Assuntos
Amilases/análise , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Pâncreas/diagnóstico por imagem , Pseudocisto Pancreático , Derrame Pleural , Tomografia Computadorizada por Raios X/métodos , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Pseudocisto Pancreático/complicações , Pseudocisto Pancreático/diagnóstico , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/terapia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Derrame Pleural/metabolismo , Fatores de RiscoRESUMO
OBJECTIVE: Recent years have witnessed an increase in acute pancreatitis (AP) in children; however, the natural history of acute fluid collection (AFC) and pseudocyst is largely unknown. We evaluated the frequency, clinical characteristics, and natural history of pseudocysts in children with AP. METHODS: Children with AP admitted at Sanjay Gandhi Postgraduate Institute of Medical Sciences from 2001 to 2011 were enrolled and studied until complete resolution. Subjects with inadequate follow-up, recurrent AP, and chronic pancreatitis were excluded. RESULTS: Of the 58 children (43 boys, median age 14 [1-18] years) with AP, 34 (58.6%) and 22 (38%) developed AFC and pseudocyst, respectively. No difference in age (12 [4-18] vs 13 [1-16] years), etiology (idiopathic 64% vs 47% and traumatic 27.2% vs 22.2%), and systemic complications (pulmonary [18% vs 11%], renal [22.7% vs 11%], and shock [13.6% vs 10%]) was observed between children with and without pseudocyst. A total of 11 of the 22 subjects with pseudocyst underwent drainage, the commonest symptom requiring drainage being gastric outlet obstruction [nâ=â5] and infection [nâ=â2]. The 11 of the 22 children with AP and pseudocyst (size 6.4 [3-14.4] cm) showed spontaneous resolution (disappearance [nâ=â9] and significant reduction in size [nâ=â2]) during 110 (25-425) days. Symptomatic pseudocysts requiring drainage were more often secondary to traumatic AP (6/6 vs 2/14 [idiopathic], Pâ=â0.0007) than asymptomatic pseudocysts resolving spontaneously. Overall, only 26.4% (9/34) children with AFC required drainage because of symptomatic pseudocyst. CONCLUSIONS: Among children with AP, 58.6% developed AFC and 38% developed pseudocysts. Only patients with symptomatic pseudocyst need drainage, and asymptomatic pseudocyst can be safely observed irrespective of size and duration of collection.
Assuntos
Pseudocisto Pancreático/cirurgia , Pancreatite/fisiopatologia , Paracentese , Doença Aguda , Adolescente , Doenças Assintomáticas , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Lactente , Masculino , Prontuários Médicos , Pseudocisto Pancreático/epidemiologia , Pseudocisto Pancreático/fisiopatologia , Paracentese/efeitos adversos , Prevalência , Remissão Espontânea , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Conduta ExpectanteAssuntos
Adenocarcinoma Mucinoso , Endoscopia do Sistema Digestório/métodos , Neoplasias Pancreáticas , Pseudocisto Pancreático , Implantação de Prótese , Adenocarcinoma Mucinoso/etiologia , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Mucinoso/fisiopatologia , Adenocarcinoma Mucinoso/cirurgia , Idoso , Progressão da Doença , Dissecação/métodos , Drenagem/métodos , Humanos , Masculino , Invasividade Neoplásica , Neoplasias Pancreáticas/etiologia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/fisiopatologia , Neoplasias Pancreáticas/cirurgia , Pseudocisto Pancreático/complicações , Pseudocisto Pancreático/diagnóstico , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/cirurgia , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Stents , Resultado do Tratamento , Ultrassonografia/métodosRESUMO
The authors have shown a possibility of minimally invasive interventional surgery in treatment of postnecrotic cysts of the pancreas and their complications. The most optimal accesses for drainage of the cavities located inside the body and the pancreas head are determined. The use of the methods of internal drainage of the cyst cavity connected with the main pancreatic duct allowed avoidance of open operations. The results of antegrade percutaneous or transcavital as well as retrograde endoscopic restoration of the patency of the main pancreatic duct in treatment of the pancreatic cysts connected with the duct system are shown.
