage for treating pancreatic pseudocyst / 中华胰腺病杂志

Objective:To evaluate the efficacy of endoscopic ultrasound-guided drainage (EUS-GD) and percutaneous drainage (PD) for the treatment of pancreatic pseudocyst (PPC) by meta-analysis.Methods:The key words were pancreatic pseudocyst, endoscopic ultrasonography, percutaneous drainage, endoscopic ultrasound-guided, EUS and EUS-guided, and the databases of CNKI, Wanfang, PubMed and Web of science were searched from the establishment to October 1, 2021 for the retrospective cohort studies on PD, endoscopic ultrasonography and PPC. The article were screened and the quality was evaluated according to the pre-set inclusion and exclusion criteria; and important data were extracted. The software REVMAN5.3 was used for meta-analysis.Results:14 articles were finally included, and a total of 843 patients with PPC were enrolled (485 in the EUS-GD group and 358 in the PD group). Mesh meta-analysis showed that in the incidence of technical success rate, clinical success rate and complication rate, there were no significant differences between PD group and EUS-GD group ( OR=0.69, 95% CI 0.32-1.46; OR=1.31, 95% CI 0.88-1.95; OR=1.01, 95% CI 0.70-1.47, all P value >0.05); but the incidence of the recurrence rate and reintervention rate in EUS-GD group were significantly lower than those in the PD group and the differences were statistically significant ( OR=0.45, 95% CI 0.23-0.85; OR=0.51, 95% CI 0.28-0.93, all P value <0.05). Conclusions:Compared with PD, EUS-GD can significantly reduce recurrence rate and complication rate, and it has more advantages than PD for the treatment of PPC.

Rotura de Pseudoaneurisma tras Pancreatitis Aguda Necrotizante que debuta como Hemorragia Digestiva Alta por Fistulización del Duodeno

Presentamos el caso de un varón de 64 años quien, tras un primer episodio de pancreatitis aguda necrotizante, reingresa a los 20 días por cuadro de dolor epigástrico intenso y posteriormente episodio de hemorragia digestiva alta en forma de hematemesis y melenas con inestabilización hemodinámica. Se realiza en ese momento gastroscopia urgente objetivándose probable fistula gastrointestinal en bulbo duodenal con coágulo adherido sin sangrado activo en ese momento por lo que se realiza angio-TC urgente que revela colección peripancreática necrótica con presencia de sangrado activo en su interior, procedente de la arteria pancreatoduodenal. La arteriografía urgente identificó imagen compatible con pseudoaneurisma arterial dependiente de la rama de arteria pancreatoduodenal, que fue embolizada con éxito. Desgraciadamente el paciente falleció en las horas posteriores, como consecuencia de un shock séptico secundario a colección pancreática infectada.

We present the case of a 64-year-old man who, after a first episode of acute pancreatitis, was readmitted 20 days later due to severe epigastric pain and later an episode of upper gastrointestinal bleeding in the form of hematemesis and melena with hemodynamic instability. An urgent gastroscopy was performed at that time, revealing a probable gastrointestinal fistula in the duodenal bulb with an adherent clot without active bleeding at that time, so an urgent CT angiography was performed that revealed a necrotic peripancreatic collection with the presence of active bleeding inside from the pancreatoduodenal artery. Urgent arteriography identified an image compatible with arterial pseudoaneurysm dependent on the pancreaticoduodenal artery branch, which was successfully embolized. Unfortunately, the patient died a few hours later as a result of septic shock secondary to an infected pancreatic collection.

Giant pancreatic pseudocyst drainage by endoscopic cystogastrostomy: Case report / Drenaje de pseudoquiste pancreático gigante mediante cistogastrostomía endoscópica: reporte de caso

Abstract Introduction: The pancreatic pseudocyst is one of the late local complications of acute pancreatitis. For managing a giant pancreatic pseudocyst, there are multiple strategies. Aim: To present the case of a patient with a giant pancreatic pseudocyst managed by endoscopic cystogastrostomy. Clinical case: A 41-year-old woman developed a giant pancreatic pseudocyst as a complication of acute pancreatitis that was managed by endoscopic cystogastrostomy without endoscopic ultrasound guidance, with good evolution. Conclusions: Endoscopic cystogastrostomy, with or without the help of ultrasound endoscopy or lumen-apposing metal stent (LAMS), is a viable, safe, effective, and economical therapeutic option for selected patients with a giant pancreatic pseudocyst.

