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1.
Alerta (San Salvador) ; 7(2): 133-137, jul. 26, 2024. ilus, tab.
Article in Spanish | BISSAL, LILACS | ID: biblio-1563134

ABSTRACT

Presentación del caso. Se trata de una mujer de 32 años quien consultó por dolor abdominal en el epigastrio no asociado a las comidas, tenía el antecedente de una pancreatectomía distal con preservación de bazo debido a un tumor en la cola del páncreas, cinco años previos. En el examen físico no presentó ninguna anormalidad y durante su abordaje se realizaron estudios de imagen. Intervención terapéutica. La tomografía axial computarizada evidenció una lesión en el segmento lateral izquierdo del hígado con características sugestivas de metástasis debido a su antecedente quirúrgico. Los exámenes de laboratorio y marcadores tumorales se encontraron dentro de límites normales. Se evaluó en conferencia multidisciplinaria y se recomendó un abordaje quirúrgico. Se realizó una hepatectomía izquierda con una evolución posquirúrgica sin complicaciones. Evolución clínica. Luego de seis meses posoperatorios, se encontraba sin evidencia de enfermedad activa o residual


Case presentation. A 32-year-old woman consulted for abdominal pain in the epigastrium not associated with meals. She had a history of distal pancreatectomy with spleen preservation due to a tumor in the tail of the pancreas five years earlier. Physical examination showed no abnormalities and imaging studies were performed during his approach. Treatment. Computed axial tomography revealed a lesion in the left lateral segment of the liver with characteristics suggestive of metastasis due to his surgical history. Laboratory tests and tumor markers were within normal limits. It was evaluated in a multidisciplinary conference, and a surgical approach was recommended. A left hepatectomy was performed with an uncomplicated postoperative evolution. Outcome. Six months postoperatively, there was no evidence of active or residual disease


Subject(s)
El Salvador
2.
Rev. colomb. cir ; 39(4): 633-639, Julio 5, 2024. fig
Article in Spanish | LILACS | ID: biblio-1566026

ABSTRACT

Introducción. La neoplasia sólida pseudopapilar de páncreas, también conocida como tumor de Frantz, es una patología poco frecuente, que comprende menos del 3 % de los tumores pancreáticos, y la mayor incidencia se observa en mujeres jóvenes entre la segunda y tercera década de la vida. Su etiología es desconocida. El tratamiento de elección es la resección quirúrgica sin linfadenectomía cuando se encuentra bien localizado. Inclusive aún cuando hay evidencia de metástasis o invasión local, el manejo quirúrgico sigue siendo el tratamiento de elección. Caso clínico. Mujer de 24 años de edad, con masa abdominal palpable, dolorosa, de tres semanas de evolución. La tomografía computarizada mencionó como presunción diagnóstica un tumor de origen pancreático. En la laparotomía se encontró una masa dependiente del cuerpo del páncreas. Se realizó pancreatectomía distal radical con esplenectomía y omentectomía parcial en bloque. Resultados. Durante la cirugía no se presentaron complicaciones y hasta el sexto mes de seguimiento, la evolución fue adecuada y sin recidiva tumoral. Conclusiones. Ante la presencia de masa abdominal, con compromiso pancreático documentado por tomografía computarizada, se debe considerar el diagnóstico de neoplasia sólida pseudopapilar de páncreas, o tumor de Frantz. El tumor de Frantz es una entidad poco frecuente que generalmente se diagnostica de forma incidental o por síntomas inespecíficos en estadios avanzados. El diagnóstico y manejo de esta neoplasia representa un reto y la resección quirúrgica continúa siendo el tratamiento indicado.


Introduction. Solid pseudopapillary neoplasia of the pancreas, also known as Frantz tumor, is a rare pathology, comprising less than 3% of pancreatic tumors, and the highest incidence is observed in young women between the second and third decades of life. Its etiology is unknown. The treatment of choice is surgical resection without lymphadenectomy when it is well located. Even when there is evidence of metastasis or local invasion, surgical management remains the treatment of choice. Clinical case. A 24-year-old woman presented with a palpable, painful abdominal mass of three weeks' duration. The computed tomography mentioned a tumor of pancreatic origin as a presumptive diagnosis. At laparotomy, a mass dependent on the body of the pancreas was found. Radical distal pancreatectomy with splenectomy and en bloc partial omentectomy was performed. Results. During the surgery there were no complications and until the sixth month of follow-up, the evolution was adequate and without tumor recurrence. Conclusions. In the presence of an abdominal mass, with pancreatic involvement documented by computed tomography, the diagnosis of solid pseudopapillary neoplasia of the pancreas, or Frantz tumor, should be considered, which must be treated surgically. Frantz tumor is a rare entity that is generally diagnosed incidentally or due to nonspecific symptoms in advanced stages. The diagnosis and management of this neoplasia represents a challenge and surgical resection continues to be the indicated treatment.


