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Koo JGA, Liau MYQ, Kryvoruchko IA, Habeeb TAAM, Chia C, Shelat VG. Pancreatic pseudocyst: The past, the present, and the future. World J Gastrointest Surg 2024; 16:1986-2002. [PMID: 39087130 PMCID: PMC11287700 DOI: 10.4240/wjgs.v16.i7.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/19/2024] [Accepted: 06/17/2024] [Indexed: 07/22/2024] Open
Abstract
A pancreatic pseudocyst is defined as an encapsulated fluid collection with a well-defined inflammatory wall with minimal or no necrosis. The diagnosis cannot be made prior to 4 wk after the onset of pancreatitis. The clinical presentation is often nonspecific, with abdominal pain being the most common symptom. If a diagnosis is suspected, contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the pseudocyst. Endoscopic ultrasound with cyst fluid analysis can be performed in cases of diagnostic uncertainty. Pseudocyst of the pancreas can lead to complications such as hemorrhage, infection, and rupture. The management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications, such as biliary or gastric outlet obstruction. Management options include endoscopic or surgical drainage. The aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions, diagnosis, and management of this condition.
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Affiliation(s)
- Jonathan GA Koo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Igor A Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv 61022, Ukraine
| | - Tamer AAM Habeeb
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Christopher Chia
- Department of Gastroenterology, Woodlands General Hospital, Singapore 737628, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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2
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Alrubia NM, Alhafez NA. Hepatic Artery Pseudoaneurysm in an Infant With Pancreatitis. Cureus 2024; 16:e59348. [PMID: 38817530 PMCID: PMC11138124 DOI: 10.7759/cureus.59348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Hepatic artery pseudoaneurysm (HAP) is an uncommon yet critical complication of acute pancreatitis. This case delves into the unusual scenario of a two-month-old male infant with a familial history of pancreatitis who develops the condition himself. Despite initial treatment, the infant's symptoms worsened, unveiling a pancreatic pseudocyst (PCC) and an atypical pseudoaneurysm stemming from the hepatic artery, a rare complication in acute pancreatitis. The pseudoaneurysm's confirmation through selective angiography and its subsequent management using embolization is highlighted. This report emphasizes the rarity of hepatic artery pseudoaneurysm in the context of acute pancreatitis, stressing the need for thorough imaging to spot arterial involvement. Early identification via selective angiography remains crucial due to the high risks associated with pseudoaneurysm rupture, underscoring the urgency for prompt intervention. In summary, this case spotlights the infrequent occurrence of hepatic artery pseudoaneurysm secondary to acute pancreatitis in an infant. It stresses the importance of swift recognition and intervention to avert potentially life-threatening complications.
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Affiliation(s)
- Nawal M Alrubia
- Pediatric Gastroenterology, Maternity and Children's Hospital, Dammam, SAU
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3
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A huge preperitoneal collection following acute necrotizing pancreatitis: A case report and the management approach. Ann Med Surg (Lond) 2022; 78:103843. [PMID: 35734743 PMCID: PMC9207096 DOI: 10.1016/j.amsu.2022.103843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
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4
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Liu W, Du JJ, Li ZH, Zhang XY, Zuo HD. Liver injury associated with acute pancreatitis: The current status of clinical evaluation and involved mechanisms. World J Clin Cases 2021; 9:10418-10429. [PMID: 35004974 PMCID: PMC8686151 DOI: 10.12998/wjcc.v9.i34.10418] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/16/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is a very common acute disease, and the mortality rate of severe AP (SAP) is between 15% and 35%. The main causes of death are multiple organ dysfunction syndrome and infections. The mortality rate of patients with SAP related to liver failure is as high as 83%, and approximately 5% of the SAP patients have fulminant liver failure. Liver function is closely related to the progression and prognosis of AP. In this review, we aim to elaborate on the clinical manifestations and mechanism of liver injury in patients with AP.
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Affiliation(s)
- Wei Liu
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Juan-Juan Du
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Zeng-Hui Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xin-Yu Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Hou-Dong Zuo
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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5
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Navarro F, Leiva L, Norero E. Acute abdomen due to pancreatic pseudocyst with splenic extension and rupture. J Surg Case Rep 2021; 2021:rjab071. [PMID: 33897994 PMCID: PMC8055058 DOI: 10.1093/jscr/rjab071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. However, spleen involvement in pancreatitis is rare. We present a patient with a pancreatic tail pseudocyst with splenic extension and rupture. Due to initial stability, conservative management was decided. However, he developed tachycardia with severe abdominal pain associated with signs of peritoneal irritation, requiring an emergency laparotomy. A large pancreatic tail pseudocyst was identified in addition to a ruptured spleen. Splenectomy and double layer hand-sewn gastrocystic anastomosis were performed. The patient had a satisfactory recovery and was discharged on the 11th postoperative day. Conservative management is an option in stable patients but with a high rate of failure. Surgery remains the standard choice in these cases.
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Affiliation(s)
- Francisco Navarro
- Department of Digestive Surgery, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile.,Esophagogastric Surgery Unit, Department of Digestive Surgery, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lissette Leiva
- Department of Digestive Surgery, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile.,Esophagogastric Surgery Unit, Department of Digestive Surgery, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Enrique Norero
- Esophagogastric Surgery Unit, Department of Digestive Surgery, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
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6
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The Lesser Sac and Foramen of Winslow: Anatomy, Embryology, and CT Appearance of Pathologic Processes. AJR Am J Roentgenol 2020; 215:843-851. [PMID: 32783559 DOI: 10.2214/ajr.19.22749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This article reviews the embryologic development, relevant anatomy, and imaging features, on CT, of pathologic processes involving the lesser sac and foramen of Winslow. CONCLUSION. The lesser peritoneal sac is an intricate anatomic region involved in many disease processes. It is a significant conduit for the spread of disease within the peritoneal cavity. The spectrum of pathologic processes pertaining to the lesser sac can be classified on the basis of the type of involvement, such as a fluid collection (e.g., transudate, exudate, bile, and blood), a mass (e.g., neoplastic or nonneoplastic conditions and lymphadenopathy), or an internal hernia into the lesser sac.
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Patel VG, Eltayeb OM, Zakaria M, Fortson JK, Weaver WL. Spontaneous Subcapsular Splenic Hematoma: A Rare Complication of Pancreatitis. Am Surg 2020. [DOI: 10.1177/000313480507101217] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subcapsular hematoma of the spleen is a rare complication of pancreatitis despite its close proximity to the pancreas. Pancreatic pseudocyst involving the tail of the pancreas may erode into the splenic hilum causing hilar vessel bleeding with subcapsular dissection and hematoma formation. The management of such complication is still controversial. It has been suggested that most of these complications spontaneously regress and therefore can be managed conservatively. A case of spontaneous splenic subcapsular hematoma resulting from pancreatitis was managed conservatively with a good outcome.
