Pub Date : 2021-01-01DOI: 10.36648/1590-8577.21.22.121-122
J. Davidwong
{"title":"A Plea for Pancreatic Cancer","authors":"J. Davidwong","doi":"10.36648/1590-8577.21.22.121-122","DOIUrl":"https://doi.org/10.36648/1590-8577.21.22.121-122","url":null,"abstract":"","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"22 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69688858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.22.2.42-46
D. Kapoor, S. Dubey, A. Perwaiz, Amanjeet Singh, A. Chaudhary
Introduction Solid pseudopapillary tumours (SPN) of pancreas are increasingly being diagnosed and reported. Understanding the management of these tumours is getting better but still there are many unanswered questions. Materials and Methods this is a retrospective analysis of prospectively maintained surgical database at the department of GI Surgery and GI Oncology, Medanta, Gurugram, Haryana. The clinicopathological and surgical parameters of 34 patients who underwent surgery for SPN, over a 10 year period were analysed. Results All patients underwent surgical resection, which included 12 (35.3%) Whipple’s pancreatoduodenectomy, 4 (11.76%) central pancreatectomy, 11 (32.35%) spleen preserving distal pancreatectomy and 6 (17.65%) distal pancreatosplenectomy. Three patients were detected to have recurrence and were re-operated. Conclusion Surgical management of SPN yields good long term results despite recurrent or metastatic disease. Many deficiencies still remain in the understanding and management of this disease.
{"title":"Solid Pseudopapillary Neoplasm of Pancreas-A 10 Year Experience from a Tertiary Care Referral Centre","authors":"D. Kapoor, S. Dubey, A. Perwaiz, Amanjeet Singh, A. Chaudhary","doi":"10.36648/1590-8577.22.2.42-46","DOIUrl":"https://doi.org/10.36648/1590-8577.22.2.42-46","url":null,"abstract":"Introduction Solid pseudopapillary tumours (SPN) of pancreas are increasingly being diagnosed and reported. Understanding the management of these tumours is getting better but still there are many unanswered questions. Materials and Methods this is a retrospective analysis of prospectively maintained surgical database at the department of GI Surgery and GI Oncology, Medanta, Gurugram, Haryana. The clinicopathological and surgical parameters of 34 patients who underwent surgery for SPN, over a 10 year period were analysed. Results All patients underwent surgical resection, which included 12 (35.3%) Whipple’s pancreatoduodenectomy, 4 (11.76%) central pancreatectomy, 11 (32.35%) spleen preserving distal pancreatectomy and 6 (17.65%) distal pancreatosplenectomy. Three patients were detected to have recurrence and were re-operated. Conclusion Surgical management of SPN yields good long term results despite recurrent or metastatic disease. Many deficiencies still remain in the understanding and management of this disease.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"22 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69689794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.36648/1590-8577.22.2.47-54
Y. Launey, T. Wallenhorst, A. Tawa, C. Rousseau, A. Foubert, Philippe Seguina
Background/Objectives The term acute fulminant pancreatitis (AFP) has been proposed to define the most severely ill patients and those who are likely to die before they develop persistent organ failure. The objective of our study was to determine the risk factors for developing AFP in patients admitted to the intensive care unit (ICU). Methods This was a retrospective study conducted between January 2007 and May 2019 in a ICU. Patients ≥18 years old admitted to the ICU within 3 days of the onset of abdominal pain related to acute pancreatitis were included. We defined AFP according to the modified Marshall scoring system for organ dysfunction based on a score ≥ 2 involving at least 2 organ systems for at least 48 hours or ≤ 48 hours if the patient died during the first 7 days of hospitalization. Results Sixty-three patients were analyzed (AFP group, n=27 - non-AFP group, n=36). In multivariate analysis, AFP was associated with a lower level of fluid loading before ICU admission (OR [95%CI] = 0.89 [0.82; 0.97], p<0.001) and a higher modified Marshall score (OR [95%CI] = 2.31 [1.53; 3.49], p<0.001). On day 7, mortality was higher in the AFP group (48% vs. 3%, p<0.001), and 29% of patients with AFP died within 48 hours of admission to the ICU before developing persistent organ failure. Conclusions A lower level of fluid resuscitation prior to admission to the ICU and a higher modified Marshall score on ICU admission were independently associated with higher risks of developing AFP.
