Pancreatic panniculitis (PP) is a necrotizing inflammation of subcutaneous fat that is a rare complication of pancreatic disease appearing in 2% to 3% of all patients. It is more common in the elderly and often affects the extremities. It presents as skin inflammation with pain and erythema nodules. We report a case of acute pancreatitis associated with PP in an old female. She was admitted for vomiting and abdominal pain for 3 days and presented with a 2-week history of erythematous subcutaneous nodules on her legs. Laboratory and ultrasonic findings revealed acute pancreatitis. High frequency ultrasound showed hypoechoic foci in subcutaneous soft tissue layer and adipose layer. Histopathological examination confirmed the diagnosis of PP. Nodules disappeared with the resolution of acute pancreatic inflammation. PP may be the first manifestation of pancreatic disease. Imaging features of this pathology are seldom described and ultrasonic diagnosis experience is worth to be accumulated.
Acute Disease ; Aged ; Female ; Humans ; Inflammation/complications* ; Pancreatic Diseases/diagnostic imaging* ; Pancreatitis/diagnostic imaging* ; Panniculitis/etiology* ; Ultrasonography

Endoscopic ultrasound (EUS) has become an essential tool for the diagnostic and therapeutic intervention of gastrointestinal diseases. Beyond the drainage of fluid collections, it enables decompression of inaccessible bile and pancreatic ducts, the gallbladder, and the creation of anastomosis within the gastrointestinal tract using fully lumen-apposing stents. This review explored the safety and efficacy of these novel procedures and discussed the training pathway that is necessary to perform them efficiently and safely.
Bile ; Decompression ; Drainage ; Endosonography ; Gallbladder ; Gastrointestinal Diseases ; Gastrointestinal Tract ; Pancreatic Ducts ; Stents ; Ultrasonography*

The feasibility of using computed tomography (CT) to identify the common bile duct (CBD) and comparison with ultrasonography (US) results were evaluated in normal beagle dogs and dogs without hepatobiliary and pancreatic diseases. In addition, CBD diameters were obtained from CT at the level of the porta hepatis and the duodenal papilla level in dogs with underlying diseases that may cause cholestasis. US is a useful modality in the estimation of gallbladder volume because ejection fraction and CBD diameter from US were not significantly different from those of CT. The normal biliary tract was visible on CT images in 68% of the normal dog group. CBD diameter was not over 3 mm and 3.5 mm at the porta hepatis and duodenal papilla levels, respectively in normal dogs weighing less than 15 kg. Dogs suspected to have cholestasis associated with hepatobiliary or pancreatic diseases had significantly larger CBD than that in normal dogs.
Animals ; Biliary Tract ; Cholestasis ; Common Bile Duct ; Dogs ; Gallbladder ; Pancreatic Diseases ; Ultrasonography

Endoscopic ultrasound is a rapidly evolving technology with an expanding list of diagnostic and therapeutic capabilities. Innovative uses of endoscopic ultrasound in pancreatic malignancy may serve to improve survivability with earlier detection and groundbreaking interventions. This article aims to review these novel techniques.
Elasticity Imaging Techniques ; Pancreatic Diseases* ; Ultrasonography*

There are increasing number of cases of serum amylase and lipase levels being examined as part of health screening, but the clinical significance of these amylase and lipase levels is unclear. When the clinicians encounter patients with elevated pancreatic enzymes, the most common causes such as acute pancreatitis, hepatic or renal dysfunction should be ruled out first by thorough history taking, physical examination, and laboratory tests. Further tests including abdominal ultrasonography or computed tomography, lipid profile, tumor marker, isoenzyme, and calculation of amylase-to-creatinine clearance ratio or polyethylene glycol precipitation test should be performed to exclude other causes. If the pancreatic enzymes are continuously elevated through repeated tests without any apparent etiology, the diagnosis is made with chronic non-pathological pancreatic hyperenzymemia (CNPH). Magnetic resonance cholangiopancreatography is very useful and important modality for the patients with CNPH but the clinical significance of magnetic resonance cholangiopancreatography with secretin stimulation is still unclear. They can be evaluated through endoscopic ultrasonography with preference but it is less suitable for follow-up. Individualized approaches should be made after considering the need for active treatment or periodic follow-up for the benign pancreatic diseases associated with CNPH. It is difficult to conclude until more long-term data are reported because there are only limited number of researches and consensus on the range of tests to be performed for diagnosis, clinical significance of benign findings and end of follow-up in patients with CNPH.
Amylases ; Cholangiopancreatography, Magnetic Resonance ; Consensus ; Diagnosis ; Endosonography ; Follow-Up Studies ; Humans ; Hyperamylasemia* ; Lipase ; Mass Screening ; Pancreas ; Pancreatic Diseases ; Pancreatitis ; Physical Examination ; Polyethylene Glycols ; Secretin ; Ultrasonography

