Partial distal duodenectomy in patient with adenocarcinoma / Duodenectomia distal parcial em paciente com adenocarcinoma

ABSTRACT BACKGROUND: Duodenal adenocarcinoma is a small percentage of gastrointestinal neoplasms, around 0.5%, and its treatment is based on resection of the tumor, classically by pancreaticoduodenectomy. In recent years, however, segmental resections of duodenal lesions, that do not involve the second portion or the periampullary region, have gained relevance with good surgical and oncological outcomes as well as the benefit of avoiding surgeries that can result in high morbidity and mortality. AIMS: To report a case of an elderly female patient with malignant neoplastic lesion in the third and fourth duodenal portion, non-obstructive, submitted to surgical treatment. METHODS: The technical option was the resection of the distal duodenum and proximal jejunum with preservation of the pancreas and reconstruction with side-to-side duodenojejunal anastomosis. RESULTS: The evolution was satisfactory and the surgical margins were free of neoplasia. CONCLUSIONS: Segmental resections of the duodenum are feasible and safe, offering the benefit of preventing complications of pancreaticoduodenectomies.

RESUMO RACIONAL: O adenocarcinoma duodenal é uma pequena porcentagem das neoplasias gastrointestinais, em torno de 0,5%, e seu tratamento baseia-se na ressecção da massa tumoral, classicamente por pancreatoduodenectomia. Nos últimos anos, porém, as ressecções segmentares de lesões duodenais que não envolvem a segunda porção ou a região periampular têm ganhado relevância com bons resultados cirúrgicos e oncológicos e com o benefício de evitar uma cirurgia que pode apresentar alta morbimortalidade. OBJETIVOS: Reportar o caso de uma paciente feminina, idosa, com lesão neoplásica maligna na terceira e quarta porção duodenal, não obstrutiva, submetida a tratamento cirúrgico. MÉTODOS: A opção técnica foi a ressecção do duodeno distal e jejuno proximal com preservação do pâncreas e reconstrução com anastomose duodenojejunal látero-lateral. RESULTADOS: A evolução foi satisfatória e as margens cirúrgicas foram livres de neoplasia. CONCLUSÕES: As ressecções segmentares do duodeno são factíveis e seguras, com os benefícios de evitar as complicações das pancreatoduodenectomias.

Colangiohidatidosis: una complicación evolutiva de la hidatidosis hepática / Cholangiohydatidosis: an evolutive complication of hepatic hydatidosis

Hydatidosis is and endemic disease in the south of Chile, especially in Region IX where remain rates of high prevalence. Cholangiohydatidosis is and infrequent complication of liver hydatidosis. The objetive of this paper is to describe clinical features of a series of patients with cholangiohydatidosis. Series of cases of cholangiohydatidosis treated consecutively and the corresponding follow-up is reported. Clinical, laboratory and images characteristics are described. Descriptive statistic was used and its incidence was calculated. In the studied period, 13 patients with cholangiohydatidosis were recruited, 9 men (69,2 percent) and 4 women (30,7 percent). Observed laboratory abnormalities were an increment of leukocytes in 8 patients (61,5 percent) and hepatic cholestasis with hepatocyte signs of cytolysis in 11 patients (84,6 percent). Choledocus diameter average measured by ultrasonography was 24,7 mm. All the patients had at least one liver cyst whose diameter average was of 12,1 cm. At surgery, evidence of biliary communications was detected in all patients and choledocoduodenal anastomoses in one case (7,7 percent). With a mean follow-up of 38,7 months morbility was 23 percent and mortality 7,7 percent. Accumulated incidence of this entity was of 0,07 cases in 5 years. Cholangiohydatidosis is an uncommon complication of liver hydatidosis that presents considerable morbidity and mortality rates