title: An unusual complication resulting from surgical treatment of periampullary tumours.
abstract: METHODS
  The authors describe the rising of four postoperative pancreatic pseudocysts in a series of 20 patients treated for periampullary tumours by pancreaticoduodenectomy (PDT), with the closure of pancreatic stump, between 1989-1996. The operation was always performed by the pylorus-preserving technique according to Traverso-Longmire.
  
  
  RESULTS
  In four patients (20%) 3, 4, 4, and 8 months after PDT with closure of the pancreatic stump, the authors observed the development of pseudocysts (PPC) in the pancreatic remnant. All these patients previously had a pancreatic fistula. Three symptomatic patients underwent surgical drainage of the pseudocyst in a jejunal loop (2) or in the stomach (1); in the asymptomatic patient, the clinical feature and the size of the cyst allowed for conservative treatment. In 2 cases PPC was the consequence of a pancreatic fistula evolved in acute pancreatitis of the stump. The PPC drained by cystogastrostomy appeared 4 months after the closure of the pancreatic fistula: the pancreatic stump was completely substituted by a cyst presenting a communication with the pancreatic duct.
  
  
  CONCLUSIONS
  The authors conclude that PPC is a rare complication of the pancreatic resection that results from acute or chronic pancreatitis; sometimes pathogenesis is due to a cyst resulting from the pancreatic duct occlusion by phlogistic tissue as a consequence of the surgical suture.
authors.affiliation: Department of Surgical Pathology, University of Bari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Testini
authors.forename: G
authors.initials: G
authors.lastname: Regina
authors.forename: C
authors.initials: C
authors.lastname: Todisco
authors.forename: F
authors.initials: F
authors.lastname: Verzillo
authors.forename: B
authors.initials: B
authors.lastname: Di Venere
authors.forename: M
authors.initials: M
authors.lastname: Nacchiero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies