X-Ray Findings of Pancreatic Cysts Diagnosed by Endoscopic Pancreatocholangiography

Abstract

In 32 cases pancreatic cysts were diagnosed by endoscopic pancreatocholangiography (ERPC) all confirmed by subsequent surgery. From the X-ray findings, we can enumerate the following symptoms as being typical of or at least suspicious for pancreatic cysts: I. Direct filling of cyst cavity. 2. Filling defect in the pancreatic branches and parenchyma. 3. Obstruction of the main pancreatic duct as a strict or as a tapering type abruption. 4. Displacement and compressions of the common bile duct. Pancreatic cysts were located in the head region in 17 cases and in 15 cases in the tail region. Single cysts are seen more often than multiple cysts. If a pancreatic cyst is diagnosed or suspected by ERPC, surgery is indicated. The time of operation depends on the X-ray findings. Filled cysts without discharge into the main duct must be operated on immediately, at least within 10 hours of ERPC, due to the danger of purulent infection.Key-Words: Endoscopic pancreatocholangiography (ERPC), pancreatic cysts, X-ray findings in the pancreatic duct system, X-ray findings in the common bile duct, localization of the cysts.Until recently, pancreatic cysts could be diagnosed only by indirect methods prior to surgery. X-ray of stomach and duodenum, including hypotonic duodenography, and Endoscopy 6 (1974) 77-83 Röntgenbefunde bei Pankreaszysten dwelt endoskopische Pankreatocholangiographie Bei 32 Patienten wurden Pankreaszysten durch die Methode der retrograden Pankreatocholangiographie (ERPC) diagnostiziert und nachfolgend operativ bestatigt. Nach den Röntgenbefunden sind die folgenden Zeichen typisch oder weitgehend verdachtig auf das Vorliegen von Pankreaszysten: 1. Direkte Auffilllung eines zystischen Hohlraumes. 2. Fiillungsdefekt in den Seitengangen und im Parenchym des Pankreas. 3. Abbruch des Pankreashauptganges, entweder scharf oder allmahlich verdammernd. Verlagerung und Einengung des Ductus choledochus. In 17 Fallen waren die Pankreaszysten in der Kopfund in 15 Fallen in der Schwanzregion lokalisiert. Einzelzysten waren häufiger als multiple Zysten. Wenn mittels ERPC eine Pankreaszyste nachgewiesen wird oder der dringende Verdacht besteht, ist ein chirurgisches Vorgehen angezeigt. Der Zeitpunkt der Operation hangt dabei vom röntgenologischen Bild ab. Gefüllte Zysten ohne freien Abfluß in den Ductus Wirsungianus sollten wegen der Gefahr einer Superinfektion umgehend, spatestens aber innerhalb von 10 Stunden nach durchgeführter ERPC operiert werden. intravenous cholangiography displacements, compression, obstructions and impressions may indicate a pancreatic cyst. Also, selective angiography of the arteria coeliaca and the

Recent Advances in the Endoscopic Retrograde Cholangiopancreatography

“…Seifert et al (76) reported in 32 cases, the following findings could be enumerated as typical of, or at least suggestive of a pancreatic cyst: direct filling of cyst cavity -filling defect in the pancreatic branches and parenchymaobstruction of the main pancreatic duct as a stricture or as a tapering type, displacement and compression of the common bile duct. They (76) also ob served that pancreatic cysts were located in the head region in 17 cases, and in 15 cases in the tail region, and that a single cyst was seen more often than multiple cysts.…”

“…They (76) also ob served that pancreatic cysts were located in the head region in 17 cases, and in 15 cases in the tail region, and that a single cyst was seen more often than multiple cysts. Filled cysts without discharge into the main duct must be oper ated on immediately, at least within 10 h of ERCP, due to the danger of puru lent infection (76).…”

Endoscopic retrograde pancreaticocholangiography in chronic diseases of the pancreas and in papillary stenoses

“…In the healing or scarring process, leakage of the duct may be closed a n d E R P C then m a y show complete occlusion of the involved duct. In such changes, which C o t t o n a n d Beales [16] observed in 4 of 25 cases and Seifert et al [15] in 13 of 32 cases, the diagnosis of necrotizing cavity c a n n o t be made by E R P C alone. The pancreatic duct can be displaced and n a r r o w e d by abscesses a n d more distinctly by pseudocysts (Fig.…”

“…In these conditions ERPC presents several advantages: A reliable diagnosis of necrotizing lesions or pseudocysts can be established, and indication and planning for surgical intervention can be assessed. However, demonstration of a necrotic cavity is an absolute indication for surgical intervention within 24 h after filling, or with a delay of 2 to 3 days if the cavity is quickly emptied [15]. Tryptic liquefaction leads to rupture of the ducts, allowing pancreatic juice to escape into the cavity or beyond the confines of the gland, forming a pseudocyst.…”

Clinical Relevance of Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

“…The possibility to inspect the papillary region endoscopically and to visualize the biliary as well as the pancreatic system radiologically by direct instillation of dye has opened new ways in the diagnosis of biliary and pancreatic diseases. This was evaluated hitherto by the frequency of positive cannulation of the ampulla of \rater or by the results in special pathological findings in the biliary and pancreatic duct system (1)(2)(3)(4)(5)(6)(7)(8)10).…”