The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5% (17/19), the incidence of re-bleeding after TAE was 36.8% (7/19) and the successful rate of hemostatis by second TAE was 71.4% (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery; In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE.
Aneurysm, False/diagnosis ; Aneurysm, False/etiology ; Aneurysm, False/therapy ; *Embolization, Therapeutic/methods ; Hemoperitoneum/diagnosis ; Hemoperitoneum/etiology ; Hemoperitoneum/*therapy ; Pancreatic Pseudocyst/diagnosis ; Pancreatic Pseudocyst/etiology ; Pancreatic Pseudocyst/therapy ; Pancreatitis, Acute Necrotizing/*complications ; Pancreatitis, Acute Necrotizing/therapy ; Retrospective Studies

Ectopic pancreas is no longer a rare clinical condition, but its unusual clinical manifestations, locations or complications are of clinical interest. We experienced a case (a 48 year-old male patient) of duodenal ectopic pancreas complicated by chronic pancreatitis and pseudocyst formation of which preoperative imaging findings mimicked a large duodenal submucosal tumor with cystic degeneration such as a leiomyosarcoma. Simultaneous chronic pancreatitis was also demonstrated in the isotopic pancreas of the patient postoperatively. Herein we report a rare clinical condition occurring in an ectopic pancreas with a brief review of the literature.
Case Report ; Choristoma/complications/*diagnosis ; Chronic Disease ; Diagnosis, Differential ; Duodenal Diseases/complications/*diagnosis ; Duodenal Neoplasms/diagnosis ; Human ; Male ; Middle Age ; *Pancreas ; Pancreatic Pseudocyst/complications/*diagnosis ; Pancreatitis/complications/*diagnosis

No abstract available.
Alcoholism/complications/*diagnosis ; Endoscopy, Digestive System ; Humans ; Male ; Middle Aged ; Pancreatic Pseudocyst/*diagnosis/diagnostic imaging ; Pancreatitis/*diagnosis/diagnostic imaging/etiology ; Tomography, X-Ray Computed

Although most of pseudocysts as one of complications of pancreatitis occur primarily within the pancreas, the extrapancreatic locations of pseudocysts, especially in the liver, are rare events. With advanced technology of imaging studies including abdominal computed tomography, ultrasonography, and magnetic resonance imaging, their frequency seems to be increasing. We report here a case of left intrahepatic pancreatic pseudocyst following acute pancreatitis. Percutaneous puncture revealed a high level of amylase and lipase in the collection, confirming the diagnosis of intrahepatic pseudocyst. Symptomatic intrahepatic pseudocysts can be managed surgically, transcutaneously or endoscopically, and asymptomatic intrahepatic pseudocysts can be treated conservatively. We report this case with a review of literature.
Acute Disease ; Aged ; Humans ; Liver Diseases/*diagnosis/etiology/ultrasonography ; Magnetic Resonance Imaging ; Male ; Pancreatic Pseudocyst/*diagnosis/etiology/ultrasonography ; Pancreatitis, Alcoholic/complications/*diagnosis/ultrasonography ; Tomography, X-Ray Computed

