Endoscopic Management of Pancreatic Pseudocysts at Atypical Locations

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2009 Nov 17

PMID 19915913

Citations 23

Authors

Deepak Kumar Bhasin

Surinder Singh Rana

Mohit Nanda

Vijant Singh Chandail

Ibrahim Masoodi

Mandeep Kang

Navin Kalra

Saroj Kant Sinha

Birinder Nagi

Kartar Singh

Affiliations

Soon will be listed here.

Abstract

Background And Aims: There is paucity of data on endoscopic management of pseudocysts at atypical locations. We evaluated the efficacy of endoscopic transpapillary nasopancreatic drain (NPD) placement in the management of pseudocysts of pancreas at atypical locations.

Patients And Methods: Eleven patients with pseudocysts at atypical locations were treated with attempted endoscopic transpapillary nasopancreatic drainage. On endoscopic retrograde pancreatography (ERP), a 5-F NPD was placed across/near the site of duct disruption.

Results: Three patients each had mediastinal, intrahepatic, and intra/perisplenic pseudocysts and one patient each had renal and pelvic pseudocyst. Nine patients had chronic pancreatitis whereas two patients had acute pancreatitis. The size of the pseudocysts ranged from 2 to 15 cm. On ERP, the site of ductal disruption was in the body of pancreas in five patients (45.4%), and tail of pancreas in six patients (54.6%). All the patients had partial disruption of pancreatic duct. The NPD was successfully placed across the disruption in 10 of the 11 patients (90.9%) and pseudocysts resolved in 4-8 weeks. One of the patients developed fever, 5 days after the procedure, which was successfully treated by intravenous antibiotics. In another patient, NPD became blocked 12 days after the procedure and was successfully opened by aspiration. The NPD slipped out in one of the patient with splenic pseudocyst and was replaced with a stent. There was no recurrence of symptoms or pseudocysts during follow-up of 3-70 months.

Conclusion: Pancreatic pseudocysts at atypical locations with ductal communication and partial ductal disruption that is bridged by NPD can also be effectively treated with endoscopic transpapillary NPD placement.

Citing Articles

Recurrent gastric intramural pseudocyst: A case report and comprehensive literature review of reported cases.

Soltani A, Salimi M, Nemati M, Mirshamsi A Radiol Case Rep. 2024; 19(11):5429-5441.

PMID: 39285981 PMC: 11403908. DOI: 10.1016/j.radcr.2024.08.041.

Pancreatico-renal fistula associated with pancreatic cysts caused by type 1 autoimmune pancreatitis.

Takuma K, Fujimoto A, Okano N, Hayashi A, Hoshi K, Sato Y Clin J Gastroenterol. 2024; 17(5):994-998.

PMID: 38922496 DOI: 10.1007/s12328-024-02008-8.

Outlandish pancreatic pseudocyst: A case report.

Tomey V, Tomey S, Choudhari-Joshi M, Singh C, Aurangabadkar G J Family Med Prim Care. 2024; 12(12):3418-3421.

PMID: 38361871 PMC: 10866256. DOI: 10.4103/jfmpc.jfmpc_1136_23.

Imaging Diagnosis and Management of Fistulas in Pancreatitis.

Chhabra M, Gupta P, Shah J, Samanta J, Mandavdhare H, Sharma V Dig Dis Sci. 2023; 69(2):335-348.

PMID: 38114791 DOI: 10.1007/s10620-023-08173-z.

Pancreatic pseudocyst mimicking a left kidney abscess: a case report.

Madani M, Ouannes Y, Chaker K, Marrak M, Nouira Y J Med Case Rep. 2023; 17(1):228.

PMID: 37254204 PMC: 10230666. DOI: 10.1186/s13256-023-03957-3.

References

Mallavarapu R, Habib T, Elton E, Goldberg M . Resolution of mediastinal pancreatic pseudocysts with transpapillary stent placement. Gastrointest Endosc. 2001; 53(3):367-70. DOI: 10.1016/s0016-5107(01)70421-x. View

Bhasin D, Rana S, Nadkarni N . Protocol-based management strategy for post-endoscopic retrograde cholangiopancreatography pancreatitis: can it make a difference?. J Gastroenterol Hepatol. 2008; 23(3):344-7. DOI: 10.1111/j.1440-1746.2008.05349.x. View

Komtong S, Chanatrirattanapan R, Kongkam P, Rerknimitr R, Kullavanijaya P . Mediastinal pseudocyst with pericardial effusion and dysphagia treated by endoscopic drainage. JOP. 2006; 7(4):405-10. View

