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Drainage of Pancreatic Abscesses and Cysts Under Ultrasound Control

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Smyła Z., Zaniewski M., Piekorz P., Repeć R., Kostecki J., Hadasik D.
Polish Journal of Surgery
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2007
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vol. 79
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issue 1
19-23
EN
The aim of the study was to determine the effectiveness and efficiency of drainage of pancreatic pseudocysts and cysts under ultrasound control during acute pancreatitis.Material and methods. During the period between 1985 and 2004, 103 patients were hospitalized at The Department of General and Vascular Surgery, Regional Specialistic Hospital in Tychy, due to pancreatic pseudocysts or abscesses. Pancreatic abscesses were observed in 36 patients, while the remaining 67 patients were diagnosed with pseudocysts. Percutaneous drainage was indicated to treat pancreatic liquid cisterns when the cistern exceeded 4-6 cm in diameter, and had no tendency towards idiopathic absorption. Drainage procedures were performed in the operating room with the use of a 3,5MHz linear probe and "Cavafix" CH 18, "Nephrofix" 10-15 or "Cystofix" 10-15 kits.Results. Recovery following percutaneous drainage was obtained in 33 of 36 (91,7%) patients with pancreatic pseudocysts, and in 60 of 67 (89,5%) patients with pancreatic abscesses. The average duration of the drainage amounted to 19.25 days in case of peudocysts and 30.2 days in case of abscesses. Six patients with pseudocysts and three with abscesses required surgical intervention due to inefficient inefficiency drainage. Pseudocyst infections were the most common complications observed following drainage and were seen in 12 (17.9%) patients.Conclusions. In selected cases, drainage of pancreatic pseudocysts and cysts under ultrasound control may be an alternative to surgery. This method is highly recommended as it is less invasive, improves the patient's life comfort and reduces treatment costs.
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Endoscopic-Ultrasound Guided Drainage of the Pancreatic Pseudocyst

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Rembiasz K., Bednarek M., Budzyński P., Poźniczek M., Budzyński A.
Polish Journal of Surgery
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2009
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vol. 81
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issue 12
641-647
EN
The aim the study was the evaluation of the treatment results of the internal ultrasound and gastroscopy-guided pancreatic pseudocysts.Material and methods. From 1994-2008 at the 2nd Department of General Surgery UJ CM there were 126 patients (incl. 45 female and 81 male) treated for pancreatic pseudocyst. Mean age of the women was 41.05 years (25-81) while men 48 years (19-79). Ultrasound and gastroscopy-guided drainage by the means of insertion of double pig tail drain was attempted in 46 patients (17 female and 29 male). Mean diameter of the cyst was 11.02 cm (from 2.5-20 cm).Results. Out of 46 patients assigned to the internal ultrasound, gastroscopy guided drainage, the procedure was technically feasible in 39. Internal marsupialization was successful in 24 patients (52.17%). We did not observe serious complications mentioned in the literature incl. iatrogenic injuries of the intraabdominal organs or fistulas. Drain was removed after 5 month (1-9 month).Conclusions. Endoscopic drainage consists an interesting minimally invasive approach in the management of pancreatic pseudocyst. More precise inclusion criteria could increase its efficacy.
3
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Splenic artery pseudoaneurysm rupture into a pancreatic pseudocyst with its subsequent perforation as the cause of a massive intra-abdominal bleeding – case report

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Szpakowicz J., Szpakowicz P., Urbanik A., Markuszewski L.
Polish Journal of Surgery
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2016
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vol. 88(6)
614-622
EN
Pseudocysts account for approximately 70% of all cystic lesions of the pancreas. One of the most dangerous complications of pancreatic pseudocysts is bleeding into the cystic lumen; the most common cause of the bleeding is a splenic artery pseudoaneurysm rupture. This paper presents the case of a 37-year-old man treated surgically for a massive intra–abdominal haemorrhage caused by a splenic artery pseudoaneurysm rupture into the lumen of a tail of pancreas pseudocyst with its subsequent perforation into the abdominal cavity and retroperitoneal space. Peripheral resection of the pancreas together with the cyst and spleen resection was performed. There were no postoperative complications.
4
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Haemorrhagic Shock as a Result of Bleeding to Pancreatic Pseudocysts - The Problem of Emergency Service

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Olejarz A., Nowikiewicz T., Piotrowski L.
Polish Journal of Surgery
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2009
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vol. 81
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issue 4
193-197
EN
Pancreatic pseudocysts (PPC) depending on their size and location can cause life-threatening complications. The paper focuses on an infrequent cause of a haemorrhagic shock that can pose a substantial diagnostic and surgical problem, especially during emergency service.Material and methods. In the years 1997-2002 five patients with bleeding to pancreatic pseudocysts were operated on due to urgent indications. In all of them the symptoms of bleeding into the digestive tract or to the retroperitoneal space diagnosed as a hypovolemic shock was the only indication to an urgent surgical intervention. The analysis was carried out on epidemiological data of patients, manner of treatment and its results.Results. The group of patients consisted of 4 man and 1 women of mean age 40.6 years. The majority of patients (4 - i.e. 80%) had a history of acute pancreatitis and severe alcohol abuse. All hospitalized patients needed, in the perioperative period, intensive shock-controlling procedures (average blood preparation transfusions at the level of 6.6 units). In total, six operation procedures were performed (in one case with subsequent relaparotomy) - in 4 cases it was distal pancreatic resection with PPC, in 1 case - retroperitoneal space packing and drainage. Finally, 4 cured patients left the hospital, 1 died (mortality rate 20%).Conclusions. PPC bleeding as a life threatening complication of acute pancreatitis requires quick diagnosis and effective treatment. A surgical procedure can be performed on many levels; the choice of an operation type depends on the patient's state, intraoperational conditions and the surgeon's experience.
5
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Leczenie chirurgiczne torbieli rzekomych trzustki – doświadczenia własne

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Zakościelny A., Ćwik G., Wallner G.
Pediatria i Medycyna Rodzinna
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2014
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vol. 10
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issue 2
190-199
EN
Introduction: Pancreatic pseudocysts are frequent complications after acute and chronic pancreatitis. They are diagnosed in 6–18% of patients with the history of acute pancreatitis and in 20–40% cases with chronic pancreatitis. The aim of the study was to analyse early results of surgical treatment of pancreatic acute and chronic pseudocysts based on our experience. Material and methods: The retrospective analysis was based on early results of surgical treatment of 46 patients aged between 20 and 78 (33 males and 13 females) who underwent treatment of acute (n = 26) and chronic (n = 20) pancreatic pseudocysts from November 2005 to July 2011 at the Second Department of General and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract in Lublin. Results: The choice of a surgical method of treatment depended on the size, localisation, thickness of pseudocystic wall and changes in the main pancreatic duct. We used the following surgical methods: cystogastrostomy (Jurasz procedure) was conducted in 22 patients (47.8%), Roux-en-Y cystojejunostomy was performed in 19 cases (41.3%), complete excision of the pseudocyst was possible in two patients (4.3%) and cystoduodenostomy – in one case (2.1%). Also, in single cases external drainage (2.1%) and cystopancreaticojejunostomy of Puestow (2.1%) were applied. Forty-four patients (95.6%) were cured. Early postoperative complications were observed in 2 patients (4.4%). Two reoperations (4.4%) were required. Early postoperative mortality was 0%. Conclusions: Classic internal drainage procedures, known since the 19th century, are still effective methods of treatment in acute and chronic pancreatic pseudocysts.
PL
Wprowadzenie: Torbiele rzekome trzustki stanowią częste powikłania ostrego oraz przewlekłego zapalenia trzustki. Rozpoznawane są u 6–18% pacjentów diagnozowanych z powodu przebytego ostrego zapalenia trzustki oraz u 20–40% diagnozowanych z powodu przewlekłego zapalenia tego narządu. Celem pracy jest retrospektywna analiza wczesnych wyników leczenia chirurgicznego ostrych i przewlekłych torbieli rzekomych trzustki na podstawie własnego materiału. Materiał i metody: Analizę przeprowadzono, opierając się na retrospektywnej ocenie wczesnych wyników leczenia chirurgicznego 46 pacjentów w wieku 20–78 lat (33 mężczyzn oraz 13 kobiet) leczonych z powodu torbieli ostrych (n = 26) oraz torbieli przewlekłych trzustki (n = 20) od listopada 2005 do lipca 2011 roku w II Katedrze i Klinice Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego w Lublinie. Wyniki: Wybór metody operacyjnej uzależniony był od wielkości, lokalizacji i grubości ściany torbieli oraz obecności zmian w obrębie przewodu Wirsunga. Zastosowano następujące metody leczenia chirurgicznego: cystogastrostomię sposobem Jurasza – u 22 chorych (47,8%), cystojejunostomię sposobem Roux-en-Y – u 19 (41,3%), wyłuszczenie torbieli – u 2 (4,3%), zespolenie torbieli z dwunastnicą – cystoduodenostomię – u 1 pacjenta (2,1%); również w pojedynczych przypadkach wykonano drenaż zewnętrzny (2,1%) oraz pankreatojejunostomię sposobem Puestowa (2,1%). Wyleczenie uzyskano u 44 operowanych (95,6%). Wczesne powikłania pooperacyjne zaobserwowano u 2 chorych (4,4%). Wykonano 2 reoperacje (4,4%). Wczesna śmiertelność pooperacyjna wynosiła 0%. Wnioski: Klasyczne zabiegi drenażu wewnętrznego, znane od XIX wieku, są w dalszym ciągu skutecznymi metodami leczenia ostrych oraz przewlekłych torbieli rzekomych trzustki.
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