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The Spread of Chest Tumours to the Abdomen, and some Abdominal Tumours to the Chest - also a consideration of some relevant abdominal conditions in differential diagnosis, particularly of the Liver, Spleen and Pancreas.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
(iii) Pancreatitis and pseudocysts - patients with pancreatitis may have an acute and florid mediastinitis, as a result of pancreatic enzymes spreading up into the thorax through the larger openings in the diaphragm (alongside the cardia, the aorta or through the foramina of Morgagni or Bochdalek) or passing through the tiny pores in the diaphragm (see ps. 14.9 - 10). Pleural effusions and pericarditis may also be present, and these may be haemorrhagic. Whilst much of this inflammatory reaction may resolve spontaneously, pseudocysts may form, as in the abdomen. These occur mainly in the lower mediastinum, or in relation to the diaphragmatic crura, and may become chronic. Occasionally secondary infection and/or fistulous communications with the viscera or bronchi occur.
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.
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
How would you treat a pseudocyst?If they are asymptomatic, these can be left alone, regardless of size.Otherwise, they can be drained endoscopically, laparoscopically, radiologically or by open cyst-gastrostomy, depending on anatomical constraints, technical expertise and patient preference.
Trends in management and outcome of cystic pancreatic lesions – analysis of 322 cases undergoing surgical resection
Published in Scandinavian Journal of Gastroenterology, 2019
Kim Ånonsen, Mushegh A. Sahakyan, Dyre Kleive, Anne Waage, Caroline Verbeke, Truls Hauge, Trond Buanes, Bjørn Edwin, Knut Jørgen Labori
This was a retrospective review of all patients undergoing pancreatectomy for presumed neoplastic CPLs at Oslo University Hospital between January 2004 and December 2016. Pancreatic surgery in the South-Eastern region of Norway is centralised to Oslo University Hospital and currently serves a population of 2.9 million inhabitants. Patients undergoing resection for preoperatively diagnosed symptomatic pseudocysts were excluded from the study. Patients selected for observation were not recorded. Data were obtained retrospectively and included data on patient demographics, clinical presentation, preoperative diagnostic workup, intra- and postoperative outcomes, and histopathological characteristics. The following types of comorbidities were distinguished and included in the analysis: cardiovascular disease, hypertension, chronic obstructive pulmonary diseases and diabetes mellitus. Type of procedure, duration of operation, perioperative blood loss and rate of severe complications were recorded. The hospital review board approved the study according to the general guidelines provided by the regional ethics committee. The manuscript was completed in accordance with the STROBE statement [12].
Stent migration following treatment of pancreatic pseudocyst by cyst gastrostomy
Published in Baylor University Medical Center Proceedings, 2019
Steven Smith, Patrick Ramirez, Alisha Hinds, Raymond Duggan, Jonathan Ramirez
Pancreatic pseudocysts are collections of fluid that form most commonly as a complication of pancreatitis. Management options include observation as well as surgical, percutaneous, and endoscopic drainage. Stent placement guided by endoscopic ultrasound has become the preferred option because of its lower complication rates compared to surgical and percutaneous techniques. Common complications of endoscopic stent placement include puncture of adjacent organs, perforation, and bleeding. However, another uncommon complication is stent migration. Despite improvement in stenting techniques and stent design, migration of the stent continues to be an issue. We present a case of lumen-apposing self-expandable metal stent (LASEMS) migration following endoscopic drainage of a pancreatic pseudocyst.
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.