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Abera MT, Damtew HD, Yaynishet YA, Adela AY. Unusual Configuration of a Giant Trans-Spatial Pancreatic Pseudocyst with Spontaneous Shrinkage: A Rare Case Report. Int Med Case Rep J 2024; 17:281-287. [PMID: 38596401 PMCID: PMC11001558 DOI: 10.2147/imcrj.s458492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024] Open
Abstract
Pancreatic pseudocysts are benign lesions that typically originate within the pancreatic parenchyma, or peripancreatic tissue. They commonly occur following recurrent episodes of pancreatitis or trauma. In this article, we present a case of a giant pancreatic pseudocyst with unusual trans-spatial extensions and spontaneous size decrement in a 40-year-old male patient with a history of alcohol abuse. He presented with chronic epigastric pain, and a physical examination showed only mild abdominal tenderness. Initial computed tomography showed a giant (18.4cm in its largest axis) pancreatic pseudocyst with left subdiaphragmatic and gastrohepatic extensions and concurrent splenic cysts. On follow-up ultrasound, the pseudocyst showed a significant spontaneous size decrement to less than half of its initial size. The giant size and trans-spatial characteristics of the pseudocyst, along with a relatively benign symptomatology and subsequent spontaneous shrinkage, constitute unique aspects of this case.
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Affiliation(s)
| | | | | | - Amanuel Yegnanew Adela
- Department of Radiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Radiology, University of Gondar, Gondar, Ethiopia
- Ethiopian Federal Police Commission Referral Hospital, Addis Ababa, Ethiopia
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2
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Yim SK, Kim SH, Seo SY, Yang HC, Lee SO. Feasibility of Adopting the "Step-up Approach" in Managing Necrotizing Pancreatitis-induced Pancreatic-colonic Fistula. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:365-369. [PMID: 31234628 DOI: 10.4166/kjg.2019.73.6.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/18/2019] [Accepted: 03/10/2019] [Indexed: 11/03/2022]
Abstract
Managing acute pancreatitis is clinically challenging because of the generally poor patient condition, the variety of treatment options depending on the severity and complications, and the uncertainty of outcomes. Recently, the step-up approach, which involves less invasive initial treatment and more invasive subsequent treatment, where necessary, has been proposed as the mainstay of managing pancreatitis. This paper presents a case of a 57-year-old man with severe acute pancreatitis, who developed an unexpected fistula in the rectum, which was treated successfully using the step-up approach. In managing this case, the authors faced clinical challenges in determining the infection of necrotic tissue in the early phase of the disease, the optimal timing and method of drainage, and the fistula closure or repair technique. Successful management of this case using the step-up approach validated current recommendations and suggests that it is a reasonable treatment strategy for pancreatic-colonic fistulas. This case also highlights the importance of an awareness that pancreatitis-associated complications can develop in an unexpected manner.
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Affiliation(s)
- Sung Kyun Yim
- Division of Gastroenterology, Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Seong Hun Kim
- Division of Gastroenterology, Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Young Seo
- Division of Gastroenterology, Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Hee Chan Yang
- Division of Gastroenterology, Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Ok Lee
- Division of Gastroenterology, Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
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3
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Boopathy V, Balasubramanian P, Alexander T, Koshy R. Spontaneous fistulisation of infected walled-off necrosis (WON) into the duodenum in a patient following acute necrotising pancreatitis. BMJ Case Rep 2014; 2014:bcr-2013-202863. [PMID: 24414192 DOI: 10.1136/bcr-2013-202863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Infected walled-off necrosis (WON), previously referred to by various terminologies including pancreatic abscess, is one of the well-known local complications of acute necrotising pancreatitis. Very rarely they can spontaneously rupture or fistulise into adjacent structures, leading to either further complications or resolution. More often these events lead to complications rather than resolution of the condition. We report a case of an infected WON following an episode of acute necrotising pancreatitis with spontaneous fistulisation into the duodenum resulting in a complete resolution of the symptoms.