Subject(s)
Humans , Pancreatectomy , Pancreatic Neoplasms , Pancreas , Incidental Findings , Diagnosis, Differential
3.
Rev. colomb. cir ; 39(4): 640-645, Julio 5, 2024. fig
Article in Spanish | LILACS | ID: biblio-1566027

ABSTRACT

Introducción. El esplenúnculo se ha descrito con una incidencia global del 10 al 30 %. Puede ser una entidad de origen congénito o adquirida, frecuentemente está asociada a trauma abdominal o antecedente de esplenectomía por diversas causas. Caso clínico. Mujer en edad media, con antecedente de trauma abdominal y esplenectomía por ruptura traumática, quien 30 años después presenta un cuadro de dolor abdominal. Los estudios imagenológicos identificaron una masa sólida intrapancreática. Resultados. Fue llevada a pancreatectomía distal. Los hallazgos histológicos e inmunohistoquímicos confirmaron que la masa pancreática correspondía a un esplenúnculo intrapancreático adquirido, asociado al evento traumático previo. Conclusión. Los esplenúnculos suelen constituir un "incidentaloma". Los estudios imagenológicos se encuentran limitados, pues la tomografía computarizada, la resonancia nuclear magnética y la ultrasonografía presentan características imagenológicas similares con los tumores pancreáticos hipervascularizados, por lo que se debe practicar el estudio histopatológico durante su valoración. Esta entidad se debe incluir dentro de los diagnósticos diferenciales, con mayor énfasis en aquellos pacientes con historia de trauma abdominal y esplenectomía asociada, un escenario en el que esta lesión puede simular una neoplasia sólida del páncreas, con características malignas.


Introduction. Splenunculus has been described with an overall incidence of 10 to 30%. It can be an entity of congenital or acquired origin, it is frequently associated with abdominal trauma or a history of splenectomy for various reasons. Clinical case. Middle-aged woman, with a history of abdominal trauma and splenectomy due to traumatic rupture, who 30 years later presents with abdominal pain. Imaging studies identified a solid intrapancreatic mass. Results. She was taken to OR for distal pancreatectomy. The histological and immunohistochemical findings confirmed that the pancreatic mass corresponded to an acquired intrapancreatic splenunculus, associated with the previous traumatic event. Conclusion. Splenuncles usually constitute an "incidentaloma". Imaging studies are limited, since computed tomography, magnetic resonance imaging, and ultrasonography present similar imaging characteristics with hypervascularized pancreatic tumors, so histopathological study must be included during their evaluation. This entity should be included in the differential diagnoses, with greater emphasis on those patients with a history of abdominal trauma and associated splenectomy, a scenario in which this lesion can simulate a solid neoplasm of the pancreas, with malignant characteristics.


Subject(s)
Humans , Pancreas , Pancreatic Neoplasms , Splenectomy , Pancreatectomy , Spleen , Splenosis , Diagnosis, Differential
4.
Rev. colomb. gastroenterol ; 39(2): 230-235, Jan.-June 2024. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1576321

ABSTRACT

Abstract Only 2% of malignant tumor lesions in the pancreas represented metastatic lesions. Endoscopic biliopancreatic ultrasonography, with the possibility of guided biopsy, is one of the main diagnostic methods currently available for lesions in the pancreas. A case of a male patient with a history of small cell carcinoma of the lung with findings of a tumor lesion in the pancreas corresponding to metastasis was described.


Resumen Tan solo el 2% de las lesiones tumorales malignas en el páncreas representan lesiones metastásicas. La ultrasonografía endoscópica biliopancreática, con posibilidad de biopsia guiada, es uno de los principales métodos diagnósticos disponibles actualmente para las lesiones en el páncreas. Se describe el caso de un paciente masculino con antecedente de carcinoma de células pequeñas de pulmón con hallazgos de lesión tumoral en el páncreas correspondiente a metástasis.

5.
Rev. cir. (Impr.) ; 76(2)abr. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1565463

ABSTRACT

Objetivo: La transformación quística acinar del páncreas es una patología poco frecuente y que afecta en su mayoría a mujeres de mediana edad. Material y Métodos: Presentamos el caso de dicha patología en un varón joven que debutó con dolor en hipocondrio izquierdo y en la pruebas de imagen se evidenció una lesión quística en cola pancreática de 50x45mm, con calcificaciones lineales. Se realizó pancreatectomía distal. Resultados: El diagnóstico anatomopatológico informó de transformación quística acinar. Discusión: Dada la dificultad de un diagnóstico preoperatorio, es frecuente someter al paciente a una intervención quirúrgica con una elevada morbilidad, a pesar de tratarse de una lesión benigna, ya que se siguen las indicaciones quirúrgicas para otras patologías quísticas pancreáticas. La presencia de mutaciones y el hecho de que algunos de ellos también presentan cambios epiteliales mucinosos, justificaría el debatir la posibilidad de mantener a estos pacientes bajo vigilancia a largo plazo.


