Endoscopic retrograde cholangiopancreatography in the preoperative diagnosis of pancreatic neoplasms associated with cysts

Article Abstract:

Cystic neoplasms (malignant cysts) of the pancreas are uncommon, representing less than 5 percent of pancreatic cancers, and are difficult to correctly diagnose prior to surgery. Differentiation of cystic neoplasm from pseudocysts (enlargements that look like cysts) is essential, since cystic neoplasm requires resection (removal), while pseudocysts require observation and internal drainage. To evaluate preoperative diagnostic accuracy, the cases of 11 patients with evidence of pancreatic neoplasia associated with cysts were reviewed. All patients complained of abdominal pain; eight had lost weight and six were anorectic. CT (computerized tomography) scans showed cysts in all patients, but the scans of six patients were mistakenly interpreted as pseudocysts. Ultrasound studies were performed on three patients, but the results, while abnormal, did not provide a diagnosis. Endoscopic retrograde pancreatography (ERCP, a method of obtaining an X-ray of the pancreatic duct after it is filled with a substance through which X-rays do not pass) showed abnormalities for all 11 patients. The abnormalities included an occluded pancreatic duct (the duct through which the pancreas discharges its digestive enzymes) in eight patients, a narrowed duct in two patients, and a displaced duct in one patient. These findings supported a diagnosis of pancreatic neoplasm. Eight patients underwent surgical resection of part of the pancreas, while biopsies were taken from the remaining three subjects. The two main types of pancreatic cysts cannot usually be distinguished from one another or from pseudocysts using the CT scan. The most accurate diagnosis can be made using a combination of CT and ERCP, leading to correct diagnosis in more than 95 percent of patients with chronic pancreatitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Endoscopic retrograde cholangiopancreatography

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Proliferative pancreatic cysts: pathogenesis and treatment options

Article Abstract:

As a result of the increased use of noninvasive imaging of the abdomen, true pancreatic cysts are being identified more frequently. True pancreatic cysts have an epithelial (cell layer) lining; this differentiates them from pancreatic pseudocysts, often the result of trauma or pancreatitis (inflammation of the pancreas). True pancreatic cysts occur more often in women than in men, and patients usually complain of intermittent abdominal or back pain, nausea and vomiting, and occasionally diarrhea and early satiety; they often have a palpable mass in the upper left area of the abdomen. Ultrasound examination should be performed initially. Computed tomographic scanning is the most useful diagnostic tool because it provides detailed anatomic information. It is important that the correct diagnosis be made prior to or at the time of surgery because the drainage procedures performed for pseudocysts are not appropriate for true cysts. True cysts should be completely removed. One type of true pancreatic cyst, mucinous cystadenoma, has the potential for becoming cancerous. However, if the entire cyst is removed, the long-term results of treatment are excellent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Risk factors, Pancreatic cancer

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Pancreatic phlegmon: what is it?

Article Abstract:

Out of 264 patients suffering from pancreatitis (inflammation of the pancreas) 22 were diagnosed to be suffering from phlegmon, diffuse inflammation of subcutaneous tissue caused by streptococcus bacteria, creating multiple small pockets of pus, on the basis of radiologic and clinical criteria. Radiologic criteria included an area of damaged tissue identified by computed tomography (CT) scan. This abnormal lesion was composed of masses of mixed density, free of gas outside of the intestine and lacking a well-defined wall. The clinical criteria used was that the patient was free of sepsis (bacterial infection in the blood). Half of the patients diagnosed with severe pancreatitis had three or more poor prognostic signs (indications for their recovery). Fever, an excess of disease-fighting white blood cells known as leukocytosis and high levels of amylase enzymes in the blood persisted longer than usual in these patients. Complications were rare but the lesion sometimes persisted for three or four months without producing symptoms. This is a relatively benign condition and surgery ought to be avoided.

Streptococcal infections, Pancreatitis

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