Pseudocyst Pancreas

Q) True about pseuodocyst of the pancreas is 

a) It is lined by epithelium and collagen

b) Spontaneous regression occurs in less than 50% of cysts

c) Symptoms occur in more than 50% of case

d) Transduodenal endoscopic drainage IS  safe and effective approaches for patients with pancreatic pseudocysts in close contact (defined as less than 2 cm) 

Pancreatic necrosis

Q) Pancreatic necrosis all are true except
a) Sterile pancreatic necrosis may be managed conservatively in most of the cases
b) Infected Pancreatic Necrosis  is managed by surgery at 2 weeks
c) Minimal access techniques have given better results than open necrosectomy
d)WOPN may be drained by either a transgastric or, less commonly, a transdoudenal route.

Post Whipple’s Bleeding

Q) Post whipples on pod4 patient presented with fever, tachycardia and pain, usg showed collection, which was drained percutaneously. on pod 10 there is frank blood of 100ml in drain, next line of management

a. Ct angiography

b. Emergency laparotomy

c. flush the drain with noradrenaline
d. Observe

Ans a 

This is extraluminal bleed on 10th POD following most likely a pancreatic fistula. Clinical condition is mentioned for day 4 which is  because of pancreatic leak.  A pancreatic fistula can cause vascular pseudo aneurysm so answer is A CT angiography

Early extraluminal PPH requires reexploration.

Intraluminal bleeding may manifest as extraluminal if there is associated anastomotic breakdown,and this may be amenable to angiographic intervention when involving the pancreaticojejunostomy.

Patients present with septic complications and/or a sentinel  bleed. Radiographic embolization has become a more successful modality, with up to 80% success,13 but is limited by the initially intermittent nature of the bleeding

Exploration - if patient is not stable
Ref SKF  page 1241