[Emergency pancreatoduodenectomy for severe iatrogenic duodenal injury--case report]. / Duodenopancreatectomie cefalica în urgenta într-un caz de leziune iatrogena severa a duodenului--prezentare de caz.

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

[Periampullar diverticulum--related to bilio-pancreatic disorders]. / Diverticulul duodenal periampular--implicatii in patologia bilio-pancreatica.

UNLABELLED: Periampullar diverticulum (PAD) represent a particular type of duodenal diverticulum, with important pathological effect on the functionality of both the billiary tree and the pancreas. In our retrospective, randomised study, we analised 204 patients who underwent ERCP. We diagnosed 34 PAD (17%). We performed the endoscopic procedure for several pathological conditions of the biliary tract (cholestasis, jaundice, angiocolitis). Most DPA were identified in patients over 60 years (80%), beeing slightly more frequent in males (59%). We found in 25% of patients (over 65 years) with bile duct stones at least one PAD. Over 50% of patients with PAD had bile duct stones. Fibrous, obstructive papillo-odditis was found in 37% of patients with PAD. CONCLUSIONS: 1. PAD are related to bilio-pancreatic disorders, especially to bile duct stones. 2. The most common physio-pathological mechanism is a alteration of the bile flow, due to angulation, compression and/or obstruction of the final part of the bile duct and Wirsung duct, followed by secondary upper stasis. 3. Papillosphincterotomy has technical particularities, because of difficulties in incision orientation (a deformed papilla, with modified anatomical relationships, being situated profound inside the diverticulum cavity). Sphincterotomy depth was limited, which lead to less succesfull extraction of bile stones (89%, compared to the control group 92%). 4. We did not encounter major accidents. Secondary acute pancreatitis after ERCP was similar in both study groups. There was no significant difference in morbidity and mortality rates in both groups.

[Voluminous complicated epigastric hernia]. / Hernia epigastrica voluminoasa complicata.

Epigastric hernia, apparently minor injury, neglected can reach impressive sizes, with major un-esthetic effect. In an unfavorable clinically context (morbid obesity, chronic respiratory failure, ground cancer, diabetes, heart failure) complications occur (incarceration, strangulation) with a complex picture. We present three clinical observations, including a low occlusion by fixed transverse colon necrosis in a strangulated epigastric hernia with pyo-stercoral phlegmon.