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

OBJECTIVETo analyze the clinical characteristics and the course of diagnosis and therapy of PEG-asparaginase associated pancreatitis (AAP) in childhood, and to reveal the pathophysiology of AAP, enhance the ability of diagnosis and treament.

METHODData of 13 cases with AAP in childhood seen from March 2011 to March 2014 were analyzed with regard to clinical manifestations, laboratory findings, imaging feature and treatment.

RESULTAAP was found in 12 of acute lymphoblastic leukemia (ALL) and 1 of non-Hodgkin's lymphoma (NHL), 8 were boys and 5 were girls, with a mean age 6 years. In 12 cases AAP occurred during the induction-remission treatment, in 1 case during the maintenance- intensification phase. AAP occurred after a median of two doses, and 9 d (median) from the latest administration of PEG-asparaginase. The major manifestations of AAP was abdominal pain (11/13) . At the time of AAP diagnosis during the first 48 hours the median peak serum amylase and serum lipase levels were 559 U/L (range 118-1 585, upper normal limit: 125) and 934 U/L (range 221-1 673, upper normal limit: 300). Three cases with serum amylase and serum lipase levels above 3 times upper normal limit were repeatedly complicated with pancreatic pseudocyst; 11 patients had abnormal CT imaging, 8 cases revealed effusion around the pancreas, and 4 cases had pseudocyst. Therapy with ulinastatin, octreotide acetate, glucocorticoid could relieve abdominal pain significantly. Three cases underwent abdominal puncture drainage and 5 cases fulfilled nasojejunal nutrition therapy. Nine of them were cured, 4 developed pseudocyst, in 2 AAP vanished gradually and 2 died with pseudocyst.

CONCLUSIONThe major manifestations of AAP were abdominal pain, but sometimes apparent and sometimes latent. Condition of acute pancreatitis may exacerbate rapidly and easily. Early identification had significance. Pancreatic pseudocyst suggested a poor prognosis.

Acute Disease ; Asparaginase ; adverse effects ; therapeutic use ; Child ; Female ; Humans ; Lymphoma, Non-Hodgkin ; drug therapy ; Male ; Pancreatic Pseudocyst ; Pancreatitis ; chemically induced ; diagnosis ; therapy ; Polyethylene Glycols ; adverse effects ; therapeutic use ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy

OBJECTIVETo explore the effectiveness and safety of endoscopic transgastric or transpapillary drainage in treating pancreatic pseudocysts.

METHODSThe clinical data of 15 patients with pancreatic pseudocyst who underwent endoscopic ultrasound-guided transgastric or transpapillary drainage in the Chinese PLA General Hospital between June 2004 and February 2013 were retrospectively analyzed. Also, we reviewed the relevant Chinese literature in the China Academic Journal Network Publishing Database (from 1994 to 2012) and VIP China Science and Technology Journal Database (from 1989 to 2012) using the key words "pancreatic pseudocyst and drainage". Five literatures including 103 cases were enrolled.

RESULTSThe data of 118 cases undergoing endoscopic drainage, included 94 cases with transgastric approach and 24 with transpapillary approach, entered the final analysis. The success rate was 94.9%, and cysts completely disappeared in 83.9% of the patients. The overall incidence of complications (bleeding, infection, and stent clogging or migration) was 19.5%. One patient lost to follow-up and only one case of recurrence was noted.

CONCLUSIONEndoscopic transgastric or transpapillary drainage is safe and effective in treating the pancreatic pseudocysts and therefore can be a preferred therapeutic approach.