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Affiliation(s)
| | - Osama M. Eltayeb
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - Majed Zakaria
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - James K. Fortson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
| | - William L. Weaver
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
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8
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Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications. Abdom Radiol (NY) 2020; 45:1290-1298. [PMID: 31696270 DOI: 10.1007/s00261-019-02310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Inflammation of the pancreas can present with a wide range of imaging findings from mild enlargement of the gland and surrounding infiltrative fat stranding through extensive glandular necrosis. Complications of pancreatitis are varied and include infected fluid collections, pseudocysts, and vascular findings such as pseudoaneurysms and thromboses. Cross-sectional imaging with computed tomography (CT) is one of the mainstays of evaluating patients with pancreatitis. New methods that allow novel visualization volumetric CT data may improve diagnostic yield for the detection of findings that provide prognostic information in pancreatitis patients or can drive new avenues of research such as machine learning. Cinematic rendering (CR) is a photorealistic visualization method for volumetric imaging data that are being investigated for a variety of potential applications including the life-like display of complex anatomy and visual characterization of mass lesions. In this review, we describe the CR appearance of different types of pancreatitis and complications of pancreatitis. We also note possible future directions for research into the utility of CR for pancreatitis.
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9
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Bakshi S. Pancreatic abscess within hepato-gastric ligament: case report of an extremely rare disease. BMC Surg 2020; 20:20. [PMID: 32000756 PMCID: PMC6993323 DOI: 10.1186/s12893-020-0688-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Pancreatic pseudocyst is a very common benign cystic lesion of the pancreas. It develops in 5–15% of patients with peri-pancreatic fluid collection following acute pancreatitis. Collection usually occurs within the lesser sac of the omentum (near the pancreatic head and body region). But in 20–22% cases, that may be extra-pancreatic like in the mediastinum, pleura, in the peritoneal cavity including the pelvis. The pancreatic pseudocyst typically contains brownish fluid with necrotic tissue sludge which may get infected giving rise to infected pseudocyst or pancreatic abscess. The present case is an unusual condition of a young alcoholic subject who was finally diagnosed as a case of a pancreatic abscess within hepato-gastric ligament and was managed with operative intervention. To the best of the author’s knowledge, it is the first-ever reported case of a pancreatic abscess within the hepato-gastric ligament in the world. Literature was reviewed to explore potential etiopathogenesis and therapeutic strategies of this extremely rare condition. Case presentation A 38 years old gentleman, chronic alcoholic, having a previous history of acute pancreatitis 3 months back, presented with fever (102 degrees Fahrenheit) and a huge [20 cm (horizontal) X 15 cm (vertical)] severely painful swelling in the epigastric region. The swelling was round-shaped, intra-abdominal, fixed to deeper tissue, tense-cystic, poorly trans-illuminant, non-pulsatile and irreducible. Routine blood tests showed leucocytosis (14,500/mm3) with neutrophilia and elevated plasma pancreatic amylase and lipase levels. USG and MDCT scan of the whole abdomen revealed a thick-walled echogenic cystic swelling of size 18 cm × 12 cm in the epigastric region. USG guided aspiration of the cyst revealed mixed purulent brownish fluid. The cyst fluid was negative for mucin stain and contained high amylase level with low CEA level, suggesting infected pancreatic pseudocyst. An open drainage procedure was considered through an upper midline laparotomy. Aspiration of the pus mixed cyst fluid along with tissue debris was done. Through irrigation of the cyst was done with normal saline. The cyst wall was de-roofed leaving a small part adherent to the inferior surface of the left lobe of the liver. Later the cyst fluid culture showed significant growth of Escherichia coli. He was put on IV antibiotics. The patient was discharged in a stable condition after 5 days. The histopathological examination confirmed pancreatic abscess. Six months after the operation, the patient is doing well, remaining asymptomatic and there is no sign of recurrence. Conclusions Due to extreme rarity, pancreatic abscess formation within hepato-gastric ligament may be a diagnostic dilemma and requires a high index of suspicion. Surgeons should be aware of this rare clinical entity for prompt management of potential morbidity.
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Affiliation(s)
- Sabyasachi Bakshi
- Department of General surgery, BSMCH, Bankura, West Bengal, PIN-722102, India. .,, Kathghara Lane, Sonatuli, Hooghly, West Bengal, PIN-712103, India.
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Manrai M, Kochhar R, Gupta V, Yadav TD, Dhaka N, Kalra N, Sinha SK, Khandelwal N. Outcome of Acute Pancreatic and Peripancreatic Collections Occurring in Patients With Acute Pancreatitis. Ann Surg 2018; 267:357-363. [PMID: 27805963 DOI: 10.1097/sla.0000000000002065] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study the outcome of acute collections occurring in patients with acute pancreatitis BACKGROUND:: There are limited data on natural history of acute collections arising after acute pancreatitis (AP). METHODS Consecutive patients of AP admitted between July 2011 and December 2012 were evaluated by imaging for development of acute collections as defined by revised Atlanta classification. Imaging was repeated at 1 and 3 months. Spontaneous resolution, evolution, and need for intervention were assessed. RESULTS Of the 189 patients, 151 patients (79.9%) had acute collections with severe disease and delayed hospitalization being predictors of acute collections. Thirty-six patients had acute interstitial edematous pancreatitis, 8 of whom developed acute peripancreatic fluid collections, of which 1 evolved into pseudocyst. Among the 153 patients with acute necrotizing pancreatitis, 143 (93.4%) developed acute necrotic collection (ANC). Twenty-three of 143 ANC patients died, 21 had resolved collections, whereas 84 developed walled-off necrosis (WON), with necrosis >30% (P = 0.010) and Computed Tomographic Severity Index score ≥7 (P = 0.048) predicting development of WON. Of the 84 patients with WON, 8 expired, 53 patients required an intervention, and 23 were managed conservatively. Independent predictors of any intervention among all patients were Computed Tomographic Severity Index score ≥7 (P < 0.001) and interval between onset of pain to hospitalization >7 days (P = 0.04). CONCLUSIONS Patients with severe AP and delayed hospitalization more often develop acute collections. Pancreatic pseudocysts are a rarity in acute interstitial pancreatitis. A majority of patients with necrotising pancreatitis will develop ANC, more than half of whom will develop WON. Delay in hospitalization and higher baseline necrosis score predict need for intervention.
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Affiliation(s)
- Manish Manrai
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Dhaka
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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11
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Majidi S, Golembioski A, Wilson SL, Thompson EC. Acute Pancreatitis: Etiology, Pathology, Diagnosis, and Treatment. South Med J 2017; 110:727-732. [PMID: 29100225 DOI: 10.14423/smj.0000000000000727] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acute pancreatitis is a fascinating disease. In the United States, the two most common etiologies of acute pancreatitis are gallstones and excessive alcohol consumption. The diagnosis of acute pancreatitis is made with a combination of history, physical examination, computed tomography scan, and laboratory evaluation. Differentiating patients who will have a benign course of their pancreatitis from patients who will have severe pancreatitis is challenging to the clinician. C-reactive protein, pro-calcitonin, and the Bedside Index for Severity of Acute Pancreatitis appeared to be the best tools for the early and accurate diagnosis of severe pancreatitis. Early laparoscopic cholecystectomy is indicated for patients with mild gallstone pancreatitis. For patients who are going to have a prolonged hospitalization, enteral nutrition is preferred. Total parenteral nutrition should be reserved for patients who cannot tolerate enteral nutrition. Prophylactic antibiotics are not indicated for patients with pancreatic necrosis. Surgical intervention for infected pancreatic necrosis should be delayed as long as possible to improve patient outcomes.