Resumen Introducción: el pseudoquiste pancreático es una de las complicaciones locales tardías de la pancreatitis aguda. Para el manejo del pseudoquiste pancreático gigante existen múltiples estrategias. Objetivo: presentar el caso de una paciente con pseudoquiste pancreático gigante manejado mediante cistogastrostomía endoscópica. Caso clínico: mujer de 41 años que desarrolló un pseudoquiste pancreático gigante como complicación de una pancreatitis aguda y se manejó mediante cistogastrostomía endoscópica sin guía ecoendoscópica, con una adecuada evolución. Conclusiones: la cistogastrostomía endoscópica, con la ayuda o no de ecoendoscopia ni stent de aposición luminal (LAMS), es una opción terapéutica viable, segura, efectiva y económica para pacientes seleccionados con pseudoquiste pancreático gigante.

Cross clamping of the supraceliac aorta is effective for bleeding control in ruptured giant splenic artery pseudoaneurysm when proximal and distal control of the splenic artery is not possible: a case report / O clampeamento da aorta supracelíaca é eficaz no controle de sangramento em pseudoaneurisma gigante roto de artéria esplênica quando o controle proximal e distal da artéria esplênica não é possível - relato de caso

Abstract Splenic artery pseudoaneurysm is the most common of all the visceral artery pseudoaneurysms. Presentation is often variable and the condition demands immediate diagnosis and management because pseudoaneurysm rupture increases morbidity and mortality. It is associated with pancreatitis and other conditions like abdominal trauma, chronic pancreatitis, pseudocyst of the pancreas, liver transplantation, and, rarely, peptic ulcer disease. We present a case of a giant splenic artery pseudoaneurysm measuring 14x8 cm. Proximal and distal control of the vessels could not be achieved during the procedure because of local adhesions and inflammation and it was necessary to cross clamp the supraceliac aorta to control bleeding.

Resumo O pseudoaneurisma de artéria esplênica é o mais comum entre os pseudoaneurismas de artérias viscerais. A apresentação geralmente varia e requer diagnóstico e tratamento imediatos, pois a ruptura do pseudoaneurisma aumenta a morbimortalidade. Esse tipo de pseudoaneurisma está associado à pancreatite e a outras condições, como trauma abdominal, pancreatite crônica, pseudocisto de pâncreas, transplante de fígado e, raramente, úlcera péptica. Apresentamos um caso de pseudoaneurisma gigante de artéria esplênica, com tamanho de 14x8 cm. Durante o procedimento, não foi possível alcançar controle proximal e distal dos vasos devido a aderências locais e inflamação, sendo necessário o clampeamento da aorta supracelíaca para controle do sangramento.

Long-term efficacy of endoscopic transluminal drainage for acute pancreatitis complicated with walled-off necrosis or pancreatic pseudocyst / 中华消化内镜杂志