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 4.0x4.5 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 9.5x4.5x10.0 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.
Acute Disease ; Alcoholism/diagnosis ; Drainage ; Female ; Humans ; Middle Aged ; Pancreatic Pseudocyst/diagnosis ; Pancreatitis/*complications ; Splenic Diseases/etiology/*radiography/ultrasonography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Pseudoaneurysm is a life-threatening complication of chronic or acute pancreatitis. This study was undertaken to evaluate the clinical features of pseudoaneurysm complicating pancreatitis. METHODS: We reviewed the medical records of 7 patients diagnosed as pseudoaneurysms with chronic pancreatitis in Korea University Guro and Anam Hospital from January 1995 to March 2006 and analyzed their demographics, clinical courses and outcomes. RESULTS: All patients were men and mean age was 54.6 years (range, 43-67 years). All the cases occurred in the setting of chronic alcoholic pancreatitis complicated by pseudocyst. Abdominal pain was the unique initial clinical symptom in 5 cases, hematemesis in 1 case, and simultaneous abdominal pain with hematemesis in 1 case. Bleeding into pseudocyst developed in 5 cases, flowing into duodenum through pancreatic duct in 1 case and rupture into the descending colon in 1 case. Mean duration between onset of symptom and diagnosis of pseudoaneurysm was 7.8 days (range, 1-23 days). Six cases were diagnosed by abdominal computed tomography disclosing characteristic finding of focal high density area in the pseudocyst. Pulsed doppler abdominal sonography was performed before computed tomography in 3 cases and results were negative in 2 cases. Transcatheter arterial embolizations were initially performed in 6 cases, and there was no recurrent bleeding except one case of splenic infarction. Distal pancreatectomy was initially performed in 1 case. CONCLUSIONS: Pseudoaneurysms complicating chronic pancreatitis shows various clinical features. Transcatheter arterial embolization can be recommended as a primary therapeutic modality.
Adult ; Aged ; Aneurysm, False/*diagnosis/etiology/ultrasonography ; Arteries/injuries ; Demography ; Embolization, Therapeutic ; Hemorrhage/etiology/surgery ; Humans ; Korea ; Male ; Middle Aged ; Pancreatic Pseudocyst/etiology/surgery ; Pancreatitis, Alcoholic/*complications/pathology ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: Pancreatic islet cell tumors are very rare tumors that are classified into functioning, secreting hormone with specific symptoms, and nonfunctioning tumors without distinct symptoms. Because of their rarity, studies of them have been limitted. METHODS: We experienced 12 cases of pancreatic islet cell tumor at Samsung Seoul Medical Center from October 1994 to May 1998 and reviewed charts retrospectively. RESULTS: The mean age was 43.3 years; 46.3 years for those with functioning tumors. The most common symptom in nonfunctioning tumors was abdominal pain; other symptoms were abdominal mass, diabetes mellitus, and jaundice. With the functioning tumors, loss of conciousness and hypoglycemic sympathetic symptoms were present in all patients, and a seizure occurred in one case. The tumors were localized with abdominal CT in 91.7% (11 of 12), abdominal US in 87.5% (7 of 8), and selective angiography in 42.9% (3 of 7). The mean size was 1.7 cm in functioning tumors and 7.6 cm in nonfunctioning tumors. In 5 of the 6 cases, where the tumor was located in the pancreatic head, a pancreaticoduodenectomy was performed; enucleation was done in the other case. In the cases receiving a pancreaticoduodenectomy, choledochojejunostomy leakage was the only postoperative complication one case; there was a pancreatic pseudocyst in one case of enucleation. Of the functioning tumors, 3 (25%) were insulinoma; the remaining 9 (75%) tumors were nonfunctioning tumors. There were 4 cases (33.3%) of malignancies, and they were all nonfunctioning tumors. An immunohistochemical staining study showed evidence of multi-hormonal production in 45.5% of the cases, and all tumors showed a positive reaction to at least one hormonal marker. Two of the 3 insulinoma cases showed a positive reaction to insulin. Somatostatin was positive in 81.8% of the tumors, glucagon in 45.5%, and insulin in 18.2%. Chromogranin was positive in 71.4% of the tumors, synaptophysin in 60%, and neuron-specific enolase in 60%. CONCLUSION: There may be more cases of functioning tumors than have been reported and early diagnosis and treatment will reduce the incidence of malignancy. Abdominal CT or US is comparatively useful to localize the site of tumor and spiral CT angiography may be useful for the cases where nothing is detected with routine CT. Immunohistochemical staining is non-specific in classification of each islet tumor, but the positivity of any one of the hormonal markers may be useful in differentiating of pancreatic islet cell tumors from non-ilset cell tumors.
Abdominal Pain ; Adenoma, Islet Cell ; Angiography ; Choledochostomy ; Classification ; Diabetes Mellitus ; Early Diagnosis ; Glucagon ; Head ; Humans ; Incidence ; Insulin ; Insulinoma ; Islets of Langerhans* ; Jaundice ; Pancreatic Pseudocyst ; Pancreaticoduodenectomy ; Phosphopyruvate Hydratase ; Postoperative Complications ; Retrospective Studies ; Seizures ; Seoul ; Somatostatin ; Synaptophysin ; Tomography, Spiral Computed ; Tomography, X-Ray Computed