ABSTRACT
CONTEXT: Local resection of the pancreatic head with longitudinal pancreaticojejunostomy (or Frey procedure) generally results in excellent pain relief in chronic pancreatitis. We report a patient with chronic pancreatitis who experienced pain recurrence after an uneventful longitudinal pancreaticojejunostomy. CASE REPORT: This is a single case study of a 58-year-old female with chronic pancreatitis undergoing longitudinal pancreaticojejunostomy for pain relief. Fifteen months after the surgery, the patient experienced pain recurrence. Radiologic evaluation followed by surgical exploration revealed a gastroenteric fistula to the Roux-limb, with obliteration of the anastomosis. After repair of the fistula and re-excavation of the pancreatic head, a two-layer longitudinal pancreaticojejunostomy was reconstructed from the same Roux-limb. An omental flap was interposed between the Roux limb and the repaired stomach. At 6-month follow-up, the patient was pain free and asymptomatic. CONCLUSION: Late failure of the Frey procedure due to a gastroenteric fistula to the Roux-limb of jejunum has not been previously reported. This finding may explain one of the causes of longitudinal pancreaticojejunostomy late failure.
Subject(s)
Intestinal Fistula/diagnosis , Pancreaticojejunostomy/methods , Postoperative Complications/diagnosis , Female , Humans , Intestinal Fistula/etiology , Intestinal Fistula/surgery , Middle Aged , Pain/etiology , Pancreaticojejunostomy/adverse effects , Pancreatitis, Chronic/surgery , Postoperative Complications/etiology , Postoperative Complications/surgery , Recurrence , Time FactorsABSTRACT
Obstruction of the retinal arterial system is most commonly associated with elderly patient populations. The major etiologic factor in adults has been attributed to emboli from atherosclerotic vascular disease of the carotid arteries, with about 75% of patients over the age of 40 years demonstrating this finding. Conversely, arterial obstruction in young patients is rarely secondary to atheromatous disease and has a variety of causative factors.(1) We describe an unusual case of a previously healthy 8-year-old boy who developed a unilateral central retinal artery occlusion in conjunction with marked optic disc edema. The etiology of these pathologic lesions was attributed to a viral-like syndrome. Vision rapidly deteriorated to no light perception and remained unchanged despite treatment.