Adult ; Drainage ; methods ; Endosonography ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Pseudocyst ; therapy ; Treatment Outcome

Chronic pancreatitis is associated with varied morphological complications, including intraductal stones, main pancreatic ductal strictures, distal biliary strictures and pseudocysts. Endoscopic therapy provides a less invasive alternative to surgery. In addition, extracorporeal shockwave lithotripsy improves the success rate of endoscopic clearance of intraductal stones. However, recent data from randomised trials have shown better long-term outcomes with surgical drainage for obstructive pancreatic ductal disease. In patients with distal biliary strictures, stent insertion leads to good immediate drainage, but after stent removal, recurrent narrowing is common. Endoscopic drainage of pancreatic pseudocysts has excellent outcome and should be accompanied by pancreatic ductal stenting when a ductal communication is evident. In those who remain symptomatic, endoscopic ultrasonography-guided coeliac plexus block may provide effective but short-term pain relief. In this review, we present the current evidence for the role of endotherapy in the management of patients with chronic pancreatitis.
Endoscopy, Digestive System ; methods ; Humans ; Lithotripsy ; Pain Management ; Pancreatic Pseudocyst ; complications ; therapy ; Pancreatitis, Chronic ; complications ; therapy ; Randomized Controlled Trials as Topic ; Stents

Inflammatory pancreatic fluid collection, such as pseudocysts, pancreatic abscesses and infected walled-off pancreatic necrosis, arise as a complication of acute pancreatitis. Recently endoscopic ultrasound (EUS)-guided drainage has emerged as the leading treatment modality for symptomatic pancreatic fluid collection. EUS-guided endoscopic drainage is less invasive than surgery and avoids local complications related to percutaneous drainage. In addition, this endoscopic treatment can drain non-bulging fluid collection and may reduce the risk of procedure related bleeding and perforation. Excellent treatment success rates exceeding 90% have been reported for pancreatic pseudocysts and abscesses. Intervention such as endoscopic drainage with necrosectomy may be indicated for infected pancreatic necrosis, and ideally be delayed as long as possible, 4 weeks or longer after the onset of disease, for better demarcation and liquefaction of the necrosis. Multimodal treatments by specialists with specific expertise in management of peripancreatic fluid collection is essential to achieve the best outcomes. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Early ERCP should be performed in patients with gallstone pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected.
Abscess ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Combined Modality Therapy ; Drainage ; Gallstones ; Hemorrhage ; Humans ; Necrosis ; Pancreatic Pseudocyst ; Pancreatitis ; Specialization

A subcapsular splenic hematoma is a very rare hemorrhagic complication of pancreatitis. We report here on a case of pseudocyst with a large subcapsular splenic hematoma in a 43-year-old man who presented with severe left flank pain for one week. Despite the initial conservative treatment consisting of pain control, bowel rest, intravenous fluids and antibiotics, the pain was not relieved. An abdominal computed tomography (CT) was performed, and it showed a pseudocyst that was increasing in size with a large subcapsular splenic hematoma measuring 6x13 cm compared to the images at admission. Ultrasonography (US)-guided percutaneous drainage was performed without any complications, and splenectomy was avoided. After the discharge, the patient remained asymptomatic for eight months. We suggest that percutaneous drainage of a large subcapsular hematoma complicating pancreatitis might be a useful treatment option in selected patients.
Adult ; *Drainage ; Hematoma/complications/*therapy/ultrasonography ; Humans ; Male ; Pancreatic Pseudocyst/*therapy/ultrasonography ; Pancreatitis/complications ; Splenic Diseases/*therapy/ultrasonography ; Tomography, X-Ray Computed

A subcapsular splenic hematoma is a very rare hemorrhagic complication of pancreatitis. We report here on a case of pseudocyst with a large subcapsular splenic hematoma in a 43-year-old man who presented with severe left flank pain for one week. Despite the initial conservative treatment consisting of pain control, bowel rest, intravenous fluids and antibiotics, the pain was not relieved. An abdominal computed tomography (CT) was performed, and it showed a pseudocyst that was increasing in size with a large subcapsular splenic hematoma measuring 6x13 cm compared to the images at admission. Ultrasonography (US)-guided percutaneous drainage was performed without any complications, and splenectomy was avoided. After the discharge, the patient remained asymptomatic for eight months. We suggest that percutaneous drainage of a large subcapsular hematoma complicating pancreatitis might be a useful treatment option in selected patients.
Adult ; *Drainage ; Hematoma/complications/*therapy/ultrasonography ; Humans ; Male ; Pancreatic Pseudocyst/*therapy/ultrasonography ; Pancreatitis/complications ; Splenic Diseases/*therapy/ultrasonography ; Tomography, X-Ray Computed