Since its introduction into clinical practice in the 1980s, endoscopic ultrasound (EUS) has been described as a good imaging modality for the diagnosis of pancreatobiliary diseases. However, differential diagnosis of certain lesions based only on B-mode ultrasound images can be challenging. Clinical use of ultrasound contrast agents has expanded the utility of EUS from that of detection to characterization of pancreatobiliary lesions based on the enhancement features of contrast-enhanced EUS (CE-EUS). Current low mechanical index techniques for CE-EUS using second-generation contrast agents have a number of distinct advantages over conventional diagnostic modalities in evaluating pancreatobiliary lesions, including real-time assessment of perfusion pattern, availability, and the absence of exposure to radiation. This article describes the technical aspects of CE-EUS and reviews the expanding indications in pancreatobiliary diseases and further development of this technique.
Biliary Tract Diseases/diagnosis/*ultrasonography ; *Contrast Media ; Diagnosis, Differential ; Endosonography/*methods ; Humans ; Medical Illustration ; Pancreatic Diseases/diagnosis/*ultrasonography

Endoscopic ultrasound (EUS) has recently become widely used for the diagnosis and treatment of gastrointestinal disease. With applications of linear EUS and EUS-guided fine needle aspiration, many EUS-guided interventions are now emerging as feasible treatment options for patients with pancreatobiliary disease. EUS-guided drainage from pseudocyst, bile duct, pancreatic duct, and the gallbladder are becoming routine procedure. EUS-guided celiac plexus neurolysis and block can relieve intractable pancreatic pain. Moreover, EUS-guided local tumor therapy (ethanol ablation and radiofrequency ablation) may be feasible in selected patients. Safe EUS-guided intervention requires a good deal of experience but is becoming widely used to treat pancreatobiliary disease.
Bile Ducts ; Biopsy, Fine-Needle ; Celiac Plexus ; Diagnosis ; Drainage ; Endosonography ; Gallbladder ; Gastrointestinal Diseases ; Humans ; Pancreatic Ducts ; Ultrasonography* ; Ultrasonography, Interventional

An epidermoid cyst arising from intrapancreatic accessory spleen (ECIPAS) is a rare disease. Most patients with an ECIPAS are detected incidentally and could be misdiagnosed as a pancreatic cystic neoplasm such as mucinous cystic neoplasm (MCN) or intraductal p ancreatic mucinous neoplasm (IPMN). We described an ECIPAS with high cystic fluid carcinoembryonic antigen (CEA), which was misdiagnosed as a MCN of pancreas. Fifty one-year-old female was presented with a 2 cm sized non-enhancing pancreas cystic mass on the outside CT scan. Endoscpic ultrasonography (EUS) guided aspiration was performed. It showed a 2.3 x 1.9 cm unilocular cyst nearby 1.6 x 1.1 cm homogenous hypoechoic mass in pancreas tail, and cystic fluid CEA was 1564.18 ng/mL. On the basis of EUS results with elevated fluid CEA level, the presumptive diagnosis is likely to MCN of pancreas, and she underwent a laparoscopic distal pancreatectomy. The final pathology was the epidermal cyst in the intrapancreatic accessory spleen.
Carcinoembryonic Antigen ; Diagnosis ; Epidermal Cyst* ; Female ; Humans ; Mucins* ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Pathology ; Rare Diseases ; Spleen* ; Tomography, X-Ray Computed ; Ultrasonography

