Repeating regional acute pancreatitis in the head of the pancreas caused by intraductal papillary mucinous neoplasms in the tail: report of a case

Asari, Sadaki; Matsumoto, Ippei; Toyama, Hirochika; Shinzeki, Makoto; Goto, Tadahiro; Shirakawa, Sachiyo; Yamada, Isao; Ajiki, Tetsuo; Fukumoto, Takumi; Ito, Tomoo; Ku, Yonson

doi:10.1007/s00595-012-0142-8

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…The physiopathology of pancreatic symptoms in the case of BD-IPMN seems to be related to main pancreatic duct (MPD) occlusion by mucin plugs, secreted and coming from the cysts 12 . For this reason, it has been postulated that endoscopic treatment including pancreatic sphincterotomy might be helpful for managing mucinous obstructions.…”

Section: Introductionmentioning

confidence: 99%

Pancreatic sphincterotomy improves pain symptoms due to branch-duct intrapapillary mucinous neoplasia without worrisome features: a multicenter study

et al. 2019

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Introduction Branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) require follow-up to detect worrisome features (WF). Data are missing about endoscopic pancreatic sphincterotomy (PS) for symptomatic IPMN. Patients and methods This was a retrospective multicenter study in four expert centers. Patients treated with endoscopic PS for symptomatic (painful) BD-IPMN without WF were included. Age, sex, follow-up time, characteristics of IPMNs and endoscopic retrograde cholangiopancreatographies (ERCPs), and indications for surgery were recorded. Results In total, 21 patients were included (median age 68 years, range 45 – 87 years). The median number of cysts was 2 (range 1 – 10), located in the head (59 %), body/tail (17 %), or multifocal (24 %). ERCP including PS was completed in all of the cases, with biliary sphincterotomy in 33 %. Clinical efficacy after one session was 81 % (17/21). Among the failures, one had a second successful PS and three were operated. The final efficacy was 86 % (18/21). Seven patients were operated after a mean of 19 months: four for WF, three for pain. The histopathology showed four low grade dysplasia, one high grade dysplasia, and two no dysplasia. No adenocarcinoma occurred during a follow-up of 99 months (range 14 – 276 months). Conclusions Endoscopic PS for symptomatic IPMN without WF is effective in more than 80 % of cases, without increasing the risk for adenocarcinoma.

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Section: Introductionmentioning

confidence: 99%

Pancreatic sphincterotomy improves pain symptoms due to branch-duct intrapapillary mucinous neoplasia without worrisome features: a multicenter study

et al. 2019

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“…According to the literature, the rate of acute pancreatitis in patients with IPMNs has varied from 12% to 67%. Both the main duct-IPMN and side branch-IPMN may be the cause of acute pancreatitis with a similar risk [32][33][34]. A number of pancreatic cysts are asymptomatic.…”

Section: Diagnosis Of Pancreatic Cystsmentioning

confidence: 99%

Pancreatic cysts: etiology, diagnosis and management

Jabłońska

2014

Open Medicine

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AbstractPancreatic cysts involve a wide spectrum of pathologies from post-inflammatory cysts to malignant neoplasms. Pancreatic pseudocysts, serous cystadenomas, mucinous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs) and solid pseudopapillary tumors occur most frequently. Differential diagnosis involves the following imaging investigations: transabdominal ultrasonography (TUS), contrast enhanced ultrasonography (CEUS) and endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance (MR) and magnetic resonance cholangiopancretography (MRCP), endoscopic retrograde cholangiopancretography (ERCP). The cyst fluid cytology is performed in difficult differential diagnosis between pseudocysts and benign and potentially malignant or malignant tumors. Most frequently, viscosity, amylase, CEA and CA 19-9 levels are determined. Imaging findings should be correlated with cytology. The management depends on the cyst type and size. Small asymptomatic pseudocysts, serous cystadenomas and branchduct IPMNs should be carefully observed, whereas symptomatic large or uncertain serous cystadenomas and cystadenocarcinomas, mucinous cystadenomas and cystadenocarcinomas, main-duct IPMNs and large branch-duct IPMNs with malignant features, serous and mucinous cystadenocarcinomas, and solid pseudopapillary tumors require surgery. Pseudocysts are usually drained. Percutaneous / EUS-guided or surgical cyst drainage can be performed. Complicated and uncertain pseudocysts and cystic tumors need surgical resection. The type of surgery depends on cyst location and size and includes proximal, central, distal, total pancreatectomies and enucleation.

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Intraductal Papillary Mucinous Neoplasm with an Associated Invasive Carcinoma Manifested by Acute Pancreatitis

Kim¹,

Lee²,

Han³

et al. 2015

Korean J Pancreas Biliary Tract

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Idiopathic acute pancreatitis (IAP) is defined as acute pancreatitis for which the standard initial evaluation has failed to reveal the etiology. Although a tumor is a rare cause of IAP, it is important to consider it in advance, because prognosis is poor if diagnosis is delayed. We describe a case of presumed IAP at the index presentation that was finally diagnosed as intraductal papillary mucinous neoplasm with an associated invasive carcinoma in a 70-year-old woman after surgery to remove a mass identified during follow-up endoscopic ultrasonography. Therefore, this is a case in which suspicion of malignancy and follow-up endoscopic ultrasonography helped to appropriately diagnose and treat the tumor.

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Repeating regional acute pancreatitis in the head of the pancreas caused by intraductal papillary mucinous neoplasms in the tail: report of a case

Cited by 4 publications

References 10 publications

Pancreatic sphincterotomy improves pain symptoms due to branch-duct intrapapillary mucinous neoplasia without worrisome features: a multicenter study

Pancreatic sphincterotomy improves pain symptoms due to branch-duct intrapapillary mucinous neoplasia without worrisome features: a multicenter study

Pancreatic cysts: etiology, diagnosis and management

Intraductal Papillary Mucinous Neoplasm with an Associated Invasive Carcinoma Manifested by Acute Pancreatitis

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