Objective:To evaluate the long-term efficacy of endoscopic transluminal drainage(ETD) for acute pancreatitis complicated with walled-off necrosis (WON) or pancreatic pseudocyst (PPC).Methods:A total of 79 patients who were diagnosed as having WON or PPC by abdominal CT or ultrasound and treated with ETD in Nanjing Drum Tower Hospital were enrolled. Past medical records and follow-up by phone call after discharge were analyzed for long-term outcomes including endocrine and exocrine functions and long-term quality of life.Results:A total of 50 patients were enrolled, including 31 patients with infected WON/PPC and 19 patients with uninfected WON/PPC. Seventeen patients (54.84%) in the infected WON/PPC group and 11 patients (57.89%) in the uninfected WON/PPC group lost 5% or more of their weight. There were no significant differences in the proportion of cases of weight loss of 5% or more ( P=0.833), or the weight loss between the two groups (12.59±8.89 kg VS 10.91±2.47 kg, P=0.522). Only one patient in the infected WON/PPC group had chronic abdominal pain. There was no significant difference in the Izbicki score between the two groups (23.79±6.74 VS 22.03±3.21, P=0.295). None of the patients developed steatorrhea after discharge. Five patients (16.67%, 5/30) in the infected WON/PPC group and 6 patients (40.00%, 6/15) in the uninfected WON/PPC group developed endocrine insufficiency with no significant difference ( P=0.140). Greater risk of secondary diabetes resulted from higher low-density lipoprotein cholesterol ( HR=1.9, 95% CI: 1.0-3.4, P=0.044)and triglycerides ( HR=1.2, 95% CI: 1.0-1.3, P =0.029). Conclusion:ETD is safe and effective for WON and PPC. But there is possibility that patients develop secondary diabetes. Additionally, greater risk of secondary diabetes results from higher low-density lipoprotein cholesterol and triglycerides.

Characteristics and management of peripancreatic effusion in chronic pancreatitis / 中华消化内镜杂志

Objective:To study the characteristics and management of peripancreatic effusion in chronic pancreatitis.Methods:Data of 32 patients with chronic pancreatitis and 141 acute pancreatitis admitted to the First Affiliated Hospital of Guangxi Medical University from January 2018 to December 2019 were collected. According to the Atlanta classification, the peripancreatic effusion was divided into four categories: acute peripancreatic fluid collection (APFC), acute necrotic collection(ANC), pancreatic pseudocyst (PPC) and walled-off necrosis (WON). The general information, clinical manifestations, medical history, laboratory examination indicators and treatment of the four types of patients were recorded and analyzed.Results:Among the 32 patients with chronic pancreatitis complicated with peripancreatic effusion, 27 patients (84.4%) were diagnosed as having PPC, 3 patients (9.4%) WON and 2 (6.2%) APFC. No chronic pancreatitis with ANC was found. The incidence of PPC was higher in patients with chronic pancreatitis than those with acute pancreatitis [84.4% (27/32) VS 31.2% (44/141), P<0.01], and the APFC was lower [6.2% (2/32) VS 24.8% (35/141), P=0.021]. The incidence of ANC was also lower [0.0% (0/32) VS 36.9% (52/141), P<0.01], and there was no significant difference in the incidence of WON [9.4% (3/32) VS 7.1% (10/141), P=0.944]. Compared with patients with peripancreatic effusion of chronic pancreatitis, acute pancreatitis showed a higher proportion of clinical manifestations: fever [19.1% (27/141) VS 3.1% (1/32)], nausea [59.6% (84/141) VS 21.9% (7/32)], vomit [56.7% (80/141) VS 21.9% (7/32)], tenderness [79.4% (112/141) VS 34.4% (11/32)], rebounding pain [42.6% (60/141) VS 0.0% (0/32)], increase of C reactive protein [95.7% (135/141) VS 40.6% (13/32)] ( P< 0.05), and the mean hospital stay was longer (13 days VS 11 days, P=0.048). Imaging examination showed that the proportion of lesions >5 cm in diameter in PPC patients with acute pancreatitis was higher than those with chronic pancreatitis [70.5% (31/44) VS 29.6% (8/27), P=0.001]. WON in chronic pancreatitis patients was limited to the pancreas [3/3 VS 1/10, P =0.014]. In terms of treatment strategies, 25 patients (78.1%) received conservative treatment in 32 chronic pancreatitis. There was no significant difference in treatment strategy between patients with acute pancreatitis and those with chronic pancreatitis. Conclusion:In the peripancreatic effusion of chronic pancreatitis, PPC is the most common. Peripancreatic effusion is mainly treated conservatively. There is no difference in treatment among different types of peripancreatic effusion in chronic pancreatitis. However, compared with chronic pancreatitis, peripancreatic effusion in acute pancreatitis may need more active intervention.