Endoscopic drainage for pancreatic and peripancreatic fluid collections (PFCs) has been increasingly used as a minimally invasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage (EUS-TD) has become the standard of care and a safe procedure for nonsurgical PFC treatment. EUS-TD ensures a safe puncture, avoiding intervening blood vessels. Single or multiple plastic stents (combined with a nasocystic catheter) were used for the treatment of PFCs for EUS-TD. More recently, the use of covered self-expandable metallic stents (CSEMSs) has provided a safer and more efficient approach route for internal drainage. We focused our review on the best approach and stent to use in endoscopic drainage for PFCs. We reviewed studies of EUS-TD for PFCs based on the original Atlanta Classification, including case reports, case series, and previous review articles. Data on clinical outcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreatic pseudocysts using CSEMSs. The treatment success and adverse event rates were 94.6% and 21.1%, respectively. The majority of complications were of mild severity and resolved with conservative therapy. A total of 56 patients underwent EUS-TD using CSEMSs for pancreatic abscesses or infected walled-off necroses. The treatment success and adverse event rates were 87.8% and 9.5%, respectively. EUS-TD can be performed safely and efficiently for PFC treatment. Larger diameter CSEMSs without additional fistula tract dilation for the passage of a standard scope are needed to access and drain for PFCs with solid debris.
Abdominal Abscess/surgery ; Drainage/*methods ; Endosonography/*methods ; Humans ; Necrosis/surgery ; Pancreas/*pathology/surgery ; Pancreatic Diseases/*surgery ; Pancreatic Pseudocyst/surgery ; *Stents ; Surgery, Computer-Assisted/*methods ; Ultrasonography, Interventional/methods

BACKGROUNDCurrently, the recommendation when treating acute biliary or pancreatic disease during pregnancy is to perform endoscopic retrograde cholangiopancreatography (ERCP) without radiation exposure, either empirically (with no radiographic guidance) or with ultrasound guidance. However, few published studies compared these two ways. This study aimed to compare ultrasound-guided ERCP with the procedure without radiographic guidance in the treatment of acute pancreaticobiliary disease in pregnant patients.

METHODSThe clinical data of 68 pregnant patients with acute pancreaticobiliary disease admitted to our hospital between January 2004 and May 2010 were reviewed retrospectively. ERCP was performed without radiographic guidance in 36 cases (group A) and with ultrasound guidance in 32 cases (group B). Data on the following variables were compared between the two groups: surgical success rate, rate of complete stone removal, time to resolution of clinical manifestations and laboratory indicators, length of hospital stay, complications, outcome and differences in efficacy of ERCP during different stages of pregnancy.

RESULTSIn group A, the rates of surgical success and complete removal of stones were 69% and 60%, respectively; the corresponding values were 91% and 89% in group B (P < 0.05). Postoperatively, clinical manifestations improved rapidly in all patients; there was no statistically significant difference between the groups (P > 0.05). Leukocyte counts and liver function had improved significantly after one week in all patients; they recovered more quickly in group B ((8.64 ± 1.83) days vs. (14.57 ± 3.74) days, (14.29 ± 4.64) days vs. (20.00 ± 5.40) days, P < 0.01). The hospital stay was shorter in group B ((16.28 ± 7.25) days vs. (28.00 ± 6.83) days, P < 0.001). The complication rate was 14% in group A and 3% in group B (P < 0.05). There were no significant differences between the two groups in the procedure's efficacy during different stages of pregnancy.

CONCLUSIONSIn the treatment of acute pancreaticobiliary disease during pregnancy, ultrasound-guided ERCP is safer and more effective than performing the procedure empirically without radiographic guidance when performed by experienced practitioners. Its more widespread use is recommended.

Acute Disease ; Adult ; Biliary Tract Diseases ; surgery ; Cholangiopancreatography, Endoscopic Retrograde ; methods ; Female ; Humans ; Pancreatic Diseases ; surgery ; Pregnancy ; Pregnancy Complications ; surgery ; Retrospective Studies ; Ultrasonography, Interventional