review of literature on clinical pancreatology - The Pancreapedia

study was to evaluate the efficacy and safety <strong>of</strong> single-step EUS-guided endoscopicapproaches for treatment <strong>of</strong> sterile PFC. During a 3-year period, 77 consecutive patients withsymptomatic, persistent sterile PFC were evaluated and treated with the linear EUS. It wasexcluded patients with grossly purulent collections, chronic pseudocyst and those whosecytology diagnostic was neoplastic cyst <strong>of</strong> pancreas. 44 patients received a single 10-Frplastic straight stent under EUS or fluoroscopic control (group I) and 33 <strong>of</strong> these underwent asingle-step complete aspiration with a 19-gauge needle (group II). The mean size <strong>of</strong> thesterile PFC was 48 mm in group I and 28 mm in group II. Overall, endoscopic treatment wassuccessful in 70 (91 %) patients. The mean volume aspirated was 25 (18-65) ml. The totalnumber <strong>of</strong> procedures was 50 in group I and 41 punctures in group II. After a mean follow-up<strong>of</strong> 64 + 16 weeks there were 6 complications (14 %): 2 recurrences (referred to surgery), 2developing abscesses (submitted a new EUS-guided endoscopic drainage with success), 1perforation that died (2 %), and 1 case <strong>of</strong> bleeding (sent to surgery) in group I. In group IIthere were only 6 (18 %) recurrences (submitted a new EUS-guided aspiration). None <strong>of</strong> thepatients undergoing single-step aspiration developed infections, perforation or hemorrhage. Itwas concluded that recurrence <strong>of</strong> pancreatic pseudocysts after endoscopic treatment wassimilar, either by means <strong>of</strong> plastic stents or by complete single-step aspiration [646].Other radiologyMost pancreatic pseudocysts are common complications <strong>of</strong> acute or chronic pancreatitis.They usually occur within the pancreas or in peripancreatic tissues, and are visualized asround or oval fluid collections with thin or thick walls on computed tomography (CT) scans.However, pancreatic pseudocysts are <strong>of</strong>ten combined with various complications, e.g.,various organ involvements, infection, hemorrhage with pseudoaneurysm formation, rupturewith fistula formation, or gastrointestinal or biliary obstruction, which may necessitate promptintervention or surgery. A <strong>review</strong> illustrates the CT appearances <strong>of</strong> various complicationsassociated with pancreatic pseudocysts [647].Case reportIt was reporter a huge pancreatic pseudocyst migrating to the psoas muscle and inguinalregion [648].Intrahepatic pancreatic pseudocyst is an extremely rare complication <strong>of</strong> acute pancreatitis.However, it was reported a case <strong>of</strong> a 37-year old diabetic male who presented with mildpancreatitis as predicted by modified Glasgow criteria. Abdominal CT scan showed a lefthepatic subcapsular cyst <strong>of</strong> 9x4 cm that progressively increased in size. CT guided aspiration<strong>of</strong> the cyst yielded 90 ml <strong>of</strong> yellow brown fluid with a high amylase concentration. Bacterialculture <strong>of</strong> the fluid was negative. The patient dramatically improved after aspiration; 3 monthslater the patient was asymptomatic and follow-up abdominal ultrasound has shown completeresolution <strong>of</strong> the cyst [649].It was reported a spontaneous gastric drainage <strong>of</strong> a pancreatic pseudocyst [650].A patient with a pancreatic pseudocyst rupture into the portal vein with a resultantnoninfectious systemic inflammatory response syndrome and subsequent portal veinthrombosis diagnosed by computed tomography and ultrasonography was reported [651].Hemosuccus pancreaticusErosion <strong>of</strong> peripancreatic arteries in acute or chronic pancreatitis is a rare cause <strong>of</strong> bleedinginto gastrointestinal tract - hemosuccus pancreaticus. It was reported a case <strong>of</strong> a patient withchronic pancreatitis who developed acute bleeding into the gastrointestinal tract due to the