Percutaneous drainage of traumatic pancreatic pseudocysts in children

In the past, children with pancreatic pseudocysts have been managed surgically. We report seven children 3-13 years old with posttraumatic pancreatic pseudocysts who were managed with percutaneous catheter drainage. All procedures were performed with local anesthesia and intramuscular sedation under sonographic or CT guidance. Two of the pseudocysts were drained via a transgastric approach, the other five via direct transcutaneous access to the pseudocyst. The catheters were in place an average of 25 days (range, 8-66). There were no serious complications. Six patients became asymptomatic with return of the serum amylase to normal and resolution of the pseudocyst on follow-up sonograms. One patient, in whom the catheter became dislodged after 2 weeks, became asymptomatic, but he had a residual 2-cm pancreatic pseudocyst that resolved over the next 6 weeks. Our experience suggests that percutaneous drainage is a safe and effective method of treatment for traumatic pancreatic pseudocysts in children.     

Percutaneous transgastric snaring for repositioning of a dislocated internal drain from a pancreatic pseudocyst

Pancreatic pseudocysts may occur in up to 10% of patients with acute or chronic pancreatitis. Symptomatic, persistent, and infected pancreatic pseudocysts require interventional therapy. We present the case of a patient with complete dislocation of a double pigtail catheter into an infected pseudocyst and the repositioning of the drainage catheter using a transgastric snaring technique. The combination of CT-guided percutaneous puncture and fluoroscopic snaring permitted minimally invasive management of this rare complication.     

Percutaneous pancreato-gastrostomy in the treatment of pancreatic pseudocysts. Presentation of 2 cases

The authors describe a new method for the treatment of pancreatic pseudocysts using a personal technique: the percutaneous pseudocystogastrostomy. Under US and fluoroscopy guidance at first a percutaneous drainage is introduced in the pseudocyst using a transgastric approach. For seven days the drainage catheter is flushed with antibiotic solution (Rifocin), then under fluoroscopy and endoscopy guidance doubled pig-tail catheter is placed with its curlend ends in the lumen of the stomach and pseudocyst respectively. After 60 days the double pig-tail catheter is removed endoscopically. Two patients with pancreatic pseudocysts were treated successful by this method. No complications or recurrences were observed.     

Percutaneous cystogastrostomy with a new catheter for drainage of pancreatic pseudocysts and fluid collections

We describe a new catheter for the initial percutaneous drainage of large symptomatic pancreatic fluid collections and abscesses using a transgastric approach to allow fluid drainage into the gastric lumen. A doublemushroom stent is placed secondarily for long-term internal drainage to the stomach, avoiding the need for an extended period of external catherter drainage. This technique, termed percutaneous cystogastrostomy (PCG), has been used in 19 consecutive patients with one recurrent symptomatic pseudocyst in the follow-up period of 9–43 months. There was one death within 30 days of PCG and 1 patients proceeded to surgical necrosectomy. After evidence of resolution of the pseudocysts, the internal stent was retrieved in 17 patients by endoscopic snare.     

Percutaneous drainage of mediastinal pseudocysts

Percutaneous catheter drainage of a mediastinal pseudocyst was performed in two patients. Access was gained through computed tomography (CT)-guided puncture of the abdominal portion of the pseudocyst in one patient, and a transhepatic-subxiphoid approach was used in the other. Guide wires and catheters were advanced into the mediastinal pseudocysts under CT control. Drainage was technically successful in both patients, with no procedure-related complications. Percutaneous drainage is an alternative to the surgical treatment of symptomatic and nonresolving mediastinal pseudocysts, provided that a safe access route can be found.     

