From indeterminant to septic: the rapid transformation of a pancreatic lesion

Q3 Medicine

VideoGIE Pub Date : 2026-10-01 Epub Date: 2026-05-06 DOI:10.1016/j.vgie.2026.04.044

Ayowumi A. Adekolu MD, Ethan M. Cohen MD, Vibhu Chittajallu MD, Rohit Agrawal MD, Abdullahi Adedotun Sulaiman MD, Brain Markovich MD, Shailendra Singh MD, Shyam Thakkar MD

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引用次数: 0

Abstract

Background and Aims

Delineation of the malignant potential of pancreatic cystic lesions (PCLs) is important for management. Current guidelines recommend EUS-guided FNA (EUS-FNA) for PCLs that meet specific criteria. However, data are conflicting on the role of prophylactic antibiotics after EUS-FNA. We present 2 cases of undifferentiated pancreatic lesions that were infected after EUS sampling.

Methods

Both patients developed signs and symptoms of sepsis after EUS sampling of PCLs. As a result, cystoduodenostomy with necrosectomy was performed for both cases with cyst wall biopsy.

Results

The cystoduodenostomy with necrosectomy and cyst wall biopsy successfully drained the cyst, resolved the sepsis, and revealed the diagnosis of the PCL as a lymphoepithelial cyst (LEC).

Conclusions

A LEC is a type of PCL that may carry a higher risk of infection for which prophylactic antibiotics should be considered. Postprocedure infections are rarely encountered with other cysts. Close observation and follow-up should be performed after EUS sampling of LECs given the risk of sepsis as seen in our cases despite prophylactic antibiotic use. EUS-guided drainage and debridement are effective for the management of infected LECs.

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从不确定到败血症：胰腺病变的快速转变

背景和目的胰腺囊性病变（PCLs）的恶性潜能的描述是重要的管理。目前的指南建议对符合特定标准的pcl进行eus引导的FNA （EUS-FNA）。然而，关于EUS-FNA后预防性抗生素的作用，数据是相互矛盾的。我们报告了2例未分化的胰腺病变，在EUS取样后感染。方法两例患者在EUS对pcl取样后均出现脓毒症的体征和症状。结果，两例囊肿壁活检均行膀胱十二指肠吻合术和坏死切除术。结果经膀胱十二指肠吻合术联合坏死切开术及囊肿壁活检成功引流囊肿，脓毒症得以缓解，诊断为淋巴上皮囊肿（LEC）。结论sa型LEC是一种感染风险较高的PCL，应考虑预防性使用抗生素。术后感染在其他囊肿中很少见。鉴于本病例中预防性使用抗生素仍有败血症的风险，应在lec EUS取样后进行密切观察和随访。eus引导下引流和清创是治疗感染lec的有效方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.