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Affiliation(s)
- Vinoth Boopathy
- Department of Gastroenterology, Pondicherry Institute of Medical Sciences, Pondicherry, India
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4
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Somani PO, Jain SS, Shah DK, Khot AA, Rathi PM. Uncomplicated spontaneous rupture of pancreatic pseudocyst into stomach: A case report. World J Gastrointest Endosc 2013; 5:461-464. [PMID: 24044048 PMCID: PMC3773861 DOI: 10.4253/wjge.v5.i9.461] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/11/2013] [Accepted: 08/13/2013] [Indexed: 02/05/2023] Open
Abstract
Pseudocysts of the pancreas are not rare, but spontaneous perforation and/or fistulization occurs in fewer than 3% of these pseudocysts. Perforation into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity and through the abdominal wall has been reported. Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection without bleeding. A 67-year-old women with a large pancreatic pseudocyst resulting from a complication of chronic pancreatitis was referred to our institution. During hospital stay, there was sudden decrease in the size of epigastric lump. Repeat computed tomography (CT) revealed that the size of the pseudocyst had decreased significantly; however, gas was observed in stomach and pseudocyst along with rent between lesser curvature of stomach and pseudocyst suggestive of spontaneous cystogastric fistula.The fistula tract occluded spontaneously and the patient recovered without any complication or need for surgical treatment. After 5 wk, follow up CT revealed complete resolution of pseudocyst. Esophagogastroduodenoscopy revealed that the orifice was completely occluded with ulcer at the site of previous fistulous opening.
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5
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Estalella L, Marinello F, González JA, Rodríguez M, Artigas V. [Spontaneous drainage of a pancreatic pseudocyst into the colon]. Cir Esp 2011; 90:602-3. [PMID: 22078403 DOI: 10.1016/j.ciresp.2011.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/14/2011] [Accepted: 04/15/2011] [Indexed: 11/26/2022]
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6
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Ali JAA, Chung H, Munk PL, Byrne MF. Pancreatic pseudocyst with fistula to the common bile duct resolved by combined biliary and pancreatic stenting--a case report and literature review. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:557-9. [PMID: 19668801 PMCID: PMC2732178 DOI: 10.1155/2009/597208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 01/30/2009] [Indexed: 12/18/2022]
Abstract
Pancreatic pseudocysts develop in 10% to 20% of patients with chronic pancreatitis, and can cause a variety of complications such as infection, bleeding or development of fistulae. However, fistulous communication with the common bile duct is very rare. The present report describes an unusual case of a patient with a large, symptomatic pancreatic pseudocyst with a fistula to the common bile duct that was treated successfully by combined biliary and pancreatic stenting.
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Affiliation(s)
| | - Henry Chung
- Department of Medicine, Division of Gastroenterology
| | - Peter L Munk
- Division of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia
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SHINOHARA Y, OHNO H, HORIBE T, NAKAGAWA M, KAWAI T, KAKUTANI H, SEKI T, YAMADA T, IKEDA H, SAITOH T. A Case of Chronic Pancreatitis Associated with a Pancreato‐gastric Fistula. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1993.tb00629.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Yasushi SHINOHARA
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
| | - Hiroyuki OHNO
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
| | - Toshiya HORIBE
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
| | - Masao NAKAGAWA
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
| | - Takashi KAWAI
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
| | - Hiroshi KAKUTANI
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
| | - Tomoyuki SEKI
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
| | - Takashi YAMADA
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
| | - Hajimu IKEDA
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
| | - Toshihiko SAITOH
- Fourth Department of Internal Medicine, TOKYO Medical College, Tokyo, Japan
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8
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Yeom HJ, Yi SY. Spontaneous resolution of pancreatic gastric fistula. Dig Dis Sci 2007; 52:561-4. [PMID: 17219065 DOI: 10.1007/s10620-006-9517-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Accepted: 07/06/2006] [Indexed: 12/14/2022]
Abstract
Pancreatic pseudocyst is one of the common complications of acute and chronic pancreatitis and has variable natural history. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection. This case presented a 46-year-old man with a pancreatic pseudocyst resulting from a complication of acute pancreatitis. This resolved spontaneously through the formation of a fistula between the pseudocyst and stomach. The fistula tract was also occluded spontaneously and the patient recovered without any complication or need for surgical treatment. The patient has been good progress at a two year follow up after spontaneous resolution of the fistula.