背景/目的急性暴发性胰腺炎(AFP)一词被用来定义病情最严重的患者和那些在发生持续性器官衰竭之前可能死亡的患者。本研究的目的是确定重症监护病房(ICU)患者发生AFP的危险因素。方法回顾性研究于2007年1月至2019年5月在ICU进行。患者年龄≥18岁，在急性胰腺炎相关腹痛发病3天内入住ICU。我们根据改良的Marshall器官功能障碍评分系统定义AFP，评分≥2分涉及至少2个器官系统至少48小时，如果患者在住院前7天死亡，则≤48小时。结果共分析63例患者，其中AFP组27例，非AFP组36例。在多变量分析中，AFP与ICU入院前较低的液体负荷水平相关(OR [95%CI] = 0.89 [0.82;0.97]， p<0.001)和更高的修正马歇尔评分(OR [95%CI] = 2.31 [1.53;3.49, p < 0.001)。在第7天，AFP组的死亡率更高(48% vs. 3%， p<0.001)， 29%的AFP患者在进入ICU 48小时内死亡，然后发生持续性器官衰竭。结论入住ICU前较低的液体复苏水平和入住ICU时较高的修正Marshall评分与AFP发生的高风险独立相关。
{"title":"Risk Factors for Acute Fulminant Pancreatitis in Patients Admitted to the Intensive Care Unit: A Retrospective Study","authors":"Y. Launey, T. Wallenhorst, A. Tawa, C. Rousseau, A. Foubert, Philippe Seguina","doi":"10.36648/1590-8577.22.2.47-54","DOIUrl":"https://doi.org/10.36648/1590-8577.22.2.47-54","url":null,"abstract":"Background/Objectives The term acute fulminant pancreatitis (AFP) has been proposed to define the most severely ill patients and those who are likely to die before they develop persistent organ failure. The objective of our study was to determine the risk factors for developing AFP in patients admitted to the intensive care unit (ICU). Methods This was a retrospective study conducted between January 2007 and May 2019 in a ICU. Patients ≥18 years old admitted to the ICU within 3 days of the onset of abdominal pain related to acute pancreatitis were included. We defined AFP according to the modified Marshall scoring system for organ dysfunction based on a score ≥ 2 involving at least 2 organ systems for at least 48 hours or ≤ 48 hours if the patient died during the first 7 days of hospitalization. Results Sixty-three patients were analyzed (AFP group, n=27 - non-AFP group, n=36). In multivariate analysis, AFP was associated with a lower level of fluid loading before ICU admission (OR [95%CI] = 0.89 [0.82; 0.97], p<0.001) and a higher modified Marshall score (OR [95%CI] = 2.31 [1.53; 3.49], p<0.001). On day 7, mortality was higher in the AFP group (48% vs. 3%, p<0.001), and 29% of patients with AFP died within 48 hours of admission to the ICU before developing persistent organ failure. Conclusions A lower level of fluid resuscitation prior to admission to the ICU and a higher modified Marshall score on ICU admission were independently associated with higher risks of developing AFP.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"22 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69690167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.18154/RWTH-2018-223495
M. Bakens, B. V. Rijssen, V. V. Woerden, M. Besselink, D. Boerma, O. Busch, K. DeJong, M. Gerhards, J. E. Hooft, Y. Keulemans, J. Klaase, M. Luyer, Q. Molenaar, J. Oor, E. Schoon, W. Steen, D. Tseng, D. Gouma, I. Hingh
Introduction A Dutch randomized trial showed that patients with obstructive jaundice due to periampullary tumors and a bilirubin below 250 μmol/l have a higher rate of complications after preoperative biliary drainage as compared to early surgery. Therefore, in the Netherlands the recommended treatment is early surgery without preoperative biliary drainage. This study investigated adherence to this recommendation. Methods A retrospective multicenter cohort study was performed in patients undergoing pancreatoduodenectomy for suspected malignancy in a 2-years period in seven Dutch high-volume centers. The proportion of and reasons for preoperative biliary drainage were studied. Results Pancreatoduodenectomy was performed in 609 patients, of whom 401 (66%) presented with preoperative jaundice. Of these, 245 patients had bilirubin levels below 250 μmol/l. Preoperative biliary drainage was performed in 165 (67%) of these patients. In the majority of patients, no medical reason justifying a preoperative biliary drainage could be retrieved from the medical charts (n=102, 62%). Preoperative biliary drainage was mostly performed in the hospital of diagnosis prior to referral to a pancreatic center (53%). After referral, the rate of preoperative biliary drainage varied considerably between pancreatic centers (13% - 58%, p<0.001). Conclusion In the Netherlands, more than half of the patients with obstructive jaundice still undergo preoperative biliary drainage prior to surgery in the Netherlands without an urgent medical reason. Given the negative influence of preoperative biliary drainage on outcome, this practice should be improved.
