Pancreatic Surgery in Chronic Pancreatitis Complicated by Extrahepatic Portal Hypertension or Cavernous Transformation of the Portal Vein: A Systematic Review.

OBJECTIVES: Chronic pancreatitis produces disabling pain and loss of pancreatic endocrine/exocrine function. Almost half of the patients will need surgery during the course of the disease. Certain conditions, such as extrahepatic portal hypertension or cavernous transformation of the portal vein, can increase the risk of morbidity and mortality. These complications must be borne in mind in the design of the surgical treatment of chronic pancreatitis. This study is a systematic review on the coexistence of chronic pancreatitis and extrahepatic portal hypertension/cavernous transformation in patients undergoing pancreatic surgery. METHODS: We conducted an unlimited search updated on 10 December 2017, which yielded 535 results. We selected 11 articles. RESULTS: Main indication for surgery was intractable pain. Presence of extrahepatic portal hypertension and/or cavernous transformation increased intraoperative bleeding and general postoperative morbidity, though the increase in general morbidity was less when the different postoperative complications were analyzed individually. Case series showed a higher mortality in patients with extrahepatic portal hypertension. CONCLUSION: Little is known about the presence of extrahepatic portal hypertension in patients undergoing pancreatic surgery for chronic pancreatitis. More studies are needed in order to standardize criteria for vascular involvement in patients with chronic pancreatitis, in order to select the surgical technique and, if necessary, to establish contraindications, in this subgroup of patients.

Systematic review of the mesopancreas: concept and clinical implications

Background: In 2007, Gockel et al. coined the term mesopancreas (MP). In the next 10 years, a limited number of publications about MP have been published, but little is known about the oncological benefit of MP resection. We performed a systematic review of the literature on MP. Methods: An electronic search was performed in PubMed, EMBASE, Cochrane, Latindex, Scielo, and Koreamed databases until 15 June 2017 to identify all published articles dealing with the subject of MP. Some language restriction was done (Chinese and Rumanian). Results: The search yielded 51 articles; 28 articles were selected as relevant. All were retrospective studies focused more on describing technical variants, feasibility and safety than on the cancer results. The R0 rate in patients with MP resection ranged between 57 and 96.7%. In all the articles with a control group, the R0 rate was higher in the MP excision group. Survival data were explicitly stated only in five series. Conclusion: MP is a difficult-to-excise retropancreatic area. In theory, it is agreed that MP excision raises the rate of R0 resections, which in turn reflected in an improvement in the oncological results; however, at present there are no randomized studies to prove this. Achieving a worldwide consensus on its concept, landmarks, excision technique and oncological results is essential

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Systematic review of the mesopancreas: concept and clinical implications.

BACKGROUND: In 2007, Gockel et al. coined the term mesopancreas (MP). In the next 10 years, a limited number of publications about MP have been published, but little is known about the oncological benefit of MP resection. We performed a systematic review of the literature on MP. METHODS: An electronic search was performed in PubMed, EMBASE, Cochrane, Latindex, Scielo, and Koreamed databases until 15 June 2017 to identify all published articles dealing with the subject of MP. Some language restriction was done (Chinese and Rumanian). RESULTS: The search yielded 51 articles; 28 articles were selected as relevant. All were retrospective studies focused more on describing technical variants, feasibility and safety than on the cancer results. The R0 rate in patients with MP resection ranged between 57 and 96.7%. In all the articles with a control group, the R0 rate was higher in the MP excision group. Survival data were explicitly stated only in five series. CONCLUSION: MP is a difficult-to-excise retropancreatic area. In theory, it is agreed that MP excision raises the rate of R0 resections, which in turn reflected in an improvement in the oncological results; however, at present there are no randomized studies to prove this. Achieving a worldwide consensus on its concept, landmarks, excision technique and oncological results is essential.

Abdomen agudo secundario a perforación de divertículo yeyunal / Acute abdomen due to jejunal perforated diverticulitis

Los divertículos yeyunoileales se encuentran en el último lugar en frecuencia de la enfermedad diverticular. En la mayoría de los casos son asintomáticos, siendo su forma de presentación más habitual alguna de sus complicaciones relacionadas, como la hemorragia,obstrucción, diverticulitis o perforación. Es fundamental plantear este posible diagnóstico en el caso de abdomen agudo para reducir en la medida de lo posible la morbilidad y mortalidad asociada a un retraso en el diagnóstico o en la indicación quirúrgica en caso de complicación asociada. Presentamos un caso de abdomen agudo secundario a perforación por diverticulitis yeyunal, con resultado satisfactorio tras tratamiento quirúrgico urgente

Jejunoileal diverticula are in last place in frequency of diverticular disease. In most cases they are asymptomatic and its most common presentation form is any of its related complications, such as bleeding, obstruction, diverticulitis or perforation. It is essential to raise this possible diagnosis in the case of acute abdomen to reduce as far as possible the morbidity and mortality associated with delayed diagnosis or surgical indication if associated complications. We report a case of acute abdomen secondary to perforation jejunal diverticulitis, with satisfactory results after emergency surgery

Litiasis pancreática y pancreatitis crónica: importancia del momento del diagnóstico / Pancreatolithiasis and chronic pancreatitis: importance of time of diagnosis

