Pancreatic injuries due to trauma in children are rare. An early diagnosis is difficult as the signs and symptoms are insidious, but delays in diagnosis can lead to significant complications. We report a case of a child who visited the emergency department with aggravating abdominal pain. The physicians first diagnosed the abdominal pain as being caused by a disease in the emergency department, but the patient was subsequently diagnosed with pancreatic injury. Clinicians should be aware of a possible trauma in children who complain of vague abdominal pain even in the absence of corresponding history.
Abdominal Pain ; Amylases ; Child ; Diagnosis ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Humans ; Lipase ; Pancreas ; Pancreatic Pseudocyst

No abstract available.
Hemorrhage ; Pancreatic Pseudocyst

Congenital pancreatic cysts are rare in newborn babies, and this makes prenatal diagnosis difficult. Diagnosis can be delayed for a few months after birth until the infant presents with an abdominal mass, abdominal distension, or vomiting due to gastric outlet obstruction. Excision of the cyst is the treatment of choice. A congenital pancreatic cyst should be considered if the fetus has an abdominal cyst without a definite origin. A prompt diagnosis is crucial to prevent fatal complications such as cholangitis, pancreatitis, cyst rupture, and peritonitis. We report a case of neonate with multiple congenital pancreatic cysts suspected prenatally to be stomach diverticulum or duplication cysts of the intestine.
Cholangitis ; Diagnosis ; Diverticulum, Stomach ; Fetus ; Gastric Outlet Obstruction ; Humans ; Infant ; Infant, Newborn ; Intestines ; Pancreatic Cyst ; Pancreatic Pseudocyst ; Pancreatitis ; Parturition ; Peritonitis ; Prenatal Diagnosis ; Rupture ; Vomiting

BACKGROUND/AIMS: Endoscopic ultrasound (EUS)-guided transmural drainage for peripancreatic fluid collections (PFCs) has gained wide acceptance as a nonsurgical intervention. Although a lumen-apposing metal stent (LAMS) was recently introduced, there are few data comparing the clinical outcomes between LAMS and plastic stent (PS) drainage. METHODS: Endoscopy databases of all patients who had undergone EUS-guided drainage for PFCs were searched and the clinical outcomes of EUS-guided drainage according to stent-type used were compared. RESULTS: A total of 27 patients (median age, 56 years) with PFCs underwent EUS-guided transmural drainage between January 2011 and December 2017. Of these, 17 underwent PS placement and 10 underwent LAMS placement. There was no significant difference in the technical success rate between the 2 groups (94.1% vs. 100%, p=1.0). Procedure time was shorter in the LAMS group compared to that in the PS group (10.6±2.5 min vs. 21.4±9.5 min, p=0.002). Among subjects with clinical success, recurrence of PFC after stent removal occurred in 5 of 12 patients with PS and 4 of 10 with LAMS, without statistical difference (41.7% vs. 40.0%, p=1.0). CONCLUSIONS: Although our study showed similar clinical outcomes for LAMS and PS, further prospective trials are required to validate the superiority of LAMS.
Drainage ; Endoscopy ; Endosonography ; Humans ; Pancreatic Pseudocyst ; Plastics ; Prospective Studies ; Recurrence ; Stents ; Ultrasonography

A 54-year old man diagnosed with advanced hepatocellular carcinoma began treatment with sorafenib. After 3 weeks of treatment, he complained of abdominal pain and nausea. Abdominal sonography showed multiple hepatic lesions only. Serum amylase and lipase levels were 35 U/L and 191 U/L, respectively. The patient was diagnosed with sorafenib-induced acute pancreatitis. After 10 days of discontinuing sorafenib he still complained of nausea and loss of appetite. Esophagogastroduodenoscopy showed a large bulging lesion, which was suspected to cause extrinsic compression on the high body of the gastric anterior wall. Computed tomography scan revealed a cystic lesion, 8.3 cm in size, in the pancreatic tail, suggesting a pancreatic pseudocyst. After the withdrawal of sorafenib, systemic chemotherapy with Adriamycin and cisplatin was administered. Four months after the discontinuation of sorafenib, the size of the pancreatic pseudocyst decreased from 8.3 cm to 3 cm. The patient's symptoms were also relieved.
Abdominal Pain ; Amylases ; Appetite ; Carcinoma, Hepatocellular ; Cisplatin ; Doxorubicin ; Drug Therapy ; Endoscopy, Digestive System ; Humans ; Lipase ; Nausea ; Pancreatic Pseudocyst ; Pancreatitis ; Tail