{"title":"Evaluation of Preoperative Biliary Drainage in Patients Undergoing Pancreatoduodenectomy For Suspected Pancreatic or Periampullary Cancer","authors":"M. Bakens, B. V. Rijssen, V. V. Woerden, M. Besselink, D. Boerma, O. Busch, K. DeJong, M. Gerhards, J. E. Hooft, Y. Keulemans, J. Klaase, M. Luyer, Q. Molenaar, J. Oor, E. Schoon, W. Steen, D. Tseng, D. Gouma, I. Hingh","doi":"10.18154/RWTH-2018-223495","DOIUrl":"https://doi.org/10.18154/RWTH-2018-223495","url":null,"abstract":"Introduction A Dutch randomized trial showed that patients with obstructive jaundice due to periampullary tumors and a bilirubin below 250 μmol/l have a higher rate of complications after preoperative biliary drainage as compared to early surgery. Therefore, in the Netherlands the recommended treatment is early surgery without preoperative biliary drainage. This study investigated adherence to this recommendation. Methods A retrospective multicenter cohort study was performed in patients undergoing pancreatoduodenectomy for suspected malignancy in a 2-years period in seven Dutch high-volume centers. The proportion of and reasons for preoperative biliary drainage were studied. Results Pancreatoduodenectomy was performed in 609 patients, of whom 401 (66%) presented with preoperative jaundice. Of these, 245 patients had bilirubin levels below 250 μmol/l. Preoperative biliary drainage was performed in 165 (67%) of these patients. In the majority of patients, no medical reason justifying a preoperative biliary drainage could be retrieved from the medical charts (n=102, 62%). Preoperative biliary drainage was mostly performed in the hospital of diagnosis prior to referral to a pancreatic center (53%). After referral, the rate of preoperative biliary drainage varied considerably between pancreatic centers (13% - 58%, p<0.001). Conclusion In the Netherlands, more than half of the patients with obstructive jaundice still undergo preoperative biliary drainage prior to surgery in the Netherlands without an urgent medical reason. Given the negative influence of preoperative biliary drainage on outcome, this practice should be improved.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"19 1","pages":"24-28"},"PeriodicalIF":0.2,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67703532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-20DOI: 10.1200/JCO.2016.34.15_SUPPL.E15733
R. Levin, P. Sirijintakarn, J. Grutsch
Context Seventy patients with adenocarcinoma of the pancreas with liver metastases, received chemotherapy every four weeks and their outcomes are reported in this retrospective series. Objective Advanced adenocarcinoma of the pancreas has a poor prognosis with only 2% 5-year survival reported by SEER (Surveillance, Epidemiology and End Results of the NCI). Chemotherapy given as intra-arterial perfusions is more intense than intravenous chemotherapy. Responses in perfused tumor is expected to be better than that obtained with only intravenous chemotherapy. Design Hepatic artery therapy is given monthly as a 5 hour perfusion of the hepatic artery using DDP and MIC. Also given is monthy Intravenous (IV) therapy with four hours of Leucovorin (LV), with an injection of FUDR during the last hour of LV, daily x 5 days. Setting all therapy was given at Midwestern Regional Medical Center. Patients Thirty seven patients had no prior chemotherapy, while 33 patients had progressed after prior IV chemotherapy. Intervention Hepatic artery therapy with IV LV-FUDR was given for up to six months depending upon marrow tolerance and response. At that point, if response was ongoing or improving, therapy was continued monthly with only IV LV-FUDR; all therapy was stopped whenever progressive disease was evident. Results of those without prior chemotherapy, the mean overall survival (OS) was 17.3 ± 30.2 months (mean±SD), ranging up to 13 years. Six patients survived more than three years with four are living in continuing complete remission for more than five years. Conclusion This therapy offers the opportunity for long term survival in a subset of patients with metastatic adenocarcinoma of the pancreas who have liver metastases, and some patients can be cured.
