[Duodenal carcinoid]. / Carcinoidul duodenal.

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.

[Pancreas divisum--a rare cause of chronic pancreatitis]. / Pancreas divisum--cauza rara de pancreatita cronica.

Pancreas divisum (P.D.) is a congenital anatomic variant, characterized by the nonunion of dorsal and ventral pancreatic ducts. A 20 years old man followed for 8 years with reccurent abdominal pain and relapsing acute pancreatitis develope chronic calcific pancreatitis. He was diagnosed with P.D. on endoscopic retrograde pancreatography and operative pancreatography. The patient was treated with longitudinal pancreatico-jejunostomy (PUESTOW-GILLESBY procedure). His pain resolved following surgical drainage of the pancreatic duct. Evaluation of the clinical course of this patient and critical review of other such cases in the literature support the role of compromised ductal drainage of the pancreas in the pathogenesis of chronic pancreatitis in P.D.

[Gall bladder carcinoma]. / Carcinomul inaparent al veziculei biliare.

The study comprises a lot of 989 cholecystectomies for gall bladder lithiasis performed in the First Surgery Clinic of the University Emergency Hospital of Bucharest throughout three years and a half (2000-June 2003). Half out of them--493 cases (50%)--were laparoscopic interventions. All of the organ material was submitted to pathological examination. In 4 cases (0.4%), all females, the pathologist surprisingly unveiled the diagnosis of gall bladder carcinoma in the 3rd stage of evolution for all of them. None of the observations presented beforehand or per operative hints suggestive for a malignant affliction. Three patients associated multiple pathology such as acute pancreatitis (obs No2), common bile duct lithiasis (obs No3) and cholecysto-duodenal fistula (obs No4). The postoperative evolution of gall bladder neoplasia of the 4 cases studied was extremely fast, the patients soon being readmitted in our clinic for jaundice, subhepatic tumoral mass and liver metastasis, on average after 31 days after cholecystectomy. That was why the reinterventions were confined to limit at exploratory laparotomies only.

[Ascites--a complication of chronic alcoholic pancreatitis]. / Ascita--complicatie a pancreatitei cronice etanolice.

We present the case a 44 year old patient previously diagnosed with chronic alcoholic pancreatitis with pancreatic ascites during hospitalization in the Gastro-Enterology department. As the conservative therapy performed for 21 days was not effective in diminishing the ascites, the patient was admitted in our Surgical Department and scheduled for surgical intervention. He was operated and we discovered a small dimension cyst (7/4 cm) developed in the body and tail of the pancreas, fistulized in the peritoneal cavity through an outlet positioned below the insertion of the mesocolonum transversum, fairly close to the duodeno-jejunal angle. We executed a cysto-jejunal anastomosis by using the first loop of the jejunum, secured with a politer drainage positioned as in WITZEL technique and drive out in the left upper quadrant. The postoperative evolution of the patient was difficult, but constantly positive. The patient left the hospital 32 days after the intervention. The clinical and ultrasound follow-up after three months were normal.