Percutaneous treatment (including pseudocystogastrostomy) of 74 pancreatic pseudocysts

Percutaneous treatment of 74 pancreatic pseudocysts was performed in 70 patients. Initially, single-step fine-needle aspiration was used and had a 71% (15 of 21 patients) recurrence rate. Better results were obtained with prolonged extragastric or transgastric external drainage, performed in 43 patients (46 pseudocysts). Two patients in this series (4.7%) required urgent surgery: one for gastric wall hematoma and the other for intracystic hemorrhage. Three patients (7.0%) were lost to follow-up. The recurrence rate in the remaining 38 patients (41 pseudocysts) was 23.7% (nine of 38 patients). Since 1986, seven patients have been treated with percutaneous pseudocystogastrostomy (one also underwent external drainage and is thus included in the previous series, too) after placement of a transgastric drainage catheter, with no recurrence (follow-up, 2-26 months). It is concluded that transgastric drainage should be performed whenever the anatomic situation is favorable and that a pseudocystogastric stent should be placed in these patients whenever secretions are still abundant after 7-10 days.     

Percutaneous Cystgastrostomy as a Single-Step Procedure

The purpose of this study was to evaluate the success of percutaneous transgastric cystgastrostomy as a single-step procedure. We performed a retrospective analysis of single-step percutaneous transgastric cystgastrostomy carried out in 12 patients (8 male, 4 female; mean age 44 years; range 21–70 years), between 2002 and 2007, with large symptomatic pancreatic pseudocysts for whom up to 1-year follow-up data (mean 10 months) were available. All pseudocysts were drained by single-step percutaneous cystgastrostomy with the placement of either one or two stents. The procedure was completed successfully in all 12 patients. The pseudocysts showed complete resolution on further imaging in 7 of 12 patients with either enteric passage of the stent or stent removal by endoscopy. In 2 of 12 patients, the pseudocysts showed complete resolution on imaging, with the stents still noted in situ. In 2 of 12 patients, the pseudocysts became infected after 1 month and required surgical intervention. In 1 of 12 patients, the pseudocyst showed partial resolution on imaging, but subsequently reaccumulated and later required external drainage. In our experience, percutaneous cystgastrostomy as a single-step procedure has a high success rate and good short-term outcomes over 1-year follow-up and should be considered in the treatment of large symptomatic cysts.     

Percutaneous puncture and drainage of pancreatic pseudocysts. A retrospective study

Experience with 19 consecutive patients who had 20 pancreatic pseudocysts treated by percutaneous puncture and/or drainage was reviewed. Ten pseudocysts (5 infected, 5 non-infected), underwent complete resolution after percutaneous treatment only and there was a considerable regression in 6 (5 infected, 1 non-infected), which means an overall cure rate of 80 per cent. Only one small pseudocyst remained unchanged. Complementary surgery was necessary in 3 cases. Fine needle evacuation was the method in 13 cases (11 cured) and catheter drainage in 7 (5 cured). We conclude that percutaneous drainage is a safe method for the treatment of pancreatic pseudocysts, that will cure the patient in most cases.     

Percutaneous transgastric cystoduodenostomy in the treatment of a pancreatic pseudocyst: A new approach

A case of an infected pseudocyst in the head of the pancreas is presented. Due to its small size and fistulization to the duodenum, a drainage catheter was placed through the fistulous tract from a distant transgastric approach. The fistula was balloon dilated to improve its emptying. Sixteen months later the patient remains asymptomatic with no recurrence of the pseudocyst.     

Pancreatic pseudocysts: treated with dual drainage.

Four patients with retrogastric pancreatic pseudocysts were successfully treated by the combined placement of a transgastric external drain and a cystogastric stent. We describe the advantages of using external transgastric drainage along with the cystogastric stent.     

