Autoimmune pancreatitis(AIP)is a rare form of chronic pancreatitis,with as yet undetermined incidence and prevalence in the general population.Our understanding of it continues to evolve.In the last few years,2separat...Autoimmune pancreatitis(AIP)is a rare form of chronic pancreatitis,with as yet undetermined incidence and prevalence in the general population.Our understanding of it continues to evolve.In the last few years,2separate subtypes have been identified:type 1 AIP has been recognised as the pancreatic manifestation of a multiorgan disease,named immunoglobulin G4(IgG4)-related disease while type 2 AIP is a pancreas specific disorder not associated with IgG4.International criteria for the diagnosis of AIP have been defined:the HISORt criteria from the Mayo clinic,the Japan consensus criteria and,most recently,the international association of pancreatology"International Consensus Diagnostic Criteria".Despite this,in clinical practice it can still be very difficult to confirm the diagnosis and differenti-ate AIP from a pancreatic cancer.There are no large studies into the long-term prognosis and management of relapses of AIP,and there is even less information at present regarding the Type 2 AIP subtype.Further studies are necessary to clarify the pathogenesis,treatment and long-term outcomes of this disease.Critically for clinicians,making the correct diagnosis and differentiating the disease from pancreatic cancer is of the utmost importance and the greatest challenge.展开更多
Liver cysts are common,affecting 5%-10% of the population.Most are asymptomatic,however 5% of patients develop symptoms,sometimes due to complications and will require intervention.There is no consensus on their manag...Liver cysts are common,affecting 5%-10% of the population.Most are asymptomatic,however 5% of patients develop symptoms,sometimes due to complications and will require intervention.There is no consensus on their management because complications are so uncommon.The aim of this study was to perform a collected review of how a series of complications were managed at our institutions.Six different patients presenting with rare complications of liver cysts were obtained from Hepatobiliary Units in the United Kingdom and The Netherlands.History and radiological imaging were obtained from case notes and computerised radiology.As a result,1 patient admitted with inferior vena cava obstruction was managed by cyst aspiration and lanreotide;1 patient with common bile duct obstruction was first managed by endoscopic retrograde cholangiopancreatography and stenting,followed by open fenestration;1 patient with ruptured cysts and significant medical co-morbidities was managed by percutaneous drainage;1 patient with portal vein occlusion and varices was managed by open liver resection;1 patient with infected cysts was treated with intravenous antibiotics and is awaiting liver transplantation.The final patient with a simple liver cyst mimicking a hydatid was managed by open liver resection.In conclusion,complications of cystic liver disease are rare,and we have demonstrated in this series that both operative and non-operative strategies have defined roles in management.The mainstays of treatment are either aspiration/sclerotherapy or,alternatively laparoscopic fenestration.Medical management with somatostatin analogues is a potentially new and exciting treatment option but requires further study.展开更多
文摘Autoimmune pancreatitis(AIP)is a rare form of chronic pancreatitis,with as yet undetermined incidence and prevalence in the general population.Our understanding of it continues to evolve.In the last few years,2separate subtypes have been identified:type 1 AIP has been recognised as the pancreatic manifestation of a multiorgan disease,named immunoglobulin G4(IgG4)-related disease while type 2 AIP is a pancreas specific disorder not associated with IgG4.International criteria for the diagnosis of AIP have been defined:the HISORt criteria from the Mayo clinic,the Japan consensus criteria and,most recently,the international association of pancreatology"International Consensus Diagnostic Criteria".Despite this,in clinical practice it can still be very difficult to confirm the diagnosis and differenti-ate AIP from a pancreatic cancer.There are no large studies into the long-term prognosis and management of relapses of AIP,and there is even less information at present regarding the Type 2 AIP subtype.Further studies are necessary to clarify the pathogenesis,treatment and long-term outcomes of this disease.Critically for clinicians,making the correct diagnosis and differentiating the disease from pancreatic cancer is of the utmost importance and the greatest challenge.
文摘Liver cysts are common,affecting 5%-10% of the population.Most are asymptomatic,however 5% of patients develop symptoms,sometimes due to complications and will require intervention.There is no consensus on their management because complications are so uncommon.The aim of this study was to perform a collected review of how a series of complications were managed at our institutions.Six different patients presenting with rare complications of liver cysts were obtained from Hepatobiliary Units in the United Kingdom and The Netherlands.History and radiological imaging were obtained from case notes and computerised radiology.As a result,1 patient admitted with inferior vena cava obstruction was managed by cyst aspiration and lanreotide;1 patient with common bile duct obstruction was first managed by endoscopic retrograde cholangiopancreatography and stenting,followed by open fenestration;1 patient with ruptured cysts and significant medical co-morbidities was managed by percutaneous drainage;1 patient with portal vein occlusion and varices was managed by open liver resection;1 patient with infected cysts was treated with intravenous antibiotics and is awaiting liver transplantation.The final patient with a simple liver cyst mimicking a hydatid was managed by open liver resection.In conclusion,complications of cystic liver disease are rare,and we have demonstrated in this series that both operative and non-operative strategies have defined roles in management.The mainstays of treatment are either aspiration/sclerotherapy or,alternatively laparoscopic fenestration.Medical management with somatostatin analogues is a potentially new and exciting treatment option but requires further study.
