Reviewer ’s report  
 
Title:  WIRSUNG ATRAUMATIC RUPTURE IN PATIENT WITH PANCREATIC 
PSEUDOCYSTS. A CASE PR ESENTATION  
 
Version: 0 Date: 29 Jan 2018 
 
Reviewer:  Vanessa M.  Shami  
 
Reviewer’s report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which  cannot be included in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
The case report entitled "Wirsung atraumatic rupture in patient with pancreatic pseudocysts: A 
case report" by Gerosa et al. describes an unusual pr esentation of pancreatic duct leak. While 
interesting, the readability of the report is limited by its grammar. I would recommend that the 
report get edited and then resubmitted for consideration.  
 
On page 5, the authors state that the patient did not pre sent with severe abdominal pain. Did he 
present with any abdominal pain? Please specify.  
 
On page 6, the authors report that EUS -FNA "ruled out the presence of neoplastic cells". It may 
be that the cytology was negative, but EUS would not rule out cancer i n any cystic lesion with 
100% specificity. Consider rephrasing.  
 
On page 8, the authors state that "In our case jaundice and upper gastrointestinal compression 
imposed an operative approach"... what do the author mean? Please clarify. Compression or 
jaundice alone would not eliminate endoscopic drainage as a good and vi able option. Please 
clarify what was meant in the above statement. Additionally the authors on patient 9 state 
"Finally a reduced experience in pseudocysts endoscopic drainage with EUS guidance at our 
institution made surgical treatment more reliable"... s o was surgery performed because that is 
how pseudocysts are managed at the authors institution? If so, that is fine, however I would not 
justify the surgical approach because of luminal compression or jaundice in that case.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an addi tional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for p ublication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the cont ent of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below . If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is  accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will n ot be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  WIRSUNG ATRAUMATIC RUPTURE IN PATIENT WITH PANCREATIC 
PSEUDOCYSTS. A CASE PR ESENTATION  
 
Version: 0 Date: 29 Jan 2018 
 
Reviewer:  Vanessa M.  Shami  
 
Reviewer’s report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which  cannot be included in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
The case report entitled "Wirsung atraumatic rupture in patient with pancreatic pseudocysts: A 
case report" by Gerosa et al. describes an unusual pr esentation of pancreatic duct leak. While 
interesting, the readability of the report is limited by its grammar. I would recommend that the 
report get edited and then resubmitted for consideration.  
 
On page 5, the authors state that the patient did not pre sent with severe abdominal pain. Did he 
present with any abdominal pain? Please specify.  
 
On page 6, the authors report that EUS -FNA "ruled out the presence of neoplastic cells". It may 
be that the cytology was negative, but EUS would not rule out cancer i n any cystic lesion with 
100% specificity. Consider rephrasing.  
 
On page 8, the authors state that "In our case jaundice and upper gastrointestinal compression 
imposed an operative approach"... what do the author mean? Please clarify. Compression or 
jaundice alone would not eliminate endoscopic drainage as a good and vi able option. Please 
clarify what was meant in the above statement. Additionally the authors on patient 9 state 
"Finally a reduced experience in pseudocysts endoscopic drainage with EUS guidance at our 
institution made surgical treatment more reliable"... s o was surgery performed because that is 
how pseudocysts are managed at the authors institution? If so, that is fine, however I would not 
justify the surgical approach because of luminal compression or jaundice in that case.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an addi tional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for p ublication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the cont ent of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below . If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is  accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will n ot be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  WIRSUNG ATRAUMATIC RUPTURE IN PATIENT WITH PANCREATIC 
PSEUDOCYSTS. A CASE PR ESENTATION  
 
Version: 0 Date: 29 Jan 2018 
 
Reviewer:  Vanessa M.  Shami  
 
Reviewer’s report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which  cannot be included in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
The case report entitled "Wirsung atraumatic rupture in patient with pancreatic pseudocysts: A 
case report" by Gerosa et al. describes an unusual pr esentation of pancreatic duct leak. While 
interesting, the readability of the report is limited by its grammar. I would recommend that the 
report get edited and then resubmitted for consideration.  
 
On page 5, the authors state that the patient did not pre sent with severe abdominal pain. Did he 
present with any abdominal pain? Please specify.  
 
On page 6, the authors report that EUS -FNA "ruled out the presence of neoplastic cells". It may 
be that the cytology was negative, but EUS would not rule out cancer i n any cystic lesion with 
100% specificity. Consider rephrasing.  
 
On page 8, the authors state that "In our case jaundice and upper gastrointestinal compression 
imposed an operative approach"... what do the author mean? Please clarify. Compression or 
jaundice alone would not eliminate endoscopic drainage as a good and vi able option. Please 
clarify what was meant in the above statement. Additionally the authors on patient 9 state 
"Finally a reduced experience in pseudocysts endoscopic drainage with EUS guidance at our 
institution made surgical treatment more reliable"... s o was surgery performed because that is 
how pseudocysts are managed at the authors institution? If so, that is fine, however I would not 
justify the surgical approach because of luminal compression or jaundice in that case.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Unable to assess  
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an addi tional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for p ublication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the cont ent of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below . If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is  accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will n ot be published.  
 
I agree to the open peer review policy of the journal  
assistant