Objective: Acinar cystic transformation of the pancreas is a rare pathology that affects mostly middle-aged women. Material and Methods: We present a case of this pathology in a young man who presented with pain in the left hypochondrium and imaging tests revealed a cystic lesion in the pancreatic tail measuring 50x45mm, with linear calcifications. Distal pancreatectomy was performed. Results: The anatomopatho-logical diagnosis was acinar cystic transformation. Discussion: given the difficulty of a preoperative diagnosis, the patient is often subjected to surgery with high morbidity, despite being a benign lesion, as surgical indications for other pancreatic cystic pathologies are followed. The presence of mutations and the fact that some of them also present mucinous epithelial changes would justify discussing the possibility of keeping these patients under long-term surveillance.

6.
Bol. méd. Hosp. Infant. Méx ; 81(2): 85-89, mar.-abr. 2024. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1568893

ABSTRACT

Resumen Introducción: La pancreatitis aguda se observa con mayor frecuencia en la edad pediátrica. Actualmente existen guías de recomendaciones para su adecuado diagnóstico y tratamiento. El objetivo de este estudio fue evaluar el nivel de conocimiento de las recomendaciones internacionales sobre pancreatitis aguda de la North American Society for Pediatric Gastroenterology, Hepatology and Nutrition en un grupo de pediatras. Métodos: Estudio observacional, multicéntrico, mediante una encuesta aplicada a médicos pediatras y médicos pediatras en formación. Resultados: El 48.8% de los médicos tenían conocimiento de las guías para tratamiento de pancreatitis aguda en niños. El 72.4% conocían los criterios actuales para el diagnóstico de pancreatitis aguda. No hubo diferencias en la mayoría de las respuestas entre médicos pediatras y médicos pediatras en formación. Conclusiones: Aunque solo la mitad de los encuestados conocían la guía para el diagnóstico y el tratamiento de la pancreatitis aguda, cerca de tres cuartas partes utilizan adecuadamente los criterios para el diagnóstico. Existe adecuado conocimiento sobre la prescripción de antibióticos y el seguimiento posterior a la pancreatitis aguda. Hay déficit en el conocimiento sobre las recomendaciones de la monitorización de los signos vitales y el momento adecuado para realizar la colecistectomía ante una pancreatitis de origen biliar.


Abstract Background: Acute pancreatitis is observed more frequently in the pediatric age. Currently, there are recommendation guidelines for its proper diagnosis and treatment. The objective of this study was to evaluate the level of knowledge of the international recommendations on acute pancreatitis in pediatrics of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition in a group of pediatricians. Methods: Observational, multicenter study, through a survey applied to pediatricians and pediatric residents. Results: 48.8% of physicians had prior knowledge of the guidelines for the treatment of acute pancreatitis in children. 72.4% knew the current criteria for the diagnosis of acute pancreatitis. There were no differences in the majority of responses between pediatricians and pediatric residents. Conclusions: Although only half of the respondents followed the guidelines for diagnosis and treatment of acute pancreatitis, about three-quarters adequately use the criteria for diagnosis. There is adequate knowledge about the prescription of antibiotics and pancreatitis follow-up. There is lack of knowledge on the recommendation of monitoring vital signs and the precise time to perform cholecystectomy in the pancreatitis of biliary origin.

7.
Int. j. morphol ; 42(2): 497-502, abr. 2024. ilus, tab
Article in Spanish | LILACS | ID: biblio-1558159

ABSTRACT

El linfangioma quístico del páncreas (LQP), es un tumor extremadamente raro y representa solo el 1% de los linfangiomas abdominales. El objetivo de este manuscrito fue reportar un caso de LQP intervenido quirúrgicamente; y revisar la evidencia existente respecto de sus características morfológicas, terapéuticas y pronósticas. Mujer de 67 años, con LQP operada en Clínica RedSalud Mayor Temuco en septiembre de 2023. Se verificó un tumor sólido-quístico de 16 cm de diámetro mayor, adherido al páncreas a nivel del cuerpo de la glándula, de 867 gramos de peso, con líquido amarillento en su interior; la que fue extirpada completamente. Después del estudio histológico, se realizaron tinciones inmunohistoquímicas complementarias para CD31, D2-40 y calretina. La paciente tuvo un curso postoperatorio sin incidentes, siendo dado de alta al tercer día postoperatorio. En el control alejado, se encontraba en buenas condiciones generales. El LQP es un tumor muy poco frecuente. Las características clínicas e imágenes de este tipo de lesiones son inespecíficas. Debe considerarse en el diagnóstico diferencial de las lesiones quísticas pancreáticas. La resección quirúrgica completa con márgenes libres es el tratamiento de elección; y el pronóstico del LQP es favorable si se reseca por completo.