Assuntos
Fístula do Sistema Digestório , Drenagem/métodos , Pseudocisto Pancreático , Pancreatite Necrosante Aguda/complicações , Adulto , Fístula do Sistema Digestório/diagnóstico por imagem , Fístula do Sistema Digestório/etiologia , Fístula do Sistema Digestório/fisiopatologia , Fístula do Sistema Digestório/cirurgia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/etiologia , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/cirurgia , Pancreatite Necrosante Aguda/mortalidade , Pancreatite Necrosante Aguda/fisiopatologia , Análise de Sobrevida , Resultado do Tratamento , UltrassonografiaAssuntos
Asparaginase , Drenagem/métodos , Endoscopia Gastrointestinal/métodos , Pseudocisto Pancreático , Pancreatite Necrosante Aguda , Polietilenoglicóis , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Asparaginase/administração & dosagem , Asparaginase/efeitos adversos , Pré-Escolar , Enzimas Imobilizadas/administração & dosagem , Enzimas Imobilizadas/efeitos adversos , Humanos , Masculino , Pseudocisto Pancreático/diagnóstico , Pseudocisto Pancreático/etiologia , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/cirurgia , Pancreatite Necrosante Aguda/induzido quimicamente , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/diagnóstico , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Resultado do TratamentoRESUMO
GOALS: To evaluate clinical, biochemical, and radiologic parameters at admission, which predict the development of acute pseudocyst (AP) after acute pancreatitis. BACKGROUND: There is limited data on factors that predict the development of AP. STUDY: Seventy-five consecutive patients with AP were prospectively enrolled and subjected to clinical, laboratory, and radiologic investigation. The patients were followed up for a period of 4 weeks and then investigated radiologically for the development of AP. RESULTS: After exclusion, 65 patients (44 males) were studied. The median age was 37 years (40.9±15.5 y). Etiology of acute pancreatitis was alcohol in 24 patients, gallstones in 18, both in 4, drugs in 4, pancreas divisum in 2, postendoscopic retrograde cholangiopancreatography in 1, trauma in 1, and idiopathic in 11 patients. On admission, acute fluid collections were observed in 34 (52.31%) patients. Necrosis was noted in 38 (58.46%) patients (<30% necrosis, 30% to 50% necrosis, and >50% necrosis was observed in 36.8%, 26.3%, and 36.8% patients, respectively). On follow-up, 34 (52.3%) patients developed a pseudocyst. On univariate analysis, the factors significantly associated with pseudocyst formation were male sex, palpable mass, blood sugar greater than 150 mg/dL, necrosis, sepsis, acute fluid collections, presence of ascites, pleural effusion, a high grade of pancreatitis, and a high computed tomography severity index (CTSI) score. Multivariate regression analysis showed that male sex, presence of a palpable abdominal mass, ascites, and a high CTSI score were associated with the development of AP. CONCLUSIONS: Male sex, palpable mass, ascites, and a high CTSI score at admission can predict the development of a pseudocyst after an attack of acute pancreatitis. Acute pancreatitis patients with these parameters at admission should be closely followed for the development of a pseudocyst.
Assuntos
Pseudocisto Pancreático/diagnóstico por imagem , Pancreatite/etiologia , Doença Aguda , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pseudocisto Pancreático/fisiopatologia , Pancreatite/complicações , Pancreatite/diagnóstico por imagem , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Pancreatic fluid collections (PFC), including pancreatic pseudocysts and walled-off pancreatic necrosis, are a known complication of severe acute pancreatitis. A majority of the PFCs remain asymptomatic and resolve spontaneously. However, some PFCs persist and can become symptomatic. Persistent PFCs can also cause further complications such as the gastric outlet, intestinal, or biliary obstruction and infection. Surgical interventions are indicated for the drainage of symptomatic sterile and infected PFCs. Management of PFCs has evolved from a primarily surgical or percutaneous approach to a less invasive endoscopic approach. Endoscopic interventions are associated with improved outcomes with lesser chances of complications, faster recovery time, and lower healthcare utilization. Endoscopic ultrasound-guided drainage of PFCs using lumen-apposing metal stents has become the preferred approach for the management of symptomatic and complicated PFCs.
