title: Endoscopic management of pancreatic pseudocysts at atypical locations.
abstract: OBJECTIVE
  There is paucity of data on endoscopic management of pseudocysts at atypical locations. We evaluated the efficacy of endoscopic transpapillary nasopancreatic drain (NPD) placement in the management of pseudocysts of pancreas at atypical locations.
  
  
  METHODS
  Eleven patients with pseudocysts at atypical locations were treated with attempted endoscopic transpapillary nasopancreatic drainage. On endoscopic retrograde pancreatography (ERP), a 5-F NPD was placed across/near the site of duct disruption.
  
  
  RESULTS
  Three patients each had mediastinal, intrahepatic, and intra/perisplenic pseudocysts and one patient each had renal and pelvic pseudocyst. Nine patients had chronic pancreatitis whereas two patients had acute pancreatitis. The size of the pseudocysts ranged from 2 to 15 cm. On ERP, the site of ductal disruption was in the body of pancreas in five patients (45.4%), and tail of pancreas in six patients (54.6%). All the patients had partial disruption of pancreatic duct. The NPD was successfully placed across the disruption in 10 of the 11 patients (90.9%) and pseudocysts resolved in 4-8 weeks. One of the patients developed fever, 5 days after the procedure, which was successfully treated by intravenous antibiotics. In another patient, NPD became blocked 12 days after the procedure and was successfully opened by aspiration. The NPD slipped out in one of the patient with splenic pseudocyst and was replaced with a stent. There was no recurrence of symptoms or pseudocysts during follow-up of 3-70 months.
  
  
  CONCLUSIONS
  Pancreatic pseudocysts at atypical locations with ductal communication and partial ductal disruption that is bridged by NPD can also be effectively treated with endoscopic transpapillary NPD placement.
authors.affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. deepakkbhasin@gmail.com
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Bhasin
authors.forename: Surinder Singh
authors.initials: SS
authors.lastname: Rana
authors.forename: Mohit
authors.initials: M
authors.lastname: Nanda
authors.forename: Vijant Singh
authors.initials: VS
authors.lastname: Chandail
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Masoodi
authors.forename: Mandeep
authors.initials: M
authors.lastname: Kang
authors.forename: Navin
authors.initials: N
authors.lastname: Kalra
authors.forename: Saroj Kant
authors.initials: SK
authors.lastname: Sinha
authors.forename: Birinder
authors.initials: B
authors.lastname: Nagi
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D003937:Diagnosis, Differential; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult