췌장가성낭종의 보존적치료

윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim),신건성(Gun Sung Shin),김용태(Yong Tae Kim),김태현(Tae Hun Kim) 대한내과학회 1996 대한내과학회지 Vol.51 No.3

Objectives: Several results of clinical studies on the etiology, clinical manifestation, diagnosis and management of pancreatic pseudocysts were reported in Korea; however they were almost all in concerned with the surgical aspect and little attention was focused on the conservative management of pancreatic pseudocysts. This study was designed to evaluate the efficacy of conservative management of pancreatic pseudocysts in Korean patients. Methods : We reviewed the medical records of 55 patients with pancreatic paseudocysts managed from 1985. 1 to 1993. 12 in Seoul National University Hospital. Results: 1) Pancreatic pseudocysts were usually associated with acute pancreatitis caused abdominal pain, and were frequently located on the head and the tail of the pancreas. 2) Sixy five percent of pancreatic pseudocysts were managed successfully with conservative treatment, and the small pseudocysts associated with pancreatitis were more prone to successful conservative treatment. 3) With respect to decreases in the size of the pseudocysts, 86% of the cases showed some size decrease within 4 weeks after treatment. Conclusion: Conservative treatment alone is effective in 65% of pancreatic pseudocysts and in Korea at least 4 weeks of conservative treatment is necessary for the management of small pseudocysts associated with pancreatitis.

췌장의 가성낭종 파열에 의한 하부 위장관 출혈 1예

장성종,김병수,부귀범,김동규,박찬국,김만우,김정용,박상헌 조선대학교 부설 의학연구소 2000 The Medical Journal of Chosun University Vol.25 No.1

Pancreatic pseudocysts usually develop as a complication of acute pancreatitis or repeated attacks of chronic pancreatitis. Pseudocysts may also develop as a result of traumatic injuries or neoplasms. An uncommon complication is massive hemorrhage inside the pancreatic pseudocyst. The exact mechanism of hemorrhage is unknown. Enzymatic digestion, pressure erosion from the cyst mass or a combination of these processes may play an important role. Gastrointestinal hemorrhage associated with a pancreatic pseudocyst can occur in 10 percent of cases. When hemorrhage occurs because of erosion into a blood vessel involved in the pseudocyst, surgery is indicated since the episodes of hemorrhage are often severe and may even be fatal. When there is colonic involvement, various complications may occur. The most dangerous one is spontaneous rupture into the colon, which requires immediate surgical treatment because of high incidence of fulminating sepsis or massive hemorrhage. We examined a sixty eight-year-old man complaining of hematochezia and dizziness, and reported that it was a case of massive lower gastrointestinal hemorrhage caused by pseudocyst of the pancreas ruptured into the colon associated with chronic pancreatitis. On operative findings, the peripancreatic fatty tissue had severe adhesions to transverse colon and tail portion of pancreas, where the pseudocyst had formed. A distal pancreatectomy, splenectomy and resection of transverse colon were performed. By microscopic examination, hemorrhagic necrosis and inflammatory change were observed in the pancreas specimen. The tail portion of pancreas had a 6×6 cm sized cystic mass and was proven to be a pseudocyst with no epithelial lining.

췌장 가성낭종의 CT진단 후 치료경과 관찰

조원수,김영통,김영화,김일영,이문호 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.1

Purpose: To evaluate clinical outcome after documentation of pancreatic pseudocyst by computed tomography (CT). Methods: The clinical course of 18 patients with pancreatic pseudocysts documented by computed tomography (CT) were retrospectively reviewed. History, physical examination, laboratory findings and CT finding were analyzed between operated and non -operated group of pancreatic pseudocysts. Result: There are 20 pancreatic pseudocysts in 18 patients with 16 males and two females (mean age: 45). There is no significant difference between operated and non- operated group in clinical symptoms and laboratory findings. On CT study, there are six cases of intrapancreatic pseudocysts and four cases of extrapancreatic pseudocysts in operated group. The mean diameter of pancreatic pseudocyst is 10.4 cm. In 10 pseudocysts of non-operated group, there are four case of intrapancreatic pseudocysts and six cases of extrapancreatic pseudocysts. The mean diameter of pancreatic pseudocyst is 5.4cm. There are approximately twice in diameter of the pseudocysts between operated and non-operated group (p < 0.05). Conclusion: CT is useful in the guiding of pancreatic pseudocyst management.

