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Bleding From the Splenic Artery into a Pancreatic Pseudocyst with a Coexisting Microfistula to the Transverse Colon as Atypical Recurent Masive Gastrointestinal Bleding

100%

Fabiszewski A., Jackowski M.

issue 11

542-549

Here we present a case of a 49-year old male patient who was hospitalized at our Clinic from 2 to 16 December 2008 due to recurrent massive gastrointestinal bleeding. It was a patient with a history of recurrent pancreatitis. He had a history of surgical treatment for postinflamamtory pancreatic cyst (Jurasz cystogastrostomy). From 28.01.2007 to 16.12.2008 he was hospitalized five times. During the last hospitalization he received a total of 12 units of packed red blood cells. Neither gastroscopy nor colonoscopy did demonstrate the site of bleeding. AngioCT of the abdominal cavity demonstrated clearly enlarged spleen and a well delineated region, 30×35 mm, reaching spleen hilum, filled with dense fluid suggesting a vascular fistula, in the projection of the body and tail of the pancreas. The patient was qualified for laparotomy. Intraoperatively, bleeding from the splenic artery into the pancreatic pseudocyst with coexisting microperforation to the transverse colon was detected. The pancreatic cyst was opened and drained, the bleeding blood vessel as well as the splenic artery were underpinned. Splenectomy was performed and wall of the transverse colon was repaired. The patient underwent reoperation due to adhesion related small bowel obstruction on day 30 after the procedure. Currently the patient is in good general condition, without complaints, undergoes periodic follow up in the outpatient setting.

Drainage of Pancreatic Abscesses and Cysts Under Ultrasound Control

100%

Smyła Z., Zaniewski M., Piekorz P., Repeć R., Kostecki J., Hadasik D.

Polish Journal of Surgery

2007

vol. 79

issue 1

19-23

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.

TRUS-guided drainage of the ectopic ureter entering the prostatic urethra and TRUS-guided transurethral neo-orifice formation using holmium laser

88%

Białek W., Mey E., Kawecki P., Styliński R., Rudzki S.

Journal of Ultrasonography

2018

vol. 18

issue 74

255-264

A fifty-nine year-old male was hospitalized for exacerbation of chronic pancreatitis. As a gigantic cyst of the pancreatic tail was identified, it was fused with the jejunal loop. Due to persistent fever and severe symptoms in the storage and voiding phases, the patient was referred to a urologist. Because transrectal ultrasound examination revealed a fluid collection resembling the left seminal vesicle filled with purulent material, a transrectal puncture procedure was performed. The analysis of computed tomography scans led to the diagnosis of duplicated collecting system of the left kidney with the enormous ureter of the upper moiety that entered the prostate gland. In order to permanently decompress the hydronephrosed upper moiety of the left kidney, the patient was deemed eligible for endoscopic treatment. A transurethral incision through the bladder wall and the adjacent segment of the ectopic ureter was made with holmium laser under transrectal ultrasonography guidance, thus creating a neo-orifice of this ureter.

Pięćdziesięciodziewięcioletni mężczyzna został hospitalizowany z powodu zaostrzenia przewlekłego zapalenia trzustki. Rozpoznawszy olbrzymią torbiel ogona trzustki, dokonano jej zespolenia z pętlą jelita czczego. Ze względu na uporczywą gorączkę i nasilone objawy w fazie napełniania i wydalania moczu pacjent został skierowany na konsultację urologiczną. Ponieważ w przezodbytniczym badaniu ultrasonograficznym rozpoznano zbiornik płynowy przypominający pęcherzyk nasienny lewy wypełniony ropną treścią, dokonano jego punkcji z dostępu przezodbytniczego. Analiza obrazów tomografii komputerowej pozwoliła rozpoznać zdwojenie układu kielichowo-miedniczkowego nerki lewej z olbrzymim moczowodem górnego segmentu uchodzącym do stercza. W celu trwałego odbarczenia wodonerczowego segmentu górnego nerki lewej zakwalifikowano pacjenta do leczenia endoskopowego. Pod kontrolą przezodbytniczego badania ultrasonograficznego, przy użyciu lasera holmowego, dokonano przezcewkowego nacięcia przez ścianę pęcherza i przylegającego odcinka moczowodu ektopowego, wytwarzając nowe ujście moczowodu.

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2 Polish Journal of Surgery

1 Journal of Ultrasonography

1 2018

1 2009

1 2007

1 Białek W.

1 Fabiszewski A.

1 Hadasik D.

1 Jackowski M.

1 Kawecki P.

1 Kostecki J.

1 Mey E.

1 Piekorz P.

1 Repeć R.

1 Rudzki S.

1 Smyła Z.

1 Styliński R.

1 Zaniewski M.

Search results

Bleding From the Splenic Artery into a Pancreatic Pseudocyst with a Coexisting Microfistula to the Transverse Colon as Atypical Recurent Masive Gastrointestinal Bleding

Drainage of Pancreatic Abscesses and Cysts Under Ultrasound Control

TRUS-guided drainage of the ectopic ureter entering the prostatic urethra and TRUS-guided transurethral neo-orifice formation using holmium laser