A cystic lesion mimicking pancreatic neoplasm

A 54-year old male patient was admitted with complaints of periodical pain in the upper abdomen, CA- 19.9-51 U/ml (reference range < 37 U/ml). Blood tests were normal. However, ultrasound scan results revealed growth of a pancreatic tumor over 52×38 mm. A CT scan was performed for further characterization of the lesion. A tumor mass of 54 mm in diameter of the pancreatic body was found. There was no differentiation of lesion border with pancreas body (Fig. 1). Surgical resection was performed without preoperative biopsy following the consensus of the International Study Group of Pancreatic Surgery which states that in the presence of a solid mass suspicious for malignancy, a biopsy proof is not required before proceeding with resection (1). A soft consistence pancreas cyst with pus-like content was resected during surgical operation....

FEATURES OF DIAGNOSIS AND TREATMENT OF PANCREATICOPLEURAL FISTULA

The analysis of features of diagnosis and treatment of pancreaticopleural fistulas according to the materials of publications and own clinical observation of a 44-year-old patient with fistula between a false pancreas cyst and both pleural cavities is presented. Diagnosis in the debut of this disease was complicated by the prevalence of pleural pulmonary pathology, lack of characteristic clinical signs of pancreatic lesion and lack of references to them in the anamnesis. The sudden color change of pleural exudates from straw yellow to red-brown and comparison of the results of blood serum and pleural fluid analysis for amylase content allowed suspecting pancreatogenic origin of bilateral hydrothorax, which served as a basis for instrumental examination of the pancreas. The nature and prevalence of the process in the pancreas, abdominal cavity and the presence of pancreaticopleural fistula with bilateral hydrothorax were established by ultrasound and multispiral computer tomography of the thoracic and abdominal cavities; specification - by magnetic resonance imaging in the modes of T1-BI, T2-BI and magnetic resonance cholangiopancreatography(MRCP). Conservative treatment of acute inflammation of the pancreas in combination with puncture method of sanation of pleural cavities led to the elimination of pancreatic pleural fistula and bilateral hydrothorax. The choice of the method for the rehabilitation of pleural cavities should be justified by the nature, volume, rate of exudates accumulation and its infection. Magnetic resonance cholangiopancreatography (MRCP) is being used routinely to determine the expediency, possibility and the choice of method and volume of surgical treatment of pancreas pathology.

A new way of modeling the true pancreatic cyst

Currently, the pathogenesis of the formation and development of cysts has not been fully studied. This creates the need to analyze existing and fi nd new ways to model pancreatic cysts.The aim: create a new way of modeling the true pancreatic cystMaterials and methods: in an experiment on 7 mongrel dogs, a new method of forming a model of a true cyst of the head of the pancreas was developed, by creating a reservoir from the 12-type intestine with the pancreas, with suturing to the posterior wall of the pyloric part of the stomach.Results: the model of the pancreas cyst proposed by the authors meets the criteria of the true pancreatic cyst and can be used in experimental studies of various methods of cyst treatment.Conclusions: this method is technically simple in execution and allows one-step, in less time to perform the operation.