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Affiliation(s)
- Hye Jung Yeom
- Department of Internal Medicine, Gastroenterology Division, Ewha Womans University, Mok-Dong Hospital, Yankcheon-Ku Mok-Dong 911-1, Seoul, Republic of Korea
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9
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Rickes S, Mönkemüller K, Peitz U, Schinkel S, Kolfenbach S, Malfertheiner P, Ebert MPA. Sonographic diagnosis and endoscopic therapy of a biliopancreatic fistula complicating a pancreatic pseudocyst. Scand J Gastroenterol 2006; 41:989-92. [PMID: 16803699 DOI: 10.1080/00365520600581553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This is the first report of a case of biliopancreatic fistula complicating a pancreatic pseudocyst diagnosed correctly by transabdominal ultrasound. The diagnosis was confirmed by magnetic resonance and endoscopic retrograde cholangiopancreatography. The fistula was treated successfully with biliary stenting. The clinical and imaging features of this exceptional complication are presented along with a brief review of the topic.
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Affiliation(s)
- Steffen Rickes
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University, Magdeburg, Germany.
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10
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Ortega-Carnicer J, Pastor-Sánchez C, Gijón-Rodríguez J. Rotura espontánea de seudoquiste pancreático en el estómago. Med Clin (Barc) 2006; 126:558. [PMID: 16756916 DOI: 10.1157/13087149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Shlansky-Goldberg RD, Soulen MC, Rosato EF, Cope C. Percutaneous management of external pancreatic fistulas: the use of articulated and metal stents. J Vasc Interv Radiol 1995; 6:191-6. [PMID: 7787352 DOI: 10.1016/s1051-0443(95)71093-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- R D Shlansky-Goldberg
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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12
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Hauptmann EM, Wojtowycz M, Reichelderfer M, McDermott JC, Crummy AB. Pancreatic pseudocyst with fistula to the common bile duct: radiological diagnosis and management. GASTROINTESTINAL RADIOLOGY 1992; 17:151-3. [PMID: 1551513 DOI: 10.1007/bf01888533] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A patient was found to have fistulization of a pancreatic pseudocyst with the common bile duct. Resolution of the pseudocyst and the attendant biliary obstruction was achieved with percutaneous biliary drainage alone. The clinical and radiological features of this case are herein presented along with a brief review of the subject.
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Affiliation(s)
- E M Hauptmann
- Department of Radiology, University of Wisconsin Clinical Sciences Center, Madison
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Warshaw AL, Moncure AC, Rattner DW. Gastrocutaneous fistulas associated with pancreatic abscesses. An aggressive entity. Ann Surg 1989; 210:603-7. [PMID: 2818029 PMCID: PMC1357793 DOI: 10.1097/00000658-198911000-00006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Previous reports of gastrocutaneous fistulas emphasize their benign nature and the probability of spontaneous healing without the need for surgical closure. In distinct contrast we report our experiences with six patients whose gastrocutaneous fistulas were caused by fulminant pancreatitis and pancreatic abscesses. High-output acid fistulas appeared days to weeks after drainage of left upper quadrant-infected collections. None occurred at the time of initial abscess drainage. Most originated high on the greater curvature of the stomach and traversed the abscess cavity. Three of six patients had previous splenectomies, but these operations were remote in time from the appearance of the fistula. Nonoperative management was successful in only two of six patients. Massive hemorrhage from the fistula tract contributed to the deaths of three patients. The pathogenesis of these fistulas appears to be consequent to gastric injury resulting from adjacent pancreatic inflammation. We conclude that (1) gastrocutaneous fistulas associated with pancreatitis are unlikely to heal even with drainage of the abscesses and are often complicated by hemorrhage, (2) surgical closure of the fistula will often be necessary and should not be unreasonably delayed, and (3) when performed in a semi-elective setting, resection of the damaged gastric segment, perhaps with an omental or serosal patch to buttress the gastric suture line, has a good chance of success.
