Abordaje percutáneo transgástrico en la disrupción ductal del páncreas: serie de casos / Percutaneous transgastric approach in pancreatic ductal disruption: Case series

Resumen Se presentan 6 pacientes con disrupción ductal del páncreas (DDP) tratados mediante drenaje percutáneo guiado por imágenes con apoyo de la endoscopia. Inicialmente, los pacientes presentaron necrosis pancreática infectada tratada con drenaje percutáneo transgástrico y luego de resolver la infección desarrollaron DDP. En el estudio por imágenes se diagnosticaron 4 pacientes con disrupción ductal parcial y 2 con disrupción total, a quienes se les indicó la colocación de una prótesis transgástrica percutánea para lograr el drenaje del líquido pancreático hacia el estómago. La duración promedio de la prótesis fue de 183 días; no hubo casos de mortalidad. Se pudo evidenciar que esta opción terapéutica mínimamente invasiva tiene baja morbimortalidad, por lo que se plantea el abordaje percutáneo transgástrico apoyado por la endoscopia como posible tratamiento de la DDP.

Abstract A total of six patients with pancreatic ductal disruption (PDD), treated with image-guided endoscopy percutaneous drainage were enrolled. Initially, patients had infected pancreatic necrosis, treated with transgastric percutaneous drainage, and after the infection was controlled, they developed PDD. In the imaging study process, four patients were diagnosed with partial duct disruption and two patients with complete duct disruption. In both cases the placement of a percutaneous transgastric prosthesis to drain the pancreatic fluids to the stomach was indicated. The prosthesis remained 183 days on average and there were no mortality cases. This therapeutic minimally invasive alternative has low rates of morbimortality and thus, the endoscopy percutaneous transgastric approach is considered as a viable treatment in PPD.

Variantes anatómicas de la vía biliar derecha y de la trayectoria del ducto pancreático en una cohorte de 1159 pacientes / Anatomical variants of the right bile duct and the path of the pancreatic duct in a cohort of 1159 patients

La Colangiopancreatografia por Resonancia Magnética (CPMR), es la modalidad de elección para la evaluación no invasiva del tracto biliar. La identificación incorrecta de la anatomía biliar puede resultar en complicaciones perioperatorias y posquirúrgicas. Las anomalías congénitas y las variantes anatómicas del conducto pancreático no se detectan hasta la edad adulta y se descubren a menudo en pacientes asintomáticos. El objetivo de este estudio fue la evaluación de la frecuencia de variantes anatómicas de la vía biliar derecha y trayectoria del conducto pancreático usando CPRM. Materiales y Métodos. Se realizó un estudio descriptivo, retrospectivo de corte transversal de 1159 pacientes, entre los meses de febrero del 2017 hasta mayo del año 2018 del Hospital Carlos Andrade Marín, los pacientes incluidos son aquellos que se sometieron a estudios de CPRM para valoración de la vía biliar tanto para patologías neoplásicas y no neoplásicas gastrointestinales. Resultados: El 54,6% de pacientes presenta una anatomía del árbol biliar normal catalogada como variante tipo 1, el conducto pancreático sigmoide se identificó con mayor frecuencia.

Magnetic Resonance Cholangiopancreatography (MRCP) is the modality of choice for the non-invasive evaluation of the biliary tract. Incorrect identification of the biliary anatomy can result in perioperative, and postoperative complications. Congenital anomalies and anatomical variants of the pancreatic duct are not detected until adulthood and are often discovered in asymptomatic patients. The objective of this study was to evaluate the frequency of the anatomical variants of the right bile duct and the trajectory of the pancreatic duct using MRCP. Materials and methods: A descriptive, retrospective, cross-sectional study of 1159 patients was carried out between February 2017 and May 2018 of the Carlos Andrade Marín Hospital, including patients who underwent MRCP studies for the assessment of the bile duct for neoplastic and non-neoplastic gastrointestinal pathologies. Results: 54.6% of patients presented an anatomy of the normal biliary tree classified as a type 1 variant; the sigmoid pancreatic duct is more frequently identified.

Emprego da anastomose pancreatojejunal tipo ducto-mucosa sem cateter transanastomótico em pâncreas de consistência mole e ducto fino: experiência inicial do Instituto Nacional de Câncer / Use of duct-to-mucosa nonstented pancreatojejunostomy in soft pancreas and small pancreatic duct: initial experience of the National Cancer Institute-Brazil

OBJETIVO: O objetivo deste trabalho foi relatar a morbimortalidade associada à técnica de reconstrução pancreática utilizando anastomose pancreato-jejunal tipo ducto-mucosa, sem cateter transanastomótico, em pâncreas de consistência mole e ducto de Wirsung menor que três mm. MÉTODOS: Analisamos consecutivamente os resultados de 16 pacientes submetidos à GDP com técnica de anastomose pancreato-jejunal tipo ducto-mucosa no Serviço de Cirurgia Abdômino-pélvica do INCA. Todos pacientes eram portadores de pâncreas de consistência mole e ducto pancreático fino (< 3mm). RESULTADOS: Dos 16 pacientes analisados, oito eram do sexo masculino e com mediana de idade de 55 anos. No período pós-operatório um paciente apresentou fístula pancreática e houve um caso que evoluiu para óbito. CONCLUSÃO: Acreditamos que é possível a realização de anastomose pancreática tipo ducto-mucosa, sem cateter transanastomótico, em pacientes com ducto pancreático menor que três mm sem aumento da morbimortalidade.

BACKGROUND: Our goal is to report the morbimortality associated to the pancreatic reconstruction technique using duct-to-mucosa nonstented pancreatojejunostomy in soft pancreas and Wirsung's duct less than 3 mm. METHODS: We analyzed 16 consecutive patients submitted to DP with duct-to-mucosa pancreatojejunostomy technique in the Service of Abdominal-pelvic Surgery of NCI-Brazil. All patients had soft pancreatic texture and small pancreatic duct (< 3mm). RESULTS: From those 16 patients, eight were males, with an mean age of 55 years old. In the post-operative period one patient developed pancreatic fistula. There had been one death. CONCLUSION: We believe that duct-to-mucosa nonstented pancreatojejunostomy is possible in patients with pancreatic duct less than three mm and soft texture pancreas without increased morbimortality.