Stent selection of endoscopic ultrasound-guided transgastric drainage for pancreatic pseudocysts / 中华消化内镜杂志

Objective:To investigate the drainage efficacy of different types of plastic stents in endoscopic ultrasound (EUS)-guided transgastric drainage for pancreatic pseudocysts.Methods:Clinical data of patients with pancreatic pseudocyst who underwent EUS-guided transgastric drainage in the surgical endoscopic center of the First Hospital of Lanzhou University from March 2014 to December 2020 were retrospectively analyzed. Patients were divided into the 10 F double plastic stents group and the 7 F double plastic stents group. The drainage efficacy, complications and long-term outcomes of the two groups were compared.Results:A total of 29 patients were included, 11 in the 10 F double plastic stents group and 18 others in the 7 F double plastic stents group. The operation time of the two groups was 48.2±8.0 min and 34.7±5.8 min, respectively, showing significant difference ( t=5.24, P<0.001). There was no significant difference in the incidence of postoperative complications such as abdominal pain [18.2% (2/11) VS 5.6% (1/18)], fever [9.1% (1/11) VS 11.1% (2/18)] or bleeding (both none) between the two groups (all P>0.05). Two months after the operation, abdominal CT scan showed that the complete disappearance rates of cysts cavity in the 10 F and 7 F groups were 90.9% (10/11) and 88.9% (16/18), respectively, with no significant difference ( P=1.00). Conclusion:There are similar drainage effect and postoperative complications rates between the 7 F and the 10 F plastic stent in EUS-guided transgastric drainage for pancreatic pseudocysts. However, operation with the 7 F stent is more convenient for a shorter time, which is worth of clinical promotion.

Hepatic Liquoric Cyst as a Complication of Ventriculoperitoneal Shunt Insertion: A Case Report

Background The ventriculoperitoneal shunt (VPS) procedure is still themost used technique for management of hydrocephalus. This article reports a case of hepatic cerebrospinal fluid (CSF) pseudocyst as a rare, but important, complication of the VPS insertion. Case Description An 18-year-old male presented to the hospital complaining of temporal headache and visual turbidity for approximately 3 months with a history of VPS insertion for treatment of hydrocephalus and revision of the valve in adolescence. The diagnosis was based on abdominal imaging, demonstrating an extra-axial hepatic CSF pseudocyst free from infection. Following the diagnosis, the management of the case consisted in the removal and repositioning of the catheter on the opposite site of the peritoneum. Conclusion The hepatic CSF pseudocyst is an infrequent complication of VPS procedure, but it needs to be considered when performing the first evaluation of the patient. Several techniques are considered efficient for the management of this condition, the choice must be made based on the variables of each individual case.

Drenaje percutáneo trans-gástrico de necrosis pancreática amurallada complicado en paciente pediátrico / WON transgastric percutaneous drainage complicated in a pediatric patient

Resumen Las complicaciones de la pancreatitis aguda se dividen en sistémicas y locales, y entre estas últimas se encuentran las colecciones líquidas pancreáticas agudas, la colección necrótica aguda, el pseudoquiste y la necrosis amurallada pancreática. Se reporta el caso de niña de nueve años con pancreatitis aguda idiopática severa, quien desarrolló una necrosis pancreática amurallada de 75 x 45 mm. Por la persistencia del dolor abdominal y la intolerancia a la vía oral, a pesar del manejo médico, se indicó un abordaje percutáneo transgástrico para su tratamiento. Se obtuvo éxito técnico y terapéutico a través del drenaje de la colección, permitiendo iniciar la vía oral y disminuyendo los requerimientos de analgesia. La paciente evolucionó satisfactoriamente, con alta quirúrgica a los 13 días y retiro del catéter a los 30 días. A los cuatro meses de seguimiento se evidenció una colección recidivante asintomática, manejándose de manera conservadora. Lo anterior permite considerar que el abordaje percutáneo transgástrico es una técnica segura y eficaz; sin embargo, evaluar la efectividad y morbimortalidad en población pediátrica requiere de otros estudios que posibiliten llegar conclusiones que generen mayor evidencia científica.

