Different clinical aspects of Wirsungocele: case series of three patients and review of literature.

The association of Santorinicele with pancreas divisum has been described. This anatomic condition creates ideal conditions for acute pancreatitis episodes and chronic abdominal pain. Saccular dilation of main pancreatic duct has also been described as incidental finding and causing episodes of acute pancreatitis. However, there is no description of associated chronic abdominal pain. Three detailed cases of Wirsungocele demonstrated by endoscopic retrograde cholangiopancretography are presented. Two of them had episodes of acute pancreatitis and one had chronic abdominal pain. All patients were treated by endoscopic biliopancreatic sphincterotomy. After a follow-up for more than two years, none presents clinical recurrence. Endoscopic biliopancreatic sphincterotomy for symptomatic patients with this anatomic condition seems safe and effective.

Pseudoquiste pancreático en edad pediátrica / Pancreatic pseudocyst in children

Los pseudoquistes de páncreas en niños ocurren después de una pancreatitis aguda o un trauma, aproximadamente enun 8-10 por ciento, es la complicación más frecuente de estas entidades. El dolor puede ser difícil de valorar en niños, sobre todo en politraumatizados, una elevación de amilasa sérica suele ocurrir luego de las 12 h iniciales al trauma, constituye el dato más importante de laboratorio, que nos puede alarmar, aunque esta elevación también se puede observar en perforación intestinal, trombosis mesentérica, etc. Los síntomas y signos en muchas ocasiones no aparecen hasta avanzada la formación del mismo, y otras veces son asintomáticos hasta descubrirse la tumoración, luego de una ultrasonografía. Por lo engorrosa que es esta enfermedad para el cirujano, con respecto al diagnóstico, tratamiento médico y quirúrgico, así como una serie de conceptos nuevos aparecidos en la literatura internacional se decidió realizar una revisión bibliográfica referente al tema(AU)

Pseudoquiste pancreático en edad pediátrica / Pancreatic pseudocyst in children

Los pseudoquistes de páncreas en niños ocurren después de una pancreatitis aguda o un trauma, aproximadamente enun 8-10 por ciento, es la complicación más frecuente de estas entidades. El dolor puede ser difícil de valorar en niños, sobre todo en politraumatizados, una elevación de amilasa sérica suele ocurrir luego de las 12 h iniciales al trauma, constituye el dato más importante de laboratorio, que nos puede alarmar, aunque esta elevación también se puede observar en perforación intestinal, trombosis mesentérica, etc. Los síntomas y signos en muchas ocasiones no aparecen hasta avanzada la formación del mismo, y otras veces son asintomáticos hasta descubrirse la tumoración, luego de una ultrasonografía. Por lo engorrosa que es esta enfermedad para el cirujano, con respecto al diagnóstico, tratamiento médico y quirúrgico, así como una serie de conceptos nuevos aparecidos en la literatura internacional se decidió realizar una revisión bibliográfica referente al tema

Renohepaticopancreatic dysplasia: diagnostic dilemma.

We present the case of an eighteen day old baby boy hospitalized with an abdominal mass, renal insufficiency and jaundice. Multiple radiographic, radionuclear and surgical interventions were required to diagnose renohepaticopancreatic dysplasia, also known as Ivemark II syndrome. In spite of aggressive intensive care support, the patient developed multisystemic organ failure and died. Clinical presentation and autopsy findings are presented.

Renohepaticopancreatic dysplasia: diagnostic dilemma

We present the case of an eighteen day old baby boy hospitalized with an abdominal mass, renal insufficiency and jaundice. Multiple radiographic, radionuclear and surgical interventions were required to diagnose renohepaticopancreatic dysplasia, also known as Ivemark II syndrome. In spite of aggressive intensive care support, the patient developed multisystemic organ failure and died. Clinical presentation and autopsy findings are presented.

