Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Conservative Management of a Large-sized Pancreatic Pseudocyst: A Case Report

GUÈYE ML*, TOURÉ AO, KONATÉ I, SECK M, THIAM O, CISSE M, KÂ O, DIENG M, DIA A, TOURÉ CT

General surgeon, surgical resident, Aristide Le Dantec Hospital, Dakar, Sénégal

Abstract: Background: The management of pancreatic pseudocyst involves several treatment options. Among them figure predominantly the surgical, endoscopic and percutaneous drainages. Conservative management is a therapeutic alternative especially for small sized pseudocysts. Larger cysts, more than 6 cm in diameter, are usually treated surgically. However, it had been reported some cases of large-sized pancreatic pseudocyst that had regressed spontaneously. It raises the question about the systematic treatment in large-sized pancreatic pseudocyst. Case presentation: A 55-year-old man who had a 40-year history of alcoholism and a medical history of acute pancreatitis 3 weeks prior to his presentation was sent for an abdominal exploration by CT scan. The CT scan showed a pancreatic pseudocyst of 13 cm in diameter. Meanwhile the patient was just complaining of epigastric pain that was well managed by analgesics. A conservative management was then decided. At the follow-up, CT scan was realized at the 1st, the 3rd and the 5th month. It showed a decreasing of the size of the cyst. Moreover, the CT scan done 3 years after the onset, showed a strictly normal pancreatic parenchyma. Conclusion: Conservative management is a feasible alternative therapy in large pancreatic pseudocysts, bearing in mind a rigorous clinical and radiological monitoring of the patient.

Keywords: pancreatic pseudocyst, conservative treatment, alcoholic pancreatitis, complication

Received April 29, 2015; Revised May 05, 2015; Accepted May 19, 2015

Citation: GUÈYE ML, TOURÉ AO, KONATÉ I, SECK M, THIAM O, CISSE M, KÂ O, DIENG M, DIA A, TOURÉ CT, Conservative Management of a Large-sized Pancreatic Pseudocyst: A Case Report. American Journal of Medical Case Reports, 3 (6). 170-173. January 2015. doi:10.12691/ajmcr-3-6-6

1. Background

Pancreatic pseudocyst is a systematized collection of pancreatic fluids with a non-epithelial wall arising as a complication of pancreatitis or pancreatic trauma [1]. Many therapeutic options are available. Surgical drainage, which has formerly been the reference treatment, nowadays presents alternatives such as endoscopic and percutaneous drainage and laparoscopic treatment [1]. Withholding treatment combined with radiological follow-up has led to many cases of spontaneous regression of the pancreatic pseudocyst. On the one hand, it questions the systematic treatment of pseudocyst and on the other, the indications of conservative management remain to be defined. We report our experience of a conservative management of a large pancreatic pseudocyst with a favorable outcome.

2. Case report

A 55-year-old man was sent to the service of radiology for an abdominal exploration by CT scan. The indication was an abdominal mass localized in the left upper quadrant that occured in the outcomes of an acute pancreatitis. He had a 40-year history of alcoholism and smocking. He reported also an acute pancreatitis that was successfully managed 3 weeks prior to the presentation. Physical examination revealed a painless and regular mass localized in the left upper quadrant of the abdomen. The CT scan showed a pancreatic pseudocyst of 13 cm in diameter confined by a shell which was developped into the pancreatic parenchyma (Figure 1). The patient was mean while just complaining of recurrent epigastric pain that was well managed by analgesics. At the 1st month, the CT scan revealed an increasing of the size of the pseudocyst (17cm) which was compressing the stomach (Figure 2). Meanwhile, the patient was complaining of intermittent post prandial vomiting. At the 5thmonth, the CT scan showed an enlarged pancre as with some hypodense areas without any mass displayed (Figure 3). Physical examination was normal. Analgesics were stopped as the patient was painfulless and there were no more vomiting since the 2ndmonth. Three years later, the patient did not complain of any pain and the CT scan showed a strictly normal pancreatic parenchyma (Figure 4).