{"title":"Hepatic Artery Chemotherapy for Advanced Adenocarcinoma of the Pancreas","authors":"R. Levin, P. Sirijintakarn, J. Grutsch","doi":"10.1200/JCO.2016.34.15_SUPPL.E15733","DOIUrl":"https://doi.org/10.1200/JCO.2016.34.15_SUPPL.E15733","url":null,"abstract":"Context Seventy patients with adenocarcinoma of the pancreas with liver metastases, received chemotherapy every four weeks and their outcomes are reported in this retrospective series. Objective Advanced adenocarcinoma of the pancreas has a poor prognosis with only 2% 5-year survival reported by SEER (Surveillance, Epidemiology and End Results of the NCI). Chemotherapy given as intra-arterial perfusions is more intense than intravenous chemotherapy. Responses in perfused tumor is expected to be better than that obtained with only intravenous chemotherapy. Design Hepatic artery therapy is given monthly as a 5 hour perfusion of the hepatic artery using DDP and MIC. Also given is monthy Intravenous (IV) therapy with four hours of Leucovorin (LV), with an injection of FUDR during the last hour of LV, daily x 5 days. Setting all therapy was given at Midwestern Regional Medical Center. Patients Thirty seven patients had no prior chemotherapy, while 33 patients had progressed after prior IV chemotherapy. Intervention Hepatic artery therapy with IV LV-FUDR was given for up to six months depending upon marrow tolerance and response. At that point, if response was ongoing or improving, therapy was continued monthly with only IV LV-FUDR; all therapy was stopped whenever progressive disease was evident. Results of those without prior chemotherapy, the mean overall survival (OS) was 17.3 ± 30.2 months (mean±SD), ranging up to 13 years. Six patients survived more than three years with four are living in continuing complete remission for more than five years. Conclusion This therapy offers the opportunity for long term survival in a subset of patients with metastatic adenocarcinoma of the pancreas who have liver metastases, and some patients can be cured.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"43 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2016-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65955526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sung Hwan Lee, D. H. Kim, H. Hwang, C. Kang, W. Lee
Context The lifelong risk of post-splenectomy overwhelming sepsis is major complication after splenectomy. Laparoscopic distal pancreatectomy is an accepted as safe, and adequate procedure for pancreatic pathologies requiring resection of the distal part of the pancreas. However, attempts to preserve the spleen are not always successful and sometimes require unnecessary splenectomy. Spleen autotransplantation can be regarded as inducing iatrogenic splenosis in the abdominal cavity. Case report In this report, we present a case of spleen autotransplantation (about 30 g of splenic tissue) following laparoscopic distal pancreatectomy and inadvertent splenectomy for benign intraductal papillary tumor of the pancreas. Conclusion This procedure may be the last option spleen preservation considered in the era of laparoscopic distal pancreatectomy. Image: Laparoscopic view after completion of spleen autotransplantation.
{"title":"Spleen Autotransplantation Following Laparoscopic Distal Pancreatosplenectomy and Cholecystectomy","authors":"Sung Hwan Lee, D. H. Kim, H. Hwang, C. Kang, W. Lee","doi":"10.6092/1590-8577/3000","DOIUrl":"https://doi.org/10.6092/1590-8577/3000","url":null,"abstract":"Context The lifelong risk of post-splenectomy overwhelming sepsis is major complication after splenectomy. Laparoscopic distal pancreatectomy is an accepted as safe, and adequate procedure for pancreatic pathologies requiring resection of the distal part of the pancreas. However, attempts to preserve the spleen are not always successful and sometimes require unnecessary splenectomy. Spleen autotransplantation can be regarded as inducing iatrogenic splenosis in the abdominal cavity. Case report In this report, we present a case of spleen autotransplantation (about 30 g of splenic tissue) following laparoscopic distal pancreatectomy and inadvertent splenectomy for benign intraductal papillary tumor of the pancreas. Conclusion This procedure may be the last option spleen preservation considered in the era of laparoscopic distal pancreatectomy. Image: Laparoscopic view after completion of spleen autotransplantation.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 1","pages":"299-302"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71235227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Katsourakis, C. Svoronos, E. Chatzitheoklitos, Iosif Hadjis, M. Alatsakis, C. Mirelis, A. Sovatzidis, G. Noussios
Context Sarcomas represent a relatively rare malignancy. Primary sarcomas of the pancreas represent an extremely rare pathology. Case report We report a case of primary pancreatic carcinoma that presented with anaemia. The patient underwent a Kausch-Whipple operation, and, 16 months after the operation, the patient is disease free. Conclusion This unique case describes an extremely rare gastrointestinal tumour that was found during the patient's anaemia assessment. Image: Gastro-duodenoscopy demonstrating a tumor at the ampulla of Vater.