Síndrome de Ogilvie: a propósito de un caso / Ogilvies syndrome: a case report

Se analiza una paciente que presenta Síndrome de Ogilvie (Pseudoobstrucción Colónica), después del drenaje percutáneo de un Pseudoquiste Pancreático. Se mencionan diferentes cuadros clínicos que se han complicado con este síndrome, como también las manifestaciones clínicas, los métodos de diagnóstico y las posibilidades terapéuticas. En la literatura consultada no ha sido encontrado el drenaje de un Pseudoquiste como etiología del Síndrome de Ogilvie. (AU)

Síndrome de Ogilvie: a propósito de un caso / Ogilvie's syndrome: a case report

Se analiza una paciente que presenta Síndrome de Ogilvie (Pseudoobstrucción Colónica), después del drenaje percutáneo de un Pseudoquiste Pancreático. Se mencionan diferentes cuadros clínicos que se han complicado con este síndrome, como también las manifestaciones clínicas, los métodos de diagnóstico y las posibilidades terapéuticas. En la literatura consultada no ha sido encontrado el drenaje de un Pseudoquiste como etiología del Síndrome de Ogilvie.

[Cavity effusions in patients with chronic pancreatitis]. / Derrames cavitários em portadores de pancreatite crônica.

In Brazil, the incidence of IPF due to alcohol-induced CP seems to be higher than in other countries. The authors analysed some general, epidemiologic, laboratory and radiologic features in 98 patients with CP, all of them alcoholics, divided in two groups: 49 patients without IPF (I) and 49 patients with IPF (II). The authors first analysed the following parameters in each group and then comparatively in both groups: age, sex, race, smokers and daily consumption of cigarettes, daily consumption of alcoholic beverages, years of alcohol consumption, and mortality. The authors concluded that pancreatic fistula plays in effusions the main role, secondary to cysts disruption or necrosis of the main pancreatic duct.

Polycystic kidneys, pancreatic cysts, and cystadenomatous bile ducts in the oral-facial-digital syndrome type I.

Oral-facial-digital syndrome type I is a group of X-linked dominant conditions, lethal in utero in male individuals. Internal anomalies are less well documented than are external findings. We report a case of typical phenotype and absent family history of kidney disease in a 15-year-old white girl (46,XX) who died of renal failure and massive cerebral hemorrhage. At necropsy, the kidneys were greatly enlarged but of fairly normal shape. The cortex was replaced by thin-walled spherical cysts, 0.5 to 2.0 cm in diameter; the majority of the smaller cysts were located deep in the cortex, and the medulla contained lesser numbers of larger cysts. No distal urinary tract obstruction was present. Microdissection revealed cysts and diverticula located in all segments of the nephrons and collecting ducts. Uninvolved nephrons showed diffuse hypertrophy. These findings were correlated with immunoperoxidase stains using peanut lectin, Lotus tetragonolobus agglutinin, antibodies to cytokeratins, stage-specific embryonic antigen-1, Tamm-Horsfall protein, and epithelial membrane antigen. Other visceral anomalies included biliary cystadenomatous proliferation in the liver and pancreatic cysts. The renal changes are similar to those of autosomal dominant (adult-type) polycystic disease.

Regressäo espontânea de cistos pancreaticos em portadores de pancreatite crônica / Spontaneous remission of pancreatic cysts in patients with chronic pancreatitis

Trinta e um pacientes portadores de pancreatite crônica alcoólica com cisto (s) de páncreas foram acompanhados, através de exames ultra-sonográficos, com o intuito de avaliar-se evoluçäo das formaçöes císticas. O tempo médio de seguimento foi de 15,6 ñ 9,2 meses; a idade média dos pacientes foi de 40,2 ñ 9,3 anos, sendo 93,5% do sexo masculino e 6,4% do feminino. A ingestäo média diária de etanol foi de 288,3 ñ 185,9 m, por um tempo médio de 20,8 ñ 9 anos. Em 67,7% dos pacientes apresentaram resoluçäo espontânea dos cistos em menos de 18 meses; os parâmetros avaliados como idade dos pacientes, tempo e qualidade de ingestäo alcoólica, presença de dor, de diabete, de calcificaçöes pancreáticas e de intervalos pancreáticas para drenagem dos cistos näo interferiram de forma significativa na resoluçäo espontánea dos cistos. Quanto a variaçäo de diámetro, em 52,3% dos pacientes cujas formaçöes císticas regrediram totalmente, as mesmas aumentaram inicialmente suas dimensöes, antes de involuírem; os cistos localizados na regiäo cefálica da glândula tiveram menor tendência a resoluçäo espontânea. Complicaçöes ocorreram em dois casos (6,4%), ambos tendo tido boa evoluaçäo, um deles após tratamento cirúrgico. Com os dados obtidos, os autores sugerem que a presença de cisto (s) pancreático (s) em pacientes com PC alcoólica näo indica necessariamente tratamento cirúrgico imediato, desde que estes pacientes possam ser acompanhados cuidadosamente para que quaisquer complicaçöes sejam detectadas precocemente

