ABSTRACT
BACKGROUND: Open converted cholecystectomy could occur in patients who planned for laparoscopic cholecystectomy after endoscopic removal of choledocholithiasis. AIM: To evaluate the risk factors associated with open converted cholecystectomy. PATIENTS AND METHODS: The data for all patients who underwent cholecystectomy after endoscopic removal of choledocholithiasis were retrospectively reviewed. Factors predictive for conversion to open cholecystectomy were analyzed. RESULTS: The rate of open converted cholecystectomy was 15.7 %. In multivariate analysis, cholecystitis (OR 1.908, 95 % CI 1.390-6.388, p = 0.005), mechanical lithotripsy (OR 6.129, 95 % CI 1.867-20.123, p < 0.005), and two or more choledocholithiases (OR 2.202, 95 % CI 1.097-4.420, p = 0.026) revealed significant risk factors for conversion to open cholecystectomy. Analyzing the risk factors for open converted cholecystectomy according to duration from endoscopic stone removal to cholecystectomy (within 2 weeks, between 2 and 6 weeks, and beyond 6 weeks), acute cholangitis (OR 3.374, 95 % CI 1.267-8.988, p = 0.015), cholecystitis (OR 3.127, 95 % CI 1.100-8.894, p = 0.033), and mechanical lithotripsy (OR 17.504, 95 % CI 3.548-86.355, p < 0.005) were related to open converted cholecystectomy in ≤2 weeks group. CONCLUSIONS: For patients who need cholecystectomy after endoscopic removal of choledocholithiasis, endoscopic retrograde cholangiography-related factors predictive for open converted cholecystectomy are helpful in planning the appropriate timing of surgery.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholecystectomy, Laparoscopic , Cholecystectomy/methods , Choledocholithiasis/therapy , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Choledocholithiasis/diagnosis , Choledocholithiasis/surgery , Female , Humans , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Retrospective Studies , Risk Factors , Time Factors , Time-to-Treatment , Treatment Outcome , Young AdultABSTRACT
Pancreatic pseudocysts are focal fluid collections that develop as a result of inflammatory diseases of the pancreas. They are managed conservatively or with a drainage procedure. Their radiological appearance can mimic cystic neoplasms of the pancreas. Pancreatic cystic neoplasms include various neoplasms with a wide range of malignant potential. Here, we report a patient with a pancreatic pseudocyst that presented with macrocystic attributes on endoscopic ultrasound.
ABSTRACT
BACKGROUND: Solid-pseudopapillary tumor (SPT) of the pancreas is a low-grade malignancy, which has been infrequently observed in adolescent and young adult females since first report by Frantz in 1959. In this article, we describe our experience of 8 cases of SPT with the clinical features, diagnosis, treatments, and outcomes. METHODS: We retrospectively reviewed the medical records and images of 8 patients who underwent surgery for SPT between January 1995 and December 2004. RESULTS: Seven females and 1 male with the mean age of 29 years (range, 10 to 64) at presentation were identified. Three patients presented palpable abdominal mass, 2 with abdominal pain, and the remainder with no specific symptom. The mean diameter of the tumors was 7.9 cm (range, 4.0 to 10.0). Four were located in the tail, 3 in the body, and 1 in the head. Surgical procedure included distal pancreatectomy with/without splenectomy in 7 patients and Whipple operation in 1 with no surgical morbidity and mortality. All were alive without evidence of recurrence after mean follow-up of 26.4 months (range, 1 to 66). CONCLUSIONS: SPT of the pancreas is an unusual neoplasm and typically occurs in young females presenting well-demarcated pancreatic masses, which are amenable to cure by complete surgical resection.
Subject(s)
Carcinoma, Papillary/pathology , Leiomyoma/pathology , Pancreatic Neoplasms/pathology , Adolescent , Adult , Biomarkers, Tumor/blood , Carcinoma, Papillary/diagnosis , Carcinoma, Papillary/surgery , Child , Colectomy , Diagnostic Errors , Endoscopy, Gastrointestinal , Female , Follow-Up Studies , Humans , Korea , Leiomyoma/diagnosis , Leiomyoma/surgery , Leiomyosarcoma/diagnosis , Male , Medical Records , Middle Aged , Pancreatectomy , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/surgery , Peritoneal Neoplasms/diagnosis , Retrospective Studies , Splenectomy , Stomach Neoplasms/diagnosis , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, InterventionalABSTRACT
Primary pancreatic lymphoma is rare, comprising 0.2-4.9% of all pancreatic malignancies and less than 1% of cases of non-Hodgkin's lymphoma. Many patients are diagnosed with lymphoma after radical resection. We report a rare presentation of diffuse large B cell lymphoma, appearing as a primary tumor of the pancreas. A 61-year old female was admitted to the hospital with the complaint of right upper abdominal pain. Computed tomography of the abdomen showed a well defined mass located at the head of the pancreas. A frozen section of pancreas, during laparotomy, revealed lymphoma. The patient received 6 cycles of chemotherapy and is currently in complete remission. This case underscores the importance of differentiating primary lymphoma from the more common adenocarcinoma of the pancreas as treatment and prognosis differ significantly. Primary pancreatic lymphoma should be considered in the differential diagnosis of pancreatic tumors and an attempt to obtain a tissue diagnosis is always necessary before proceeding to radical surgery, especially on young patients.