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Affiliation(s)
- Shirin Majidi
- From the Joan Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Adam Golembioski
- From the Joan Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Stephen L Wilson
- From the Joan Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Errington C Thompson
- From the Joan Edwards School of Medicine, Marshall University, Huntington, West Virginia
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12
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Kim HJ, Jun CH, Park CH, Cho CK. Intrahepatic Pancreatic Pseudocyst Complicated by Pancreatitis: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 70:202-207. [PMID: 29060959 DOI: 10.4166/kjg.2017.70.4.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pancreatic pseudocyst is a common complication of acute pancreatitis. Pseudocysts are commonly observed in the lesser sac and retroperitoneum; they are rarely seen in the liver. Herein, we report a case of intrahepatic pseudocyst, complicated by asymptomatic groove pancreatitis, that has successfully been treated with hepatic resection. A 70-year-old woman was referred to our hospital with severe upper abdominal pain. Abdominal computed tomography scan showed 11x10 cm sized cystic lesion in the left lateral section of the liver. Appearance of the pancreas was relatively normal. Endoscopic aspiration revealed a high level of amylase in the cystic fluid. After endoscopy, signs of peritonitis were observed; then, a left hemihepatectomy was performed. Pathologic examination revealed an intrahepatic pancreatic pseudocyst. The presence of intrahepatic cystic lesion in patients with suspected pancreatitis should raise the suspicion of intrahepatic pseudocyst. Intrahepatic pancreatic pseudocysts may be the only clinical manifestation even without an episode of acute pancreatitis.
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Affiliation(s)
- Hee Joon Kim
- Department of Surgery and Division of Gastroenterology, Chonnam National University Medical School, Gwangju, Korea
| | - Chung Hwan Jun
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chol Kyoon Cho
- Department of Surgery and Division of Gastroenterology, Chonnam National University Medical School, Gwangju, Korea
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13
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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14
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Akhter S, Khan ZURR, Ahmed B, Ahmed F, Memon ZA. Complications of acute pancreatitis in tertiary care hospital. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2017. [DOI: 10.5348/ijhpd-2017-69-oa-5] [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: 11/12/2022]
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15
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Nam HS, Noh MH, Han JE, Kim JH, Oh KJ, Lee H, Jo JH. Left Hepatic Artery Pseudoaneurysm Caused by Acute Pancreatitis. Med Princ Pract 2017; 26:192-194. [PMID: 28068658 PMCID: PMC5588379 DOI: 10.1159/000455860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this work was to report a case of left hepatic artery pseudoaneurysm due to acute pancreatitis following endoscopic papillectomy. CLINICAL PRESENTATION AND INTERVENTION A 74-year-old female with an ampullary adenoma underwent papillectomy, which was complicated by acute pancreatitis. Computed tomography showed aneurysmal dilatation of the proximal left hepatic artery. An angiography with coli embolization was performed and was successful. The patient was doing well at the 1-year follow-up. CONCLUSION This patient with left hepatic artery pseudoaneurysm following severe acute pancreatitis was successfully treated with coil embolization.
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Affiliation(s)
- Hwa Seong Nam
- Department of Internal Medicine, Busan, Republic of Korea
| | - Myung Hwan Noh
- Department of Internal Medicine, Busan, Republic of Korea
- *Myung Hwan Noh, Department of Internal Medicine, College of Medicine, Dong-A University, 26 Daesingongwon-ro, Seo-gu, Busan 602-715 (Republic of Korea), E-Mail
| | - Ji Eun Han
- Department of Internal Medicine, Busan, Republic of Korea
| | - Jae Hoon Kim
- Department of Internal Medicine, Busan, Republic of Korea
| | - Ki Jong Oh
- Department of Internal Medicine, Busan, Republic of Korea
| | - Hyuk Lee
- Department of Internal Medicine, Busan, Republic of Korea
| | - Jeong Hyun Jo
- Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea
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Demeusy A, Hosseini M, Sill AM, Cunningham SC. Intrahepatic pancreatic pseudocyst: A review of the world literature. World J Hepatol 2016; 8:1576-1583. [PMID: 28050239 PMCID: PMC5165272 DOI: 10.4254/wjh.v8.i35.1576] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/26/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate and summarize the literature regarding the diagnosis and management of intrahepatic pancreatic pseudocysts (IHPP).
METHODS A literature search was performed using PubMed (MEDLINE) and Google Scholar databases, followed by a manual review of reference lists to ensure that no articles were missed. All articles, case reports, systematic reviews, letters to editors, and abstracts were analyzed and tabulated. Bivariate analyses were performed, with significance accepted at P < 0.05. Articles included were primarily in the English language, and articles in other languages were reviewed with native speakers or, if none available, were translated with electronic software when possible.
RESULTS We found 41 published articles describing 54 cases since the 1970s, with a fairly steady rate of publication. Patients were predominantly male, with a mean age of 49 years. In 42% of published cases, the IHPP was the only reported pseudocyst, but 58% also had concurrent pseudocysts in other extrapancreatic locations. Average IHPP size was 9.5 cm and they occurred most commonly (48%) in the left hemiliver. Nearly every reported case was managed with an intervention, most with a single intervention, but some required up to three interventions. Percutaneous treatment with either simple aspiration or with an indwelling drain were the most common interventions, frequently performed along with stenting of the pancreatic duct. The size of the IHPP correlated significantly with both the duration of treatment (P = 0.006) and with the number of interventions required (P = 0.031). The duration of therapy also correlated with the initial white blood cell (WBC) count (P = 0.048).
CONCLUSION Diagnosis of IHPP is difficult and often missed. Initial size and WBC are predictive of the treatment required. With appropriate intervention, most patients achieve resolution.
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Sharma SS, Singh B, Jain M, Maharshi S, Nijhawan S, Sapra B, Jhajharia A. Endoscopic management of pancreatic pseudocysts and walled-off pancreatic necrosis: A two-decade experience. Indian J Gastroenterol 2016; 35:40-47. [PMID: 26923376 DOI: 10.1007/s12664-016-0624-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 01/21/2016] [Indexed: 02/04/2023]
Abstract
AIM To determine long-term outcome of endoscopic management of pancreatic pseudocyst/walled-off pancreatic necrosis (WOPN) without necrosectomy. METHODS One-hundred and sixty-five pancreatic pseudocysts/WOPN managed endoscopically over a period of 22 years were analyzed retrospectively for technical success, complications, and recurrence. RESULTS Symptomatic 118 males and 47 females with mean age of 35.8 years were included. Alcohol was the most common etiology (41.2%). Transmural endoscopic drainage was done in 144 patients, while 21 patients underwent transpapillary drainage. All the patients were subjected to contrast computed tomography (CT) abdomen or routine/Doppler ultrasound. Endoscopic ultrasound was done in last 11 patients. One or two double pigtail 7 Fr stents were placed when clear watery fluid came out from cyst (130 patients, 78.8%), and nasocystic drainage (NCD) tubes were placed in addition to two 7 Fr stents when there were frank pus, thick dark fluid, or solid components inside the cyst (35 patients). All these patients settled on this treatment. Thirty-three of 35 patients of WOPN could be managed endoscopically without necrosectomy. Complications occurred in 9.2% of pseudocysts and 40% of WOPN. Thirty-five patients were followed up for more than 5 years (3 patients more than 10 years), and 130 patients were followed up for up to 5 years. Recurrence occurred in 8.1% of pseudocysts and 5.7% of WOPN. CONCLUSION Majority of pancreatic pseudocysts/WOPN can be managed with endoscopic drainage without necrosectomy with high success, low complication, and recurrence rates.
