Hemorragia digestiva alta por páncreas ectópico: A propósito de un caso / Hemorragia digestiva alta por páncreas ectópico: A propósito de un caso

Introducción: El coristoma pancreático o páncreas ectópico es la presencia de tejido pancreático fuera de la localización anatómica del páncreas. Es una patología rara que puede presentarse en cualquier localización del tracto gastrointestinal, mayormente es asintomático, pero puede manifestarse como inflamación, hemorragia, obstrucción y cambios neoplásicos. Reporte de caso: Presentamos un paciente varón de 27 años, procedente de Cajamarca, con antecedente desde los 12 años de úlcera péptica, que ingresa con cuadro de hemorragia digestiva y descompensación hemodinámica, con evidencia endoscópica de tumoración duodenal y estudio histopatológico posterior de páncreas ectópico. Conclusiones: El páncreas ectópico es una entidad rara, siendo el estómago y el intestino las ubicaciones más frecuentes; su hallazgo es incidental, a menos que se complique con hemorragia gastrointestinal, inflamación o malignización. En nuestro caso la ubicación fue duodenal, con presentación hemorrágica, que requirió tratamiento endoscópico y posteriormente quirúrgico.(AU)

Introduction: The pancreatic choristoma or ectopic pancreas is the presence of pancreatic tissue outside the anatomic location of the pancreas. It is a rare pathology that can occur in any location of the gastrointestinal tract, it is mostly asymptomatic, but it can manifest as inflammation, bleeding, obstruction and neoplastic changes. Case report: Present a 27-year-old patient from Cajamarca, with a 12-year history of peptic ulcer, presenting with symptoms of gastrointestinal hemorrhage and hemodynamic decompensation, with endoscopic evidence of duodenal tumor and subsequent histopathological study of ectopic pancreas. Conclusions: The ectopic pancreas is a rare entity, being the stomach and intestine the most frequent; Its finding is incidental, unless complicated by bleeding, inflammation or malignancy. In our case, the location was duodenal, with hemorrhagic presentation, which required endoscopic and later surgical treatment. (AU)

Impact of Temperature on Porcine Liver Machine Perfusion From Donors After Cardiac Death.

Normothermic machine perfusion (NMP) has been introduced as a promising technology to preserve and possibly repair marginal liver grafts. The aim of this study was to compare the effect of temperature on the preservation of donation after cardiac death (DCD) liver grafts in an ex vivo perfusion model after NMP (38.5°C) and subnormothermic machine perfusion (SNMP, 21°C) with a control group preserved by cold storage (CS, 4°C). Fifteen porcine livers with 60 min of warm ischemia were preserved for 10 h by NMP, SNMP or CS (n = 5/group). After the preservation phase all livers were reperfused for 24 h in an isolated perfusion system with whole blood at 38.5°C to simulate transplantation. At the end of transplant simulation, the NMP group showed significantly lower hepatocellular enzyme level (AST: 277 ± 69 U/L; ALT: 22 ± 2 U/L; P < 0.03) compared to both SNMP (AST: 3243 ± 1048 U/L; ALT: 127 ± 70 U/L) and CS (AST: 3150 ± 1546 U/L; ALT: 185 ± 97 U/L). There was no significant difference between SNMP and CS. Bile production was significantly higher in the NMP group (219 ± 43 mL; P < 0.01) compared to both SNMP (49 ± 84 mL) and CS (12 ± 16 mL) with no significant difference between the latter two groups. Histologically, the NMP livers showed preserved cellular architecture compared to the SNMP and CS groups. NMP was able to recover DCD livers showing superior hepatocellular integrity, biliary function, and microcirculation compared to SNMP and CS. SNMP showed some significant benefit over CS, yet has not shown any advantage over NMP.

Ex vivo normothermic machine perfusion is safe, simple, and reliable: results from a large animal model.

