1/9. Intrapancreatic duodenal duplication cyst with inversion of the superior mesenteric vessels: CT findings.We present a case of intrapancreatic duodenal duplication cyst and inversion of the superior mesenteric vessels. CT findings of this association are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/9. Solid and cystic tumor of the pancreas--three cases report.Solid and cystic tumor of the pancreas is a rare, low-grade malignant tumor that predominantly occurs in young women. Clinically, the patients are often asymptomatic and are usually found incidentally due to other diseases. The pre-operative diagnosis is difficult due to the similarity to other cystic pancreatic lesions (such as serous adenoma, mucinous cystadenoma and endocrinologically inactive islet cell tumor), or inflammatory changes (such as pancreatic pseudocyst). This tumor has a slow growth, usually does not have metastases and has a favorable prognosis. Complete removal is the treatment of choice for the tumors arising anywhere in the pancreas. We collected specimens of pancreatic tumors that were kept at Kaohsiung Medical University Hospital (KMUH) in the past 11 years. Three cases varying in clinical course were found. The first is a case of a middle aged woman with a slow growing tumor who had a misdiagnosis of pseudocyst eight years ago. The second is a case of a young woman that showed no symptoms, while the third case was also a young woman diagnosed with a huge tumor with portal vein and inferior vessel encasement. We review some articles to revise the study of this disease in order to make the correct diagnosis before proceeding with the operation, and to provide proper treatment.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
3/9. Laparoscopic spleen-preserving distal pancreatectomy.Distal pancreatectomy with spleen preservation may be the preferred procedure for certain benign tumors and cystic lesions of the pancreatic body or tail. Alternatively, laparoscopic removal including either distal pancreatectomy with splenectomy or splenic-preservation with ligation of the splenic vessels have also been described. We describe, herein, our method to perform spleen-preserving laparoscopic distal pancreatectomy that preserves the splenic vessels and hence splenic function. The described technique of spleen-preserving distal pancreatectomy has been used in two patients with favorable results. Both patients underwent laparoscopic distal pancreatectomy with splenic conservation for an oligocystic serous cystadenoma and serous cystadenoma. operative time was 3-6 hours with total blood loss of less than 200 cc in both cases. The length of stay in the hospital was 4-8 days and both patients returned to work within 3 weeks. Laparoscopic spleen-preserving distal pancreatectomy should be considered for younger patients with select body or tail lesions that are not candidates for less extensive procedures.- - - - - - - - - - ranking = 0.4keywords = vessel (Clic here for more details about this article) |
4/9. Severe hemorrhage associated with pancreatic pseudocysts: report of two cases.Severe hemorrhage from pancreatic pseudocysts is a rare condition that poses a diagnostic and therapeutic challenge. Two cases of preoperative intracystic bleeding and massive postoperative gastrointestinal hemorrhage observed during the last year form the basis of the present report. In the first patient, transcystic suture ligation of the bleeding vessel was necessary to control this life-threatening and dramatic condition--External drainage of the cyst was followed by an uneventful postoperative course. In the second patient, massive gastrointestinal bleeding occurred after cysto-gastrostomy, and neither endoscopy nor arteriography was able to identify the source. Despite aggressive medical and surgical therapy, the patient died. Massive intracystic or gastrointestinal hemorrhage caused by rupture of pseudoaneurysms into pancreatic pseudocysts still remains a rare but severe condition, difficult to treat and affected by high mortality rates. angiography should be performed routinely in the preoperative assessment of pancreatic pseudocysts, even when the other diagnostic techniques do not raise the suspicion of pseudoaneurysm formation. After internal drainage procedures early surgery is recommended whenever GI bleeding occurs in the postoperative course.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
5/9. 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 = 0.2keywords = vessel (Clic here for more details about this article) |
6/9. Value of arteriography in the evaluation of a sonolucent pancreatic mass.A pseudoaneurysm of the pancreaticoduodenal artery secondary to chronic pancreatitis was erroneously diagnosed as a pancreatic pseudocyst by abdominal plain films, barium gastrointestinal studies, and abdominal ultrasound. Because of the operative findings, it was necessary to interrupt surgery undertaken to drain the presumed pseudocyst. angiography is strongly recommended as a preoperative study in patients with sonolucent pancreatic masses to distinguish pseudoaneurysms of pancreatic vessels from pseudocyts.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
7/9. gastrointestinal hemorrhage from pseudoaneurysms in pancreatic pseudocysts.gastrointestinal hemorrhage secondary to hemosuccus pancreaticus is a rare condition that poses a significant diagnostic and therapeutic challenge. It is reported to occur most commonly in the setting of acute or chronic pancreatitis with rupture of pseudoaneurysms of the spleen or hepatic artery into the pancreatic duct. In this report three such cases have been reported. Abdominal ultrasound and CT scanning can noninvasively define pancreatic pseudocysts with a high degree of accuracy. Real-time ultrasonography may document a pulsatile pseudoaneurysm. Radionuclide arterial scanning, by demonstrating pooling of blood in the area of a pseudocyst, can point to the source of bleeding in patients with pancreatitis and gastrointestinal hemorrhage. Selective celiac angiography, however, is the only diagnostic test that can definitively outline a pseudoaneurysm and demonstrate its rupture into a pseudocyst or into the pancreatic duct. Pancreatic resection including excision of the pseudoaneurysm and pseudocyst (when present) is the treatment of choice. In cases where resection is not possible, ligation of the artery proximal and distal to the pseudoaneurysm and drainage of the pseudocyst into the gastrointestinal tract is an acceptable alternative procedure. Although intraarterial catheter embolization of the bleeding vessel can be a lifesaving procedure in these very sick patients, subsequent resection of the lesion is warranted as the definitive treatment.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
8/9. Intrasplenic pancreatic pseudocyst complicating severe acute pancreatitis.Since 13 cases of intrasplenic pancreatic pseudocysts have been previously described in the world literature, an additional case is reported. The mechanisms for the development of this lesion are: 1. direct extension of the pancreatic cyst into the splenic hilum; 2. digestive effects of pancreatic enzymes on splenic vasculature and parenchyma; 3. pancreatitis occurring in ectopic intrasplenic pancreatic tissue and 4. liquefaction of splenic infarcts secondary to thrombosis of the splenic vessels. Criteria for diagnosis and current available diagnostic methods are discussed. Early surgical intervention with splenectomy and possibly caudal pancreatectomy, is advocated.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |
9/9. Angiographic demonstration of gastrointestinal bleeding through the pancreatic duct.This article describes the angiographic findings in the case of a bleeding stump of the left gastric artery, following subtotal gastrectomy, into a pancreatic pseudocyst with instantaneous opacification of the pancreatic duct and duodenum. This is the first reported case to demonstrate a frank bleed with total opacification of the pancreatic duct. Based on our experience and previously reported cases, we conclude that subselective catheterization of the bleeding vessel is necessary to demonstrate total opacification of the pancreatic duct in such cases.- - - - - - - - - - ranking = 0.2keywords = vessel (Clic here for more details about this article) |