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Affiliation(s)
- Shyam S Sharma
- Department of Gastroenterology, Sawai Man Singh Medical College, Jawaharlal Nehru Marg, Gangawal Park, Jaipur, 302 004, India.
| | - Bir Singh
- Department of Gastroenterology, Sawai Man Singh Medical College, Jawaharlal Nehru Marg, Gangawal Park, Jaipur, 302 004, India
| | - Mukesh Jain
- Department of Gastroenterology, Sawai Man Singh Medical College, Jawaharlal Nehru Marg, Gangawal Park, Jaipur, 302 004, India
| | - Sudhir Maharshi
- Department of Gastroenterology, G B Pant Hospital, 1, Jawaharlal Nehru Marg, New Delhi, 110 002, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, Sawai Man Singh Medical College, Jawaharlal Nehru Marg, Gangawal Park, Jaipur, 302 004, India
| | - Bharat Sapra
- Department of Gastroenterology, Sawai Man Singh Medical College, Jawaharlal Nehru Marg, Gangawal Park, Jaipur, 302 004, India
| | - Ashok Jhajharia
- Department of Gastroenterology, Sawai Man Singh Medical College, Jawaharlal Nehru Marg, Gangawal Park, Jaipur, 302 004, India
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Sarathi Patra P, Das K, Bhattacharyya A, Ray S, Hembram J, Sanyal S, Dhali GK. Natural resolution or intervention for fluid collections in acute severe pancreatitis. Br J Surg 2014; 101:1721-8. [PMID: 25329330 DOI: 10.1002/bjs.9666] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/23/2014] [Accepted: 09/05/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Revisions in terminology of fluid collections in acute pancreatitis have necessitated reanalysis of their evolution and outcome. The course of fluid collections in patients with acute pancreatitis was evaluated prospectively. METHODS Consecutive adults with acute pancreatitis, who had contrast-enhanced CT (CECT) within 5-7 days of symptom onset, were enrolled in a prospective cohort study in a tertiary-care centre. Patients were treated according to standard guidelines. Follow-up transabdominal ultrasonography was done at 4-week intervals for at least 6 months. CECT was repeated at 6-10 weeks, or at any time if there were new or persistent symptoms. Asymptomatic collections were followed until spontaneous resolution. Risk factors for pancreatic pseudocysts or walled-off necrosis (WON) were assessed in multivariable analyses. RESULTS Of 122 patients with acute pancreatitis, 109 were analysed. Some 91 patients (83·5 per cent) had fluid collections at baseline. Eleven of 29 with interstitial oedematous pancreatitis had acute peripancreatic fluid collections, none of which evolved into pseudocysts. All 80 patients with acute necrotizing pancreatitis had at least one acute necrotizing collection (ANC); of these, five patients died (2 after drainage), three underwent successful drainage within 5 weeks, and collections resolved spontaneously in 33 and evolved into WON in 39. By 6 months' follow-up, WON had required drainage in eight patients, resolved spontaneously in 23 and was persistent but asymptomatic in seven. Factors associated with increased risk of WON were blood urea nitrogen 20 mg/dl or more (odds ratio (OR) 10·96, 95 per cent c.i. 2·57 to 46·73; P = 0·001) and baseline ANC diameter greater than 6 cm (OR 14·57, 1·60 to 132·35; P = 0·017). Baseline ANC diameter over 6 cm was the only independent predictor of either the need for drainage or persistence of such collections beyond 6 months (hazard ratio 6·61, 1·77 to 24·59; P = 0·005). CONCLUSION Pancreatic pseudocysts develop infrequently in oedematous acute pancreatitis. Only one-quarter of ANCs either require intervention or persist beyond 6 months, whereas more than one-half of WONs resolve without any intervention within 6 months of onset. Baseline diameter of ANC(s) is an important predictor of outcome.
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Affiliation(s)
- P Sarathi Patra
- Divisions of Gastroenterology, School of Digestive and Liver Diseases, Institute of Post-Graduate Medical Education and Research, Kolkata, India
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An Unusual Case of Ascending Pancreatitis with Mediastinal Involvement: A Case Report with CT and MRI Findings. Case Rep Radiol 2014; 2014:925105. [PMID: 24955277 PMCID: PMC4052052 DOI: 10.1155/2014/925105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/03/2014] [Accepted: 05/04/2014] [Indexed: 12/14/2022] Open
Abstract
Fluid collections are common findings of pancreatitis and spread, more often, along preferential drainage pathways in the abdomen. In some rare cases, fluid collections may spread towards extra-abdominal sites like the mediastinum leading to the formation of mediastinal collections. We present the case of a 52-years-old man with pain in the right upper quadrant of the abdomen and mid-epigastrium lasting for some hours. Laboratory tests suggested a diagnosis of pancreatitis. CT and subsequent MRI revealed changes consistent with acute exacerbation on chronic pancreatitis spreading to the mediastinum and to the greater omentum. The patient received medical treatment and reported gradual improvement in his laboratory results and CT findings.
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Türkvatan A, Erden A, Türkoğlu MA, Seçil M, Yüce G. Imaging of acute pancreatitis and its complications. Part 2: complications of acute pancreatitis. Diagn Interv Imaging 2014; 96:161-9. [PMID: 24703377 DOI: 10.1016/j.diii.2013.12.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into "acute peripancreatic fluid collection" and "acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled of pancreatic necrosis". Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections.
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Affiliation(s)
- A Türkvatan
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey.
| | - A Erden
- Department of Radiology, Ankara University School of Medicine, Talatpaşa Street, 06100 Sıhhiye, Ankara, Turkey
| | - M A Türkoğlu
- Department of General Surgery, Akdeniz University School of Medicine, Dumlupınar street, Antalya, Turkey
| | - M Seçil
- Department of Radiology, Dokuz Eylul University School of Medicine, Cumhuriyet street, İzmir, Turkey
| | - G Yüce
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey
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Türkvatan A, Erden A, Seçil M, Türkoğlu MA. Fluid collections associated with acute pancreatitis: a pictorial essay. Can Assoc Radiol J 2014; 65:260-6. [PMID: 24650871 DOI: 10.1016/j.carj.2013.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/05/2013] [Accepted: 08/15/2013] [Indexed: 12/15/2022] Open
Abstract
The terminology and classification scheme of acute pancreatitis proposed at the initial Atlanta Symposium was reviewed, and a new consensus statement was recently proposed. Major changes include subdividing acute fluid collections in the first 4 weeks into "acute peripancreatic fluid collection" and "acute necrotic collection" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled-off necrosis." Correct use of the new terms that describe these collections is important because they lead to different treatment decisions. The purpose of this article is to present an overview of fluid collections associated with acute pancreatitis, with an emphasis on their prognostic significance and impact on clinical management, and to illustrate the new terminology.