La pancreatitis crónica es una entidad de curso insidioso, que se asocia con brotes de pancreatitis aguda o clínica de dolor recurrente. El manejo depende de la sintomatología del paciente, la posibilidad de manejo con tratamiento conservador y la causas etiológicas asociadas. Así en el caso de las calcificaciones pancreáticas puede ser necesario el abordaje quirúrgico, existiendo la litotripsia extracorpórea como posibilidad menos invasiva en algunos casos

Chronic pancreatitis is associated with exacerbations of acute pancreatitis or recurrent abdominal pain. Management depends on symptoms, results with conservative treatment and etiology. If pancreactic calcificationes are founded on diagnosis, surgical treatment could be necessary, with extracorporeal lithotripsy as less invasive option

Metástasis pulmonar de cáncer de páncreas / No disponible

Está aceptado que el tratamiento quirúrgico de las metástasis pulmonares aumenta la supervivencia en pacientes seleccionados y en distintas estirpes histológicas. En el caso de las lesiones de origen pancreático no hay datos concluyentes debido a la escasa supervivencia de esta enfermedad. Presentamos el caso de un paciente con lesión pulmonar única a los 14 meses de una intervención quirúrgica por neoplasia de páncreas. Se realiza resección quirúrgica de la lesión pulmonar avalada por los escasos datos que hay en la literatura médica, que parecen demostrar una tendencia al aumento de la supervivencia tras tratamiento quirúrgico de estas lesiones

Surgical treatment of pulmonary metastasis is an accepted treatment that increases the survival rate in chosen patients and histolgical types. Regarding pulmonary metastases of a pancreatic nature, there is no conclusive data due to the low survival rate of this disease. Supported by the limited data available in the medical literature that suggests an increased survival rate after surgical treatment of these lesions, we performed resection of a solitary pulmonary nodule in a patient fourteen months after surgical treatment of a pancreatic cancer

Neoplasia poco frecuente: tumor de instestino delgado metastásico / Rare malignancy: metastatic neoplam of small bowel

Los tumores de intestino delgado son lesiones poco frecuentes, representando un 5% de las neoplasias gastrointestinales. El diagnóstico es a menudo difícil, dada la baja frecuencia y la poca especificidad de los síntomas, lo que hace sea tardío, con peores pronósticos y cifras de supervivencia bajas. Presentamos el caso de un varón de 60 años con el diagnóstico de neoplasia de intestino delgado mestastásica, tras cuadro de dolor abdominal y cuadro constitucional. Se presentan datos epidemiológicos y clínicos de esta entidad, así como discusión en aspectos relacionados con el manejo diagnóstico y terapáutico en este tipo de patología

Small bowel neoplasm are rare malignancy, accounting for 5% of gastrointestinal cancer. Diagnosis of this pathology is conditioned by low frequency and vague presentation, causing a delayed diagnosis with poor prognosis and low survival rates. We describe a 60-years-old man with a metastatic small bowel neoplasm, presented with after abdominal pain and constitutional syndrome. The aim of this report is to introduce epidemiological and clinical data and discuss aspects related to diagnosis and treatment of this pathology

Agesia del lóbulo hepático izquierdo asociada a quistes hidatídicos y colelitiasis / Agenesis of the left hepatic lobe associated with liver hydatidosis and gallbladder stones

Las anomalías congénitas del hígado son infrecuentes. La agenesia lóbulo hepático izquierdo es poco común y se define como la ausencia de parénquima en el lado izquierdo, en un paciente sin antecedentes de enfermedad o cirugía hepática previa. Esta condición, habitualmente asintomática, puede ser un hallazgo casual en una prueba de imagen o en una cirugía abdominal. Se presenta el caso de una paciente de 46 años, sin antecedentes relacionados de interés, que consulta por presentar dispepsia. En los estudios de imagen se encuentra ausencia del lóbulo hepático izquierdo, dos quistes hidatídicos en el lóbulo derecho y colelitiasis única. Hallazgos que se confirman tras realizar quiste-periquistectomía de los quistes y colecistectomía convencional por vía abierta. Se discute la etiopatogenia, se analizan los métodos diagnósticos y se revisa la literatura existente sobre esta entidad. Creemos que es el primer caso publicado, en el que se describe esta asociación (AU)

Congenital anomalies of the liver are infrequet. Agenesis of the left hepatic lobe is uncommon and was defined as the abscence of the liver on the left side, without previous disease or surgery. This condition is usually asymptomatic and may be an incidental finding during imaging test or abdominal surgery. We present the case of a 46-year-old woman, with no past history of related symptoms, who was admited for abdominal disconfort. Imaging studies revealed the absence of left hepatic lobe associated with liver hydatidosis and gallblader stones. Open total pericystectomies and cholecystectomy was carried out and diagnosis of the agenesis of left hepatic lobe accompained by two hydatadic cysts and gallbladder stones was confirmed. We discuss the etipatogenia, diagnostics methods and review the literature to date of this pathology. We believe that this is the first reported case of agenesis of the left hepatic lobe associated with liver hydatidosis and gallblader stones (AU)