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OBJECTIVE: To investigate the clinical value of pancreaticogastrostomy(PG) in the treatment ofpancreatojejunostomy stricture(PJS) after pancreaticoduodenectomy(PD).METHODS: The clinical data of 3 patients withPJS who failed the endoscopic treatment underwent PG followed by resection of pancreatojejunostomy(PJ) from May2010 to December 2017 in Department of General Surgery,Xinhua Hospital,Shanghai Jiaotong University School ofMedicine were analyzed retrospectively. After the pancreatointestinal anastomosis was explored and resected, thedigestive tract of the remnant pancreas was reconstructed by using the single-layer bundle pancreaticogastric mucosaanastomosis. The intraoperative and postoperative conditions were observed.RESULTS: The median time of presentationwas 72,37 and 21 months. Three cases of operation were completed successfully. The operation time was 137, 210, 120 min,and blood loss was 210, 350, 180 m L. No pancreatic fistula,surgical bleeding and other serve complicationoccurred postoperatively. All the 3 patients experienced resolution of symptoms without recurrent acute pancreatitis afterPG during the follow-up of 23, 58 and 15 months.CONCLUSION: PG especially duct-to-mucosa PG followed byresection of PJ could be used in the PJS patients who failed the endoscopic treatment.
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Introduction: Without the knowledge of the normal pattern of the duct system and its variations, a radiologistcan’t interpret an Endoscopic Retrograde Cholangiopancreatography (ERCP) picture. So it becomes important tostudy the anatomy of pancreatic ducts, their relation to each other, to common bile duct and to duodenum in theavailable human cadavers. The present paper is about the study of distance between minor and major duodenalpapilla from pylorus which was carried out on 96 cadaveric specimens of human duodeno-pancreas. To visualiseand to see distance between minor and major duodenal papillae is necessary for the endoscopist who aims toperform the dilation, stenting, or papillotomy of the minor papilla.Materials and Methods: The study was conducted in 96 (64 male and 32 female) cadavers. Major and minorduodenal papillae were visualized through eosin dye installation in both common bile duct and the accessorypancreatic duct. The measurement of distance between the duodenal papillae and to pylorus was done in cm.Results: In the present work, the mean ± SD of the Distance between pylorus to MAP is 8.05 ± 1.71 cm, pylorus toMIP is 6.19 ± 1.49 cm, the major to minor duodenal papilla was on an average 2.02 ± 0.40 cm, these distanceswere more in males as compared to females. But the size of Orifice of MAP in specimens is 7.25 ± 1.25 mm morein females as compared to males.Conclusion: The length of the duct shows sexual dimorphism; the length being more in males than females.
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The accessory pancreatic duct is the smaller and less constant pancreatic duct in comparison with the mainpancreatic duct. We investigated the patency of the accessory pancreatic duct and its role in pancreaticpathophysiology. The present study was carried out in the department of Anatomy and forensic medicine, ACSRGovt. medical college, Nellore, Andhra Pradesh, India and in the department of Anatomy, RIMS, Ongole, AndhraPradesh, India. With 96 human cadavers (64 males and 32 females) with 30 to 80 years age group have beenstudied after obtained of ethical committee permission. The dissection method was followed to obtain specimenof pancreas along with C-loop of duodenum, papillae were identified ad dye was injected into APD to see itspatency at MIP. 93.75% specimens present MIP. The prevalence of patency of APD at MIP in population understudy was 38.89%; this is more in males was 43.33%, when compared to the females was 30% but this differencewas not significant statistically. It observed that out of 35 patent APD cases, 33 cases had inter papillarydistance either 2cm or more than 2cm. I t indicates 94.29% of patent APD cases had inter-papillary distancee”2cm. So there is strong relationship between APD patency and inter papillary distance in population understudy. The means inter-papillary distance in patent APD cases was 2.29 ± 0.2cm and non-patent APD cases was1.85 ± 0.25 cm. This difference was statistically significant.
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BACKGROUND/AIMS: Options for the endoscopic management of symptomatic pancreatic fluid collections (PFCs) include transmural drainage (TM) alone, transpapillary drainage (TP) alone, or a combination of both drainage method (CD). There have been conflicting reports about the best method. This study performed a meta-analysis to determine whether CD presents an added clinical benefit over TM. METHODS: The included studies compared TM with CD and reported clinical success for both methods. A random-effects model was used to determine the pooled odds ratios (ORs) and the 95% confidence intervals (CIs) for the following outcomes: technical success, clinical success, complications, and recurrence. RESULTS: Nine studies involving a combined total of 604 drainage procedures—373 TMs (62%) and 231 CDs (38%)—were included. CD showed no additional benefit over TM in terms of technical success (OR, 1.12; 95% CI, 0.37–3.37; p=0.85), clinical success (OR, 1.11; 95% CI, 0.65–1.89; p=0.70), recurrence (OR, 1.49; 95% CI, 0.53–4.21; p=0.45), or complications (OR, 1.15; 95% CI, 0.61–2.18; p=0.67). CONCLUSIONS: Pancreatic duct (PD) stenting provides no additional clinical benefit for the TM of PFCs (particularly pseudocysts). Patients undergoing the TM of symptomatic pseudocysts may not require endoscopic retrograde pancreatography (ERP).
