Document Detail

Endoscopic management of pancreatic pseudocysts at atypical locations.
MedLine Citation:
PMID:  19915913     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIMS: There is paucity of data on endoscopic management of pseudocysts at atypical locations. We evaluated the efficacy of endoscopic transpapillary nasopancreatic drain (NPD) placement in the management of pseudocysts of pancreas at atypical locations. PATIENTS AND METHODS: Eleven patients with pseudocysts at atypical locations were treated with attempted endoscopic transpapillary nasopancreatic drainage. On endoscopic retrograde pancreatography (ERP), a 5-F NPD was placed across/near the site of duct disruption. RESULTS: Three patients each had mediastinal, intrahepatic, and intra/perisplenic pseudocysts and one patient each had renal and pelvic pseudocyst. Nine patients had chronic pancreatitis whereas two patients had acute pancreatitis. The size of the pseudocysts ranged from 2 to 15 cm. On ERP, the site of ductal disruption was in the body of pancreas in five patients (45.4%), and tail of pancreas in six patients (54.6%). All the patients had partial disruption of pancreatic duct. The NPD was successfully placed across the disruption in 10 of the 11 patients (90.9%) and pseudocysts resolved in 4-8 weeks. One of the patients developed fever, 5 days after the procedure, which was successfully treated by intravenous antibiotics. In another patient, NPD became blocked 12 days after the procedure and was successfully opened by aspiration. The NPD slipped out in one of the patient with splenic pseudocyst and was replaced with a stent. There was no recurrence of symptoms or pseudocysts during follow-up of 3-70 months. CONCLUSION: Pancreatic pseudocysts at atypical locations with ductal communication and partial ductal disruption that is bridged by NPD can also be effectively treated with endoscopic transpapillary NPD placement.
Deepak Kumar Bhasin; Surinder Singh Rana; Mohit Nanda; Vijant Singh Chandail; Ibrahim Masoodi; Mandeep Kang; Navin Kalra; Saroj Kant Sinha; Birinder Nagi; Kartar Singh
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-11-14
Journal Detail:
Title:  Surgical endoscopy     Volume:  24     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-28     Completed Date:  2010-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1085-91     Citation Subset:  IM    
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
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MeSH Terms
Cholangiopancreatography, Endoscopic Retrograde / methods*
Diagnosis, Differential
Drainage / instrumentation*
Follow-Up Studies
Middle Aged
Pancreatic Ducts
Pancreatic Pseudocyst / diagnosis,  surgery*
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
Young Adult

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