SUMMARY: Pancreas cystic lymphangioma (PCL) are extremely rare, accounting for only 1% of abdominal lymphangiomas. The aim of this study was to report a rare case of PCL, who underwent surgery; and review the existing evidence regarding its morphological, therapeutic and prognostic characteristics. 67-year-woman patient with PCL who underwent surgery at Clínica RedSalud Mayor Temuco in September 2023. In this case, a solid-cystic tumor with a major diameter of 16 cm was identified, adhering to the pancreas at the level of the body of the gland, weighing 867 grams and containing yellowish fluid in its interior. The tumor was completely excised. Subsequent to histological examination, additional immunohistochemical staining was performed for CD31, D2-40, and calretinin. The patient experienced an uneventful postoperative course and was discharged on the third postoperative day. During the follow-up, the patient remains in good general condition. LQP is a very rare tumor. Clinical features and images of this type of lesions are nonspecific. It should be considered in the differential diagnosis of pancreatic cystic lesions. Complete surgical resection with free margins is the treatment of choice; and the prognosis of LQP is favorable if it is completely resected.


Subject(s)
Humans , Female , Aged , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/pathology , Lymphangioma, Cystic/surgery , Lymphangioma, Cystic/pathology
8.
Article | IMSEAR | ID: sea-226824

ABSTRACT

Aim: In this study, the effects of alpha-tocopherol (AT), quercetin (QT) or their combination on ethanol-induced pancreatic and duodenal mucosal damage were investigated in rats using morphological and biochemical evaluations.Study Design: Experimental study.Place and Duration of Study: University of Ibadan, Ibadan, Nigeria.Methodology: Ethanol-induced injuries were produced by oral administration of 40% ethanol (0.2 ml/day) for 40 consecutive days, while a control group of rats was served distilled water. Other groups received AT (2.5 mg/kg), QT (50 mg/kg) or their combination with 40% ethanol during the experimental period.Results: Blood glucose level was significantly (p<0.05) increased in ethanol-treated rats relative to controls. Ethanol administration caused shrinkage of insulin-secreting islets tissues in the pancreas, while lesions such as erosions, loss of villi and severe inflammatory cell infiltrations of the mucosa and sub-mucosa were observed in the duodenum. These changes were accompanied by significant elevation in the levels of hydrogen peroxide (H2O2), malondialdehyde (MDA) and advanced oxidation protein products (AOPP) in the pancreas and duodenum, along with reduced activities of glutathione peroxidase (GPx) and glutathione S-transferase (GST). Treatment of rats with AT, QT, and especially their combination, yielded profound reversal of ethanol-induced effects indicated by restoration of blood glucose to control levels, preservation of pancreatic and duodenal morphology and the inhibition of ethanol-induced oxidative stress.Conclusion: Overall, dietary supplementation with AT and/or QT could potentially counteract the adverse effects associated with chronic alcohol consumption.

9.
Rev. colomb. cir ; 39(2): 260-267, 20240220. tab
Article in Spanish | LILACS | ID: biblio-1532615

ABSTRACT

Introducción. La fístula pancreática postoperatoria es una de las complicaciones más importantes en la cirugía hepatobiliopancreática. Su diagnóstico se hace mediante la presencia de un nivel de amilasa en el líquido de drenaje al menos tres veces por encima del valor de la amilasa en suero a partir del tercer día postoperatorio. El objetivo de este estudio fue caracterizar los pacientes con fístula pancreática postoperatoria en nuestra institución, evaluando la importancia de la detección temprana y el establecimiento de un manejo oportuno. Métodos. Estudio descriptivo, retrospectivo, que incluyó los pacientes sometidos a pancreatoduodenectomía, con diagnóstico de fístula pancreática postoperatoria como complicación de cirugía hepatobiliopancreática, en el Hospital Internacional de Colombia, en Piedecuesta, entre enero del 2017 y diciembre de 2020. Se excluyeron los pacientes con otro tipo procedimiento quirúrgico y aquellos que decidieron no participar en el estudio. Resultados. Se evaluaron 69 pacientes, con un predominio del sexo femenino (n=38; 55,1 %) y mediana de la edad de 57 años. El 33,3 % (n=24) de los pacientes intervenidos desarrollaron fístula pancreática postoperatoria, siendo el 23,2 % fuga bioquímica, grado B 8,7 % y grado C 2,9 %, para quienes se indicaron manejo expectante, control ecográfico y reintervención, respectivamente. Fallecieron 5 pacientes (7,2 %). Conclusiones. La fístula pancreáticapostoperatoria es una complicación para tener en cuenta en todos los pacientes sometidos a pancreatoduodenectomía. Existen estrategias que pueden permitir disminuir la incidencia de esta complicación, con el fin de mejorar el desenlace, el pronóstico y la morbilidad posquirúrgica.