Assuntos
Drenagem/métodos , Endossonografia/métodos , Pseudocisto Pancreático/terapia , Pancreatite Necrosante Aguda/terapia , Aneurisma/etiologia , Ascite/etiologia , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Tratamento Conservador , Líquido Cístico/citologia , Líquido Cístico/metabolismo , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Nutrição Enteral , Infecções/etiologia , Obstrução Intestinal/etiologia , Icterícia Obstrutiva/etiologia , Imageamento por Ressonância Magnética , Fístula Pancreática/etiologia , Pseudocisto Pancreático/complicações , Pseudocisto Pancreático/diagnóstico , Pseudocisto Pancreático/fisiopatologia , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/fisiopatologia , Veia Porta , Ruptura Espontânea/etiologia , Veia Esplênica , Stents , Tomografia Computadorizada por Raios X , Ultrassonografia , Trombose Venosa/etiologiaRESUMO
BACKGROUND: Acute pancreatitis leads to abdominal hypertension and compartment syndrome. Weeks after the episodes pancreatic fluids sometimes organize to pseudocysts, fluid collections by or in the gland. Aims of the present study were to evaluate the intra-abdominal pressure (IAP) induced by large pancreatic pseudocysts and to examine the effect of their transcutaneous drainage on IAP. METHODS: Twenty seven patients with a pancreatic pseudocyst were included. Nine patients with pseudocysts greater than 1l (group A) had CT drainage and eighteen (volume less than 1l) were the control group. The measurements of group A were taken 6 hours before and every morning after the drainage, while for group B, two measurements were performed, one at the day of the initial CT and one 7 days after. Abdominal compliance (Cabd) was calculated. Data were analyzed using student's t-test. RESULTS: Baseline IAP for group A was 9.3 mmHg (S.D. 1.7 mmHg), while the first post-drainage day (PDD) IAP was 5.1 mmHg (S.D. 0.7 mmHg). The second PDD IAP was 5.6 mmHg (S.D. 0.8 mmHg), the third 6.4 mmH (S.D. 1.2 mmHg)g, the fourth 6.9 mmHg (S.D. 1.6 mmHg), the fifth 7.9 mmHg (S.D. 1.5 mmHg), the sixth 8.2 mmHg (S.D. 1.4 mmHg), and the seventh 8.2 mmHg (S.D. 1.5 mmHg). Group B had baseline IAP 8.0 mmHg (S.D. 1.2 mmHg) and final 8.2 mmHg (S.D. 1.4 mmHg). Cabd after drainage was 185.6 ml/mmHg (SD 47.5 ml/mmHg). IAP values were reduced between the baseline and all the post-drainage measurements in group A. IAPs seem to stabilize after the 5th post-drainage day. Baseline IAP was higher in group A than in group B, while the two values, at day 7, were equivalent. CONCLUSION: The drainage of large pancreatic pseudocyst reduces IAP. Moreover, the IAP seems to rise shortly after the drainage again, but in a way that it remains inferior to the initial value. More chronic changes to the IAP are related to abdominal cavity's properties and have to be further studied.
Assuntos
Abdome/fisiopatologia , Drenagem/métodos , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/terapia , Pressão , Cavidade Abdominal/fisiopatologia , Doença Aguda , Idoso , Doença Crônica , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/fisiopatologia , Feminino , Humanos , Masculino , Pseudocisto Pancreático/etiologia , Pancreatite/complicações , Estudos Prospectivos , Resultado do TratamentoRESUMO
Pancreatic pseudocyst is a rare benign condition, in particular among children. It is an intra or extra pancreatic juice collection lacking of an epithelial lining. We conducted a retrospective study of 7 children whose medical record data were collected in the Department of Paediatric Surgery at the University Hospital Hassan II in Fez, over a period of 11 years, from 1 January 2005 to 31 December 2016. All children were male, their average age was 6.6 years (15 months - 12 years). An history of abdominal trauma was found in 4 cases, abdominal bloating, pain, vomiting and transit disorders were the primary reason for consultation. Clinical examination showed epigastric tenderness and an alteration of the general state in all cases. Abdominal ultrasound as well as abdominal CT scan helped to diagnose pancreatic pseudocyst before surgery. Six patients, out of a total of seven, underwent surgery; we opted for internal bypass (gastro-cystic anastomosis) in 4 cases, external bypass in 2 cases and therapeutic abstention in one case. Pancreatic pseudocysts are rare. Nevertheless, they are the most frequent (80% of pancreatic cystic lesions are pseudocysts and due to acute and/or chronic pancreatitis, pancreatic trauma or pancreatic ductal obstruction).