Chronic pancreatitis (CP) is a debilitating disease that can result in chronic abdominal pain, malnutrition, and other related complications. The main aims of treatment are to control symptoms, prevent disease progression, and correct any complications. A multidisciplinary approach involving medical, endoscopic, and surgical therapy is important. Endoscopic therapy plays a specific role in carefully selected patients as primary interventional therapy when medical measures fail or in patients who are not suitable for surgery. Endoscopic therapy is also used as a bridge to surgery or as a means to assess the potential response to pancreatic surgery. This review addresses the role of endoscopic therapy in relief of obstruction of the pancreatic duct (PD) and bile du ct, closure of PD leaks, and drainage of pseudocysts in CP. The role of endoscopic ultrasound-guided celiac plexus block for pain in chronic pancreatitis is also discussed.
Cholangiopancreatography, Endoscopic Retrograde/*methods ; Common Bile Duct ; Endoscopy, Gastrointestinal/methods ; Humans ; Pain/surgery ; Pancreatic Pseudocyst/surgery/therapy ; Pancreatitis, Chronic/*surgery ; Sphincter of Oddi ; Stents

Previously reported series suggested that the morbidity rate of internal surgical drainage procedure alone was about 15% and the mortality rate was less than 5% in patients with pancreatic pseudocysts. Recently, ultrasonography or CT-guided percutaneous drainage and endoscopic drainage techniques have created a new dimension of invasive, non-surgical treatment options for these patients. In the absence of prospective, randomized, controlled studies comparing outcomes of different pseudocysts drainage techniques, the decision as to which method should be employed often lies with local expertise and enthusiasm. In our experience, radiologic percutaneous drainage with subsequent transpapillary endosopic drainage had a high success rate and was relatively less difficult which resulted in rapid clinical improvement. We report three cases of pancreatic pseudocysts treated with percutaneous drainage as a first-line treatment followed by endoscopic treatment.
Aged ; *Cholangiopancreatography, Endoscopic Retrograde ; *Drainage/instrumentation ; Female ; Hemostasis, Surgical ; Humans ; Male ; Middle Aged ; Pancreatic Ducts/radiography ; Pancreatic Pseudocyst/*radiography/*therapy ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the effect of different procedures in the treatment of pancreatic pseudocyst.

METHODThis retrospective review analyzed the outcome of 114 patients with pancreatic pseudocysts managed in PUMC Hospital from January 1990 to March 2002.

RESULTThere were 25 patients without intervention, the spontaneous resolution of pseudocysts occurred in 23 of these patients during follow up. Twenty-nine cases underwent CT-guided percutaneous catheter drainage; the effective rate of therapy was 67.85%. Surgical procedures performed in 60 cases and the overall mortality was 5% (3/60). The procedures included external drainage (8 cases) with 1 death (12.5%), excision (13 cases), cyst-duodenostomy (1 cases), cyst-gastrostomy (19 cases) with 7 postoperative gastrointestinal bleeding (36.8%) and 1 death (5.26%), Roux-en-Y cyst-jejunostomy (19 cases) with 3 postoperative gastrointestinal bleeding (15.8%) and 1 death (5.26%).

CONCLUSIONSCT-guided percutaneous catheter drainage has the advantage of minimal invasive and simple technique; it can be as an effective substitute method of traditional open external drainage. Although minimally invasive techniques offer a variety of treatment options, surgical procedures are still indicated for significant number of patients. The incidence of postoperative gastrointestinal bleeding in cyst-gastrostomy was higher than those patients with Roux-en-Y cyst-jejunostomy, but most of them were not difficult to treatment, so cyst-gastrostomy is still a simple and reasonable procedure for selected patients. Excision is a correct choice for cases in which pseudocysts cannot be differentiated from neoplastic cysts.

Adolescent ; Adult ; Aged ; Anastomosis, Roux-en-Y ; Drainage ; methods ; Endosonography ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Pancreatic Pseudocyst ; surgery ; therapy ; Retrospective Studies ; Treatment Outcome