Abstract The complications of acute pancreatitis are divided into systemic and local such as acute pancreatic fluid collections, acute necrotic collection, pseudocyst and pancreatic walled necrosis. The case of a nine-year-old girl with idiopathic severe acute pancreatitis who developed a pancreatic walled necrosis of 75 x 45mm is reported. Due to the persistence of abdominal pain and intolerance to the oral route, despite medical treatment, a trans gastric percutaneous approach was indicated for the treatment of pancreatic walled necrosis. Technical and therapeutic success was obtained through the drainage of the collection, allowing to start the oral route and decreasing the analgesia requirements. The patient evolved satisfactorily, with surgical discharge after 13 days and removal of the catheter after 30 days. After 4 months of follow-up, a recurrent asymptomatic collection was evidenced, being handled in a conservative manner. The above mentioned allows considering that the trans-gastric percutaneous approach is a safe and effective technique; however, evaluating the effectiveness and morbimortality in pediatric population requires other studies that make possible to reach conclusions that generate more scientific evidence.

Abordaje percutáneo transgástrico en la disrupción ductal del páncreas: serie de casos / Percutaneous transgastric approach in pancreatic ductal disruption: Case series

Resumen Se presentan 6 pacientes con disrupción ductal del páncreas (DDP) tratados mediante drenaje percutáneo guiado por imágenes con apoyo de la endoscopia. Inicialmente, los pacientes presentaron necrosis pancreática infectada tratada con drenaje percutáneo transgástrico y luego de resolver la infección desarrollaron DDP. En el estudio por imágenes se diagnosticaron 4 pacientes con disrupción ductal parcial y 2 con disrupción total, a quienes se les indicó la colocación de una prótesis transgástrica percutánea para lograr el drenaje del líquido pancreático hacia el estómago. La duración promedio de la prótesis fue de 183 días; no hubo casos de mortalidad. Se pudo evidenciar que esta opción terapéutica mínimamente invasiva tiene baja morbimortalidad, por lo que se plantea el abordaje percutáneo transgástrico apoyado por la endoscopia como posible tratamiento de la DDP.

Abstract A total of six patients with pancreatic ductal disruption (PDD), treated with image-guided endoscopy percutaneous drainage were enrolled. Initially, patients had infected pancreatic necrosis, treated with transgastric percutaneous drainage, and after the infection was controlled, they developed PDD. In the imaging study process, four patients were diagnosed with partial duct disruption and two patients with complete duct disruption. In both cases the placement of a percutaneous transgastric prosthesis to drain the pancreatic fluids to the stomach was indicated. The prosthesis remained 183 days on average and there were no mortality cases. This therapeutic minimally invasive alternative has low rates of morbimortality and thus, the endoscopy percutaneous transgastric approach is considered as a viable treatment in PPD.

Manejo quirúrgico de pseudoquiste pancreático gigante: caso clínico / Surgical management of giant pancreatic pseudocyst: case report

Resumen Introducción: Los pseudoquistes pancreáticos (PQP) corresponden al 80% de las lesiones quísticas del páncreas. Se debe descartar un tumor quístico, que representan el 10% al 15% de los quistes del páncreas y 1% de los tumores malignos por lo que es fundamental el estudio y diagnóstico diferencial. El término pseudoquiste pancreático gigante se usa tradicionalmente cuando el tamaño es mayor de 10 cm. Hay pocos casos de PQP gigantes en la literatura nacional. Objetivo: Reportar caso clínico con PQP gigante, analizar el diagnóstico diferencial y las opciones terapéuticas. Materiales y Método: Paciente con distensión abdominal progresiva, pérdida de peso y anorexia, posepisodio de pancreatitis aguda. Tomografía computarizada abdominal y resonancia magnética confirman lesión quística gigante intraabdominal. El paciente fue tratado con una cistoyeyunostomía pancreática abierta en Y de Roux. El análisis del contenido aspirado durante la cirugía sugiere PQP. Para la discusión se revisa la literatura más relevante. Resultados: Excelente resultado clínico postoperatorio, el estudio histopatológico de la pared del quiste confirmó el diagnóstico de pseudoquiste pancreático. Al año de seguimiento, el paciente permanece asintomático. Discusión: El estudio preoperatorio es crucial para determinar el diagnóstico diferencial y descartar lesiones neoplásicas o parasitarias quísticas. Los PSQ gigantes reportados son poco frecuentes y su manejo quirúrgico dependerá fundamentalmente de su tamaño, de las relaciones anatómicas y de la experiencia del equipo tratante.

