CLINICAL STUDY AND MANAGEMENT OF PSEUDOPANCREATIC CYST

Introduction: The pseudocysts present clinically as epigastric pain, abdominal masses to jaundice. Radiology helps in the diagnosis of the pseudocysts with the help of USG, CT scan, MRI, etc. These investigations govern the therapeutic procedures to be carried out. Aims and objectives: To understand the epidemiology of pancreatic pseudocysts. To analyze the various treatment modalities that can be utilized in the management of the pancreatic pseudocysts. To compare USG guided per-cutaneous aspiration with the other treatment options available in terms of patient and physician factors. Materials and methods: Data was collected from patients who came to Konaseema Institute of Medical Sciences & Research Institute for treatment. Patients diagnosed as pseudopancreatic cyst with help of diagnostic procedure like USG abdomen, Barium meal, if required CT scan Abdomen and admitted patients of both sex and all age groups were included in the study. Results: Commonest treatment was Internal drainage in 50% of the patients followed by conservative management in 36.66% of patients, external catheter drainage was done in 13.33% of the patients. Immediate postoperative pain was present in 16.66% of patients and wound infection in 13.3%. Conclusion: Acute Pancreatic pseudocysts were treated conservatively, infected cysts and ruptured cyst required external drainage.

Two infant cases of intraperitoneal arterial hemorrhage due to a duplication cyst: a case report

Background Intraperitoneal arterial hemorrhage without trauma is extremely rare. We report two infant cases of intraperitoneal arterial hemorrhage due to intestinal duplication. Case presentation In case 1, a 2-month-old girl experienced sudden intraperitoneal hemorrhage from the middle colic artery with no apparent trauma. Hemostasis was achieved with suturing of the hemorrhage point, but the cause of hemorrhage was still unknown. Computed tomography after the first operation revealed a duodenal duplication cyst and a pseudopancreatic cyst. Percutaneous drainage of the pseudopancreatic cyst was performed, and the contents had high pancreatic amylase. As the size of the duodenal duplication cyst also decreased with this drainage, we suspected that the duodenal duplication cyst was connected to the pseudopancreatic cyst and the arterial hemorrhage. We hypothesized that the pancreatic juice inside the duplication cyst leaked into the intraperitoneal cavity and caused rupture of the arterial wall. Therefore, marsupialization of the duodenal duplication was performed to evacuate the pancreatic juice contained in the cyst toward the native duodenum. The postoperative course was uneventful. In case 2, a 6-month-old boy experienced sudden intraperitoneal hemorrhage without trauma. The hemorrhage site was identified as the ileocecal artery, and hemostasis was achieved with sutures. Tissue near the hemorrhage point was biopsied, because the cause of arterial wall rupture was still unknown. The biopsied tissue was found to be intestinal mucosa. The patient had recurrent abdominal pain after the first operation, and computed tomography showed a duplication cyst located near the hemorrhage point. Therefore, we resected the intestinal duplication. Pathology results showed that the intestinal duplication contained intestinal mucosa, ectopic gastric mucosa, and pancreatic tissue. The postoperative course was uneventful. Conclusion Intraperitoneal arterial hemorrhage without trauma is an extremely rare condition, and identifying its cause is difficult. To our knowledge, this is the first report of intraperitoneal arterial hemorrhage due to intestinal duplication. In cases of unexplained intraperitoneal arterial hemorrhage in infants, intestinal duplication near the hemorrhage point should be suspected.

An Unusual Case of Gallbladder Carcinoma with Pseudopancreatic cyst

Generally, carcinoma of the gallbladder is an extremely unusual neoplasm, however, high incidence rates have been reported in certain parts of the world. The role of certain factors such as genetic susceptibility, lifestyle and infections of gallbladder in causing carcinogenesis is still not clearly understood. Due to its early vague symptoms and lack of serosa in the gallbladder to slow its spread, gallbladder carcinoma typically presents at an advanced stage with a five-year survival rate of less than 5%. Pseudopancreatic cyst is an uncommon but not a rare complication of acute pancreatitis and injury to the pancreas. However, it rarely presents with carcinoma of gallbladder. We present here an unusual case of gallbladder carcinoma with pseudopancreatic cyst in a 58-year old male.

Pseudopancreatic Cyst Extending into the Mediastinum in a 7-Year-Old Child

Mediastinal pseudopancreatic cyst (MPP) is the extension of a pancreatic pseudocyst through esophageal or aortic hiatus into the posterior mediastinum. It can produce a range of manifestations caused by compression by the cyst, for instance, odynophagia, dysphagia, pericardial, or pleural effusion. Here we report a case of MPP in a 7-year-old child who was presented with repeated chest infections and left pleural effusion. It was successfully drained by cystogastrostomy.