[Spontaneous remission of pancreatic cysts in patients with chronic pancreatitis]. / Regressão espontânea de cistos pancreáticos em portadores de pancreatite crônica.

Thirty one alcoholic patients with pancreatic cysts were studied by ultrasonographic scanning with the purpose to observe the evolution of the cysts. The mean time of the follow-up was 15.6 +/- 9.2 months; the patients were aged 40.2 +/- 9.3 years (male = 93.5%; female = 6.4%) the average pure ethanol intake was 288.3 +/- 185.9 ml for a period of 20.8 +/- 9.3 years. In 21 of the 31 patients (67.7%) the ultrasonographic examination showed total spontaneous resolution of the cysts within a time span of less than 18 months. The majority of the parameters studied (age, time and volume of ethanol intake, pain, diabetes, calcifications and previous cyst drainage) had no relation with the evolution of the cysts. In 11 patients (52.3%) the cysts showed an initial enlargement before decreasing in size. The cysts located in the pancreatic head showed less tendency to spontaneous resolution. Complications were observed in two patients: intra-cystic haemorrhage in one and rupture into the peritoneal cavity in the other. Our observations suggest that patients with pancreatic cysts secondary to chronic alcoholic pancreatitis should be controlled with periodical ultrasonography. Surgical approach should be reserved for patients with complications.

Free intraperitoneal rupture of a pancreatic pseudocyst: a presentation of acute abdominal trauma.

A rare case of traumatic rupture of a pancreatic pseudocyst is presented. Its unique aspect is definitive pseudocyst drainage via a Roux-en-Y cystjejunostomy at initial laparotomy.

[Value of echography in acute pancreatitis]. / Valeur de l'échographie dans les pancréatities aiguës.

We were evaluated the sensibility in acute pancreatitis with ultrasound method (US). Thus, we were studied 48 cases with clinical and biological table of acute pancreatitis. In all these cases, we had surgical confirmation. US exploration were made before and/or after surgical treatment. US was made once in 27 patients, twice in 14, and more times in 7. Accurate diagnosis we made in the 75% of the cases; 8.3% were false negatives; 16,6% were unexplored ultrasonically. The increase of the pancreatic volume, was the most tiically characteristic ultrasound finding. In agreement with others authors, we had 35.41% of the cases with cysts and abscess formation between the complicated acute pancreatitis, (20.84% were confirmed surgically). Hence, we conclude that US is an high sensitive and specific method to employ when clinical acute pancreatitis is pose.

[Pseudocysts of the pancreas. Considerations on 18 cases]. / Seudoquistes de páncreas. Consideraciones sobre 18 casos.

The authors present their experience in the study and treatment of 18 patients with pancreatic pseudocysts. Fifteen patients were operated on as follows: 6 external drainage 4 cyst-gastrostomy, 4 cystoyeyunostomy and one had distal pancreatectomy. Nine of the patients who were operated did well and 6 died in the postoperative course; one died after a prolonged period of time.

Pseudocyst formation in hereditary pancreatitis.

The previously estimated incidence of pseudocyst formation in hereditary pancreatitis is approximately 10%. Our experience in nine patients with hereditary pancreatitis yielded five surgically documented pseudocysts and three additional patients with radiographically documented mass effects. Recent studies have shown a 20% spontaneous regression rate for pancreatic pseudocysts (of all etiologies), when evaluated by B-mode ultrasonography; our experience suggests that the incidence of pseudocyst formation in hereditary pancreatitis is considerably higher than previously suspected. Ultrasonography is thought to be an excellent method for diagnosing this entity, of evaluating mass effects identified on radiographic studies, and of providing sequential evaluation of pseudocysts treated surgically or conservatively.