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Affiliation(s)
- Aysel Türkvatan
- Department of Radiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
| | - Ayşe Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Seçil
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mehmet A Türkoğlu
- Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey
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Tang W, Zhang XM, Zhai ZH, Zeng NL. Hepatic abnormal perfusion visible by magnetic resonance imaging in acute pancreatitis. World J Radiol 2013; 5:491-497. [PMID: 24379936 PMCID: PMC3874506 DOI: 10.4329/wjr.v5.i12.491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/26/2013] [Accepted: 11/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To study the prevalence and patterns of hepatic abnormal perfusion (HAP) visible by magnetic resonance imaging (MRI) in acute pancreatitis (AP). METHODS Enhanced abdominal MRI was performed on 51 patients with AP. These patients were divided into two groups according to the MRI results: those with signs of gallstones, cholecystitis, common bile duct (CBD) stones or dilatation of the CBD on MRI and those without. The prevalence, shape and distribution of HAP in the two groups were analyzed and compared. The severity of AP was graded using the MR severity index (MRSI). The correlation between the MRSI and HAP was then analyzed. RESULTS Of the 51 patients with AP, 32 (63%) showed at least one sign of gallbladder and CBD abnormalities on the MR images, while 19 (37%) showed no sign of gallbladder or CBD abnormalities. Nineteen patients (37%) had HAP visible in the enhanced images, including strip-, wedge- or patch-shaped HAP distributed in the hepatic tissue adjacent to the gallbladder and left and right liver lobes. There were no significant differences in the prevalence of HAP (χ (2) = 0.305, P = 0.581 > 0.05) or HAP distribution in the liver (χ (2) = 2.181, P = 0.536 > 0.05) between patients with and without gallbladder and CBD abnormalities. There were no significant differences in the MRSI score between patients with and without HAP (t = 0.559, P = 0.552 > 0.05). HAP was not correlated with the MRSI score. CONCLUSION HAP is common in patients with AP and appears strip-, patch- or wedge-shaped on MRI. HAP on MRI cannot be used to indicate the severity of AP.
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23
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The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines. ACTA ACUST UNITED AC 2013; 38:125-36. [PMID: 22584543 DOI: 10.1007/s00261-012-9908-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Imaging of acute pancreatitis requires not only an understanding of the disease subtypes and the myriad of associated complications but also familiarity with the appropriate radiologic nomenclature as defined by the Atlanta symposium in 1992 and, more recently, by the Acute Pancreatitis Classification Working Group in 2008. The accurate description of the radiological findings plays a critical role in the evaluation and management of patients with acute pancreatitis, particularly those with severe disease. There have been increasing efforts to develop uniformity in the use of terminology used to define the radiologic findings in acute pancreatitis, in particular, the terminology for fluid collections, a common area of inconsistency and confusion. Terms such as "acute peripancreatic fluid collections," "acute post- necrotic fluid collections," "pseudocyst," and "walled-off pancreatic necrosis" are now recommended as they describe the evolution of fluid collections in patients with both interstitial and necrotizing pancreatitis and nonspecific terms such as "pancreatic abscess" and "phlegmon" are being abandoned. In this review we illustrate, with case examples, the standardized terminology used in the radiological and clinical description of acute pancreatitis, its severity, and complications with an emphasis on the role of ultrasound, computed tomography and magnetic resonance imaging. Different management options of the associated complications are also discussed. The use of standardized terminology will hopefully improve the communication between radiologists, gastroenterologists, and surgeons to facilitate treatment planning and will lead to enhanced outcomes for patients with acute pancreatitis as well as create uniformity for enrollment into research studies.
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Shiozawa K, Watanabe M, Ikehara T, Mukozu T, Kamata I, Kishimoto Y, Mimura T, Ito K, Okano N, Igarashi Y, Sumino Y. Right hepatic artery pseudoaneurysm complicating acute pancreatitis: a case report. Med Princ Pract 2013; 22:402-4. [PMID: 23147463 PMCID: PMC5586757 DOI: 10.1159/000343707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 09/24/2012] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To report a rare case of right hepatic artery pseudoaneurysm complicating acute pancreatitis based upon imaging findings obtained before and after the development of pseudoaneurysm. CLINICAL PRESENTATION AND INTERVENTION A 32-year-old male with a history of acute pancreatitis 1 year prior was readmitted for acute pancreatitis. Computed tomography (CT) and angiography after admission revealed pseudoaneurysm of the right hepatic artery. Transcatheter arterial embolization with coils was used to successfully treat the pseudoaneurysm. A CT and angiography 1 year earlier did not reveal any pseudoaneurysm. CONCLUSION This patient with a rare right hepatic artery pseudoaneurysm complicating acute pancreatitis was successfully treated with coil embolization.
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Affiliation(s)
| | - Manabu Watanabe
- *Manabu Watanabe, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital 6-11-1, Omorinishi, Ota-ku, Tokyo 143-8541 (Japan), E-Mail
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25
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Elkhatib I, Savides T, Fehmi SMA. Pancreatic fluid collections: Physiology, natural history, and indications for drainage. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2012. [DOI: 10.1016/j.tgie.2012.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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26
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Pancreatic pseudocyst: therapeutic dilemma. Int J Inflam 2012; 2012:279476. [PMID: 22577595 PMCID: PMC3345229 DOI: 10.1155/2012/279476] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 02/17/2012] [Indexed: 02/08/2023] Open
Abstract
Pancreatic pseudocyst develops in both acute and chronic pancreatitis. It is an entity likely to either remain asymptomatic or develop devastating complications. Despite being diagnosed easily, treatment exercise is still at crossroads whether in the form of internal or external drainage or endoscopic, laparoscopic, or open intervention with a good radiological guidance. The therapeutic dilemma whether to treat a patient with a pancreatic pseudocyst, as well as when and with what technique, is a difficult one. This paper is intended to get information about diagnostic and therapeutic exercises most appropriate for acute and chronic pancreatic pseudocyst.