Assuntos
Traumatismos Abdominais/epidemiologia , Dor Abdominal/etiologia , Pseudocisto Pancreático/diagnóstico por imagem , Traumatismos Abdominais/complicações , Dor Abdominal/epidemiologia , Criança , Pré-Escolar , Hospitais Universitários , Humanos , Lactente , Masculino , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Vômito/epidemiologia , Vômito/etiologiaRESUMO
CONTEXT: Vascular complications of pancreatitis are more common in alcohol- rather than gallstone-induced pancreatitis. Such complications are an important cause of mortality and morbidity, although peripancreatic vessel obstruction is a rare consequence. Patients with peripancreatic arterial obstruction can present with sudden and unexplained clinical deterioration requiring prompt diagnosis and intervention. CASE REPORT: A 42-year-old woman with a proven pancreatic pseudocyst presented with acute abdominal pain. Initial investigations were non-diagnostic. A gastroscopy revealed patchy necrosis of the proximal stomach. Following sudden clinical deterioration, a contrast-enhanced CT scan was performed. The CT scan demonstrated a thickened gastric wall with intramural gas. The decision was taken to proceed to laparotomy, which revealed both gastric and splenic infarction. A total gastrectomy with Roux-en-Y reconstruction and splenectomy was performed. She made a successful recovery. CONCLUSION: Arterial thrombosis should be considered in any patient with chronic pancreatitis who presents with an acute clinical deterioration. Successful outcomes can be achieved with prompt diagnosis using contrast-enhanced CT scanning and early surgical intervention.
Assuntos
Artéria Celíaca/patologia , Pseudocisto Pancreático/complicações , Baço/patologia , Infarto do Baço/etiologia , Estômago/patologia , Trombose/etiologia , Adulto , Alcoolismo/complicações , Anastomose em-Y de Roux , Artéria Celíaca/fisiopatologia , Feminino , Gastrectomia , Humanos , Laparotomia , Necrose , Pseudocisto Pancreático/diagnóstico , Pseudocisto Pancreático/fisiopatologia , Pancreatite Crônica/complicações , Baço/irrigação sanguínea , Baço/cirurgia , Esplenectomia , Infarto do Baço/diagnóstico , Infarto do Baço/cirurgia , Estômago/irrigação sanguínea , Estômago/cirurgia , Trombose/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
RATIONALE: Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis, which is rarely associated with pseudocyst. PATIENT CONCERNS: A 48-year-old man complained of a recurrent upper abdominal pain in our hospital. DIAGNOSES: A cystic mass of size 4â×â3âcm in his pancreatic tail was found by computed tomography. The concentrations of serum carbohydrate antigen19-9 (81âU/mL) and serum immunoglobulin G4 (181âmg/dL) were elevated. INTERVENTIONS: The patient received partial pancreatectomy with splenectomy and partial esophagectomy. OUTCOMES: Further histopathological examination revealed a pseudocyst, significant lymphoplasmatic infiltration, and fibrosis in the pancreas and esophagus. We report a rare case of AIP complicated with a pancreatic pseudocyst and invasion of lower esophagus. LESSONS: Our study demonstrated that surgical therapy should be considered for the refractory AIP complicated with a pancreatic pseudocyst and invasion of lower esophagus.
Assuntos
Doenças Autoimunes , Esofagectomia/métodos , Pâncreas , Pancreatectomia/métodos , Pseudocisto Pancreático , Pancreatite Crônica , Prednisona/administração & dosagem , Esplenectomia/métodos , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/fisiopatologia , Doenças Autoimunes/terapia , Esofagoscopia/métodos , Glucocorticoides/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Pseudocisto Pancreático/diagnóstico , Pseudocisto Pancreático/etiologia , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/cirurgia , Pancreatite Crônica/complicações , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
AIM: To introduce the pancreatic index assessing severity of chronic pancreatitis (CP). MATERIAL AND METHODS: Ultrasonography was made in 28 patients with clinically documented diagnosis of CP. A total of 6 groups of ultrasonographic signs served the basis for calculation of scores for a complex formalized semiquantitative criterion--the pancreatic index (PI). Ultrasonographic signs--the size of the head, calcinates, structure, maximal size of the ductus pancreaticus, pseudocysts, etc. were assessed in scores from 1 to 3. Severity of the disease was classified according to total PI. RESULTS: The following correlation was found between severity of CP and the PI: in mild CP--57%, in moderate CP--71%, in severe CP--66%. CONCLUSION: Ultrasonographic PI objectively evaluates severity of CP course.