Introduction. Postoperative pancreatic fistula is one of the most important complications in hepatobiliopancreatic surgery. Its diagnosis is made by the presence of an amylase level in the drainage fluid at least three times above the serum amylase value from the third postoperative day. The objective of this study was to characterize patients with postoperative pancreatic fistula at our institution, evaluating the importance of early detection and to establish a timely management. Methods. Descriptive, retrospective study that included patients who underwent pancreatoduodenectomy with a diagnosis of postoperative pancreatic fistula as a complication of hepatobiliopancreatic surgery at the Hospital Internacional Colombia, between January 2017 and December 2020. Patients with another type of procedure performed by this specialty and those who did not decide to participate in the study were excluded. Results. A total of 69 patients were included, the median age was 57 years with a predominance of females (n=38; 55.1%). 33.3% (n=24) of the operated patients developed postoperative pancreatic fistula, with 23.2% having a biochemical leak, grade B in 8.7% and grade C in 2.9%, for whom expectant management, ultrasound control and reintervention were indicated, respectively. Five patients died (7.2%). Conclusions. Pancreatic fistula is a complication to take into account in all patients undergoing pancreatoduodenectomy. There are strategies that can reduce the incidence of this complication and thus improve not only the outcome but also the prognosis and postoperative morbidity.


Subject(s)
Humans , Pancreas , Pancreatic Fistula , Pancreatic Neoplasms , Postoperative Complications , Pancreaticoduodenectomy
10.
Journal of Clinical Surgery ; (12): 89-91, 2024.
Article in Chinese | WPRIM | ID: wpr-1019300

ABSTRACT

Objective Summarizing the recent efficacy and initial experience of using da Vinci robot surgery for pediatric annular pancreas in our hospital.Methods The clinical data of 3 children with annular pancreas treated by Da Vinci robotic surgery in Wuhan Children's Hospital from October 2020 to December 2022 were retrospectively analyzed.Results All three cases were successfully completed with robot-assisted lateral duoduodenal anastomosis without intraoperative complications.The operation time was 240 min,212 min,135 min,respectively.Postoperative feeding was started at 12 d,7 d,and 6 d,respectively.The postoperative hospital stays were 33 d,18 d,and 13 d,respectively.The first case was complicated with neonatal necrotizing enterocolitis after operation,and was cured and discharged after conservative treatment.The remaining 2 cases were cured and discharged.The follow-up time was 2 years,3 months and 5 months,respectively.No relevant complications occurred during the follow-up period,and the prognosis of the three children was good.Conclusion Da Vinci robotic surgery is safe and feasible in the treatment of annular pancreas in children,but it still needs to be supported by large sample studies.

11.
Article in Chinese | WPRIM | ID: wpr-1020424

ABSTRACT

Post-acute pancreatitis diabetes is one of the most common distant complications of acute pancreatitis. However, its incidence has been underestimated for a long time, indicating that it has not been taken seriously by healthcare professionals in clinical practice. This article provides a review of the urgent need for healthcare professionals to focus on the current status, adverse outcomes, screening and management aspects of diabetes after acute pancreatitis, and aims to provide a reference for healthcare professionals in their relevant clinical work.

12.
Journal of Clinical Hepatology ; (12): 644-648, 2024.
Article in Chinese | WPRIM | ID: wpr-1013152

ABSTRACT

The incidence rate of abdominal trauma is increasing year by year in pediatric trauma, and traumatic pancreatic injury should be taken seriously by clinicians. The pancreas is located behind the peritoneum, and it is difficult to make an early diagnosis of pancreatic injury, especially in children with grade ‍Ⅰ‍/Ⅱ injury. Through a literature review, this article analyzes the application value of endocrine indices and abdominal ultrasound in the early diagnosis of pediatric pancreatic injury, so as to improve the rate of early diagnosis and avoid the onset of related complications. Changes of the endocrine indices such as serum insulin and C Peptide have certain advantages in diagnosing and evaluating the degree of pediatric pancreatic injury and can thus be used as early warning indices for pediatric pancreatic injury. Ultrasound elastography provides a new method for the diagnosis and differentiation of pancreatic injury; contrast-enhanced ultrasound, which has no radioactive damage, has relatively high specificity and sensitivity in identifying pediatric pancreatic injury, and therefore, it is expected to become an alternative to CT examination.

13.
Journal of Clinical Hepatology ; (12): 365-368, 2024.
Article in Chinese | WPRIM | ID: wpr-1007254

ABSTRACT

Accessory spleen refers to the spleen tissue that exists outside of the normal spleen, with a similar structure to the main spleen and certain functions. Intrapancreatic accessory spleen (IPAS) completely enveloped by the pancreas has an incidence rate of only 2%, and it is easily misdiagnosed in clinical practice due to its atypical clinical symptoms and similar radiological features to pancreatic neuroendocrine tumor, pancreatic solid pseudopapillary tumor, and other pancreatic space-occupying lesions. This article reports the clinical data of two patients with IPAS who were misdiagnosed as pancreatic neuroendocrine tumor and pancreatic solid pseudopapillary tumor, respectively, analyzes the reasons for misdiagnosis, and summarizes the experience in diagnosis and treatment, in order to improve the ability for the differential diagnosis of IPAS in clinical practice.

