The pancreas and tuberculosis: a diagnostic challenge.

Pancreatic tuberculosis is often mistaken for malignancy and can pose a diagnostic challenge. A high degree of suspicion is necessary to diagnose this condition which responds well to anti-tuberculosis treatment (ATT). Fine-needle aspiration cytology helps to differentiate malignancy from treatable conditions like tuberculosis. Records of four patients treated for pancreatic tuberculosis between 1997 and 2006 were studied. All patients had a pancreatic mass which was suspected to be malignant at imaging. The diagnosis of tuberculosis was established by FNAC in one case and after laparotomy in one; two had tuberculosis of other systems. All showed good response to ATT which included resolution of the pancreatic mass over mean follow up of 2 years. We suggest that all inoperable masses of the pancreas should be subjected to FNAC to rule out treatable conditions like pancreatic tuberculosis.

Spontaneous perforation of choledochal cyst and hyperemesis gravidarum.

A 28-year-old primigravida at seven weeks gestation presented to the Accident & Emergency Department complaining of vomiting for five days. She was admitted and managed as a case of hyperemesis gravidarum. Two days later she developed abdominal distension. Ultrasound scan revealed ascites and common bile duct dilatation. The ascitic fluid was bile stained. At emergency laparotomy spontaneous perforation of the supraduodenal part of the common bile duct was seen. This was closed around a T-tube. She then underwent medical termination of pregnancy. The post-operative T-tube cholangiogram was suggestive of a type I choledochal cyst. Three months later this was excised and biliary enteric continuity restored by performing a hepaticojejunostomy. To the best of our knowledge, spontaneous rupture of a choledochal cyst in a patient of hyperemesis gravidarum has not been reported before. In this article, we discuss treatment options for choledochal cyst during pregnancy.

Left gastric artery pseudoaneurysm following traumatic pancreatic transection.

A 24-year-old man presented to us 10 days after suffering blunt trauma to the abdomen. He was diagnosed with pancreatic transection and underwent distal pancreatectomy and splenectomy. Two weeks after the operation, he developed intra-abdominal haemorrhage. Selective visceral angiogram revealed left gastric artery pseudoaneurysm, which had embolised. His recovery was uneventful. To our knowledge, ruptured left gastric artery pseudoaneurysm following pancreatic trauma, has not been reported before. In this article, we discuss some vascular complications of pancreatic trauma.

Pancreatic metastasis from renal cell carcinoma 16 years after nephrectomy: a case report and review of the literature.

Two percent of all malignant pancreatic tumors are metastases from other primaries, with small cell lung cancer, colorectal cancer, breast cancer and hematological neoplasms being the commonest. Renal cell carcinoma (RCC) metastasizing to the pancreas is rare and occurs in 2.8% of patients with metastatic RCC. However, RCC is the most common primary leading to solitary pancreatic metastasis. Metastases often present many years after nephrectomy for primary RCC (median time of 8 years) and should therefore be looked for on surveillance or when patients present with upper abdominal symptoms. Complete surgical resection when possible offers the best chance for cure.

Omental lymphangioma in an adult.

Lymphangiomas are commonly found in the head and neck region. They are commonly seen in children while mesenteric cysts are more common in adults. We report the case of a 34-year-old man who was diagnosed as having a lymphangioma.

Ectopic pancreas mimicking superior mesenteric artery syndrome.

Ectopic pancreas rarely produces symptoms and often goes undetected. We report a 28-year-old man with ectopic pancreas presenting with symptoms and radiological findings mimicking superior mesenteric artery syndrome. Excision of the lesion and duodeno-jejunostomy led to relief.