1/4. Percutaneous embolization of the distal pancreatic duct to treat intractable pancreatic juice fistula.Pseudocysts and post-necrotic collections of the pancreas are sometimes treated by percutaneous drainage. In cases of post-necrotic collection, intractable pancreatic juice fistula is often formed by disruption of the main pancreatic duct in the necrotized region. We radically treated intractable pancreatic juice fistulae by selective cannulation into the distal pancreatic duct via the route for percutaneous drainage of post-necrotic collections to extinguish the exocrine function of the caudal pancreas. We performed this procedure in two patients in whom the major pancreatic duct was damaged at the body of the pancreas, which was extensively necrotic. Although mild symptoms of acute pancreatitis appeared in both patients after the first procedure, they recovered without severe side effects. Neither recurrence of pancreatic juice fistulae nor reduction of the glucose tolerance was caused by removing the exocrine function of the caudal pancreas in either patient 32 and 24 months after treatment, respectively. This method is an effective treatment modality with which to treat intractable pancreatic juice fistulae with damage of the main pancreatic duct.- - - - - - - - - - ranking = 1keywords = cannulation (Clic here for more details about this article) |
2/4. Pancreatic duct arteriovenous fistula and the metastatic fat necrosis syndrome.This report summarizes the course of a patient with asymptomatic chronic pancreatitis associated with hemorrhage into the pancreatic duct and metastatic fat necrosis. Retrograde cannulation of the pancreatic duct and superior mesenteric arteriography established the presence of a pseudocyst with a pancreatic duct-arteriovenous (DAV) fistula as the cause of the syndrome. ligation of feeder vessels with external drainage of the cyst as the initial surgical procedure stopped the bleeding but failed to prevent recurrence of the pancreatic duct-venous fistula. A pancreaticoduodenectomy with resection of the cyst and fistula was required to arrest destruction of distant tissues. Although serum and urine amylase concentrations were markedly elevated, serum lipase levels were normal throughout the patient's course. Elevation of serum lipase does not seem to be a necessary condition for the development of the metastatic fat necrosis syndrome.- - - - - - - - - - ranking = 1keywords = cannulation (Clic here for more details about this article) |
3/4. pleural effusion with pancreaticopleural fistula: a case report.A case of pancreaticopleural fistula with recurrent hemorrhagic pleural effusion has been described and the pathogenesis of pleural effusion associated with pancreatitis was discussed. Importance of thinking about pancreatic disease as a cause and estimation of amylase in pleural fluid is stressed. The diagnostic limitation of endoscopic retrograde cannulation of the pancreatic duct for defining a fistulous tract has also been noted.- - - - - - - - - - ranking = 1keywords = cannulation (Clic here for more details about this article) |
4/4. portal vein opacification during ERCP in patients with pancreatitis.We report two cases of portal vein visualization during ERCP in patients with pancreatitis, one from inadvertent cannulation of the superior mesenteric vein, and in the other, through a preexisting fistula. Prompt recognition of this potentially significant event will obviate confusion and unnecessary prolongation of the procedure.- - - - - - - - - - ranking = 1keywords = cannulation (Clic here for more details about this article) |