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27
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Lee HN, Lee TH, Ryu KH, Rim SM, Jeong IB, Kim YS, Choi YW, Kang YW. [A case of splenic pseudocyst complicated by acute pancreatitis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:193-6. [PMID: 22387841 DOI: 10.4166/kjg.2012.59.2.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Splenic pseudocyst is a rare disease associated with chronic and acute pancreatitis splenic pseudocyst is treated by distal pancreatectomy and splenectomy. A 47-year old woman with a 10-year history of alcohol abuse presented with epigastric and left upper quadrant pain of 3 days duration. Abdominal CT showed a 4.0×4.5 cm sized cystic lesion in the tail of the pancreas. Analgesics was administrated for the relief of abdominal pain. On the 4th hospital day, the patient complained more of left upper quadrant pain, so we took follow up CT scans. On follow up CT, one large splenic pseudocyst with size of 9.5×4.5×10.0 cm was noted. The patient was treated conservatively by percutaneous catheter drainage and discharged on the 13th hospital day. This case is the first case report of splenic pseudocyst treated conservatively, not by surgery in Korea.
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Affiliation(s)
- Han Na Lee
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
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Abstract
The advent of computed tomographic scan with its wide use in the evaluation of acute pancreatitis has opened up a new topic in pancreatology i.e. fluid collections. Fluid collections in and around the pancreas occur often in acute pancreatitis and were defined by the Atlanta Symposium on Acute Pancreatitis in 1992. Two decades since the Atlanta Conference additional experience has brought to light the inadequacy and poor understanding of the terms used by different specialists involved in the care of patients with acute pancreatitis when interpreting imaging modalities and the need for a uniformly used classification system. The deficiencies of the Atlanta definitions and advances in medicine have led to a proposed revision of the Atlanta classification promulgated by the Acute Pancreatitis Classification Working Group. The newly used terms "acute peripancreatic fluid collections," "pancreatic pseudocyst," "postnecrotic pancreatic/peripancreatic fluid collections," and "walled-off pancreatic necrosis" are to be clearly understood in the interpretation of imaging studies. The current treatment methods for fluid collections are diverse and depend on accurate interpretations of radiologic tests. Management options include conservative treatment, percutaneous catheter drainage, open and laparoscopic surgery, and endoscopic drainage. The choice of treatment depends on a correct diagnosis of the type of fluid collection. In this study we have attempted to clarify the management and clinical features of different types of fluid collections as they have been initially defined under the 1992 Atlanta Classification and revised by the Working Group's proposed categorization.
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30
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Cystoduodenal ligament as an abnormal fold and the accompanying anatomical and clinical implications. Surg Radiol Anat 2010; 33:171-4. [DOI: 10.1007/s00276-010-0736-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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31
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Takada T, Hirata K, Mayumi T, Yoshida M, Sekimoto M, Hirota M, Kimura Y, Takeda K, Isaji S, Wada K, Amano H, Gabata T, Arata S, Hirota M, Yokoe M, Kiriyama S, Nakayama T, Otomo K, Tanaka M, Shimosegawa T. Cutting-edge information for the management of acute pancreatitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2010; 17:3-12. [PMID: 20020160 DOI: 10.1007/s00534-009-0216-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 09/01/2009] [Indexed: 01/30/2023]
Abstract
Considering that the Japanese (JPN) guidelines for the management of acute pancreatitis were published in Takada et al. (J HepatoBiliary Pancreat Surg 13:2-6, 2006), doubts will be cast as to the reason for publishing a revised edition of the Guidelines for the management of acute pancreatitis: the JPN guidelines 2010, at this time. The rationale for this is that new criteria for the severity assessment of acute pancreatitis were made public on the basis of a summary of activities and reports of shared studies that were conducted in 2008. The new severity classification is entirely different from that adopted in the 2006 guidelines. A drastic revision was made in the new criteria. For example, about half of the cases that have been assessed previously as being 'severe' are assessed as being 'mild' in the new criteria. The JPN guidelines 2010 are published so that consistency between the criteria for severity assessment in the first edition and the new criteria will be maintained. In the new criteria, severity assessment can be made only by calculating the 9 scored prognostic factors. Severity assessment according to the contrast-enhanced computed tomography (CT) grade was made by scoring the poorly visualized pancreatic area in addition to determining the degree of extrapancreatic progress of inflammation and its extent. Changes made in accordance with the new criteria are seen in various parts of the guidelines. In the present revised edition, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is treated as an independent item. Furthermore, clinical indicators (pancreatitis bundles) are presented to improve the quality of the management of acute pancreatitis and to increase adherence to new guidelines.
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Affiliation(s)
- Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1, Kaga-cho, Itabashi, Tokyo, 173-8605, Japan.
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Desai G, Filly RA. Sonographic anatomy of the gastrohepatic ligament. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:87-93. [PMID: 20040779 DOI: 10.7863/jum.2010.29.1.87] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this presentation is to illustrate anatomic and pathologic features of the gastrohepatic ligament (GHL) and to show its usefulness for precise localization of abnormalities, particularly in relation to the lesser peritoneal cavity and diseases occurring within the confines of the ligament itself. METHODS Cases were selected that illustrate the objectives above. RESULTS Illustrations show various anatomic and pathologic features meant to enhance interpretation of left upper quadrant sonograms. CONCLUSIONS Illustrations seen in the sonographic literature vaguely interpret the relationships of the GHL. Misunderstanding has led not only to improper nomenclature but also to the use of inappropriate indicators of lesser omental diseases. With a clear understanding of the anatomy of the GHL and its use as a pivotal marker for structures around and within it, one can avoid these pitfalls and better evaluate adult and pediatric lesser omental anatomy.
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Affiliation(s)
- Gaurav Desai
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143-0628 USA
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EUS-guided diagnosis and successful endoscopic transpapillary management of an intrahepatic pancreatic pseudocyst masquerading as a metastatic pancreatic adenocarcinoma (with videos). Gastrointest Endosc 2009; 70:393-6. [PMID: 19394005 DOI: 10.1016/j.gie.2008.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 10/13/2008] [Indexed: 01/10/2023]
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Tutcu S, Serter S, Kaya Y, Kara E, Neşe N, Pekindil G, Coşkun T. Hepatic perfusion changes in an experimental model of acute pancreatitis: evaluation by perfusion CT. Eur J Radiol 2009; 75:203-6. [PMID: 19501998 DOI: 10.1016/j.ejrad.2009.04.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 04/27/2009] [Indexed: 01/12/2023]
Abstract
PURPOSE It is known that acute pancreatitis may cause secondary changes in several organs. Liver is one of these involved organs. In different experimental studies hepatic damages were shown histopathologically in acute pancreatitis but there are a few studies about perfusion disorders that accompany these histopathologic changes. Perfusion CT (pCT) provides the ability to detect regional and global alterations in organ blood flow. The purpose of the study was to describe hepatic perfusion changes in experimental acute pancreatitis model with pCT. MATERIALS AND METHODS Forty Sprague-Dawley rats of both genders with average weights of 250 g were used. Rats were randomized into two groups. Twenty rats were in control group and 20 in acute pancreatitis group. pCT was performed. Perfusion maps were formed by processing the obtained images with perfusion CT software. Blood flow (BF) and blood volume (BV) values were obtained from these maps. All pancreatic and liver tissues were taken off with laparotomy and histopathologic investigation was performed. Student's t test was used for statistical analyses. RESULTS In pCT we found statistically significant increase in blood volume in both lobes of liver and in blood flow in right lobe of the liver (p<0.01). Although blood flow in left lobe of the liver increased, it did not reach statistical significance. CONCLUSION The quantitative analysis of liver parenchyma with pCT showed that acute pancreatitis causes a significant perfusion changes in the hepatic tissue. Systemic mediators seem to be effective as well as local inflammatory changes in perfusion changes.