Complicated pancreatic inflammatory disease: diagnostic and therapeutic role of interventional radiology

Diagnostic and therapeutic interventional radiology techniques in 41 patients with complications of pancreatic inflammatory disease (noninfected pseudocyst, infected pseudocyst, phlegmon, abscess, hemorrhagic pancreatitis) are described. Computed tomography or ultrasound-guided aspiration or percutaneous pancreatic ductography enabled specific diagnoses in 43 of 45 patients (96%). In almost half the patients, diagnostic aspiration with 22-gauge needles was unsuccessful due to viscous contents or firm cavity walls. Single-step needle aspiration of noninfected pseudocysts was successful in only three of ten patients (30%). Catheter drainage cured six of seven noninfected pseudocysts (85.7%) and seven of nine infected pseudocysts (77.7%). Pancreatic phlegmons were aspirated in five patients to exclude secondary infection and help determine the need for surgery. Pancreatic abscesses were drained successfully in nine of 13 patients (69.2%); temporizing benefit was achieved in the other four who eventually underwent surgery in improved condition. Early diagnosis of the complications of pancreatitis may be established almost uniformly, and at least 70% of patients with infected or noninfected pseudocysts and pancreatic abscesses may be cured by nonoperative drainage.     

Pancreatic pseudocysts drained through a percutaneous transgastric approach

We describe a new method for the percutaneous drainage of pancreatic pseudocysts using a transgastric approach. We used this technique in three dogs and six patients for whom no other "safe" access route was available. The procedures were performed under US guidance alone or with US combined with fluoroscopy. No complications were observed.     

Percutaneous aspiration and drainage of pancreatic pseudocysts

Twenty-five patients with pancreatic pseudocysts had therapeutic intervention procedures that included diagnostic aspiration, short-term drainage (aspiration until completely drained), and long-term catheter drainage. Diagnostic aspirations were used to classify the pseudocysts as infected or noninfected. Short-term drainage was performed on six pseudocysts (two infected and four noninfected) with little success. One resolved and five recurred. Fifteen pseudocysts were treated by long-term catheter drainage. Eight of these (four infected and four noninfected) resolved after initial long-term drainage; two others resolved after additional drainage. The cure rate in these 15 patients was 67%. The other five patients were treated surgically after they had been stabilized but not cured by percutaneous drainage. Complications were few and uniformly minor except for one pneumothorax. Percutaneous aspiration should be used in the diagnosis of pancreatic fluid collections. In noninfected pseudocysts, drainage can be curative. In infected pseudocysts, percutaneous drainage is useful to stabilize the patient and can be either a cure or a temporizing measure until surgery can be performed.     

Pancreatic pseudocyst: comparative evaluation by sonography and computed tomography

Fifty-four patients were referred to rule out pancreatic pseudocyst. These patients underwent both sonographic and abdominal computed tomographic (CT) examinations for the evaluation of suspected pseudocysts. Among the 54 cases were 24 with proven pseudocysts. CT correctly identified 23 of the 24 pseudocysts with one false-negative and two false-positive studies. With sonography, the studies were technically inadequate in 20 of the 54 patients examined. Sonography correctly diagnosed 18 of the 24 pseudocysts; however, in 10 of these 18 cases sonographic findings were incomplete relative to CT findings. There were one false-negative and three false-positive sonographic studies. On the basis of this study, it was concluded that CT is more accurate than sonography in both diagnosing and demonstrating the extent of pseudocysts of the pancreas.     

Computed tomography of pancreatic pseudocysts of the duodenum

The findings of computed tomography (CT) in seven patients with pancreatic pseudocysts involving the duodenum are reported. Specific CT characteristics of duodenal wall involvement by the pseudocysts are tubular configuration of the pseudocyst, extending along the wall and conforming to the course of the duodenum (seven of seven), and abrupt flattening of the otherwise tubular or spherical pseudocyst at the border of the duodenal lumen (five of seven). The second part of the duodenum was involved in all cases; in some cases the first part of the duodenum was also involved (two of seven), and in others the pseudocyst extended to the third part of the duodenum (two of seven). All patients had other CT evidence of pancreatitis in addition to duodenal pseudocysts. CT findings are compared to other imaging methods and clinical and surgical findings. Patients with duodenal pseudocysts should be watched carefully for signs and symptoms of gastric outlet obstruction, since this was a prominent clinical problem in six of seven patients, and gastric outlet obstruction complicating suspected pancreatitis should alert to the possibility of duodenal pseudocyst.     

