A 56-year-old woman presents 6 months after an episode of acute pancreatitis complicated by pseudocyst, which was treated with percutaneous drainage and subsequent drain removal. She now reports abdominal pain and early satiety. Computed tomography shows a 5-cm pancreatic pseudocyst near the pancreatic tail, in a similar location as her initial pseudocyst. Magnetic resonance cholangiopancreatography demonstrates a communication between the pseudocyst and pancreatic duct. What is the most appropriate initial management?
A. Repeat percutaneous drainage
B. Endoscopic pancreatic stent placement
C. Endoscopic transgastric drainage
D. Minimally invasive pseudocyst drainage and cystogastrostomy
E. Open pseudocyst drainage and pancreatojejunostomy
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A 49-year-old male presents with chronic abdominal pain. The patient has a history of chronic alcoholic pancreatitis with constant abdominal pain. He has abstained from alcohol for the past 2 years, and has made a sincere effort to be free of narcotic analgesics. His BMI is 23 kg/m2, and his fasting blood glucose is normal. CT scan shows an enlarged pancreatic head, and the distal pancreatic duct is small. The patient is requesting an operative procedure because he cannot tolerate the chronic pain any longer. Which of the following procedures is most appropriate for this patient?
A. Celiac block
B. Frey
C. Puestow
D. Beger
E. Total
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