Introduction: Pancreatic pseudocysts (PQP) correspond to 80% of cystic lesions of the pancreas. A cystic tumor must be ruled out, which represents 10% to 15% of pancreatic cysts and 1% of malignant tumors, so the study and differential diagnosis is essential. The term giant pancreatic pseudocyst is traditionally used when the size is greater than 10 cm. There are few cases of giant PQP in the national literature. Objective: To report a clinical case with giant PQP, to analyze the differential diagnosis and therapeutic options. Materials and Method: Patient with progressive abdominal distension, weight loss and anorexia post episode of acute pancreatitis. Abdominal computed tomography and magnetic resonance imaging confirm a giant intra-abdominal cystic lesion. The patient was treated with an open Roux-en-Y pancreatic cysto-jejunostomy. Analysis of the content aspirated during surgery suggests PQP. The most relevant literature is reviewed for discussion. Results: Excellent postoperative clinical results, the histopathological study of the cyst wall, confirmed the diagnosis of pancreatic pseudocyst. At one year of follow-up, the patient remains asymptomatic. Discussion: The preoperative study is crucial to determine the differential diagnosis and rule out neoplastic or cystic parasitic lesions. Reported giant PSQs are rare and their surgical management will depend fundamentally on their size, anatomical relationships, and the experience of the treating team.

Cistogastroanastomosis laparoscópica en un paciente pediátrico: reporte de un caso / Laparoscopic cystogastroanastomosis in a pediatric patient: a case report

RESUMEN Los trastornos pancreáticos, las pancreatitis agudas de etiología biliar son infrecuentes en pediatría y más aún los pseudoquistes pancreáticos, los cuales son colecciones líquidas rodeadas por una cápsula fibrosa sin epitelio, generalmente secundario a una pancreatitis aguda. Presentamos el caso de una paciente femenina de 14 años, con antecedente de pancreatitis aguda de origen biliar hace 10 meses, que presenta dolor abdominal y una masa palpable en epigastrio. Se realizaron estudios imagenológicos, confirmando el diagnóstico de pseudoquiste pancreático y colelitiasis. Se optó por las bondades técnicas y estéticas de la laparoscopía, para esta población. Por lo cual, se realizó una cistogastroanastomosis y colecistectomía laparoscópica, con una evolución favorable. Nosotros reafirmamos que esta técnica, es un método seguro y efectivo, para el manejo de esta patología en pacientes pediátricos, y debería considerarse como primera opción, al no contar con procedimientos endoscópicos. Siendo este, el primer reporte en nuestro medio.

ABSTRACT The pancreatic disorders, as acute pancreatitis, of biliary etiology are rare in pediatrics, even more the pancreatic pseudocysts. They are liquid collections surrounded of a fibrous capsule without epithelium, secondary to acute pancreatitis. We present the case of a 14-year-old female patient with a history of acute pancreatitis because of biliary etiology, 10 months prior. She complained of intermittent abdominal pain and a palpable mass in the epigastrium. The Imaging studies showed a pancreatic pseudocyst and cholelithiasis. The laparoscopy was chosen because the technical and esthetic benefits for this population. Therefore, a laparoscopic cystogastro-ostomy-anastomosis and cholecystectomy were performed, with good progress. We affirm this technique is a safe and effective method for the management of this pathology in pediatric patients, and it should be considered as the first option in case endoscopic procedures are not available. This is the first report in our settings.

