Isolated Pyogenic Pancreatic Abscess Successfully Treated via Endoscopic Ultrasound-guided Drainage

Abstract

An isolated pyogenic pancreatic abscess (IPPA) without pancreatitis is extremely rare but can occur in patients with uncontrolled diabetes. This pathologic condition poses a clinical challenge in diagnosis and management because it can be confused easily with a malignancy. Endoscopic ultrasound (EUS) may be a useful diagnostic modality for indeterminate pancreatic lesions and IPPA. Here, we report two cases with elevated carbohydrate antigen 19-9 levels and pancreatic masses on cross sectional imaging. The patients were subsequently diagnosed with IPPA by EUS. EUS-guided drainage was performed successfully and the patients' clinical symptoms and radiologic findings improved. In our experience, EUS and EUS-guided drainage are crucial steps for the diagnosis and management of patients with an indeterminate pancreatic lesion. In addition, EUS-guided drainage has excellent technical and clinical outcomes for the treatment of IPPA. (Korean J Gastroenterol 2017;69:321-324)

Spontaneous Infection of a Nonmalignant Intraductal Papillary Mucinous Neoplasm

“…Other potential mechanisms include the occurrence of acute pancreatitis, a known complication of IPMN, 4 which is associated with bacterial translocation and infection of the pancreatic parenchyma. 5 The patients in both previous cases, 4 as well as our patient, had a history of regular alcohol use or alcohol abuse, both of which are associated with immunosuppression and bacterial translocation. 6 Finally, we note that our patient and one of the previous patients 4 have a history of DM, which has been associated with immunosuppression and spontaneous pancreatic infections.…”

“… 6 Finally, we note that our patient and one of the previous patients 4 have a history of DM, which has been associated with immunosuppression and spontaneous pancreatic infections. 5 …”

“…6 Finally, we note that our patient and one of the previous patients 4 have a history of DM, which has been associated with immunosuppression and spontaneous pancreatic infections. 5 For the diagnosis of infection, imaging provided an important clue. Fluid layering is an unusual finding in IPMN cysts, and although mucin is commonly observed within these cysts on EUS, it is typically clumped together as a round ball or irregularly shaped cloud-like material within the cyst cavity.…”

Pancreatic abscess: a modern look at an old problem

“…Once the abscess is diagnosed, immediate combined antibacterial and, if possible, minimally invasive drainage should be performed. In recent years there are many results of successful surgical treatment of abdominal abscesses of various localizations, including the pancreas, by drainage under ultrasound or CT guidance (Jo, 2015;Lee, 2017;Rani, 2016;Yang, 2016). Shavrina et al (2019) 2019) didn't find significant difference in mortality (endoscopy 8.8% vs surgery 6.3%; P = .999), but complications rate was significantly higher in the surgery group (0.69 ± 1.03) compared with the endoscopy group (0.15 ± 0.44) (P = .007).…”