{"title":"Carcinosarcoma of the Pancreas: How a Common Blood Disorder Can Hide an Extremely Rare Tumour","authors":"A. Katsourakis, C. Svoronos, E. Chatzitheoklitos, Iosif Hadjis, M. Alatsakis, C. Mirelis, A. Sovatzidis, G. Noussios","doi":"10.6092/1590-8577/3003","DOIUrl":"https://doi.org/10.6092/1590-8577/3003","url":null,"abstract":"Context Sarcomas represent a relatively rare malignancy. Primary sarcomas of the pancreas represent an extremely rare pathology. Case report We report a case of primary pancreatic carcinoma that presented with anaemia. The patient underwent a Kausch-Whipple operation, and, 16 months after the operation, the patient is disease free. Conclusion This unique case describes an extremely rare gastrointestinal tumour that was found during the patient's anaemia assessment. Image: Gastro-duodenoscopy demonstrating a tumor at the ampulla of Vater.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"1 1","pages":"310-312"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71235083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yezaz A Ghouri, Idrees Mian, Gitanjali Bhattacharjee, Modushudan Bhattacharjee
Context Long-standing diabetes mellitus results in autonomic nervous system dysfunction, leading to gastroparesis and cholecystoparesis. The latter can result in hydropic gallbladder, a condition that arises from the accumulation of mucinous secretions within the gallbladder, usually caused by obstruction of the cystic duct, but not in the case of the patients with diabetes that we have illustrated. Case report We describe three patients who presented with non-specific abdominal discomfort at the time of admission for complications of poorly controlled diabetes and were subsequently found to have hydropic gallbladder. We theorize that hydropic gallbladder may be a result of a natural progression of gallbladder dysfunction in poorly controlled diabetics with autonomic neuropathy. In our cases the risk of perioperative mortality was high at the time of presentation. No surgical intervention was performed except in one case with the most significant sized gallbladder, and underwent a temporizing cholecystostomy. Conclusions The development of hydropic gallbladder in patients with non-obstructed cystic ducts highlights the complexities of management of patients with functional biliary pain. The rome committee on functional biliary and pancreatic disorders has defined the characteristics of this pain. There is a need for guidelines to direct appropriate assessment of hydropic gallbladder in diabetics and also to determine the indications for cholecystectomy. Image: HIDA scan showing a low ejection fraction of the gallbladder after administration of CCK.
{"title":"Hydropic Gallbladder in Three Patients with Poorly Controlled Diabetes Mellitus: What Constitutes Optimal Management?","authors":"Yezaz A Ghouri, Idrees Mian, Gitanjali Bhattacharjee, Modushudan Bhattacharjee","doi":"10.6092/1590-8577/2998","DOIUrl":"https://doi.org/10.6092/1590-8577/2998","url":null,"abstract":"Context Long-standing diabetes mellitus results in autonomic nervous system dysfunction, leading to gastroparesis and cholecystoparesis. The latter can result in hydropic gallbladder, a condition that arises from the accumulation of mucinous secretions within the gallbladder, usually caused by obstruction of the cystic duct, but not in the case of the patients with diabetes that we have illustrated. Case report We describe three patients who presented with non-specific abdominal discomfort at the time of admission for complications of poorly controlled diabetes and were subsequently found to have hydropic gallbladder. We theorize that hydropic gallbladder may be a result of a natural progression of gallbladder dysfunction in poorly controlled diabetics with autonomic neuropathy. In our cases the risk of perioperative mortality was high at the time of presentation. No surgical intervention was performed except in one case with the most significant sized gallbladder, and underwent a temporizing cholecystostomy. Conclusions The development of hydropic gallbladder in patients with non-obstructed cystic ducts highlights the complexities of management of patients with functional biliary pain. The rome committee on functional biliary and pancreatic disorders has defined the characteristics of this pain. There is a need for guidelines to direct appropriate assessment of hydropic gallbladder in diabetics and also to determine the indications for cholecystectomy. Image: HIDA scan showing a low ejection fraction of the gallbladder after administration of CCK.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 1","pages":"290-294"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71235273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Patel, Ali Khan, Sami Naveed, Jason Brazleton, Mel C. Wilcox
Context Pancreatic panniculitis is a very rare complication associated with pancreatic disease and perhaps even a presage to pancreatic pathology. Case report We present a case of pancreatic panniculitis in a 61 year old patient who was treated for sudden onset of abdominal pain associated with nausea and vomiting secondary to acute pancreatitis of unknown etiology. He subsequently developed skin lesions consistent with pancreatic panniculitis which gradually improved after resolution of his acute condition and treatment with topical steroid cream. Conclusion We discuss and review the literature along with highlighting for the readers the important clinical and histopathologic features of acute pancreatitis associated pancreatic panniculitis. Image: Initial dermatologic manifestation on lower extremities.
