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Patient S.C.

CT - pseudocyst. 2/03 5 x 8 cm thick walled pseudocyst in tail of pancreas5/03 Pseudocyst slightly decreased in size1/04 New Pseudocyst 8 x 7 cm posterior to stomach. Patient C.S.. 1/12 Open Cystgastrostomy~200 cc of greenish/brown fluid drainedAnterior wall of stomach opened to expose poste

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Patient S.C.

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    1. Patient S.C. 60M h/o alcoholism, chronic pancreatitis, HTN, CAD Reduced Etoh intake 2000, still binge drinks Persistant, intermittent epigastric pain x 1-2 years Past 1-2 months, pain worsening, assoc w/ 20 lb wt loss, anorexia, n/v Chronically moderately elevated amylase

    2. CT - pseudocyst 2/03 5 x 8 cm thick walled pseudocyst in tail of pancreas 5/03 Pseudocyst slightly decreased in size 1/04 New Pseudocyst 8 x 7 cm posterior to stomach

    3. Patient C.S. 1/12 Open Cystgastrostomy ~200 cc of greenish/brown fluid drained Anterior wall of stomach opened to expose posterior wall Hand sewn anastamosis of cyst wall to posterior wall of stomach

    4. Pancreatic Pseudocysts Scott Nguyen Bronx VA Hospital Jan 15, 2004

    5. Definition Localized collection pancreatic secretions Within or adjacent to pancreas Enclosed by a nonepithelialized wall Associated w/ pancreatic duct disruption

    6. Etiology Acute Pancreatitis More associated w/ alcohol related pancreatitis Chronic pancreatitis Pancreatic trauma Pancreatic neoplasm

    7. Pathogenesis Acute Pancreatitis Pancreatic necrosis causes ductular disruption, resulting in leakage of pancreatic juice from inflamed area of gland, accumulates in space adjacent to pancreas Inflammatory response induces formation of distinct cyst wall composed of granulation tissue, organizes w/ connective tissue and fibrosis

    8. Pathogenesis Chronic Pancreatitis Pancreatic duct chronically obstructed ? ongoing proximal pancreatic secretion leads to saccular dilation of duct – true retention cyst Formed microcysts can eventually coalesce and lose epithelial lining as enlarge

    9. Characteristics Single or multiple (90% single) Size 2 to 30 cm, 50 to 6000 cc Smooth and rounded Mostly anterior to pancreas, in lesser sac Also can extend to pararenal space, mediastinum, retroperitoneum

    10. Large Pseudocyst

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