췌장 가성낭종의 치료 - D`Egidio 및 Schein분류에 따른 치료

이옥재(Ok Jae Lee),김영채(Young Chai Kim) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: The classical approach to acute pseudocyst was to wait for 4-6 weeks before operation, in order to allow spontaneous resolution or maturation of the pseudocyst wall. However, with the recent use of less invasive techniques, this expectant policy may not be nesessary. The aim of this study is to evaluate the usefulness of Degidio and Schein classification of pancreatic pseudocyst as guideline for management. Methods: We classified 38 patients with pancreatic pseudocysts as type I, II and III according to Degidio and Schein classification, and analysed outcornes of treatment in relation to the types of pseudocysts. Results: Early percutaneous r.atheter drainage(PCD) was tried in 17 patients with acute pseudocysts and the success rate was 82.4%. In 23 patients with type I pseudocysts, PCD, operation and conservative treatment were tried in 14, 4 and 5 cases, respectively. Tbe resolution rate of PCD was 85.7%(12/14), the complication rate 28.6%(4/14) and the recurrence rate 16.7%(2/12). The complication and recurrence after operation were observed in 1 and 1 cases, respectively. In 9 patients with type II pseudocysts, PCD was tried in 5 cases with the resolution rate 60%(3 cases), complication rate 60% and recurrence of 1 cases. Operation was successful in all 3 cases without complication and recurrence. In 6 patients with type llI pseudocysts, PCD was not effective in all 2 cases and operation was successful in all 2 cases without complication and recurrence. Conclusions: Early PCD may be useful in acute pseudocysts although pseudocyst wall is immature. Degidio K Schein classification may provide useful guideline for management of pseudocysts. Type l pseudocysts can be adequately managed by PCD alone. In type 11 pseudocysts, surgery is adequate and PCD can be applied depending on presence of cyst-duct communication. Type III pseudocysts should be managed surgically due to ductal pathology. (Korean J Gastroenterol 1996; 28:714 - 720)

췌장 장액낭선종에 의해 발생한 췌장 가성낭 1예

김재환,김용태,송병준,윤원재,류지곤,윤용범 대한췌담도학회 2011 대한췌담도학회지 Vol.16 No.2

췌장 장액낭선종은 대부분 양성 종양으로 대부분 수술 없이 경과 관찰하는 것이 원칙이다. 하 지 만 진단이 확실하지 않은 경우 또는 증상을 동반한 췌장 장액낭선종인 경우에는 수술적인 절 제가 필요하다. 췌장 장액낭선종의 종괴 효과로 인한 원위부 췌관의 확장을 동반한 췌관의 협착은 매 우 드물게 발생하며, 급성 췌장염도 유발할 수 있다. 이와 같은 경우, 수술적인 절제는 합병 증 재 발을 방지하기 위해 필요하다. 본 증례는 췌장 가성낭을 동반한 급성 췌장염으로 나타난 50 세 여 자 환자에서 췌관 스텐트 및 낭위연결술로 췌장 가성낭을 치료 후, 췌장염과 췌장 가성낭의 원인 이라고 여겨지는 췌장 장액낭선종에 대해 비장절제술을 동반한 췌미부 절제술을 시행받은 경 우였 다. Pancreatic serous cystadenoma is usually a benign tumor and observation alone without surgery has been known as the reasonable treatment in most cases. However, surgical resection is necessary in cases of uncertain diagnosis or a symptomatic serous cystadenoma. Pancreatic duct stenosis with a proximal duct dilatation due to a mass effect by serous cystadenoma is rare and pancreatitis can be followed. A 50-year-old female, who had no past medical history except a small amount of alcohol drinking, experienced acute pancreatitis with pancreatic pseudocyst. After endoscopic treatment of pancreatic pseudocyst with pancreatic stent and cystogastrostomy, she underwent distal pancreatectomy because pancreatic serous cystadenoma was considered as the cause of pancreatitis and pseudocyst. After the surgery, the patient is followed up for one year without recurrence of acute pancreatitis.