14.
Chinese Journal of Medical Imaging ; (12): 162-165,167, 2024.
Article in Chinese | WPRIM | ID: wpr-1026368

ABSTRACT

Purpose To explore the diagnostic value of beak sign in fetal annular pancreas by analyzing the ultrasonographic features of fetal annular pancreas.Materials and Methods The ultrasound images and clinical data of 13 cases of fetal annular pancreas diagnosed by prenatal ultrasound in Shandong Provincial Maternal and Child Health Hospital from September 2019 to December 2021 and confirmed by surgery after birth were retrospectively analyzed.The degree of duodenal stenosis at the obstruction site was observed,especially whether the angle formed by the intestinal wall could identify the fetal annular pancreas,and the ultrasonic characteristics were summarized and analyzed.Results A total of 13 fetuses with annular pancreas showed double bubble sign,3 cases showed clamp sign,and 7 cases showed beak sign at the end of duodenal dilatation.All the 13 cases underwent surgical treatment after birth,including 2 cases with duodenal atresia and 1 case with atypical intestinal malrotation.All the children had good prognosis after operation.Conclusion By observing the dilated end of duodenum and the relationship with pancreatic head,prenatal ultrasound combined with beak sign and double bubble sign could improve the diagnostic accuracy of fetal annular pancreas,which has significant value in prenatal diagnosis of fetal annular pancreas.

15.
Gastroenterol. latinoam ; 35(2): 50-55, 2024. ilus, tab
Article in Spanish | LILACS | ID: biblio-1568098

ABSTRACT

Pancreatoscopy is an advanced endoscopic technique that allows direct observation of the main pancreatic duct, facilitating both diagnosis and treatment of various pancreatic conditions. It enables biopsies and assessment of lesion malignancy. This procedure is performed under deep sedation or anesthesia, with non-steroidal anti- inflammatory drugs recommended for prophylaxis. It is primarily used in diagnosing pancreatic duct strictures and intraductal papillary mucinous neoplasms. Within treatment, its utility is highlighted in intraductal lithotripsy, especially in cases of chronic pancreatitis. The most common adverse effect is acute post-procedural pancreatitis, though estimated in less than 5% of cases. Proper technique, saline administration control, and placement of stents at the end of procedure help minimize complications. Despite being reserved as second-line therapy for pancreatic lithiasis, it offers several advantages over traditional techniques, and it is anticipated that with some advancements in the future, it will become a first-line therapeutic option.


La pancreatoscopia es una técnica endoscópica que permite la observación directa del conducto pancreático prin- cipal, facilitando tanto el diagnóstico como el tratamiento de diversas afecciones pancreáticas. Permite realizar biopsias y evaluar la malignidad de las lesiones. Este procedimiento se realiza bajo sedación profunda o anestesia, y se recomienda la administración de antiinflamatorios no esteroidales en forma de profilaxis. Se utiliza princi- palmente en el diagnóstico de estenosis del conducto pancreático y neoplasias mucinosas papilares intraductales. En el tratamiento, se destaca su utilidad en la litotricia intraductal, especialmente en casos de pancreatitis crónica. El efecto adverso más común es la pancreatitis aguda posprocedimental, aunque se estima en menos del 5% de los casos. Una adecuada técnica, control del suero y la colocación de prótesis al final del procedimiento ayudan a minimizar las complicaciones. A pesar de reservarse como segunda línea en el tratamiento de litiasis pancreáti- cas, presenta diversas ventajas sobre técnicas tradicionales, y se espera que con algunos avances en un futuro se convierta en una opción de primera línea terapéutica.


Subject(s)
Humans , Pancreatic Diseases/therapy , Pancreatic Ducts/surgery , Endoscopy, Digestive System/methods , Pancreatic Ducts/pathology , Treatment Outcome
16.
Rev. argent. cir ; 115(4): 371-374, dic. 2023. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1559252

ABSTRACT

RESUMEN La incidencia de metástasis pulmonares aisladas en adenocarcinoma ductal de páncreas es aproximadamente del 13%. La resección de estas metástasis es infrecuente; sin embargo, los pacientes que se presentan únicamente con metástasis pulmonares tienen una mejor supervivencia comparadas con otras localizaciones. Presentamos el caso de una paciente a quien se le realizó una lobectomía pulmonar por metástasis de adenocarcinoma ductal de páncreas. Luego de la resección, el período libre de recurrencia y la supervivencia libre de enfermedad específica fueron de 84 y 152 meses, respectivamente. Consideramos que el siguiente paso en el tratamiento de esta subpoblación es poder seleccionar a los pacientes con una biología tumoral favorable y que una estrategia de tratamiento enérgica estaría justificada.


ABSTRACT The incidence of isolated pulmonary metastases in pancreatic ductal adenocarcinoma is about 13%. Resection of these metastases is uncommon; however, patients presenting only with pulmonary metastases have better survival compared to those with metastases on other locations. We report the case of a female patient who underwent lobectomy for metastases from pancreatic ductal adenocarcinoma. After resection, disease-free interval and specific diseases-free survival were 84 and 152 moths, respectively. We consider that the next step in the treatment of this subpopulation of patients is to select those patients with favorable tumor biology who would benefit from a more aggressive approach.