Abdominal cerebrospinal fluid pseudocyst

A case of an abdominal cerebrospinal fluid (CSF) pseudocyst in a patient with a ventriculoperitoneal shunt is reported to illustrate this known but rare complication. In the setting of a VP shunt, the frequency of abdominal CSF pseudocyst formation is approximately 3.2%, often being precipitated by a recent inflammatory or infective process or recent surgery. Larger pseudocysts tend to be sterile, whereas smaller pseudocysts are more often infected. Ultrasound and CT each have characteristic findings.     

内镜技术治疗慢性胰腺炎的临床应用价值

目的探讨内镜在慢性胰腺炎治疗中的临床应用价值。方法回顾性分析2002-2004年内镜治疗慢性胰腺炎患者33例的临床疗效。所有慢性胰腺炎病例均经临床检查、实验室检查、CT、超声及ERCP确诊。根据患者的情况采取单独或联合进行经内镜胰管括约肌切开（EPS）、乳头括约肌切开（FAT）、胰管内支架（PS）、胰石取出、鼻胰引流（ENPD）、胰管狭窄扩张等治疗措施。结果18例行EPS，27例行FAT，6例行网篮或气囊取胰石，13例行PS，5例行ENPD，9例行胰管扩张，1例巨大假性囊肿经胃壁穿刺放置内支架引流。33例中29例治疗后腹痛消失或明显减轻。治疗后复查实验室检查及影像指标均有明显改善。结论内镜技术联合应用治疗慢性胰腺炎是一种较安全、低创伤、有效的方法。     

CT scanning and ultrasound in the evaluation of pancreatic pseudocysts: a preliminary comparison

A retrospective review of 12 surgically proved cases of pancreatic pseudocyst was performed. CT correctly demonstrated 6/8 uncomplicated pseudocysts and 4/4 infected pseudocysts. Ultrasound identified 7/8 uncomplicated and 2/4 infected pseudocysts. Errors by one modality are due to limitations not shared by the other method. This suggests a basis for the complementary use of CT scanning and ultrasound in the evaluation of suspected pancreatic pseudocysts.     

Lymphocele Mimicking a Pancreatic Pseudocyst: Imaging Characteristics and Percutaneous Management

Lymphocele can be a difficult diagnosis to establish and may be confused for other abdominal fluid collections. Conversely, pancreatic pseudocysts may occur inadvertently from upper abdominal surgery and must be included in the differential diagnosis of virtually all peripancreatic fluid collections. We report the unusual occurrence of an unsuspected postoperative peripancreatic lymphocele that was thought to be a pancreatic pseudocyst. In retrospect, CT findings were evident and diagnostic. The lymphocele responded well to percutaneous drainage.     

胰腺炎并发脾门区及脾脏假性囊肿的CT诊断(附8例报告)

目的：探讨脾门区及脾脏内胰源性假性囊肿形成的解剖学机制及CT诊断价值。方法：收集经手术或临床治疗随访证实的脾及脾门区胰源性假性囊肿8例，对其CT征象进行回顾性分析。结果：8例患者胰尾或胰体尾部发现囊肿，其中5例在随访过程中发现脾内囊肿形成，2例发现脾间囊肿形成；1例单纯发现脾门区囊肿。7例早期均有明确的胰腺炎病史，发病部位以胰体尾为主，囊肿密度早期较高，后期CT值在12HU左右。壁厚薄不一，较大者壁薄。随着囊液的吸收，壁逐渐变厚。脾内囊肿初期表现边界欠清，平均7周左右出现较清晰的边界，结合增强及薄层扫描，有4例脾内囊肿与脾被囊问有明确的裂隙相连通。结论：脾肾韧带及胃脾韧带是脾门区及脾脏内胰源性假性囊肿形成的重要解剖学基础；CT检查对胰腺假性囊肿诊断及其动态监测具有重要临床意义。