Infeasibility of endoscopic transmural drainage due to pancreatic pseudocyst wall calcifications - case report
Journal Title: Polish Journal of Surgery - Year 2017, Vol 89, Issue 1
Abstract
Postinflammatory pancreatic pseudocysts are one of the most common complications of acute pancreatitis. In most cases, pseudocysts self-absorb in the course of treatment of pancreatitis. In some patients, pancreatic pseudocysts are symptomatic and cause pain, problems with gastrointestinal transit, and other complications. In such cases, drainage or resection should be performed. Among the invasive methods, mini invasive procedures like endoscopic transmural drainage through the wall of the stomach or duodenum play an important role. For endoscopic transmural drainage, it is necessary that the cyst wall adheres to the stomach or duodenum, making a visible impression. We present a very rare case of infeasibility of endoscopic drainage of a postinflammatory pancreatic pseudocyst, impressing the stomach, due to cyst wall calcifications. A 55-year-old man after acute pancreatitis presented with a 1-year history of epigastric pain and was admitted due to a postinflammatory pseudocyst in the body and tail of pancreas. On admission, blood tests, including CA 19-9 and CEA, were normal. An ultrasound examination revealed a 100-mm pseudocyst in the tail of pancreas, which was confirmed on CT and EUS. Acoustic shadowing caused by cyst wall calcifications made the cyst unavailable to ultrasound assessment and percutaneous drainage. Gastroscopy revealed an impression on the stomach wall from the outside. The patient was scheduled for endoscopic transmural drainage. After insufflation of the stomach, a large mass protruding from the wall was observed. The stomach mucosa was punctured with a cystotome needle knife, and the pancreatic cyst wall was reached. Due to cyst wall calcifications, endoscopic drainage of the cyst was unfeasible. Profuse submucosal bleeding at the puncture site was stopped by placing clips. The patient was scheduled for open surgery, and distal pancreatectomy with splenectomy was performed. The histopathological examination confirmed the initial diagnosis of postinflammatory pancreatic pseudocyst. Endoscopic transmural drainage is a highly effective procedure for treating postinflammatory pancreatic pseudocysts. In some patents, especially with large pseudocysts, pseudocysts with calcified walls, and cysts of primary origin, resection should be performed.<br/><br/>
Authors and Affiliations
Andrzej Krajewski, Gustaw Lech, Marcin Makiewicz, Monika Wojtasik, Sławomir Kozieł, Maciej Słodkowski
Keywords
Related Articles
- EP ID EP187490
- DOI 10.5604/01.3001.0009.6006
- Views 86
- Downloads 0
Multifocal Extra-Adrenal Paraganglioma – Case Report
Paraganglioma is a rare neoplasm originating from extra-adrenal pheochromocytes of the sympathetic and parasympathetic nervous system. It is usually benign and the treatment method of choice is a complete resection of th...
An Effect of Nuss Procedure on Lung Function Among Patients with Pectus Excavatum
The aim of the study was to evaluate lung function among patients who underwent Nuss Procedure. The analysis included spirometric evaluation of the lung function before Nuss Procedure, during perioperative period and aft...
Leczenie trudno gojących się ran po zabiegach z zakresu chirurgii onkologicznej - zastosowanie nowoczesnych opatrunków
Problem trudno gojących się ran dotyczy 1−1,5% ogółu populacji i około 3% populacji powyżej 60 roku życia. Głównymi czynnikami ryzyka złego gojenia się ran są cukrzyca, tętnicza i żylna niewydolność naczyń, zaawansowana...
Resekcja aorty w odcinku podnerkowym oraz żyły głównej dolnej z jednoczasową ich rekonstrukcją - opis przypadku
Wstęp: Jednoczasowa resekcja mięsaka przestrzeni zaotrzewnowej i dużych naczyń z ich jednoetapową rekonstrukcją od niedawna uważana jest za optymalną strategię postępowania. Jednakże dotychczas w literaturze prawie nie o...
Biological Dressings as a Substitutes of the Skin in the Treatment of Burn Wounds