ABSTRACT
BACKGROUND: Intramural duodenal haematoma is a rare entity that usually occurs in the context of patients with coagulation disorders. A minimum percentage is related to processes such as pancreatitis and pancreatic tumours. CLINICAL CASE: The case is presented of a 45 year-old male with a history of chronic pancreatitis secondary to alcoholism. He was seen in the emergency room due to abdominal pain, accompanied by toxic syndrome. The abdominal computed tomography reported increased concentric duodenal wall thickness, in the second and third portion. After oesophageal-gastro-duodenoscopy, he presented with haemorrhagic shock. He had emergency surgery, finding a hemoperitoneum, duodenopancreatic tumour with intense inflammatory component, as well a small bowel perforation of third duodenal portion. A cephalic duodenopancreatectomy was performed with pyloric preservation and reconstruction with Roux-Y. DISCUSSION: Treatment of a duodenal haematoma is nasogastric decompression, blood transfusion and correction of coagulation abnormalities. Surgery is indicated in the cases in which there is no improvement after 2 weeks of treatment, or there is suspicion of malignancy or major complications arise. CONCLUSIONS: Duodenal intramural haematoma secondary to chronic pancreatitis is rare, although the diagnosis should be made with imaging and, if suspected, start conservative treatment and surgery only in complicated cases.
Subject(s)
Abdomen, Acute/etiology , Duodenal Diseases/complications , Hematoma/complications , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Pancreatic cancer has a high mortality rate due to late diagnosis and aggressive behavior. The prognosis is poor, with 5-year survival occurring in less than 5% of cases. AIM: To analyze demographic characteristics, comorbidities, type of procedure and early postoperative complications of patients with pancreatic cancer submitted to surgical treatment. METHODS: Cross-sectional study with analysis of 28 medical records of patients with malignant tumors of the pancreas in a 62 month. Data collection was performed from the medical records of the hospital. RESULTS: Of the total, 53,6% were male and the mean age was 60.25 years. According to the procedure, 53,6% was submitted to duodenopancreactectomy the remainder to biliodigestive derivation or distal pancreatectomy. The ductal adenocarcinoma occurred in 82,1% and 92,9% of tumors were located in the pancreatic head. Early postoperative complications occurred in 64,3% of cases and the most prevalent was intra-abdominal abscess (32,1%). Among duodenopancreactectomies 77,8% had early postoperative complications. CONCLUSION: Its necessary to encourage early detection of tumors of the pancreas to raise the number operations with curative intent. Refinements in surgical techniques and surgical teams can diminish postoperative complications and, so, operative morbimortality can also decrease over time. .
RACIONAL: O câncer de pâncreas apresenta alta taxa de mortalidade por conta do diagnóstico tardio e comportamento agressivo. O prognóstico é reservado com sobrevida de cinco anos em menos de 5% dos casos. OBJETIVO: Analisar as características demográficas, as comorbidades, o tipo de procedimento e as intercorrências pós-operatórias precoces dos pacientes de câncer de pâncreas submetidos ao tratamento cirúrgico. MÉTODOS: Estudo transversal, que analisou 28 prontuários de pacientes portadores de tumores malignos do pâncreas, no período de 62 meses. A coleta de dados foi realizada a partir dos prontuários médicos do hospital. RESULTADOS: Do total de participantes 53,6% eram do sexo masculino. A média de idade foi de 60,25 anos. Em relação ao procedimento, 53,6% foram submetidos à duodenopancreactectomia e o restante à derivação biliodigestiva ou pancreatectomia corpo-caudal. O adenocarcinoma ductal ocorreu em 82,1% e 92,9% dos tumores estavam localizados na cabeça do pâncreas. As complicações pós-operatórias precoces ocorreram em 64,3%, e a mais prevalente foi abscesso intra-abdominal (32,1%). Entre as duodenopancreatectomias, 77,8% apresentaram complicações pós-operatórias precoces. CONCLUSÃO: Há necessidade de se incentivar a detecção precoce dos tumores de pâncreas para que se consiga realizar mais operações com intenção curativa. Também, é necessário o aprimoramento das técnicas operatórias e das equipes cirúrgicas para que as complicações pós-operatórias e a morbimortalidade operatória diminuam ao longo do tempo. .