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Affiliation(s)
- A L Warshaw
- Surgical Services, Massachusetts General Hospital, Boston 02114
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14
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Radin DR, Halls JM. Cavitating metastases of the stomach and duodenum. THE JOURNAL OF COMPUTED TOMOGRAPHY 1987; 11:283-7. [PMID: 3038471 DOI: 10.1016/0149-936x(87)90097-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Three patients with cavitating gastric or duodenal metastases are presented. Metastatic disease, either by direct extension or by hematogenous spread, should be included in the differential diagnosis of an excavated exoenteric gastric or duodenal mass.
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Abstract
Colonic involvement should be suspected in patients with severe acute pancreatitis, especially in the following clinical settings: plain abdominal radiographs suggesting bowel ischemia, colonic obstruction, acute lower gastrointestinal hemorrhage, gram-negative septicemia, enteric bacteria on Gram stain or culture of peritoneal fluid, and feculent abdominal drainage from a previously drained pancreatic abscess. Intraoperatively, the pancreas should be widely drained and the fecal stream diverted. Colonic hemorrhage and nonviable bowel require immediate resection. Broad-spectrum antibiotic administration and vigorous nutritional support also are required in these critically ill patients. Although proximal diversion and pancreatic diversion alone may suffice, colonic resection may be required later for persistent obstruction or fistulization, but in a more elective setting. Colonic anastomoses should be performed only when pancreatic inflammation and associated sepsis have resolved completely.
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Petruschak MJ, Haaga JR, Pardes J. CT demonstration of spontaneous internal drainage of a pancreatic pseudocyst. THE JOURNAL OF COMPUTED TOMOGRAPHY 1981; 5:534-6. [PMID: 7343175 DOI: 10.1016/0149-936x(81)90087-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Rosen RJ, Teplick SK, Shapiro JH. Spontaneous communication between a pancreatic pseudocyst and the colon: unusual clinical and radiographic presentation. GASTROINTESTINAL RADIOLOGY 1980; 5:353-5. [PMID: 7461412 DOI: 10.1007/bf01888657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A huge pancreatic pseudocyst which nearly filled the entire abdomen ruptured into the sigmoid colon, and caused perplexing clinical and radiographic findings. Because of the thickness of its wall, the pseudocyst did not collapse but became filled with intestinal gas. The more common features of pseudocysts that rupture are discussed.
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De Graaff CS, Taylor KJ, Rosenfield AT, Kinder B. Gray scale ultrasonography in the diagnosis of pseudocysts of the pancreas simulating renal pathology. J Urol 1978; 120:751-3. [PMID: 731819 DOI: 10.1016/s0022-5347(17)57350-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ultrasonography has proved to be a reliable tool in the diagnosis of pseudocysts. A case is reported of a patient with a pseudocyst in the transverse mesocolon adjacent to the left kidney and spleen. Initial examination by computerized tomography and angiography failed to visualize the mass, while a renal cyst was simulated on nephrotomography. Repeat ultrasound examinations showed progressive increases in the size of the pseudocyst. This diagnosis was confirmed at operation. We believe that ultrasound is the modality of choice in patients with clinical suspicion of a pseudocyst.
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Wilson DA. Ultrasound: applications in the pediatric heart and abdomen. CURRENT PROBLEMS IN PEDIATRICS 1978; 9:1-52. [PMID: 400840 DOI: 10.1016/s0045-9380(78)80007-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Pseudocyst of the pancreas with perirenal extension: Demonstration by computed tomography. ACTA ACUST UNITED AC 1977. [DOI: 10.1016/s0149-936x(97)90033-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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