17.
Medisur ; 21(6)dic. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1550566

ABSTRACT

Las neoplasias endocrinas múltiples engloban una serie de síndromes caracterizados por su origen genético y la afectación de una o más glándulas. Se describe el caso de un paciente masculino, de 23 años, con antecedentes de salud de nesidioblastosis diagnosticado a los 16 años de edad, quien acudió al Hospital General Docente Ambato por presentar convulsiones tónico clónicas, e hipoglucemia severa con posterior estatus epiléptico. Los estudios de laboratorio mostraron hiperparatiroidismo primario, y los de imagen identificaron lesiones sugerentes de adenoma paratiroideo e insulinoma de cabeza de páncreas. Después de analizar el caso, se identificaron dos criterios para plantear una neoplasia endocrina múltiple tipo 1: presencia de insulinoma e hiperparatiroidismo primario. Además de tratamiento con bifosfonato, se planificó interconsulta con el servicio de Genética, para estudio del paciente y familiares; y con Cirugía General, para programación de resolución quirúrgica. Debido a la poca frecuencia de esta enfermedad, resulta de interés describir el caso, con el objetivo de exponer las principales manifestaciones clínicas y conducta a seguir. Constituye una prioridad el diagnóstico de su causa en cada paciente.


Multiple endocrine neoplasias encompass a series of syndromes characterized by their genetic origin and the involvement of one or more glands. A 23-years-old male patient with a health history of nesidioblastosis diagnosed at 16 years of age, who attended the Ambato General Teaching Hospital with tonic-clonic seizures and severe hypoglycemia with subsequent epileptic status, is described. Laboratory studies showed primary hyperparathyroidism, and imaging identified lesions suggestive of parathyroid adenoma and insulinoma of the head of the pancreas. After analyzing the case, two criteria were identified to suggest multiple endocrine neoplasia type 1: presence of insulinoma and primary hyperparathyroidism. In addition to treatment with bisphosphonate, consultation with the Genetics service was planned for study of the patient and family members; and with General Surgery, for scheduling surgical resolution. Due to the infrequency of this disease, it is of interest to describe the case, with the aim of exposing the main clinical manifestations and conduct to follow. Diagnosing its cause in each patient is a priority.

18.
Rev. cir. (Impr.) ; 75(6)dic. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1535658

ABSTRACT

Introducción: El cáncer de páncreas (CP) tiene un pronóstico ominoso a pesar de los avances en técnica quirúrgica y en los cuidados peri/postoperatorios. Nuestro objetivo fue identificar factores asociados a mayor sobrevida en pacientes con CP tratados mediante pancreatoduodenectomía (PD). Material y Método: Estudio de casos y controles de pacientes con CP tratados mediante PD en el Hospital Clínico de la Universidad Católica entre 2002-2015. Se definió como caso al paciente con sobrevida ≥ 3 años y como control a aquel con sobrevida inferior a ese plazo. Se comparó entre casos y controles datos biodemográficos, clínicos, histopatológicos, de morbilidad y mortalidad mediante regresión logística. Resultados: Se analizaron 70 pacientes, con una edad media de 62 ± 11 años; 40 (57%) mujeres. Hubo morbilidad en 26 enfermos (37,1%); Clavien-Dindo ≥ Illa en 8 (11,4%). La mediana (rango) de días de hospitalización fue 12 (7-84). La sobrevida actuarial a 1, 3 y 5 años fue 77%, 32% y 22% respectivamente. Se identificaron 21 casos (30%) y 49 controles (70%). En el análisis univariable, la resección R0, los ganglios regionales negativos, la ausencia de infiltración perineural, los estadios más precoces (IA, IB y IIA) y la ausencia de diabetes mellitus (DM2) al momento del diagnóstico, fueron variables asociadas a sobrevida ≥ 3 años (p 100 U/mL) y los tratamientos complementarios no se asociaron a diferencias significativas en sobrevida. En el análisis multivariable, se identificó la ausencia de DM2 (OR ajustado: 12; IC95% 1,7-84,3), la ausencia de infiltración perineural (OR ajustado: 7; IC95% 1,3-36,3) y los estadios precoces IA, IB y IIA (OR ajustado: 10,3; IC95% 2,1-49,1) como los factores independientes asociados a sobrevida mayor a 3 años. Conclusión: Los pacientes no diabéticos, con etapas precoces del CP sin infiltración perineural, resecados R0 mediante PD pueden obtener una sobrevida mayor a 3 años.


