ABSTRACT
A 59-year-old woman was referred for investigation of a pancreatic cystic lesion. Computed tomography revealed a well-demarcated, multilocular cyst, approximately 4 cm in size, at the pancreas head. Endoscopic ultrasonography demonstrated honeycomb-like components at the cyst margin. The cyst was associated with a widely-dilated upstream main pancreatic duct (MPD). Endoscopic retrograde pancreatography demonstrated a communication between the stenotic Santorini's duct and the cyst. Aspiration cytology from the cyst demonstrated clusters of mucinous epithelial neoplasm cells. Branch-type intraductal papillary mucinous neoplasm, possibly invading to the MPD, was suspected and pancreatoduodenectomy was performed. Surprisingly, pathology of the resected pancreas showed mixed-type serous cystadenoma.
Subject(s)
Cholestasis/pathology , Cystadenoma, Serous/pathology , Pancreatic Cyst/pathology , Pancreatic Ducts/pathology , Pancreatic Neoplasms/pathology , Biopsy , Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Cholestasis/diagnostic imaging , Cholestasis/surgery , Constriction, Pathologic , Cystadenoma, Serous/diagnostic imaging , Cystadenoma, Serous/surgery , Dilatation, Pathologic , Endosonography , Female , Humans , Middle Aged , Pancreatic Cyst/therapy , Pancreatic Ducts/diagnostic imaging , Pancreatic Ducts/surgery , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Tomography, X-Ray ComputedABSTRACT
Acute pancreatitis after esophagectomy is a very rare but fatal complication. This case report describes a 74-year-old man diagnosed with cT2N0M0, cStage IB esophageal squamous cell carcinoma (Union for International Cancer Control, seventh edition). On the basis of the patient's condition, it was decided that he should undergo esophagectomy without thoracotomy. The patient developed pyrexia 3 days after the operation. Chest and abdominal computed tomography revealed severe acute pancreatitis and gastric tube necrosis; therefore, gastrectomy was performed. Subsequent surgical exploration indicated pancreatic necrosis that was diagnosed as acute necrotic pancreatitis. Postoperative management of acute pancreatitis and the general condition of the patient were quite challenging, and rapid deterioration of the respiratory status was observed. The patient experienced multiple organ failure and died 57 days after the second surgery (60 days after the first surgery). This is a report of a patient with acute necrotic pancreatitis after esophagectomy.
ABSTRACT
Dissecting hepatic artery aneurysm caused by an isolated spontaneous celiac artery dissection is a life-threatening condition with only 5 cases reported previously. We report a successful resection and revascularization of all affected arteries with an inferior mesenteric vein graft in a 59-year-old asymptomatic man with a large dissecting common and proper hepatic artery aneurysm (diameter, 4.2 cm) due to a spontaneous dissection from the celiac trunk to the proximal splenic artery and the right hepatic artery. Our case suggests that intervention should not be delayed in cases of hepatic aneurysm and a long dissection extending to the proper hepatic artery because of the difficulty in restoring hepatic circulation and preventing rupture.