Assuntos
Pancreatite/diagnóstico por imagem , Pancreatite/fisiopatologia , Doença Crônica , Progressão da Doença , Humanos , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/fisiopatologia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
BACKGROUND: Endoscopic ultrasound (EUS) is a useful diagnostic and therapeutic tool in the pediatric population. Given the high accuracy and sensitivity of EUS, it is particularly effective in evaluating pancreaticobiliary disease. Published literature in the use of pediatric EUS is limited. Therefore we aimed to review the current literature for EUS indications, safety, and effectiveness for the pediatric population. DATA SOURCES: English language articles on the use of pediatric endoscopic ultrasound in evaluating pancreaticobiliary diseases were retrieved from PubMed/ MEDLINE. RESULTS: We analyzed various retrospective studies and case series publications. Data were extrapolated for pediatric patients with pancreaticobiliary diseases. CONCLUSIONS: EUS offers superior imaging. It is comparible to magnetic resonance imaging and/or pancreatic-protocol computed tomography. In the current literature, there are a variety of pancreaticobiliary conditions where EUS was utilized to make a diagnosis. These include recurrent pancreatitis, congenital anomalies, microlithiasis, pancreatic pseudocysts, and pancreatic mass lesions. EUS was shown to be a safe and cost-effective modality with both diagnostic and therapeutic capabilities in the pediatric population. EUS is now increasingly being recognized as a standard of care when evaluating pancreaticobiliary conditions in children.
Assuntos
Doenças Biliares/diagnóstico por imagem , Endossonografia/métodos , Pancreatopatias/diagnóstico por imagem , Doenças Biliares/epidemiologia , Doenças Biliares/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pancreatopatias/epidemiologia , Pancreatopatias/fisiopatologia , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/epidemiologia , Pseudocisto Pancreático/fisiopatologia , Pancreatite/diagnóstico por imagem , Pancreatite/epidemiologia , Pancreatite/fisiopatologia , Segurança do Paciente , Pediatria , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XAssuntos
Anemia Hipocrômica/etiologia , Cistadenoma Mucinoso , Melena/etiologia , Pancreatectomia , Pseudocisto Pancreático/etiologia , Anemia Hipocrômica/fisiopatologia , Feminino , Humanos , Melena/fisiopatologia , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/fisiopatologia , Neoplasias Pancreáticas/cirurgia , Pseudocisto Pancreático/fisiopatologia , Resultado do TratamentoRESUMO
Chronic pancreatitis is a debilitating condition often associated with severe abdominal pain and exocrine and endocrine dysfunction. The underlying cause is multifactorial and involves complex interaction of environmental, genetic, and/or other risk factors. The pathology is dependent on the underlying pathogenesis of the disease. This review describes the clinical, gross, and microscopic findings of the main subtypes of chronic pancreatitis: alcoholic chronic pancreatitis, obstructive chronic pancreatitis, paraduodenal ("groove") pancreatitis, pancreatic divisum, autoimmune pancreatitis, and genetic factors associated with chronic pancreatitis. As pancreatic ductal adenocarcinoma may be confused with chronic pancreatitis, the main distinguishing features between these 2 diseases are discussed.
