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Internal drainage of pancreatic pseudocysts is contraindicated in the presence of infection but is the treatment of choice for mature prostate and masurbation purchase alfuzosin 10 mg with amex, symptomatic, noninfected pseudocysts. About 90% of primary malignant neoplasms of the exocrine pancreas are adenocarcinomas of duct cell origin. The remaining neoplasms include serous and mucinous cystadenomas/cystadenocarcinomas, solid pseudopapillary tumors, and intraductal mucinous papillary adenomas/tumors. Cystadenocarcinomas may be several times the size of typical ductal cancers and often arise in the body or tail of the pancreas. They may become very large without invading adjacent viscera and do not generally cause significant pain or weight loss. The clinical presentation is usually quite subtle, with symptoms related primarily to the enlarging mass. There are no diagnostic laboratory findings, and definitive preoperative diagnosis is rare. An elderly patient with no history of pancreatitis is unlikely to have a pseudocyst, and a benign neoplasm is also less likely in this age group. Internal drainage is the treatment of choice for noninfected pancreatic pseudocysts (as opposed to external drainage which is the treatment of choice for infected pseudocysts) but is contraindicated if malignancy is suspected. Symptomatic herniation requires operative relocation of the stoma or mesh herniorrhaphy. They include irregularity of function, irritation of the skin due to leakage of enteric contents, or bleeding from the exposed mucosa following trauma. Prolapse occurs most frequently with transverse loop colostomies and is likely due to the use of the transverse loop to decompress distal colon obstructions. As the intestine decompresses, it retracts from the edge of the surrounding fascia, which allows prolapse or herniation of the mobile transverse colon. Optimal treatment of stomal prolapse is restoration of intestinal continuity or conversion to an end colostomy. Perforation of a stoma is usually because of careless instrumentation with an irrigation catheter. An acute abdominal series is composed of three x-rays (upright chest, upright abdomen, supine abdomen) and is useful in evaluating patients for bowel perforation or bowel obstruction.

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