INTRODUCTION: Normothermic machine perfusion (NMP) is an emerging preservation modality that holds the potential to prevent the injury associated with low temperature and to promote organ repair that follows ischemic cell damage. While several animal studies have showed its superiority over cold storage (CS), minimal studies in the literature have focused on safety, feasibility, and reliability of this technology, which represent key factors in its implementation into clinical practice. The aim of the present study is to report safety and performance data on NMP of DCD porcine livers. MATERIALS AND METHODS: After 60 minutes of warm ischemia time, 20 pig livers were preserved using either NMP (n = 15; physiologic perfusion temperature) or CS group (n = 5) for a preservation time of 10 hours. Livers were then tested on a transplant simulation model for 24 hours. Machine safety was assessed by measuring system failure events, the ability to monitor perfusion parameters, sterility, and vessel integrity. The ability of the machine to preserve injured organs was assessed by liver function tests, hemodynamic parameters, and histology. RESULTS: No system failures were recorded. Target hemodynamic parameters were easily achieved and vascular complications were not encountered. Liver function parameters as well as histology showed significant differences between the 2 groups, with NMP livers showing preserved liver function and histological architecture, while CS livers presenting postreperfusion parameters consistent with unrecoverable cell injury. CONCLUSION: Our study shows that NMP is safe, reliable, and provides superior graft preservation compared to CS in our DCD porcine model.

Sanguineous normothermic machine perfusion improves hemodynamics and biliary epithelial regeneration in donation after cardiac death porcine livers.

The effects of normothermic machine perfusion (NMP) on the postreperfusion hemodynamics and extrahepatic biliary duct histology of donation after cardiac death (DCD) livers after transplantation have not been addressed thoroughly and represent the objective of this study. Ten livers (5 per group) with 60 minutes of warm ischemia were preserved via cold storage (CS) or sanguineous NMP for 10 hours, and then they were reperfused for 24 hours with whole blood in an isolated perfusion system to simulate transplantation. In our experiment, the arterial and portal vein flows were stable in the NMP group during the entire reperfusion simulation, whereas they decreased dramatically in the CS group after 16 hours of reperfusion (P < 0.05); these findings were consistent with severe parenchymal injury. Similarly, significant differences existed between the CS and NMP groups with respect to the release of hepatocellular enzymes, the volume of bile produced, and the levels of enzymes released into bile (P < 0.05). According to histology, CS livers presented with diffuse hepatocyte congestion, necrosis, intraparenchymal hemorrhaging, denudated biliary epithelium, and submucosal bile duct necrosis, whereas NMP livers showed very mild injury to the liver parenchyma and biliary architecture. Most importantly, Ki-67 staining in extrahepatic bile ducts showed biliary epithelial regeneration. In conclusion, our findings advance the knowledge of the postreperfusion events that characterize DCD livers and suggest NMP as a beneficial preservation modality that is able to improve biliary regeneration after a major ischemic event and may prevent the development of ischemic cholangiopathy in the setting of clinical transplantation.

Role of vasodilation during normothermic machine perfusion of DCD porcine livers.

INTRODUCTION: Normothermic machine perfusion (NMP) of the liver is a promising preservation modality that holds the potential to better preserve and even repair marginal grafts. In spite of several literature studies showing the benefits of NMP over cold storage, there is paucity of data regarding the mechanisms involved in the optimization of the microcirculation during preservation of these organs. We present our data on the impact of different vasodilators on DCD porcine livers preserved with NMP. MATERIALS AND METHODS: Livers from 15 female Yorkshire pigs (30-40 kg) were subjected to 60 min of WIT followed by 10 h of NMP. Group PC (n = 5) received a prostacyclin analog (epoprostenol sodium) and the AD group (n = 5) received adenosine, whereas group WV (n = 5) was perfused without using any vasodilator. Liver function was assessed by measuring, liver enzyme levels, bile production rate, and histological analysis. RESULTS: At the end of perfusion, the PC group showed significantly lower AST (583 ± 62 vs. 2471 ± 745 and 2547 ± 690 IU/dl), ALT (41 ± 3 vs. 143 ± 28 and 111 ± 25 IU/dl) and LDH (840 ± 85 vs. 2756 ± 408 and 4153 ± 1569 IU/dl) levels compared to the AD and WV groups respectively (p<0.05). Bile production was significantly higher in the PC group compared to the AD group and WV, respectively (95 ± 9 vs. 37 ± 10 and 45 ± 18ml) (p<0.05). Histological samples of the PC group showed preserved hepatic architecture while those of the AD group and WV showed sinusoidal dilatation, architectural distortion, and profuse intraparenchymal hemorrhage. CONCLUSIONS: Maintenance of optimal microcirculatory homeostasis using proper vasodilators is a key factor in NMP of DCD livers.