Pancreaticopleural fistulas are a rare complication of acute or chronic pancreatitis, and are usually treated by surgery. We report three patients whose pancreaticopleural fistulas were successfully treated by endoscopic retrograde cholangiopancreatography and drainage (stenting, nasopancreatic drainage). In one patient a pancreatic pseudocyst persisted despite successful initial closure of the leak using this method and, as it was also suspected to be infected, additional drainage of the pseudocyst was required. Endotherapy of pancreaticopleural fistulas could obviate the need for surgery when conventional medical treatment has failed in this condition.

A previously healthy 42-year-old woman presented to the hospital with a 1-year history of right groin pain, which did not fluctuate with the menstrual cycle. We suspected an inguinal hernia or lymphadenopathy, but a right inguinal ultrasound revealed a mixed-echo mass with intralesional vascular flow (Figure 1A). Pelvic magnetic resonance imaging (MRI) revealed a mass that showed high intensity on T1-and T2-weighted images (Figure 1B, 1C). The mass was located at the apex of the inguinal hernia

Background and Aim: Surgical site infection (SSI) remains an important concern in Japan. The Japanese Society for Infection and Prevention Control disclosed that the incidence of SSIs has been lowered only by a fraction over the past 10 years. The importance of taking steps to reduce the occurrence of SSIs is recognized by many hospitals, but to date, no truly effective countermeasures have been reported. We executed a plan to better understand the specific surveillance needs at St. Marianna University School of Medicine Hospital and then develop and institute procedures that would reduce the incidence of SSIs. Methods and Results:In 2005, we began development of an enhanced SSI surveillance system. With our basic CDC-based surveillance system in place, we assembled a team of doctors and nurses to oversee surveillance. We practiced strict record keeping and data analysis, gleaned information from staff, and enlisted the cooperation of other departments. New procedures were established accordingly and implemented in three phases. Between 2005 and 2013, we witnessed informative fluctuations in the incidence of SSIs. Key components of our new system were standardized postoperative wound cleansing, use of buried absorbable sutures to close surgical wounds, consistent provision of 6 antibacterial agents, each one active against a common organ-specific pathogen, and establishment of a prophylactic protocol. New methods of information sharing were also instituted. We lowered the incidence of SSIs from 8% in 2006 to approximately 6.9% in 2012. We continue to monitor the number of SSIs occurring and are encouraged by a steady decline. Conclusion: Establishment of the SSI team at our hospital has proven to be a useful multidisciplinary approach to nosocomial infection awareness and control. Gradual introduction of the system to the various departments and step-by-step implementation have decreased the occurrence of SSIs and the nosocomial spread of infectious agents.

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