Assuntos
Transtornos Induzidos por Álcool/patologia , Doenças Autoimunes/patologia , Carcinoma Ductal Pancreático/patologia , Pâncreas/patologia , Pseudocisto Pancreático/patologia , Pancreatite/patologia , Transtornos Induzidos por Álcool/complicações , Transtornos Induzidos por Álcool/fisiopatologia , Doenças Autoimunes/complicações , Doenças Autoimunes/fisiopatologia , Doença Crônica , Diagnóstico Diferencial , Humanos , Pâncreas/anormalidades , Pâncreas/fisiopatologia , Ductos Pancreáticos , Pseudocisto Pancreático/complicações , Pseudocisto Pancreático/fisiopatologia , Pancreatite/etiologiaRESUMO
Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct (PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Desbridamento , Drenagem/métodos , Nutrição Enteral , Suco Pancreático/metabolismo , Pseudocisto Pancreático/terapia , Pancreatite/terapia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Desbridamento/efeitos adversos , Drenagem/efeitos adversos , Drenagem/instrumentação , Nutrição Enteral/efeitos adversos , Humanos , Necrose , Suco Pancreático/microbiologia , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/microbiologia , Pseudocisto Pancreático/fisiopatologia , Pancreatite/diagnóstico por imagem , Pancreatite/microbiologia , Pancreatite/fisiopatologia , Índice de Gravidade de Doença , Stents , Resultado do TratamentoRESUMO
Pancreatitis may be acute or chronic, mild or severe. Acute necrotizing pancreatitis remains the most serious form of acute pancreatitis and accounts for the majority of complications. Although there is an established nomenclature for pancreatitis and pancreatic fluid collections, such as pancreatic pseudocysts, it is not widely understood or recognized by physicians, including gastroenterologists. Because nonspecialists will be increasingly called upon to treat and appropriately refer patients with pancreatitis and its complications for more specialized care, it is important to understand the evolving treatment options for managing these patients. This article addresses and summarizes pancreatitis and its complications, particularly pancreatic collections.
Assuntos
Pancreatite/fisiopatologia , Abscesso/fisiopatologia , Doença Aguda , Doença Crônica , Exsudatos e Transudatos , Humanos , Pancreatopatias/fisiopatologia , Pseudocisto Pancreático/fisiopatologia , Pancreatite/diagnóstico por imagem , Pancreatite/terapia , Pancreatite Necrosante Aguda/fisiopatologia , Radiografia , Índice de Gravidade de Doença , Terminologia como AssuntoRESUMO
BACKGROUND: Operative internal drainage has been standard treatment for chronic unresolved pancreatic pseudocysts (PPs). Recently, percutaneous external drainage (PED) has become the primary mode of treatment at many medical centers. STUDY DESIGN: A retrospective chart review was performed of 96 patients with PPs who were managed between 1987 and 1996. Longterm followup information was obtained by telephone and mail questionnaire. RESULTS: Twenty-seven patients underwent computed tomographic (CT)-guided PED. PP resolution occurred in 17 patients. Clinical deterioration or secondary infection mandated urgent pancreatic debridement in 7 (26%) patients and cystgastrostomy in 2 (7%) patients. There was one hospital death in this group. Thirty-two patients underwent cystgastrostomy or cystjejunostomy (n = 21), distal pancreatectomy (n = 8), pancreatic debridement and external drainage (n = 2), or cystectomy (n = 1). Two (6%) patients required postoperative pancreatic debridement for failure of resolution and peritonitis and two patients underwent PED of abscess. There was one hospital death in the expectantly managed group of 37 patients. Median followup of 3 years (range, 0.5-9.3 years) in 66 patients revealed that 6, 3, and 4 patients of PED, surgery, and expectantly managed groups, respectively, had radiologic evidence of recurrent PPs. CONCLUSIONS: Operative management for PPs appears to be superior to CT-guided PED. Although the later was often successful, it required major salvage procedures in one third of the patients. An expectant management protocol may be suitable for selected patients.
Assuntos
Drenagem/métodos , Pseudocisto Pancreático/terapia , Abscesso/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/cirurgia , Causas de Morte , Desbridamento , Progressão da Doença , Feminino , Seguimentos , Humanos , Jejuno/cirurgia , Tempo de Internação , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/cirurgia , Peritonite/etiologia , Peritonite/cirurgia , Radiografia Intervencionista , Recidiva , Estudos Retrospectivos , Estômago/cirurgia , Inquéritos e Questionários , Telefone , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The wide variety of surgical procedures available for the relief of pain in patients with chronic pancreatitis attests to a lack of understanding of the precise mechanisms responsible for the onset of pain in this condition. In the development of surgical procedures designed to "decompress" the pancreatic duct in chronic pancreatitis, it has been tacitly assumed that pancreatic duct hypertension exists and is important in the pathophysiology of the disease. In 19 patients with chronic pancreatitis and dilated pancreatic ducts, pancreatic duct pressure was significantly higher than in control patients. In view of the dramatic relief of preoperative pain after procedures for decompressing the pancreatic ducts, ductal hypertension has been confirmed as an important mechanism of pain production in this group of patients.