Figure 1. CT scan at the 3rd week showing the pancreatic pseudocyst

Figure 2. CT scan at the 1st month showing the increasing size of the pancreatic pseudocyst

Figure 3. CT scan at the 5th month showing an hypertrophied Pancreas without mass

Figure 4. CT scan at the 3rd year showing a normal pancreas

3. Discussion

The indications for conservative management of pancreatic pseudocysts are still controversial. It is widely agreed that pseudocysts over 6 cm evolving for more than 6 weeks, are unlikely to regress spontaneously and need to be treated surgically [2,3,4,5]. However, in our patient, the size of the cysts was greater than 10 cm. There were no complications. Furthermore, follow-up CT scan had noted a decline in the size of the cyst from the 8th week. In a serie of 36 patients, Cheruvu observed cysts between 4 and 15 cm in diameter. He nevertheless noted a success of the conservative management in 39% of his patients, among whom 4 presented a cyst of more than 10 cm [1]. As for Vitas, he recorded a success rate of 57 % for the conservative management, and among his patients, 7 presented a cyst of more than 10 cm [3]. As Cheruvu and Ragland’ studies suggest, our observation call into question the systematic therapeutic indication advocated by Lerch for symptomatic pseudocyst larger than 6 cm and evolving for more than six weeks [1,4,6]. Furthermore, Gouyon, in his study, reported some predictive factors of failure of conservative management in pseudocysts complicating alcoholic pancreatitis [7]. According to him, the cyst greater than 4 cm in size with an intrapancreatic and cephalic locations are more likely to fail to conservative treatment [7]. In our patient, the cyst had an intrapancreatic and corporeal location, and its size was greater than 4 cm. In contrast, Vitas and Sarr showed that the size of pseudocysts was not significantly associated with their outcome [3]. In addition, Ragland reported a case of large-sized pancreatic pseudocyst compressing the duodenum, which had regressed under conservative management [6]. These facts suggest that conservative treatment may be indicated if the symptoms can be controlled regardless of the size of the cyst. However, careful monitoring is appropriate, given the potential complications of pancreatic pseudocyst.

4. Conclusion

Conservative management is a feasible alternative therapy in large pancreatic pseudocysts, bearing in mind a rigorous clinical and radiological monitoring of the patient. Nonetheless, indications of the conservative treatment still remain to be defined.

Statement of Competing Interests

The authors have no competing interests.

Sources of Funding for Research

Personal fund of the corresponding author.

References

[1]   | Cheruvu CVN, Clarke MG, Prentice M, Eyre-Brook IA. Conservative treatment as an option in the management of pancreatic pseudocyst. Ann R CollSurg Engl. 2003; 85:313-16.
[2]   | Yeo CL, Bastidas JA, Lunch-Nyhan A, Fishman EK, Zinner MJ, Cameron JL. The natural history of pancreatic pseudocysts documented by computed tomography. SurgGynecol Obstet. 1990; 170: 411-17.
[3]   | Vitas GJ, Sarr MG. Selected management of pancreatic pseudocysts: operative versus expectant management. Surgery 1992; 111: 123-30.
[4]   | Binmoeller KF, Seifert H, Walter A, Soehendra N: Transpapillary and transmural drainage of pancreatic pseudocysts. GastrointestEndosc. 1995;42:219-24.
[5]   | Lerch MM, Stier A, Wahnschaffe U, Mayerle J. Pancreatic Pseudocysts. Observation, Endoscopic Drainage, or Resection? DtschArztebl Int. 2009; 106: 614-21.
[6]   | Ragland R, Press HCJ, Washington MD. Non operative management in aCase of complicated pancreatic Pseudocyst. J Natl Med Assoc1988, 80:449-51.
[7]   | Gouyon B, Lévy P, Ruszniewski P, Zins M, Hammel P, Vilgrain V, Sauvanet A, Belghiti J, Bernades P. Predictive factors in the outcome of pseudocysts complicating alcoholic chronic. Gut1997, 41:821-25.