ABSTRACT
The embryologic defect that results when the ventral and dorsal anlages of the pancreas do not fuse has been referred to as pancreas divisum. The patients who present with recurrent pancreatitis or pancreatitis-like pain in association with pancreas divisum should be investigated to determine the presence of minor papilla stenosis. In the present study of 11 patients, 9 became asymptomatic with surgical decompression of the dorsal pancreatic duct. Two surgical failures were related to wrong diagnosis and restenosis of the sphincteroplasty. A delay in the clearance of dye from the dorsal pancreatic duct after endoscopic retrograde cholangiopancreatography was utilized to determine minor papilla stenosis. In the future, secretin ultrasound tests should prove of value in assessing minor papilla stenosis. Once the diagnosis is made, sphincteroplasty of the minor papilla is the most logical procedure because of the good results obtained. In the present study, pancreaticojejunostomy provided good duct decompression as well.
Subject(s)
Pancreas/abnormalities , Pancreatitis/surgery , Abdomen , Adult , Amylases/blood , Clinical Enzyme Tests , Female , Humans , Male , Middle Aged , Pain/etiology , Pancreas/surgery , Pancreaticojejunostomy , Pancreatitis/diagnosis , Pancreatitis/etiology , Postoperative Complications , RecurrenceABSTRACT
A 78-year-old man had complete dehiscence of the suture line of the aorta to a prosthesis, 8 years after standard repair of an abdominal aortic aneurysm. For 6 months, until the aortic was reconstructed, the patient had no hemorrhage or limb ischemia because a conduit was maintained by the original aneurysm wall which had been wrapped around the prosthesis. The authors believe this is the first report of survival following such dehiscence. They advocate the use of non-absorbable sutures when anastomosing the graft to the aorta and repair rather than resection of abdominal aortic aneurysms.
