134
Once the device protruded from the tip of the panendoscope the sheath was retracted, thereby exposing the needle. The needle was inserted into the mass. The initial aspirate was clear and yellow. After 45 ml had been collected, the fluid became cloudy and brown. Total volume aspirated was 60 ml. Aspiration of the cyst left a volcano like deformity on the posterior wall. The patient complained of vague abdominal pains following the procedure but appeared to suffer no serious consequences. It was clear that the drainage of the cyst did not relieve her abdominal discomfort. Two days later on 10/3/73 upper gastrointestinal radiography was repeated. It showed the cyst had refilled and had resumed its hemispherical form. A repeated study 3 weeks later was essentially the same. It was decided not to attack the cyst surgically.
communication between the cyst and the pancreatic duct. Communication in these cases was shown by endoscopic retrograde pancreatography. Transgastric needle aspiration through an endoscope should be done with great care. A combined approach by both endoscopist and surgeon seems highly desirable. In elderly patients an aneurysm of the splenic artery must be considered in the differential diagnosis. Such an aneurysm can cause a compression deformity of the posterior wall of the stomach indistinguishable by x-ray from a cyst.' The endoscopic therapeutic maneuver in this case apparently had no sggnificant effect on the course of the patient's disease. The procedure was important because it indicated conventional surgical drainage of the pseudocyst was unnecessary.
DISCUSSION Drainage of a pancreatic pseudocyst by means of the fiberoptic endoscope may be helpful in deciding whether or not a particular cyst is causing symptoms. The fact that in this patient the cyst quickly reformed indicates that it was probably communicating with one of the pancreatic ducts. In a recent report by Silvis, Rohrman, and Vennes 3 8 of 11 cases of pseudocyst of the pancreas were shown to have a
REFERENCES
Colonoscopic removal of a foreign body from the cecum Ronald M. Sorenson, MD John H. Bond Jr., MD Gastroenterology Section Veterans Administration Hospital 54th Street and 48th Avenue South Minneapolis, Minnesota 55417 While there have been numerous reports of removal of foreign bodies from the esophagus and stomach using fiberoptic endoscopes,l-4 we are not aware of any report of similar visualization and retrieval of a foreign body from the colon using the colonoscope. Foreign bodies passing to the colon from the upper gastrointestinal tract are almost always successfully evacuated by the colon. Objects inserted through the anus are generally within easy reach of the rigid proctosigmoidoscope. This report describes an unusual case wherein part of a gastrostomy tube became lodged in the ileocecal valve and was successfully removed with the colonoscope and polypectomy snare.
Figure 1. Abdominal radiograph showing tip of gastrostomy tube lodged in the right lower quadrant (a). The colonoscope was successfully directed to the foreign body which was then snared and withdrawn (b).
1. SHACKELFORD RF: Surgery of the alimentary tract. W. B. Saunders, Phila·
delphia; 1955, pp 919·920 2. WARREN KW, ATHANASSIADES S, FREDERICK P, KUNE GA: Surgical treat-
ment of pancreatic cysts: review of 183 cases. Ann Surg 1&3 :88&, 19&& 2. SILVIS SE, ROHRMAN CA, VENNES JA: Diagnostic criteria for the evaluation
of the endoscopic pancreatogram. Gastrointestinal Endoscopy 20:51, 1973 4. CASTLEMAN B, SCULLY RE, MCNEELY BU: Case records of the Massachu-
setts General Hospital. New Engl J Me
Once the device protruded from the tip of the panendoscope the sheath was retracted, thereby exposing the needle. The needle was inserted into the mass. The initial aspirate was clear and yellow. After 45 ml had been collected, the fluid became cloudy and brown. Total volume aspirated was 60 ml. Aspiration of the cyst left a volcano like deformity on the posterior wall. The patient complained of vague abdominal pains following the procedure but appeared to suffer no serious consequences. It was clear that the drainage of the cyst did not relieve her abdominal discomfort. Two days later on 10/3/73 upper gastrointestinal radiography was repeated. It showed the cyst had refilled and had resumed its hemispherical form. A repeated study 3 weeks later was essentially the same. It was decided not to attack the cyst surgically.
communication between the cyst and the pancreatic duct. Communication in these cases was shown by endoscopic retrograde pancreatography. Transgastric needle aspiration through an endoscope should be done with great care. A combined approach by both endoscopist and surgeon seems highly desirable. In elderly patients an aneurysm of the splenic artery must be considered in the differential diagnosis. Such an aneurysm can cause a compression deformity of the posterior wall of the stomach indistinguishable by x-ray from a cyst.' The endoscopic therapeutic maneuver in this case apparently had no sggnificant effect on the course of the patient's disease. The procedure was important because it indicated conventional surgical drainage of the pseudocyst was unnecessary.
DISCUSSION Drainage of a pancreatic pseudocyst by means of the fiberoptic endoscope may be helpful in deciding whether or not a particular cyst is causing symptoms. The fact that in this patient the cyst quickly reformed indicates that it was probably communicating with one of the pancreatic ducts. In a recent report by Silvis, Rohrman, and Vennes 3 8 of 11 cases of pseudocyst of the pancreas were shown to have a
REFERENCES
Colonoscopic removal of a foreign body from the cecum Ronald M. Sorenson, MD John H. Bond Jr., MD Gastroenterology Section Veterans Administration Hospital 54th Street and 48th Avenue South Minneapolis, Minnesota 55417 While there have been numerous reports of removal of foreign bodies from the esophagus and stomach using fiberoptic endoscopes,l-4 we are not aware of any report of similar visualization and retrieval of a foreign body from the colon using the colonoscope. Foreign bodies passing to the colon from the upper gastrointestinal tract are almost always successfully evacuated by the colon. Objects inserted through the anus are generally within easy reach of the rigid proctosigmoidoscope. This report describes an unusual case wherein part of a gastrostomy tube became lodged in the ileocecal valve and was successfully removed with the colonoscope and polypectomy snare.
Figure 1. Abdominal radiograph showing tip of gastrostomy tube lodged in the right lower quadrant (a). The colonoscope was successfully directed to the foreign body which was then snared and withdrawn (b).
1. SHACKELFORD RF: Surgery of the alimentary tract. W. B. Saunders, Phila·
delphia; 1955, pp 919·920 2. WARREN KW, ATHANASSIADES S, FREDERICK P, KUNE GA: Surgical treat-
ment of pancreatic cysts: review of 183 cases. Ann Surg 1&3 :88&, 19&& 2. SILVIS SE, ROHRMAN CA, VENNES JA: Diagnostic criteria for the evaluation
of the endoscopic pancreatogram. Gastrointestinal Endoscopy 20:51, 1973 4. CASTLEMAN B, SCULLY RE, MCNEELY BU: Case records of the Massachu-
setts General Hospital. New Engl J Me