Kim D, Chung H, Gham C, Na H, Park S, Lee S . A case of complete resolution of mediastinal pseudocyst and pleural effusion by endoscopic stenting of pancreatic duct. Yonsei Med J. 2003; 44(4):727-31. DOI: 10.3349/ymj.2003.44.4.727. View

Ammann R, MUNCH R, Largiader F, AKOVBIANTZ A, Marincek B . Pancreatic and hepatic abscesses: a late complication in 10 patients with chronic pancreatitis. Gastroenterology. 1992; 103(2):560-5. DOI: 10.1016/0016-5085(92)90847-r. View

Gupta R, Munoz J, Garg P, Masri G, Nahman Jr N, Lambiase L . Mediastinal pancreatic pseudocyst--a case report and review of the literature. MedGenMed. 2007; 9(2):8. PMC: 1994836. View

Mohl W, Moser C, Kramann B, Zeuzem S, Stallmach A . Endoscopic transhiatal drainage of a mediastinal pancreatic pseudocyst. Endoscopy. 2004; 36(5):467. DOI: 10.1055/s-2004-814385. View

Malka D, Hammel P, Levy P, Sauvanet A, Ruszniewski P, Belghiti J . Splenic complications in chronic pancreatitis: prevalence and risk factors in a medical-surgical series of 500 patients. Br J Surg. 1999; 85(12):1645-9. DOI: 10.1046/j.1365-2168.1998.00952.x. View

Topa L, Laszlo F, Sahin P, Pozsar J . Endoscopic transgastric drainage of a pancreatic pseudocyst with mediastinal and cervical extensions. Gastrointest Endosc. 2006; 64(3):460-3. DOI: 10.1016/j.gie.2006.04.009. View

10.

Kozarek R . Pancreatic stents can induce ductal changes consistent with chronic pancreatitis. Gastrointest Endosc. 1990; 36(2):93-5. DOI: 10.1016/s0016-5107(90)70958-3. View

11.

Saftoiu A, Ciurea T, Dumitrescu D, Stoica Z . Endoscopic ultrasound-guided transesophageal drainage of a mediastinal pancreatic pseudocyst. Endoscopy. 2006; 38(5):538-9. DOI: 10.1055/s-2006-925229. View

12.

Lo J, Tang S . CT of multiple subcapsular pseudocysts of the kidney complicating acute pancreatitis. J Comput Assist Tomogr. 1995; 19(5):823-4. DOI: 10.1097/00004728-199509000-00027. View

13.

Gandhi M, Barone J . Pediatric renal pseudocyst due to pancreatitis. Urology. 2006; 68(6):1344.e5-6. DOI: 10.1016/j.urology.2006.09.055. View

14.

Smith M, Sherman S, Ikenberry S, Hawes R, Lehman G . Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy. Gastrointest Endosc. 1996; 44(3):268-75. DOI: 10.1016/s0016-5107(96)70163-3. View

15.

Varadarajulu S, Noone T, Tutuian R, Hawes R, Cotton P . Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement. Gastrointest Endosc. 2005; 61(4):568-75. DOI: 10.1016/s0016-5107(04)02832-9. View

16.

Baillie J . Pancreatic pseudocysts (Part II). Gastrointest Endosc. 2004; 60(1):105-13. DOI: 10.1016/s0016-5107(04)01532-9. View

17.

Bhasin D, Udawat H, Rana S, Sood A, Sinha S, Nagi B . Intrasplenic pancreatic abscess successfully treated by endoscopic transpapillary drainage through the minor papilla. Gastrointest Endosc. 2005; 62(1):192-4. DOI: 10.1016/s0016-5107(05)00552-3. View

18.

Shibasaki M, Bandai Y, Ukai T . Pancreatic pseudocyst extending into the liver via the hepatoduodenal ligament: a case report. Hepatogastroenterology. 2002; 49(48):1719-21. View

19.

Bhasin D, Dhavan S, Sriram P, Nagi B, Varma V, Singh G . Endoscopic management of pancreatic diseases. Indian J Gastroenterol. 1997; 16(4):151-2. View

20.

Musana K, Yale S, Abdulkarim A, Rall C . Successful endoscopic treatment of mediastinal pseudocysts. Clin Med Res. 2005; 2(2):119-23. PMC: 1069081. DOI: 10.3121/cmr.2.2.119. View