Efficacy and safety of endoscopic ultrasound-guided drainage of pancreatic pseudocysts using double-pigtail plastic stents: A single tertiary center experience

OBJECTIVES: Pancreatic pseudocysts (PPC) are fluid collections with a well-defined wall that persist for more than 4 weeks inside or around the pancreas as a result of pancreatic inflammation and/or a ductal lesion. PPC have been successfully treated with endoscopic ultrasound (EUS)-guided drainage using different stents. This study aimed to evaluate the safety and efficacy of EUS-guided drainage of PPC using double-pigtail plastic stents in a tertiary hospital. METHODS: Patients with PPC referred for EUS-guided drainage between May 2015 and December 2019 were included in this case series. The primary endpoint was to evaluate the efficacy (clinical success) and safety (adverse events and mortality) of EUS-guided drainage of PPC. Secondary endpoints included technical success and pseudocyst recurrence. RESULTS: Eleven patients (mean age, 44.5±18.98 years) were included in this study. The etiologies for PPC were acute biliary pancreatitis, chronic alcoholic pancreatitis, and blunt abdominal trauma. The mean pseudocyst size was 9.4±2.69 cm. The clinical success rate was 91% (10/11). Adverse events occurred in three of 11 patients (27%). There were no cases of mortality. The technical success rate was 100%. Pseudocyst recurrence was identified in one of 11 patients (9%) at 12 weeks after successful clinical drainage and complete pseudocyst resolution. CONCLUSION: EUS-guided transmural drainage of PPC using double-pigtail plastic stents is safe and effective with high technical and clinical success rates.

Risk factor analysis of pancreatic pseudocyst in patients with severe acute pancreatitis / 中华胰腺病杂志

Objective:To investigate the risk factors of pancreatic pseudocyst (PPC) in patients with severe acute pancreatitis (SAP).Methods:The clinical data of 142 SAP patients treated in the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2019 were collected and retrospectively analyzed. The patients were divided into two groups: group with PPC ( n=48) and group without PPC ( n=94) according to whether they were complicated with PPC. The sex, age, body mass index, etiology, past history of diabetes or pancreatitis, modified CT severity index (MCTSI) score within 3 to 10 days of the onset, APACHEⅡ score within 48 hours of admission, fasting time, oxygenation index, hematocrit, white blood cell count, the percentage of neutrophil, serum procalcitonin (PCT), the levels of albumin, urea nitrogen(BUN), serum calcium, lactate dehydrogenase and creatinine, whether complicated with ascites and whether hemofiltration treatment was performed within 24 hours after admission were recorded. Univariate analysis and multivariate logistic stepwise regression were used to analyze the independent risk factors of PPC formation after SAP. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to evaluate the efficacy of each index in predicting the formation of PPC in patients with SAP. Results:Univariate analysis showed that PPC formation significantly correlated with MCTSI score, APACHEⅡ score, fasting time, PCT, serum albumin, BUN, lactate dehydrogenase, creatinine, serum calcium level and ascites ( P<0.05). Multivariate regression analysis showed that MCTSI score ( OR=1.81, 95% CI 1.273-2.571, P=0.001) and fasting time ( OR=1.083, 95% CI 1.002-1.171, P=0.044) were the risk factors for PPC formation in SAP patients. Serum albumin ( OR=0.875, 95% CI 0.781-0.979, P=0.02) and serum calcium ( OR=0.02, 95% CI 0.002-0.178, P<0.001) were the protective factors for PPC formations. AUC predicted by MCTSI score, fasting time, serum albumin and serum calcium levels for PPC formations in patients with SAP were 0.783 (95% CI 0.706-0.860), 0.650 (95% CI 0.553-0.746), 0.809(95% CI 0.738-0.881) and 0.855(95% CI 0.795-0.915) respectively, and the best cut-off values predicted were 7 points, 17.5 days, 33.5 g/L and 1.79 mmol/L. Conclusions:MCTSI score >7, fasting time >17.5 days, hypocalcemia and low albumin level were the independent risk factors for SAP complicated with PPC, which need close follow-up and timely intervention.