Pancreatic panniculitis is a rare disease in which necrosis of fat in the panniculus and other distant foci occurs in the setting of pancreatic diseases; these diseases include acute and chronic pancreatitis, pancreatic carcinoma, pseudocyst, and other pancreatic diseases. This malady is manifested as tender erythematous nodules on the legs, buttock, or trunk. Histopathologically, it shows the pathognomonic findings of focal subcutaneous fat necrosis and ghost-like anucleated cells with a thick shadowy wall. We herein report a case of fatal pancreatic panniculitis that was associated with acute pancreatitis in a 50-yr-old man. He presented with a 3-week history of multiple tender skin nodules, abdominal pain and distension. Laboratory and radiologic findings revealed acute pancreatitis, and skin biopsy showed pancreatic panniculitis. Despite intensive medical care, he died of multi-organ failure 3 weeks after presentation.
Acute Disease ; Biopsy ; Erythema/pathology ; Fatal Outcome ; Humans ; Male ; Middle Aged ; Necrosis ; Pancreas/pathology ; Pancreatitis/*complications/*mortality ; Pancreatitis, Alcoholic/diagnosis/pathology ; Panniculitis/*complications/*mortality ; Skin/pathology ; Skin Diseases/diagnosis/pathology ; Tomography, X-Ray Computed/methods

Hepatic portal venous gas (HPVG) is an uncommon disease entity that usually has grave prognosis. It is generally associated with bowel necrosis, and has been reported in a wide variety of conditions such as ulcerative colitis, Crohn's disease, diverticulitis, intestinal ischemia, or infarction. We experienced two cases of HPVG associated with acute pancreatitis. HPVG was found in patients with severe necrotizing pancreatitis and concurrent bowel ischemia. Despite aggressive resuscitation with fluids and broad spectrum antibiotics, each patient developed multiorgan failure, and died within few days. Acute pancreatitis is a potential cause of severe intraabdominal systemic catastrophe. Moreover, HPVG is associated with bowel ischemia in the setting of acute pancreatitis which could lead to rapid aggravation of symptom and complicated clinical course. Therefore, vigilant and aggressive management should be warranted in such condition.
Adult ; Fatal Outcome ; *Hepatic Veins/radiography ; Humans ; Male ; Middle Aged ; Pancreatitis, Alcoholic/*complications/radiography ; Pneumatosis Cystoides Intestinalis/etiology/*radiography ; *Portal Vein/radiography ; Tomography, X-Ray Computed

In acute pancreatitis, colonic complications such as mechanical obstruction, ischemic necrosis, hemorrhage, and fistula are rare but their outcomes are fatal. It is known that colonic obstruction in acute pancreatits is more likely found in splenic flexure and transverse colon caused by severe inflammation of body and tail of pancreas leading to pressure necrosis. A 43-year-old man presented with abdominal distension lasting for 2 weeks. The patient had been admitted to our institution 6 weeks prior to the current admission, and the abdominal CT scan performed during the first admission revealed the pancreatic enlargement with peri-pancreatic fatty infiltration and fluid collection. At that time he was diagnosed as acute pancreatitis. The conservative management resulted in clinical improvent so that the patient was discharged. Upon the second admission, abdominal CT scan revealed multiple pseudocysts in the tail portion of pancreas with concominant wall thickening and narrowing of the proximal descending colon, and a dilatation of the bowel proximal to the splenic flexure. An obstruction of the descending colon as a complication of acute pancreatitis was suspected and the patient underwent left hemicolectomy. Abdominal distension was relieved after the operation and he was discharged on the 15th hospital days.
Acute Disease ; Adult ; Colectomy ; Colonic Diseases/*diagnosis/etiology/surgery ; Diagnosis, Differential ; Humans ; Intestinal Obstruction/*diagnosis/etiology/surgery ; Male ; Pancreatitis, Alcoholic/*complications/diagnosis ; 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

Peripancreatic pseudoaneurysm and splenic infarction are rare but life-threatening complications of chronic pancreatitis. The incidence of pseudoaneurysm in patients who undergo angiography for pancreatitis is about 10%. Clinically, pseudoaneurysm is hard to discover until rupture occurs. The authors have recently experienced a case of intact pseudoaneurysm and splenic infarction in chronic alcoholic pancreatitis. A bolus enhanced CT scan and angiography were essential to confirm these complications of pancreatitis. We managed these complications successfully by distal pancreatectomy and splenectomy.
Adult ; Aneurysm, False/diagnosis/*etiology/surgery ; Case Report ; Human ; Male ; Pancreatectomy ; Pancreatitis, Alcoholic/*complications ; Splenectomy ; *Splenic Artery/surgery ; Splenic Infarction/diagnosis/*etiology/surgery