Introduction: Pancreatic cancer (PC) remains one of the most lethal malignancies, despite developments in surgical and non-surgical therapies. Significant improvements in long-term survival have not been achieved. Only radical surgical resection has obtained a moderate extension in survival. We aim to identify factors associated with longer survival in patients with PC treated by pancreatoduodenectomy (PD). Material and Method: We designed a case-control study of patients with PC treated by PD in our center between 2002-2015. We compare patients who survived ≥ 3 years (case) with those not achieving it (control). Bio-demographic, clinical, histopathological, morbidity and mortality data were compared between cases and controls using logistic regression. Results: Seventy patients were analyzed; mean age 62 ± 11 years; 40 (57%) women. Morbidity was found in 26 patients (37.1%); Clavien-Dindo ≥ Illa in 8 (11.4%). The median (range) of hospitalization days was 12 (7-84). The actuarial 1, 3, and 5 years survival was 77%, 32%, and 22%, respectively, for the entire series. Twenty-one cases (30%), and 49 controls (70%) were identified. In the univariate analysis, R0 resection, negative regional lymph nodes, the absence of perineural infiltration, the earliest stages (IA, IB, and IIA) and the absence of diabetes mellitus (DM) at time of diagnosis were variables associated with survival ≥ 3 years (p 100 U / mL), and neo/adjuvant treatments, did not significantly show differences in survival. In the multivariate analysis, no DM at diagnosis (adjusted OR: 12; 95% CI 1.7 - 84.3), no perineural infiltration (adjusted OR: 7; 95% CI 1.3 - 36.3) and early stages IA, IB, and IIA (adjusted OR: 10.3; 95% CI 2.1 - 49.1) were identified as independent factors associated with survival > 3 years. Conclusion: Nondiabetic patients with early stages PC without perineural infiltration, resected R0 by PD can achieve survival over 3 years.

19.
Article | IMSEAR | ID: sea-233690

ABSTRACT

Disseminated tuberculosis (TB) refers to concurrent involvement of at least two non-contiguous organ sites of the body, or involvement of the blood or bone marrow by tuberculosis process. Pancreatic TB is a rare manifestation of such a common disease possibly due to protective pancreatic enzymes. We described a case report of a patient who presented with chronic pancreatitis with pancreatic pseudocyst with empyema of left lung which intraoperatively was a psoas abscess which was managed by drainage of the abscess and Intercostal tube placement and thoracoscopic drainage of empyema and its adhesiolysis. Histopathology revealed tuberculous granulation tissue of psoas muscle biopsy and in thoracoscopic scrapings. Patient became symptomless since the surgery and initiation of anti-tubercular therapy.

20.
Rev. medica electron ; 45(5)oct. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1522055

ABSTRACT

Introducción: Los tumores malignos ubicados en la región periampular pueden ser: ampular, biliar, pancreático o duodenal, y constituyen un problema de salud por su alta mortalidad. En su etiopatogenia se involucran múltiples factores de riesgo, cuyo comportamiento clínico y epidemiológico se desconoce en la población matancera. Objetivo: Determinar el comportamiento clínico y epidemiológico de los tumores periampulares malignos. Materiales y métodos: Se realizó un estudio descriptivo, prospectivo en 34 pacientes con diagnóstico de tumores periampulares malignos, atendidos en el Servicio de Gastroenterología del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, de enero a diciembre de 2021. Se estudiaron variables como: grupos de edad, sexo, factores de riesgo y antecedentes patológicos personales, tiempo de evolución de los síntomas y localización del tumor. Los resultados fueron recogidos en una planilla de recolección de datos. Resultados: Predominó el sexo masculino y el grupo de 50 a 69 años. Los factores de riesgo más frecuentes fueron el consumo de café, tabaquismo y diabetes mellitus. El íctero fue el síntoma más frecuente. La mayoría de los pacientes iniciaron los síntomas de 1 a 3 meses antes del diagnóstico. El cáncer de páncreas fue el más frecuente. Conclusiones: Los tumores periampulares predominaron en la población mayor de 50 años. Los hábitos tóxicos fueron los factores de riesgo más frecuentes. El cáncer de páncreas tuvo mayor incidencia. El comportamiento clínico estuvo relacionado con la localización de la lesión, el tiempo de evolución de los síntomas, y los factores de riesgo que predominaron.


Introduction: Malignant tumors located in the periampullary region can be ampullary, biliary, pancreatic or duodenal and are a health problem due to their high mortality. Their etio-pathogenesis involves many risk factors, whose clinic and epidemiological behavior is unknown by the population of Matanzas. Objective: To determine the clinical-epidemiological behavior of malignant periampullary tumors. Materials and methods: A descriptive, prospective study was conducted in 34 patients with diagnosis of malignant periampullary tumors, treated in the Gastroenterology Service of the Clinical-Surgery University Hospital Comandante Faustino Perez Hernandez, of Matanzas, from January to December 2021. Variables such as age group, sex, risk factors and personal pathological history, time of evolution of symptoms and tumor location were studied. The results were collected in a data collection form. Results: Male sex and the 50-69 years age group predominated. The most frequent risk factors were coffee consumption, smoking and diabetes mellitus. Jaundice was the most frequent symptom. Most of the patients started symptoms one to three months before the diagnosis. Pancreatic cancer was the most frequent. Conclusions: Periampullary tumors predominated in the population older than 50 years. Toxic habits were the most common risk factors. Pancreatic cancer had a higher incidence. Clinical behavior was related to the location of the lesion, the time of evolution of the symptoms, and the risk factors that predominated.

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