ABSTRACT
We present the case of a male patient admitted for high flow biliary fistula (> 2000 ml/24h) as a consequence of a prior right nephrectomy by lumbar approach. The patient was operated after the failure of the medical conservative treatment and continous declining medical status. We noted the complete absence of the gastric antrum, duodenum I and II with the intraperitomeal direct display and opening of the Vater papilla, witch was difficult to identify unless common bile duct (CBD) was catheterized by supraduodenal choledocotomy. We performed emergency pancreatoduodenectomy with a good postoperative outcome , excepting a residual postnephrectomy abscess, witch was consequently evacuated and drained. The patient left the clinic 28 days postoperatively. The two years after follow up notes that the patient is in a good condition
Subject(s)
Abdominal Abscess/etiology , Abdominal Abscess/surgery , Biliary Fistula/surgery , Duodenum/injuries , Emergency Treatment/methods , Iatrogenic Disease , Nephrectomy/adverse effects , Pancreaticoduodenectomy , Adult , Biliary Fistula/etiology , Follow-Up Studies , Humans , Male , Treatment OutcomeABSTRACT
Carcinoid tumors of the duodenum are extremely rare. We present two cases (observation) of duodenal carcinoid tumors. The main clinical manifestation in both cases was upper GI tract hemorrhage associated to severe anemia.The tumors were high dimension (2.5 cm and 6.5 cm respectively) and were discovered by upper GI endoscopy. First observation presented a lymph node metastasis and the second one a massive invasion of the pancreas. In both cases the diagnosis was precised only postoperatively, through histological and immunohistochemical analisys. In the first observation we performed local transduodenal resection and in the second one cephalic duodenopancreatectomy. After six months we had a reintervention at the first case for a retroduodenal carcinoid tumoral reoccurrence--extirpation completed with total gastrectomy for neuroendocrine carcinoma. Despite the locoregional aspect of advanced evolution of the disease, the long-term evolution of the patient was satisfactory. Both patients are alive 42 months respectively 15 months after the operation. Carcinoid tumors of the duodenum are indolent and their impact on survival is uncertain.