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Affiliation(s)
- Semra Tutcu
- Department of Surgery, Celal Bayar University, School of Medicine, Manisa, Turkey
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Scaglione M, Casciani E, Pinto A, Andreoli C, De Vargas M, Gualdi GF. Imaging assessment of acute pancreatitis: a review. Semin Ultrasound CT MR 2009; 29:322-40. [PMID: 18853839 DOI: 10.1053/j.sult.2008.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis is one of the more commonly encountered etiologies in the emergency setting. While in the majority of cases it is a self-limiting disease which responds rapidly to conservative management, in some cases acute pancreatitis may present with a more pronounced, sometimes dramatic, clinical picture and requires immediate medical care to avoid fatal complication. In this context, imaging plays a significant role because it enables identification of the development of the disease and local/systemic complications. The purpose of this article is to offer an overview of the disease and a spectrum of imaging findings in patients with acute pancreatitis, emphasizing the role of ultrasound, computed tomography, and magnetic resonance imaging according to the appropriate clinical context and advantages and limitations of each imaging modality are examined.
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Affiliation(s)
- Mariano Scaglione
- Department of Diagnostic Imaging, Clinica Pineta Grande, Castel Volturno, Caserta, Italy.
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Abstract
Pancreatic pseudocysts are complications of acute or chronic pancreatitis. Initial diagnosis is accomplished most often by cross-sectional imaging. Endoscopic ultrasound with fine needle aspiration has become the preferred test to help distinguish pseudocyst from other cystic lesions of the pancreas. Most pseudocysts resolve spontaneously with supportive care. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolution or complications, but in general, larger cysts are more likely to be symptomatic or cause complications. The main two indications for some type of invasive drainage procedure are persistent patient symptoms or the presence of complications (infection, gastric outlet or biliary obstruction, bleeding). Three different strategies for pancreatic pseudocysts drainage are available: endoscopic (transpapillary or transmural) drainage, percutaneous catheter drainage, or open surgery. To date, no prospective controlled studies have compared directly these approaches. As a result, the management varies based on local expertise, but in general, endoscopic drainage is becoming the preferred approach because it is less invasive than surgery, avoids the need for external drain, and has a high long-term success rate. A tailored therapeutic approach taking into consideration patient preferences and involving multidisciplinary team of therapeutic endoscopist, interventional radiologist and pancreatic surgeon should be considered in all cases.
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Casado D, Sabater L, Calvete J, Mayordomo E, Aparisi L, Sastre J, Lledo S. Multiple intrahepatic pseudocysts in acute pancreatitis. World J Gastroenterol 2007; 13:4655-7. [PMID: 17729426 PMCID: PMC4611847 DOI: 10.3748/wjg.v13.i34.4655] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver pseudocysts are a very rare complication in acute pancreatitis with only a few cases previously described. The lack of experience and literature on this condition leads to difficulties in the differential diagnosis and management. We report herein a case of acute pancreatitis who developed multiple intrahepatic pseudocysts. After complete imaging evaluation, the diagnosis was still unclear and the patient was operated on. The presence of liver lesions in patients with acute pancreatitis should raise the possibility of intrahepatic pseudocysts.
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Affiliation(s)
- David Casado
- Department of Surgery, Liver, Biliary and Pancreatic Unit, University of Valencia, Valencia, Spain
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38
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Cadranel J. Acquired Conditions. TEXTBOOK OF HEPATOLOGY 2007:810-817. [DOI: 10.1002/9780470691861.ch8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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39
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Abstract
Acute pancreatitis is a common disease with potentially serious outcomes. Multiple imaging modalities can be used to evaluate the disease process and its associated complications. Familiarity with the pathogenesis of this disease, indications for imaging, imaging protocols, staging systems, and the strengths and weaknesses of various modalities will help the radiologist optimize patient care.
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Affiliation(s)
- Anuradha Saokar
- Department of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital-White 270, 55 Fruit Street, Boston, MA 02114, USA
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40
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Gamanagatti S, Kandpal H, Mishra V. Acute pancreatitis complicated by intrasplenic and intrahepatic pseudocysts. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.ejrex.2006.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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41
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Kim YS, Kim Y, Kim SK, Rhim H. Computed tomographic differentiation between alcoholic and gallstone pancreatitis: Significance of distribution of infiltration or fluid collection. World J Gastroenterol 2006; 12:4524-8. [PMID: 16874865 PMCID: PMC4125640 DOI: 10.3748/wjg.v12.i28.4524] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the usefulness of various computed tomography (CT) findings including distribution of infiltration or fluid collection in differentiating the major etiologies of acute pancreatitis.
METHODS: We reviewed 75 relatively severe cases of acute pancreatitis of alcoholic (n = 43) or biliary stone (n = 32) etiology having infiltration or fluid collection on CT. We compared the pancreatic size, CT grading, presence or absence of biliary calculi, and dilatation of pancreatic or bile duct. We also evaluated degree and the distribution of infiltration and fluid collection in each group.
RESULTS: The sizes of pancreas were not different between alcohol group and stone group. Alcohol group showed higher CT grading than stone group (P < 0.05). Presence of biliary stone and duct dilatation was statistically significant in differentiating etiology (P < 0.05). Alcohol group showed significantly prominent peripancreatic pathology than stone group only in left peritoneal compartment (P = 0.020).
CONCLUSION: Alcoholic pancreatitis tends to form more prominent peripancreatic changes than gallstone pancreatitis in relatively severe cases. This is evident on the anterior aspect of left abdomen. Although clinical history and some CT findings usually are a major determinant of the etiology, this pattern of peripancreatic pathology may have an ancillary role in determining the etiologies of acute pancreatitis in the equivocal cases.
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Affiliation(s)
- Young-Sun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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42
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Wang X, Zhao X, Shi C, Börjesson A, Chen Z, Axelsson J, Zhao H, Andersson R. Potential mechanisms and significance of acute pancreatitis-associated liver injury. Scand J Gastroenterol 2006; 41:604-613. [PMID: 16638705 DOI: 10.1080/00365520500347105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Xiangdong Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, China.
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43
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Fiamingo P, Veroux M, Gringeri E, Mencarelli R, Veroux P, Madia C, D'Amico DF. True Solitary Pancreatic Cyst in an Adult: Report of a Case. Surg Today 2005; 35:979-83. [PMID: 16249857 DOI: 10.1007/s00595-005-3039-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2002] [Accepted: 01/18/2005] [Indexed: 11/26/2022]
Abstract
The differential diagnosis of cystic neoformations in the pancreas is challenging. We report a case of a true solitary cyst of the pancreas in a 26-year old woman. Abdominal magnetic resonance imaging and computed tomography showed a unilocular neoformation in the head of the pancreas, without obstruction of Wirsung's duct. We excised the cyst and performed Roux-en-Y loop pancreaticojejunostomy, but the patient suffered recurrent acute pancreatitis from Wirsung's duct stenosis. Thus, a new Roux-en-Y loop pancreaticojejunostomy was successfully done 6 months later. Histologically, the cyst was lined by cuboidal epithelium, immunohistochemically positive to anti-carbohydrate antigen 19-9 antibodies. To our knowledge, only 11 cases of solitary true cyst of the pancreas in adults have been reported, so the characteristics of this unusual entity are not well known. We propose a scheme for the differential diagnosis of cystic neoformations of the pancreas, starting from the histopathological definition of a true solitary cyst.
