Pseudocyst formation is a common complication of acute and chronic pancreatitis. Most common site of pseudocyst is lesser sac; mediastinal extension of pseudocyst is rare. Other possibilities of posterior mediastinal ...Pseudocyst formation is a common complication of acute and chronic pancreatitis. Most common site of pseudocyst is lesser sac; mediastinal extension of pseudocyst is rare. Other possibilities of posterior mediastinal cyst must be considered. This patient presented with computed tomography abdomen with thorax showing a large thoraco-abdominal pseudocyst with right sided pleural effusion. It was confirmed to be pancreatic pseudocyst by analyzing fluid for amylase and lipase during surgery. In our patient, the pseudocyst was accessible transabdominaly. Cystogastrostomy was not possible as it was causing twisting of cardio-esophageal junction; we did retrocolic and retrogastric Roux-en-Y cystojejunostomy. Only two such cases were reported in literature.展开更多
AIM:To perform a systematic review comparing the outcomes of endoscopic,percutaneous and surgical pancreatic pseudocyst drainage.METHODS:Comparative studies published between January 1980 and May 2014 were identified ...AIM:To perform a systematic review comparing the outcomes of endoscopic,percutaneous and surgical pancreatic pseudocyst drainage.METHODS:Comparative studies published between January 1980 and May 2014 were identified on Pub Med,Embase and the Cochrane controlled trials register and assessed for suitability of inclusion.The primary outcome was the treatment success rate.Secondary outcomes included were the recurrence rates,re-interventions,length of hospital stay,adverse events and mortalities.RESULTS:Ten comparative studies were identified and 3 were randomized controlled trials.Four studies reported on the outcomes of percutaneous and surgical drainage.Based on a large-scale national study,surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach.Three studies reported on the outcomes of endoscopic ultrasound(EUS)and surgical drainage.Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay,cost and improved quality of life.Three other studies comparedEUS and esophagogastroduodenoscopy-guided drainage.Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.CONCLUSION:In patients with unfavorable anatomy,surgical cystojejunostomy or percutaneous drainage could be considered.Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.展开更多
文摘Pseudocyst formation is a common complication of acute and chronic pancreatitis. Most common site of pseudocyst is lesser sac; mediastinal extension of pseudocyst is rare. Other possibilities of posterior mediastinal cyst must be considered. This patient presented with computed tomography abdomen with thorax showing a large thoraco-abdominal pseudocyst with right sided pleural effusion. It was confirmed to be pancreatic pseudocyst by analyzing fluid for amylase and lipase during surgery. In our patient, the pseudocyst was accessible transabdominaly. Cystogastrostomy was not possible as it was causing twisting of cardio-esophageal junction; we did retrocolic and retrogastric Roux-en-Y cystojejunostomy. Only two such cases were reported in literature.
文摘AIM:To perform a systematic review comparing the outcomes of endoscopic,percutaneous and surgical pancreatic pseudocyst drainage.METHODS:Comparative studies published between January 1980 and May 2014 were identified on Pub Med,Embase and the Cochrane controlled trials register and assessed for suitability of inclusion.The primary outcome was the treatment success rate.Secondary outcomes included were the recurrence rates,re-interventions,length of hospital stay,adverse events and mortalities.RESULTS:Ten comparative studies were identified and 3 were randomized controlled trials.Four studies reported on the outcomes of percutaneous and surgical drainage.Based on a large-scale national study,surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach.Three studies reported on the outcomes of endoscopic ultrasound(EUS)and surgical drainage.Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay,cost and improved quality of life.Three other studies comparedEUS and esophagogastroduodenoscopy-guided drainage.Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.CONCLUSION:In patients with unfavorable anatomy,surgical cystojejunostomy or percutaneous drainage could be considered.Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.