{"title":"Pancreatic Panniculitis: A Rare Manifestation of Acute Pancreatitis","authors":"R. Patel, Ali Khan, Sami Naveed, Jason Brazleton, Mel C. Wilcox","doi":"10.6092/1590-8577/3001","DOIUrl":"https://doi.org/10.6092/1590-8577/3001","url":null,"abstract":"Context Pancreatic panniculitis is a very rare complication associated with pancreatic disease and perhaps even a presage to pancreatic pathology. Case report We present a case of pancreatic panniculitis in a 61 year old patient who was treated for sudden onset of abdominal pain associated with nausea and vomiting secondary to acute pancreatitis of unknown etiology. He subsequently developed skin lesions consistent with pancreatic panniculitis which gradually improved after resolution of his acute condition and treatment with topical steroid cream. Conclusion We discuss and review the literature along with highlighting for the readers the important clinical and histopathologic features of acute pancreatitis associated pancreatic panniculitis. Image: Initial dermatologic manifestation on lower extremities.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"38 1","pages":"303-306"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Jin, A. Small, C. Vollmer, N. Jhala, E. Furth, G. Ginsberg, M. Kochman, N. Ahmad, V. Chandrasekhara
Context Carcinoembryonic antigen analysis of pancreatic cyst fluid is the tumor marker of choice for preoperatively differentiating mucinous from non-mucinous cystic lesions. Objective We aim to determine the most accurate cyst carcinoembryonic antigen cut-off value for distinguishing mucinous cysts from non-mucinous cysts with a focus on discriminating intraductal papillary mucinous neoplasms. Methods The results of pancreatic cyst aspiration carcinoembryonic antigen levels from a single center were retrospectively collected and evaluated for a diagnosis of a mucinous cyst and an assessment of malignancy using surgical histology as the diagnostic standard in 86 patients. Results The median cyst carcinoembryonic antigen level (ng/mL) was significantly higher in mucinous cysts compared with non-mucinous cysts (218 vs. 4.4; P=0.0006) and in intraductal papillary mucinous neoplasms compared with non-mucinous cysts (135 vs. 4.4; P=0.0027). A cyst carcinoembryonic antigen cut-off of 30.7 ng/mL was most accurate (87.2%) for differentiating mucinous from non-mucinous cysts and specifically for differentiating intraductal papillary mucinous neoplasms from non-mucinous cysts (82.7%). Cyst carcinoembryonic antigen levels were not significantly different between malignant and non-malignant mucinous cysts (68.5 vs. 238.1; P=0.51). Conclusions Pancreatic cyst fluid carcinoembryonic antigen can accurately differentiate histologically verified mucinous lesions, including intraductal papillary mucinous neoplasms, from non-mucinous lesions with an optimal cut-off that is much lower than previously reported values. Cyst carcinoembryonic antigen levels are not a reliable predictor of malignancy. Image: Sensitivity and specificity curves of cyst fluid CEA levels for differentiating mucinous from non-mucinous cysts.
背景:胰腺囊肿液癌胚抗原分析是术前鉴别粘液性和非粘液性囊性病变的肿瘤标志物。目的探讨鉴别导管内乳头状黏液性肿瘤的最准确的囊肿癌胚抗原切断值。方法回顾性收集86例胰腺囊肿单中心抽吸癌胚抗原检测结果，并以手术组织学为诊断标准，评价其对粘液囊肿的诊断和恶性程度的判断。结果黏液囊肿中囊癌胚抗原水平(ng/mL)明显高于非黏液囊肿(218∶4.4;P=0.0006)，导管内乳头状黏液性肿瘤与非黏液性囊肿相比(135 vs 4.4;P = 0.0027)。囊肿癌胚抗原切断值为30.7 ng/mL，区分黏液性囊肿和非黏液性囊肿最准确(87.2%)，特别是区分导管内乳头状黏液性肿瘤和非黏液性囊肿(82.7%)。恶性和非恶性黏液囊肿癌胚抗原水平无显著差异(68.5比238.1;P = 0.51)。结论胰腺囊肿液癌胚抗原可以准确区分组织学证实的粘液性病变，包括导管内乳头状粘液性肿瘤和非粘液性病变，其最佳临界值远低于先前报道的值。囊肿癌胚抗原水平不是恶性肿瘤的可靠预测指标。图像:囊肿液CEA水平鉴别黏液囊肿与非黏液囊肿的敏感性和特异性曲线。
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