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Affiliation(s)
- Pietro Fiamingo
- Department of Surgical and Gastroenterological Sciences, First Surgical Clinic, University of Padua, Italy
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44
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Chen WX, Li YM, Gao DJ, Xiang Z, Yu CH, Xu GQ, Ji F. Application of endoscopic sphincterotomy in acute pancreatitis with fluid collection: a prospective study. World J Gastroenterol 2005; 11:3636-3639. [PMID: 15962392 PMCID: PMC4315978 DOI: 10.3748/wjg.v11.i23.3636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Revised: 06/09/2004] [Accepted: 07/22/2004] [Indexed: 02/06/2023] Open
Abstract
AIM To elucidate the role of endoscopic sphincterotomy (EST) in the treatment of acute pancreatitis. METHODS Ninety patients with acute pancreatitis were randomly divided into two groups: EST group and control group. All the patients underwent pancreatitis routine therapy, additionally the EST group was treated with EST and endoscopic naso-bile drainage (ENBD). The time of disappearance of abdominal symptoms and signs, normalization of amylase, hospitalization and absorption of acute fluid was recorded for all patients. RESULTS The time of disappearance of abdominal pain, normalization of blood and urine amylase and hospitalization was significantly shorter in EST group than in control group. The ratios of disappearance of fluid in mild acute pancreatitis patients was significantly higher in EST group (51.52%, 84.85%, 90.91%, 93.94%) than in the control group (0%, 30.30%, 69.70%, 72.73%, P<0.01 or P<0.05). When the ratios of reduction of fluid in severe acute pancreatitis patients of the EST group were compared (8.33%, 58.33%, 83.33%, 91.67%) with those in the control group (0%, 8.33%, 25% and 41.67%), there were significant differences. CONCLUSION The effect of EST+ENBD on acute pancreatitis with fluid is rather good.
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Affiliation(s)
- Wei-Xing Chen
- Department of Gastroenterology, The First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
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45
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Shankar S, vanSonnenberg E, Silverman SG, Tuncali K, Banks PA. Imaging and Percutaneous Management of Acute Complicated Pancreatitis. Cardiovasc Intervent Radiol 2004; 27:567-80. [PMID: 15578132 DOI: 10.1007/s00270-004-0037-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acute pancreatitis varies from a mild, self-limited disease to one with significant morbidity and mortality in its most severe forms. While clinical criteria abound, imaging has become indispensable to diagnose the extent of the disease and its complications, as well as to guide and monitor therapy. Percutaneous interventional techniques offer options that can be life-saving, surgery-sparing or important adjuncts to operation. Close cooperation and communication between the surgeon, gastroenterologist and interventional radiologist enhance the likelihood of successful patient care.
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Affiliation(s)
- Sridhar Shankar
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
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46
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Affiliation(s)
- Betty J Tsuei
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky 40536, USA
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47
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Tan MH, Kirk G, Archibold P, Kennedy P, Regan MC. Cardiac compromise due to a pancreatic mediastinal pseudocyst. Eur J Gastroenterol Hepatol 2002; 14:1279-82. [PMID: 12439127 DOI: 10.1097/00042737-200211000-00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Cardiac complications from a pancreatic mediastinal pseudocyst are rare. Pericardial effusions associated with pancreatitis have been reported only very occasionally. To the best of our knowledge, the direct extension of a pancreatic pseudocyst into the pericardial sac causing tamponade has not been described before. We present a case in which a pancreatic pseudocyst masquerading as a pericardial effusion dissected into the mediastinum, eroding into the pericardial sac and causing a life-threatening pericardial tamponade. A pericardial catheter was placed producing rapid symptomatic relief. Surgery was avoided by the use of octreotide as an adjuvant to ultrasound guided catheter drainage of the pseudocyst and it resolved completely within 4 weeks of admission to hospital. The importance of rapid and accurate diagnosis of this life-threatening complication is reiterated and the management of pancreatic mediastinal pseudocyst is discussed.
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Affiliation(s)
- Mei Hong Tan
- Departments of Surgery and Radiology, The Royal Victoria Hospital, Belfast, UK
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48
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Siegelman SS. Elias A. Zerhouni, MD, radiologist: new director of the National Institutes of Health. Radiology 2002; 224:309-12. [PMID: 12147818 DOI: 10.1148/radiol.2242020547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stanley S Siegelman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 N Caroline St, Rm 4214, Baltimore, MD 21287-0801, USA.
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49
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West JH, Vogel SB, Drane WE. Gallium uptake in complicated pancreatitis: a predictor of infection. AJR Am J Roentgenol 2002; 178:841-6. [PMID: 11906860 DOI: 10.2214/ajr.178.4.1780841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A retrospective evaluation was performed of the use of gallium imaging in patients with known severe pancreatitis to detect infection in pancreatic and peripancreatic fluid collections. MATERIALS AND METHODS Gallium-67 single-photon emission computed tomography (SPECT) studies were retrospectively reviewed in patients with complicated pancreatitis. Only patients who had undergone interventional procedures within 10 days of the scanning were included in our analysis. A total of 23 scans from 20 patients were reviewed. SPECT imaging was typically performed 48-72 hr after injection of the gallium. All studies were correlated with conventional CT findings. Findings from subsequent interventions (results of aspiration, Gram stains, or cultures) were used as evidence of infection. RESULTS Twenty patients underwent either percutaneous or surgical drainage within 10 days of their gallium scanning. One patient underwent gallium scanning on three different occasions and underwent three different interventional procedures after each of the gallium scans, bringing the total number of cases in our study to 23. Of these 23 cases, 18 patients (78%) with gallium scans showing positive findings for infection had infected fluid; five patients (22%) with negative findings for infection on gallium scans had sterile fluid (p < 0.00001). No false-positive scans were found among our study cases, and we found no correlation between the uptake of gallium and the presence or absence of pancreatic necrosis. CONCLUSION Gallium does not actively accumulate in all patients with severe pancreatitis, and gallium uptake does not correlate with the presence or absence of necrosis. In patients with severe pancreatitis complicated by fluid collections or inflammatory masses, gallium SPECT is a useful predictor of infection and can be used to help guide subsequent intervention. Gallium SPECT allows targeting sites of infected fluid in patients with multiple fluid collections and potentially obviates intervention in patients with sterile fluid collections.
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Affiliation(s)
- Jeffrey H West
- Department of Radiology, Shands Hospital at the University of Florida, 1600 S.W. Archer Rd., Gainesville, FL 32610, USA
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50
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