ABSTRACT
Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.
Subject(s)
Aged , Female , Humans , Male , Adenocarcinoma, Mucinous/diagnosis , Mesenteric Veins/diagnostic imaging , Pancreas/abnormalities , Pancreatic Diseases/diagnosis , Pancreatic Fistula/etiology , Pancreatic Neoplasms/diagnosis , Pancreaticoduodenectomy/adverse effects , Portal Vein/diagnostic imaging , Splenic Vein/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Serous cystic neoplasm (SCN) of the pancreas is considered a benign tumor with almost no malignant potential. Most surgeons agree that asymptomatic SCN requires only regular observation. However, several complexities and interference with organ preservation during the operation, may develop when a huge symptomatic tumor is treated with surgery. So, the purpose of this study is to develop a potential management plan based on a literature review and by describing three recent cases of SCN of the pancreas. We suggest that SCNs be responded to with a timely and appropriate surgical intervention - before they require clinical attention.
Subject(s)
Cystadenoma, Serous , Organ Preservation , PancreasABSTRACT
Newer atypical antipsychotics have many benefits compared with conventional antipsychotics. However it has been known that atypical antipsychotics are associated with drug-induced weight gain and dibetes mellitus. Obesity and diabetes mellitus may be problematic side effects to patients with schizophrenia because they can cause many medical problems and also drug compliance which is important to prognosis can be reduced by those adverse effects. We present here a male patient, aged 26 years old, who was treated with risperidone, olanzapine, quetiapine subsequently and gained weight by 32 kilograms (almost 50% increase) during four years long treatment and diagnosed as having diabetes mellitus. We switched the antipsychotics to amisulpride at the day of admission and increased the dosage to 800 mg. At discharge after 34 days after admission, his psychotic symptoms were considerably improved and blood glucose level at fasting time was stabilized within acceptable range. And he also lost weight by 5 kilograms after admission. Amisulpride would be a relatively appropriate choice of drug in patient with atypical antipsychotics induced weight gain and/or diabetes mellitus.