췌장 가성낭종의 임상적 고찰

김영채(Young Chai Kim),손미정(Mee Jung Sohn),이옥재(Ok Jae Lee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

N/A Backgrounds/Aims: Although surgical procedures remain the principal method of treating pancreatic pseudocysts, it has recently been challenged. The objective of this study is to evaluate the outcomes of surgical and nonsurgical treatment, in order to recognize the necessity for changing guideline to treatment option of pancreatic pseudocysts. Methods: We analysed retrospectively clinical characteristics, classification, treatment modalities and its success, complication rate and mortality rate of 48 patients with pancreatic pseudocysts from January 1988 to Febrary 1994. Results: Acute pseudocysts were 34, chronic pseudocysts 14cases. According to D'Egidio and Schein, type I, II, or III pseudocysts were 30, 17 and ] cases, respectively. Percutaneous catheter drainage, surgical treatment and conservative treatment were applied in 45.8%, 25.0% and 29.2%, respectively and the success rates were 81.8%, 91.7% and 50.0%, respectively. The complication rate of percutaneous catheter drainage and surgical treatment were 36.9% and 33.0%, respectively, but the mortality rate was 0%. Conclusion: Percutaneous catheter drainage as well as surgical treatment were effective and safe in the treatment of pancreatic pseudocyst. Thus we recognized the necessity for considerating nonsurgical treatment based on classification of pseudocyst and changing guideline to treatment of pseudocyst. (Korean J Gastroenterol 1995;27:719 - 727)

Intrahepatic Bile Duct Dilatation Caused by Pancreatic Pseudocyst: A Case Report

Donghyeon Kim,박미현 대한자기공명의과학회 2022 Investigative Magnetic Resonance Imaging Vol.26 No.4

Pancreatic pseudocyst can fistulize to adjacent organs such as stomach, duodenum, colon, and esophagus. Fistula formation with bile duct is rare. Reported cases of biliary involvement of pancreatic pseudocyst include fistula formation between the pancreatic pseudocyst and common bile duct. Intrahepatic bile duct dilatation caused by fistula formation with pancreatic pseudocyst is extremely rare. There are no published reports to the best of our knowledge. Herein, we report a case of intrahepatic bile duct dilatation caused by fistulous communication with a pancreatic pseudocyst. The peripheral intrahepatic bile duct surrounding the pseudocyst was dilated without involving the common bile duct. Magnetic resonance cholangiopancreatography image showed a connection between the pancreatic pseudocyst and dilated intrahepatic bile ducts with a multifocal cystic and beaded appearance.

췌장 가성낭종의 치료에서 조기 경피적 외배액술식

전명진,김해영,심문섭 釜山外科學會 2000 釜山外科學會誌 Vol.16 No.-

종례 : 십이지장 출혈로 발현한 췌장 가성낭종 1예

이정화 ( Jeong Hwa Lee ),권기현 ( Ki Hyun Kwon ),하동천 ( Dong Cheon Ha ),김보경 ( Bo Kyoung Kim ),정승혜 ( Seung Hye Jung ),김연수 ( Yeon Soo Kim ),이동수 ( Dong Soo Lee ) 대한내과학회 2012 대한내과학회지 Vol.82 No.6

Pancreatic pseudocysts occur following acute pancreatitis, chronic pancreatitis or secondary to pancreatic trauma. Most pancreatic pseudocysts are located in or around the pancreas, but they can be found in all the potential spaces around viscera in and outside of the abdominal cavity. The complications of pancreatic pseudocyst are infection, rupture, obstruction, fistula, or hemorrhage. Hemorrhage is a rare but frequently fatal complication of pancreatic pseudocysts. We report a case of pancreatic pseudocyst presented as bleeding of duodenum, which was misidentified for duodenal submucosal tumor bleeding.

가성낭종으로 오인된 급성 췌장염을 동반한 점액성 낭성종양 1예

김소연 ( So Yeon Kim ),문성훈 ( Sung Hoon Moon ),김동훈 ( Dong Hoon Kim ),박동선 ( Dong Seon Park ),안정선 ( Jung Sun An ),김성열 ( Seong Yeol Kim ),김종혁 ( Jong Hyeok Kim ) 대한내과학회 2014 대한내과학회지 Vol.87 No.1

Pancreatic cystic lesions include retention cysts (congenital cysts), pseudocysts, and cystic neoplasms. Pancreatic cystic neoplasms have recently been diagnosed more commonly, possibly due to advances in imaging and widespread screening programs. Cystic neoplasms of the pancreas account for 10-20% of pancreatic tumors. Mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms are regarded as premalignant lesions, whereas serous cystadenoma is not. In the clinical setting of acute pancreatitis, pancreatic cystic lesions are usually diagnosed as pseudocysts. However, cystic neoplasms of the pancreas should be considered in the differential diagnosis of pancreatic cysts, even in patients with a history of pancreatitis. In the Korean literature, MCN combined with acute pancreatitis has rarely been reported. Here, we report a case of MCN presenting with acute pancreatitis in a 22-year-old female, which was initially misdiagnosed as pancreatic pseudocyst. (Korean J Med 2014;87:61-66)