Subject(s)
Humans , Drainage , Endoscopy , Methods , Odds Ratio , Pancreatic Ducts , Pancreatic Pseudocyst , Recurrence , StentsABSTRACT
Objective: The present paper is about the study of distance between minor and major duodenal papillae which was carried out on 30 cadaveric specimens of human duodeno-pancreas. With introduction of ERCP, the pattern of pancreatic ductal system visualization has attained popularity. Without the knowledge of the normal pattern of the duct system and its variations, a radiologist can’t interpret an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) picture. So it becomes important to study the anatomy of pancreatic ducts, their relation to each other, to common bile duct and to duodenum in the available human cadavers. To visualise and to see distance between minor and major duodenal papillae is necessary for the endoscopist who aims to perform the dilation, stenting, or papillotomy of the minor papilla. ERCP is proved to be “first line” therapeutic tool in the management of surgical, medical and pathological disorders involving the biliary tree and pancreatic duct. Methods: The study was conducted in thirty (20 male and 10 female) cadavers. Major and minor duodenal papillae were visualized through eosin dye installation in both common bile duct and the accessory pancreatic duct. The measurement of distance between the duodenal papillae was done in cm. Results: In the present work, the distance measured between the major and minor duodenal papilla was on an average 1.93+0.61 cm. in females and in males it was 2.05+0.31 cm. Conclusion: The length of the duct shows sexual dimorphism; the length being more in males than females.
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Aim Large pancreatic ductal calculi and pain are a feature of chronic calcific pancreatitis (CCP) in the tropics. This large single center study evaluates the role of extracorporeal shock wave lithotripsy (ESWL) in fragmentation of large pancreatic stones and relief of pain in patients with CCP. Methods Patients with CCP presenting with pain and large pancreatic duct (PD) calculi (>5 mm diameter) not amenable to extraction at routine endoscopic retrograde cholangio pancreatography (ERCP) were taken up for ESWL using a 3rd generation lithotripter. Stones in the head and body of pancreas were targeted at ESWL; 5,000 shocks were given per session. The calculi were fragmented to <3 mm size and then cleared by endotherapy. Pancreatic duct stents were deployed when indicated. A total of 1,006 patients underwent ESWL. Complete clearance was achieved in 762 (76%), partial clearance in 173 (17%) and unsuccessful in the rest. More than 962 (90%) of patients needed less than three sessions of ESWL. At 6 months, 711 (84%) of 846 patients who returned for follow up had significant relief of pain with a decrease in analgesic use. Complications were mild and minimal. Conclusion ESWL is an effective and safe modality for fragmentation of large PD calculi in patients with CCP.
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We performed a bentiromide test in 25 patients with chronic pancreatitis and 7 normal controls to evaluate pancreatic exocrine function, and compared the test results of patients with their endoscopic retrograde pancreatography(ERP) findings. The cumulative 6-hour recovery rate of para-aminobenzoic acid(PABA) in the urine was significantly lower in patients with chronic pancreatitis(55.8 +/- 24.2%) than in controls(82.0 +/- 10.0%). Among 25 patients with chronic pancreatitis, however, 7 patients showed normal recovery rates of PABA. Pancreatograms of the patients represented 4 mild changes, 5 moderate changes, and 16 marked changes. The average 6-hour recovery rates of PABA of the groups were 56.9 +/- 21.6%, 78.4 +/- 10.5%, and 47.2 +/- 23.7%, respectively. Urinary PABA recovery rates were found subnormal as follows: 3(75%) in the mild changes group; 1(20%) in the moderate changes group; and 14(87.5%) in the marked changes group. We found hardly any correlation between the degree of functional impairment and the changes noted by ERP. These findings suggest that both the pancreatic function test and morphologic study are required to evaluate the degree of functional impairment in patients with chronic pancreatitis.
Subject(s)
Adult , Aged , Female , Humans , Male , 4-Aminobenzoic Acid , 4-Aminobenzoic Acid/analogs & derivatives , Bicarbonates/metabolism , Chronic Disease , Comparative Study , Middle Aged , Pancreas/diagnostic imaging , Pancreatitis/diagnosisABSTRACT
Tuberculosis of the pancreas is a very rare disorder, little reported in the literature. Several theories of the pathogenesis of pancreatic tuberculosis have been proposed. Direct invasion of the pancreas by Mycobacterium tuberculosis is rare; most commonly the pancreas is spared even when liver and spleen are severely involved by miliary dissemination. More common is the involvement of abdominal lymph nodes which, as caseating masses, subsequently invade the pancreas. Pancreatic tuberculosis is a treatable and preventable disease; however, major challenges remain in diagnosis. There have been several reports including the endoscopic retrograde pancreatographic(ERP) findings, however, our case of pancreatic tuberculosis showed quite unusual ERP findings. We report a 54-year old man suffering from chronic epigastric pain and weight loss who was diagnosed intraabdominal tuberculosis with pancreatic involvement. Abdominal ultrasonography showed ill-defined hypoechoic mass at pancreatic head, peripancreatic lymph nodes enlargement and intra- and extrahepatic bile ducts dilatations. Endoscopic retrograde pancreatogram showed blurring and irregularity of the second branch of pancreatic duct at head and the parenchymal abnormal pooling of the contrast dye was noted. Percutanieous transhepatic cholangiogram revealed the complete obstruction of the distal common bile duct. At explo-laparotomy, massive necrosis and fibrous adhesions were noticed around the extrahepatic bile duct and pancreas head and multiple pericholedochal lymph nodes enlargement and several whitish-yellow nodules on the surface of the liver were noted. The extrahepatic bile duct was dilated and the common bile duct at the suprapancreatic portion was compressed by the lymph nodes and necro-inflammatory tissues which invaded the pancreatic head posteriorly. The microscopic findings of the nodules on liver surface and lymph nodes revealed the typical findings of the tuberculosis.