BACKGROUND/AIMS: To determine the nutritional markers important for assessing the degree of pancreatic insufficiency due to chronic pancreatitis in routine clinical practice. METHODS: A total of 137 patients with chronic pancreatitis were followed up for more than 1 year. They were divided into two groups: a pancreatic diabetes mellitus (DM) group, consisting of 47 patients undergoing medical treatment for DM of pancreatic origin, and a nonpancreatic DM group, consisting of 90 other patients (including 86 patients without DM). Serum albumin, prealbumin, total cholesterol, cholinesterase, magnesium, and hemoglobin were compared between the two groups. RESULTS: The total cholesterol was significantly lower in the pancreatic than the nonpancreatic DM group (164 mg/dL vs 183 mg/dL, respectively; p=0.0028). Cholinesterase was significantly lower in the former group (263 U/L vs 291 U/L, respectively; p=0.016). Among the 37 patients with nonalcoholic pancreatitis, there was no difference in the cholinesterase levels between the pancreatic and nonpancreatic (296 U/L vs 304 U/L, respectively; p=0.752) DM groups, although cholesterol levels remained lower in the former (165 mg/dL vs 187 mg/dL, respectively; p=0.052). CONCLUSIONS: Cholinesterase levels are possibly affected by concomitant alcoholic liver injury. The total cholesterol level should be considered when assessing pancreatic insufficiency due to chronic pancreatitis.
Adult ; Aged ; Aged, 80 and over ; Cholesterol/*blood ; Cholinesterases/blood ; Diabetes Mellitus, Type 2/complications ; Exocrine Pancreatic Insufficiency/*blood/etiology ; Female ; Follow-Up Studies ; Humans ; Liver Cirrhosis, Alcoholic/blood ; Male ; Middle Aged ; Nutritional Status ; Pancreas/enzymology ; Pancreatitis, Alcoholic/blood/complications ; Pancreatitis, Chronic/blood/*complications ; Serum Albumin/analysis

BACKGROUND: Pancreatic pseudocysts are localized collections of pancreatic secretions in a cystic structure that lack an epithelial lining and occur as a result of surrounding tissues walling off and containing a pancreatic duct disruption. METHODS: This is paper presents a clinical analysis of 32 cases of pancreatic pseudocysts treated from January 1987 to July 1997 at Pusan Medical Center. RESULTS: The results are summarized briefly as follows: 1) The age and the sex distributions of these patients showed that 19 cases occurred between the 3rd and the 4th decades and the male-to-female ratio was 10.3:1. 2) Pancreatitis was most frequently associated with pancreatic pseudocysts (75%). 3) Common clinical manifestations were abdominal pain (89%), abdominal tenderness (78%), nausea and vomiting (56%), abdominal mass (32%), abdominal distension (31%). 4) Abdominal CT and ultrasound were major diagnostic methods. 5) The location of the peudocysts were the body (41%), head and tail (31%), the tail (22%), and others (6%). 6) The sizes of the pseudocysts were as follows less than 5 cm (5 cases), 5-10 cm (19 cases), above 11 cm (8 cases) in 32 cases. 7) Valuable laboratory data for a pancreatic pseudocyst were blood WBC count (above 10,000/mm in 78%), serum amylase (above 160 unit/L in 62%), urine amylase (above 300 unit/L in 56%), blood glucose (above 110 mg/L in 50%), serum alkaline phosphatase (above 250/L in 44%). 8) The surgical methods in 29 cases were excision (1 case), external drainage (4 cases), cystogastrostomy (7 cases), cystojejunostomy (16 cases), cystoduodenostomy (1 case). 9) Postoperative complications were encountered in 13 cases, and many of the cases involved pulmonary complications and wound infections. CONCLUSIONS: Currently, treatment of patients with pancreatic pseudocysts is based on the clinical setting, the presence or absence of symptoms, the age and size of the pseudocyst, and the presence or absence of complications. In the most common clinical settings, a pseudocyst is discovered after an episode of acute alcoholic pancreatitis.
Abdominal Pain ; Alkaline Phosphatase ; Amylases ; Blood Glucose ; Busan ; Drainage ; Head ; Humans ; Nausea ; Pancreatic Ducts ; Pancreatic Pseudocyst* ; Pancreatitis ; Pancreatitis, Alcoholic ; Postoperative Complications ; Sex Distribution ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting ; Wound Infection

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