ABSTRACT
El síndrome del ducto pancreático desconectado (SDPD) consiste en la disrupción del ducto pancreático principal con pérdida de continuidad entre el remanente pancreático distal viable y el tracto gastrointestinal, generalmente causado por necrosis ductal secundaria a pancreatitis aguda grave. Esto resulta en fuga de fluido pancreático, provocando un curso de enfermedad prolongado y complicaciones. La literatura sobre este tema es limitada, con algoritmos de tratamiento poco claros. Hemos realizado una revisión de la literatura sobre el tema. Revisión en Pubmed y Scielo (2011-2021) de artículos en inglés y español utilizando términos «síndrome del conducto pancreático desconectado», «DPDS» y «páncreas desconectado» encontrando 16 artículos relevantes. Dadas las pocas citas, se revisaron las referencias de estos artículos. Finalmente, revisamos un total de 21 artículos. Entre las referencias encontradas existe 1 metaanálisis, 4 estudios prospectivos y no existen ensayos aleatorizados.
Disconnected pancreatic duct syndrome (DPDS) is characterized by disruption of the main pancreatic duct with a loss of continuity between the viable upstream pancreatic parenchyma and the gastrointestinal tract, generally caused by ductal necrosis after severe acute necrotizing pancreatitis. This compromised ductal integrity leads to extraductal leakage of pancreatic secretions, causing a prolonged disease course and complications. The existing literature is limited, with unclear therapeutic algorithms. We have performed a review of the literature on DPDS. Review in Pubmed and Scielo (2011-2021) of articles in English and Spanish using the terms "disconnected pancreatic duct syndrome", "DPDS" and "disconnected pancreas" finding 16 relevant articles. Given the few citations, the references of these articles was reviewed. Finally, we found 21 articles. Among them, there is one meta-analysis, 4 prospective studies and no randomized trials.
ABSTRACT
The term Choledocholithiasis refers to the presence of biliary stones in the extrahepatic bile ducts, which are found in 5 to 10% of patients undergoing cholecystectomy for gallstones. Nowadays, with the adoption of the laparoscopic cholecystectomy(LC) as a standard, multiple minimally invasive treatment options for bile duct stones are feasible, with no consensus to date on the procedure of choice. The two stage endoscopic techniques involve the use of Endoscopic Retrograde Cholangiopancreatography(ERCP) before or after performing a LC, which has the main advantage of separating the bile duct procedure from the LC. However, the need for two separate anesthesia times, the possibility of blank or failed ERCP, and the chance for calculi migration between procedures increase the length of hospital stay and associated costs. The single stage procedures include the Laparoscopic Bile Duct Exploration (LBDE), and more recently, the performance of a laparoscopy guided intraoperative ERCP(Rendez Vous). The LBDE, when performed by an experienced surgical team, is an effective and safe technique. Nonetheless, it is considered a technically demanding procedure, whose results cannot be extrapolated to the general surgical community. Recently, the Rendez Vous has become a treatment alternative that simplifies both the surgical and the endoscopic procedures, decreases morbidity, and requires a single anesthesia time. On the downside, Rendez Vous technique involves complex operating room (OR) logistics, requiring both a trained surgical and endoscopic team at the same time. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Choledocholithiasis/therapy , Choledocholithiasis/surgery , Choledocholithiasis/physiopathology , CholecystolithiasisABSTRACT
Background: Advanced gallbladder cancer has a high mortality. Therefore, this tumor should be diagnosed and treated in early stages. Aim: To analyze the survival rates of patients with an early gallbladder cancer. Material and Methods: Retrospective analysis of medical records of patients with early gallbladder cancer diagnosed until 2003. From that date, all patients with gastrointestinal cancer were registered in a prospective record. Patients with early gallbladder cancer defined as Tis (Carcinoma in situ), T1A (Tumor invades lamina propia) and T1B (Tumor invades muscular layer), were included in this analysis. Results: Eighty patients aged 31 to 87 years (74 percent women) were analyzed. The diagnosis was made during surgery in two patients and during the pathological study in the rest. All 24 patients with Tis tumors were alive after 96 months of follow up. Only one of 16 patients with T1A tumors died of unknown causes. Among the 40 patients with T1B tumors, 24 were re-operated and survival was over 90 percent. Conclusions: This group of patients with early gallbladder cancer had a five years survival over 90 percent. In patients with muscle involvement does not seem necessary to extend the surgery.
Introducción: Dada la elevada mortalidad del cáncer vesicular en etapas avanzadas, lo ideal es diagnosticarlo y tratarlo en una etapa temprana de la enfermedad. Objetivo: Analizar la sobrevida de pacientes con carcinoma temprano de la vesícula biliar y el impacto de una eventual re-operación. Material y Método: Se incluyen en el estudio 80 pacientes con cáncer temprano, siendo la mayoría (65 pacientes) parte de un estudio prospectivo desde mayo de 2004 hasta febrero de 2013. Fueron divididos en 3 grupos: a) carcinoma in situ T1s; b) carcinoma mucoso T1a; c) carcinoma muscular I1b. Seguimiento en el 100 por ciento de los casos. Resultados: El diagnóstico de carcinoma temprano se hizo en 2 pacientes durante la cirugía, en el resto fue un hallazgo del estudio histo-patológico. Los 24 pacientes con carcinoma in situ estaban vivos a los 96 meses de seguimiento. De los 16 pacientes con carcinoma mucoso, sólo 1 (6 por ciento) falleció sin conocerse la causa. Entre los 40 pacientes con cáncer muscular, hubo 24 que no se reoperaron y 16 reoperados. Los resultados anatomo patológicos fueron similares y la sobrevida de ambos grupos fue superior al 90 por ciento. Conclusión: En pacientes con carcinoma de la vesícula biliar in situ y hasta la mucosa, la colecistectomía logra sobrevida mayor del 95 por ciento a largo plazo. En pacientes con carcinoma muscular, ésta se acompaña de una sobrevida mayor a 90 por ciento a 5 años y no parece justificarse ampliar la cirugía.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Aged, 80 and over , Gallbladder Neoplasms/surgery , Gallbladder Neoplasms/mortality , Early Diagnosis , Follow-Up Studies , Gallbladder Neoplasms/pathology , Prospective Studies , Reoperation , Survival AnalysisABSTRACT
Introduction: The benefits of liver metastasis excision in gastric cancer are not clearly demonstrated. Aim: To communicate preliminary experience concerning excision of hepatic metastasis and simultaneously performing gastrectomy in patients with gastric cancer. Material and Methods: In a prospective study, 3 of 397 patients treated for gastric cancer that met certain criteria, underwent hepatic metastasis excision. Results: Three patients with gastric cancer and liver metastases. A 58 years old male in whom one liver metastasis was excised and two were treated with radiofrequency ablation, who is alive after 40 months of follow up. A 26 years old female subjected to the excision of one liver metastasis. Eight months later, the lesion relapsed and a right hepatectomy was carried out. The patient died after 19 months of follow up. A 56 years old female subjected to the excision of one liver metastasis, who died 9 months later...
Introducción: En pacientes con cáncer gástrico y metástasis hepáticas sincrónicas, la posibilidad de tener sólo 1 a 3 metástasis es cerca de 2 por ciento, ya que, en la inmensa mayoría, corresponde a una enfermedad sistémica. Objetivos: Comunicar una experiencia preliminar que se refiere a realizar metastasectomía hepática simultánea a la gastrectomía en pacientes con cáncer gástrico. Material y Método: En estudio prospectivo, 3 de 397 pacientes tratados por cáncer gástrico que cumplían algunos criterios, fueron sometidos además a metatasectomía hepática. Resultados: Se incluye a 3 pacientes, 2 con sólo metástasis hepáticas y 1 paciente con metástasis hepáticas y peritoneales, en los que se realizó metastasectomía. La evolución postoperatoria en los 3 fue sin incidentes. En 2 pacientes la metástasis era única y en otro se realizó además radiofrecuencia de 3 pequeñas metástasis, siendo el único paciente vivo a 40 meses; los otros fallecen a los 19 y 9 meses...
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Stomach Neoplasms/pathology , Liver Neoplasms/surgery , Liver Neoplasms/secondary , Clinical Evolution , Metastasectomy , Stomach Neoplasms/surgery , Prospective Studies , Survival RateABSTRACT
Pseudoaneurysm of the pedal artery is an uncommon condition that is usually caused by a traumatic injury or an iatrogenic intervention. The patient usually complains of an enlarging painless, pulsatile mass. We report a previously healthy 49 years old male presenting with a pulsatile mass of his left foot and a history of a traumatic lesion in the zone three months ago. A Doppler ultrasound examination confirmed the presence of a pseudoaneurysm of the pedal artery of 2.6 x 1.5 cm diameter. The patient underwent surgical resection of the mass and suture ligation of the artery. The postoperative period was uneventful.
Los pseudoaneurismas de la arteria pedia son infrecuentes y habitualmente se generan secundariamente a un traumatismo o a una intervención iatrogénica. Presentamos el caso de un paciente sano de 49 años que presenta un aumento de volumen pulsátil 3 meses posterior al traumatismo contuso de su pie izquierdo. En el doppler color se evidencia la presencia de un pseudoaneurisma de la arteria pedia de 2,64 x 1,53 cm. El paciente fue intervenido con resección y ligadura de la arteria con buena evolución postoperatoria.