Retrograde Pancreatic Duct Stent Migration into the Biliary Tract Presenting as a Rare Early Complication of Pancreaticoduodenectomy (Whipple Procedure).

BACKGROUND Pancreaticoduodenectomy (Whipple procedure) is an established surgical procedure for the treatment of carcinoma of the head of the pancreas. Modifications to this procedure include gastropancreaticoduodenectomy, which includes the removal of parts of the pancreas, duodenum, and stomach. Complications of surgery include fistula formation, failure of the anastomosis, and leak of pancreatic enzymes, which can be reduced by stenting the pancreatic duct. This report is of a rare complication of pancreaticoduodenectomy and describes a case of retrograde migration of a pancreatic duct stent into the biliary tract through the orifice of the hepaticojejunostomy. CASE REPORT A 50-year-old man with a history of gastric cancer, underwent gastropancreaticoduodenectomy. Surgery was complicated by displacement of the pancreatic stent to the biliary system, which resulted in postoperative obstructive jaundice and bile leakage from the hepaticojejunostomy between the hepatic duct and the jejunum. An endoscopy was performed and the stent was successfully retrieved. The patient recovered rapidly, the bile leakage resolved, the patient's jaundice resolved, and was discharged home with no further surgical complications. CONCLUSIONS A case is reported of a rare early complication of pancreaticoduodenectomy in a patient with gastric cancer. Endoscopy successfully retrieved the pancreatic duct stent that had migrated into the biliary tract through the orifice of the hepaticojejunostomy.

Ultrasound guided sparing resection of locally recurrent abdominal wall desmoid tumor.

Desmoid tumors are uncommon benign tumors with locally aggressive behavior. Even with aggressive resection with or without radiotherapy, the relapse rate is relatively high. Surgical resection can be challenging especially in large size tumors, as the resultant post-operative wide wall defect can lead to cosmetically undesirable bulging and functional loss. The use of Ultrasound may be useful to aid in radical resection of the desmoid tumor with adequate margins. In our 30-year-old patient with recurrent abdominal wall desmoid tumor, intra-operative ultrasound was utilized in successful resection of the tumor followed by a minimal but adequate margin. The patient has recovered well and within the 6 months follow-up period and has not reported any functional limitations or recurrence.

Secondary Omental Infarction in a Patient with a Hypercoagulable State.

Omental infarction is a rare cause of acute and non-specific abdominal pain. We report a case of a 46-year-old man who presented to the emergency room with right upper quadrant cramping pain that was of sudden onset. The patient's presentation was later diagnosed as an omental infarction, by an abdominal CT. After extensive work-up, it was revealed that the cause of the patient's omental infarction was secondary to a hypercoagulable state caused by antiphospholipid syndrome, based on his thrombophilia work-up. The patient was successfully managed conservatively and was started on lifelong anticoagulation. The patient was followed up with an abdominal CT after 2 months into therapy, which showed a decrease in the size of the omental infarction and a significant improvement in his state.