A rare case of ulcerative colitis with diffuse parenchymal lung disease, spontaneous pneumomediastinum and subcutaneous emphysema.

A 50-year-old male, a tobacco smoker, who was known to have ulcerative colitis presented with dry cough, chest pain, dysponea and frequent passage of blood and mucous mixed stools. Physical examination revealed clubbing, subcutaneous emphysema of upper chest and auscultatory findings of crunching sound over pre-cordial area and basal crepitations. Spirometry was suggestive of restrictive pattern. High resolution computed tomography (HRCT) of thorax revealed pneumomediastinum, subcutaneous emphysema, bilateral diffuse centrilobular nodules and ground-glass haziness with mosaic pattern along with posterior basal fibrotic changes. The present case documents the uncommon pulmonary involvement of spontaneous pneumomediastinum and subcutaneous emphysema diffuse parenchymal lung disease, in a patient with ulcerative colitis.

Does preoperative biliary stenting affect the outcome of pancreatico-duodenectomy?

BACKGROUND: Controversy exists whether preoperative endoscopic biliary stenting to reduce serum bilirubin level affects the outcome of pancreaticoduodenectomy. AIM: To determine whether preoperative endoscopic biliary stenting is associated with altered morbidity or mortality after pancreaticoduodenectomy. METHODS: In 37 consecutive patients with periampullary lesion undergoing pancreaticoduodenectomy over a 6-year period, frequency of septic complications, occurrence of pancreatic leak or bleeding, duration of hospital stay, and mortality were studied; of these, 15 had preoperative biliary stenting and 22 had not. RESULTS: Postoperative infective complications occurred more often in the patients with biliary stent than in those without (26% vs 0%, p=0.04). Postoperative recovery time, hospital stay and mortality were similar in the two groups. CONCLUSION: Preoperative biliary stenting is associated with septic complications, but this does not affect postoperative recovery after pancreaticoduodenectomy.