The pathogenesis of hepatocellular carcinoma (HCC) is a complex process. During the last decade, advances in genomic technologies enabled delineation of the genomic landscape of HCC, resulting in the identification of the common underlying molecular alterations. The tumor microenvironment, regulated by inflammatory cells, including cancer cells, stromal tissues, and the surrounding extracellular matrix, has been extensively studied using molecular data. The integration of molecular, immunological, histopathological, and clinical findings has provided clues to uncover predictive biomarkers to enhance responses to novel therapies. Herein, we provide an overview of the current HCC genomic landscape, previously identified gene signatures that are used routinely to predict prognosis, and an immune-specific class of HCC. Since biomarker-driven treatment is still an unmet need in HCC management, translation of these discoveries into clinical practice will lead to personalized therapies and improve patient care, especially in the era of targeted and immunotherapies.
Biomarkers ; Carcinoma, Hepatocellular ; Extracellular Matrix ; Humans ; Immunotherapy ; Pancreatic Pseudocyst ; Pancreatitis ; Patient Care ; Prognosis ; Stromal Cells ; Tumor Microenvironment

No abstract available.
Pancreatic Pseudocyst*

BACKGROUND/AIMS: Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. Endoscopy ultrasound (EUS)-guided drainage includes multiple steps and requires many resources such as a linear echoendoscope and a fluoroscopy room, which may not be available at all medical centers. We aimed to evaluate the efficacy and safety of EUS-guided pancreatic pseudocyst drainage without fluoroscopy. METHODS: This retrospective study analyzed 10 patients who had undergone EUS-guided transmural drainage of pancreatic pseudocyst without use of fluoroscopy at the Pusan National University Hospital between January 2009 and December 2016. Drainage was performed via a transgastric approach and one or two 7 Fr double-pigtail stents were inserted. RESULTS: The technical success rate was 100% and the clinical success rate was 80%. In two patients, clinical success was not achieved and additional percutaneous catheter drainage was done. Therefore, pseudocysts in all the patients were treated successfully without surgical drainage. However, there were three adverse events in three patients: bleeding, infection, and stent migration in each respective patient. During the median follow-up period of 36.5 months, there was no recurrence of pseudocysts in any of the patients. CONCLUSIONS: EUS-guided transmural drainage of pseudocyst drainage without use of fluoroscopy is a technically feasible, safe, and effective procedure for the treatment of pancreatic pseudocyst.
Busan ; Catheters ; Drainage ; Endoscopy ; Endosonography ; Fluoroscopy ; Follow-Up Studies ; Hemorrhage ; Humans ; Pancreas ; Pancreatic Pseudocyst ; Pancreatitis, Chronic ; Recurrence ; Retrospective Studies ; Stents ; Ultrasonography

The pathogenesis of pancreatic pseudocyst is still not understood. A 5-year-old, 24-kg intact female Shetland Sheepdog was presented with anorexia and vomiting. Diagnostic imaging tests revealed that the left limb of the pancreas was thickened and contained two cystic lesions (6.3 × 5.6 × 4 cm³ and 3.5 × 4.6 × 5.5 cm³). During the laparotomy, lesions were opened with de-roofing of superabundant tissue, and omentalization was performed. The dog recovered uneventfully after surgery and was discharged on postoperative day 12. Histopathologically, it was diagnosed as chronic pancreatic pseudocyst. This case report describes the diagnosis and successful omentalization of pancreatic pseudocysts in a dog.
Animals ; Anorexia ; Child, Preschool ; Diagnosis ; Diagnostic Imaging ; Dogs ; Extremities ; Female ; Humans ; Laparotomy ; Pancreas ; Pancreatic Pseudocyst ; Vomiting

Pancreatic Fluid Collection (PFC) develops as a result of acute pancreatitis, chronic pancreatitis, trauma, and postoperation. Although percutaneous drainage, surgery and Endoscopic Retrograde Panceatogram are used as conventional treatments in complicated PFC, the clinical course of PFC is unsatisfactory due to its clinical success rate and the risk of procedure-related complications. Endoscopic ultrasonography-guided transmural drainage of PFC is a safe and effective modality for the management of PFC, particularly in patients with pancreas necrosis. A range of techniques and stents have been introduced and a newly designed metal stent is now available.
Drainage ; Endosonography ; Humans ; Necrosis ; Pancreas ; Pancreatic Pseudocyst ; Pancreatitis ; Pancreatitis, Chronic ; Stents