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Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Pancreatic pseudocyst is a collection of pancreatic fluid within a fibrous cavity; its presence may be heralded by persistent abdominal pain or chronically elevated amylase levels. Infected pancreatic necrosis must be considered if patient develops fever and leukocytosis. A CT scan or ultrasonogram (the latter is preferable in the pregnant patient) may reveal the presence of fluid and necrosis in the pancreas, but cannot determine whether or not there is concomitant infection. The diagnosis of infected pancreatic necrosis is therefore usually made on clinical grounds. Hemorrhagic pancreatitis due to necrosis and blood vessel rupture may lead to massive bleeding. Pancreatic ascites results from rupture of pancreatic ducts with leakage of amylase-rich fluid into the peritoneum.
The pancreas
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Also, a pancreatic pseudocyst may develop. If the main duct is intact, the cyst can be aspirated percutaneously in the first instance; it may not be necessary to undertake a cyst- gastrostomy. If the cyst develops in the presence of complete disruption of the pancreas, there is no alternative but to undertake a distal resection or, occasionally, a pancreatoje- junostomy with a Roux-en-Y loop. In a patient who presents with a peripancreatic cyst and a history of previous blunt abdominal trauma, do not assume that it is a post-traumatic pseudocyst. The possibility of a cystic neoplasm should be considered and excluded.
Abdominal trauma
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Marianne Beaudin, Rebeccah L Brown
Complications including pancreatitis, abscess, pancreatic pseudocysts and pancreatic fistulas occur in 22% of patients with pancreatic trauma. One of the most frequent complications associated with non-operative management of pancreatic injury is development of a pancreatic pseudocyst. This should be suspected in a child who develops abdominal pain, abdominal distension or vomiting after pancreatic injury. Diagnostic studies include CT scan, MRI, endoscopic ultrasound and ERCP. Most cases will resolve spontaneously by keeping the patient nil by mouth and providing nutritional support via TPN or nasojejunal enteral feeds. Other options for treatment include percutaneous drainage or internal drainage via cyst gastrostomy or cyst duodenotomy. Pancreatic fistula is a complication more commonly seen after operative management of pancreatic injury. It presents with output from a drain (or incision) with amylase levels three times greater than blood levels. This usually responds to conservative expectant management but ERCP and stent placement are sometimes necessary.
Endoscopic management of pancreaticopleural fistula after recurrent acute pancreatitis
Published in Baylor University Medical Center Proceedings, 2021
Abinash Subedi, Dragos Manta, Amrendra Mandal, Aakritee Sharma Subedi, Nuri Ozden
Pancreaticopleural fistula can be managed medically, endoscopically, or operatively. Medical management includes use of octreotide, which inhibits the exocrine pancreatic secretions and facilitates the fistula closure. Endoscopy therapy with ERCP has revolutionized management and is also helpful in diagnosis by revealing the ductal morphology and site of leak. Endoscopic management includes pancreatic sphincterotomy and/or pancreatic duct stenting.13–15 Surgical management is recommended when medical or endoscopic management fails. Cystogastrostomy or cystojejunostomy is done if symptomatic pancreatic pseudocyst is present. Distal and middle pancreatectomy are a last resort in patients who fail medical, endoscopic, or cyst drainage procedures.16,17
Imaging in pancreatitis: current status and recent advances
Published in Expert Opinion on Orphan Drugs, 2018
Itegbemie Obaitan, Umar Hayat, Hiba Hashmi, Guru Trikudanathan
Pancreatic pseudocyst refers to a fluid collection surrounded by a well-defined wall with essentially no solid material. It is usually peripancreatic but may be partly or wholly intra-pancreatic [3]. It is thought to arise from disruption of the main pancreatic duct or a side-branch and consequently, aspiration of pseudocyst usually shows fluid with increased amylase [3]. Presence or absence of communication of pseudocyst to pancreatic duct may have implications towards management and is best visualized on the magnetic resonance cholangiopancreatography owing to superior contrast resolution [3]. Occasionally many pseudocysts seal off such communication and will resolve spontaneously [5]. Development of a pancreatic pseudocyst is extremely rare in AP. It can also occur in the setting of ‘disconnected pancreatic duct syndrome’ (Figure 3) where it arises from leakage from the disconnected duct into the necrosectomy cavity.
Clinical summary of pediatric acute lymphoblastic leukemia patients complicated with asparaginase-associated pancreatitis in SCCLG-ALL-2016 protocol
Published in Hematology, 2023
Jian Wang, Wen-Guang Jia, Li-Hua Yang, Wen-Yong Kuang, Li-Bin Huang, Hui-Qin Chen, Li-Na Wang, Dun-Hua Zhou, Ning Liao
We analyzed the occurrent time of AAP and found that 25.71% (9/35) of the patients occurred after the second use of PEG-ASNase, the specific distribution of occurrent time was listed in Table 3. The number of days from the usage of PEG-ASNase prior to AAP diagnosis was from 1 to 21 days, with an average of 9.36 ± 5.51 days. The percentage of severe cases was 31.43% (11/35), and 8.57% (3/35) needed insulin treatment. After comprehensive therapy, 31 patients cured with the median course was 13.33 ± 8.35 days (range 3–36 days), 2 patients developed pancreatic pseudocyst, and another 2 severe cases died due to the septic shock with a mortality rate was 5.71%.