ABSTRACT
INTRODUCTION: With the greater availability of imaging exams, the diagnosis of intraductal papillary mucinous neoplasms (IPMNs) has increased recently. However, there are still questions about adequate management approaches for this disease, especially regarding the best therapeutic strategy. The objective is to describe the case of a patient with mixed-type (MT) IPMN successfully treated by a tailored surgical plan that adopted duodenopancreatectomy and imaging to monitor the remaining lesions of the tail and body of the pancreas. PRESENTATION OF CASE: A 65-year-old asymptomatic man underwent ultrasonography of the abdomen and was diagnosed with a cystic tumor, measuring 3.0 × 2.5 cm, located on the head of the pancreas. Magnetic resonance cholangiopancreatography (MRCP) showed dilation of the main pancreatic duct and multiple cystic lesions scattered throughout the entire parenchyma. The patient underwent duodenopancreatectomy; postoperatively, he did not have complications and was discharged on the 6th postoperative day. The histopathological panel confirmed the presence of MT-IPMN of the intestinal pattern. The patient is currently well four years after surgery and is undergoing semiannual MRCP examinations to follow up the remaining lesions. DISCUSSION: MT-IPMNs represent 28-41% of all IPMNs. Among all subtypes, MT-IPMNs are the most challenging in terms of choosing the ideal therapeutic strategy. These lesions are the most difficult to treat because they can be multifocal and compromise different locations of the pancreatic parenchyma. CONCLUSION: MRI findings, Ca19.9 serum level and negative family history of pancreatic neoplasia were indications for the surgical choice for the MT- IPMN presented in this case.
ABSTRACT
Pica é um tipo específico de transtorno alimentar caracterizada pela ingestão persistente de substâncias inadequadas a nutrição e que não fazem parte de uma prática aceita culturalmente. Geralmente ocorrem em crianças, adolescentes e doentes com distúrbios psiquiátricos. O objetivo do presente relato é apresentar homem de 36 anos, usuário de cocaína, em surto psicótico, que procurou atendimento médico em virtude de dor abdominal após ter ingerido objetos metálicos. A radiografia simples do abdômen confirmou a presença de estruturas metálicas no interior do estômago (faca, colher média, dois parafusos de grandes proporções, talhadeira, boca perfuratriz, estilete de uso odontológico e fragmento de serra metálica). A endoscopia digestiva alta revelou a presença dos objetos metálicos na luz do estômago que em virtude das suas características não foram passíveis de remoção endoscópica. Os objetos foram removidos cirurgicamente através de gastrotomia anterior. A recuperação pós-operatória se fez sem intercorrências e o doente encaminhado para acompanhamento psiquiátrico.
Pica is a specific type of alimentary disturbance characterized by the persistent ingestion of substances that are inappropriate for nutrition and do not form part of culturally acceptable practices. It generally occurs among children, adolescents and patientswith psychiatric disturbances. The objective of the present reportis to present here the case of a 36-year-old man who was a cocaine user and had a psychotic attack due to abstinence. He sought medical assistance because of abdominal pain after ingesting metal objects. Simple radiography of the stomach showed the presence of metallic structures inside the stomach (knife, dessert spoon, two large screws, chisel, drill bit, a probe for dental use and a fragment of a metal saw blade). Endoscopy of the upper digestive tract confirmed the presence of the metal objects in the lumen of the stomach. Because of their physical characteristics, they could not be removed by means of endoscopy. The patient was submitted to laparotomy andthe objects were removed by means of anterior gastrotomy of small dimensions. The postoperative recovery took place without intercurrences and the patient was referred for psychiatric follow-up.
