Symptomatic pancreatic body endometrial cyst requiring en bloc distal pancreatectomy

2021 ◽  
Vol 14 (9) ◽  
pp. e244911
Author(s):  
Cameron Ludwig ◽  
Avery Kopacz ◽  
M Logan Warren ◽  
Edwin Onkendi
Keyword(s):  
Distal Pancreatectomy ◽  
Surgical Resection ◽  
Epigastric Pain ◽  
Rare Condition ◽  
The Body ◽  
Uneventful Recovery ◽  
En Bloc ◽  
Spleen Preserving ◽  
Robotic Resection ◽  
Endometrial Cyst

Pancreatic endometriosis is an extremely rare condition, with only a few cases described in the literature. Definitive diagnosis is often difficult to elucidate and will almost always require biopsy or surgical resection. We present a case of a female in her early thirties with a well-known history of widespread endometriosis presenting with vague epigastric pain. CT imaging showed an 11 cm well-circumscribed simple-appearing cyst in the lessor sac. Its origin could not be determined preoperatively but it appeared to involve the parenchyma of the body of the pancreas. Due to the associated pain and indeterminate nature, subtotal surgical resection of the extrapancreatic cyst was performed with the intrapancreatic cyst being managed by a cystogastrostomy to the adjacent stomach in a planned pancreas-sparing procedure following intraoperative confirmation it was arising within the pancreas. Pathological evaluation of the resected cyst confirmed it to be an endometrial cyst. The cystogastrostomy anastomosis subsequently obstructed a few weeks postoperatively and symptoms recurred from cyst enlargement. Redo robotic resection with resection of the remnant cyst, cystogastrostomy and en bloc spleen-preserving distal pancreatectomy was performed. The patient had an uneventful recovery. She has had no recurrence of cyst or symptoms since. A procedure video is included in the report.

Torsion of the gallbladder: a rare but important differential to consider when treating acute cholecystitis non-operatively

2021 ◽  
Vol 14 (1) ◽  
pp. e237842
Author(s):  
Arun Ahluwalia ◽  
Matthew George Roy Allaway ◽  
Serena Giga ◽  
Richard James Curran
Keyword(s):  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Epigastric Pain ◽  
Vital Signs ◽  
Rare Condition ◽  
Liver Function Tests ◽  
Uneventful Recovery ◽  
Imaging Characteristics ◽  
Gallbladder Torsion ◽  
Torsion Of The Gallbladder

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.

scholarly journals A Rare Case of Giant Neuroendocrine Tumor of the Thymus Treated with EN Bloc Resection

2019 ◽  
Vol 4 (02) ◽  
Author(s):  
João Isidro Fracasso ◽  
Antônio Benincá Albuquerque ◽  
André Luca Boeira Rovani ◽  
Larissa Maroni ◽  
Guilherme Baroni De Macedo ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Neuroendocrine Tumors ◽  
Epigastric Pain ◽  
Neuroendocrine Differentiation ◽  
En Bloc Resection ◽  
Anterior Mediastinum ◽  
Bloc Resection ◽  
The Body ◽  
En Bloc ◽  
Tumors Of The Thymus

Neuroendocrine tumors (NETs) are epithelial neoplasms with predominant neuroendocrine differentiation that arise in most organs of the body. Neuroendocrine tumors of the thymus (tNET) and mediastinum are very uncommon. We report the case of a 49-year-old male patient with neuroendocrine tumor of the thymus, superiorly in the anterior mediastinum, asymptomatic of the respiratory tract presenting with epigastric pain, treated with the lesion's surgical resection en bloc associated with radiotherapy and chemotherapy.

scholarly journals Distal pancreatectomy: en‐bloc splenectomy vs spleen‐preserving pancreatectomy

HPB ◽  
2005 ◽  
Vol 7 (2) ◽  
pp. 93-98 ◽  
Author(s):  
Laureano Fernández‐Cruz ◽  
David Orduña ◽  
Gleydson Cesar‐Borges ◽  
Miguel Angel López‐Boado
Keyword(s):  
Distal Pancreatectomy ◽  
En Bloc ◽  
Spleen Preserving

scholarly journals Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection

2021 ◽  
Vol 12 (1) ◽  
pp. 47-51
Author(s):  
Kunal Sadanand Joshi ◽  
Sisir Bodepudi ◽  
Santhosh Kumar Ganapathi ◽  
Chandrasekar Murugesan ◽  
Jagan Balu ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Distal Pancreatectomy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
The Body ◽  
Metastatic Spread ◽  
Pathological Examination ◽  
Jejunal Loop ◽  
En Bloc ◽  
Lateral Pancreaticojejunostomy

Abstract Tumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicated in those patients in whom there is no evidence of metastatic spread. Surgery is often not possible in cancers of the body and tail of the pancreas if the tumor invades celiac artery. Controversy exists regarding the margin status impact of microscopic resection margin involvement (R1) after pancreaticoduodenectomy (PD) for PDAC. There are reports indicating the rate of R1 resections increases significantly after PD if pathological examination is standardized. In this report, we present the case of a 56-year-old female who had undergone lateral pancreaticojejunostomy for chronic pancreatitis 8 years ago, but has now developed malignancy of the body and tail of the pancreas involving multiple organs. This patient underwent en bloc resection involving: 1. distal pancreatectomy with jejunal loop (lateral pancreaticojejunostomy) resection; 2. splenectomy; 3. left nephrectomy; 4. total gastrectomy; and 5. segmental colectomy with reconstruction by esophagojejunostomy, jejunojejunostomy, and colocolic anastomosis. The infrequent occurrence of tumor in the distal gland and advanced tumor stage at the time of diagnosis have both combined to produce therapeutic nihilism/dilemma in the minds of many surgeons. This report highlights the decision on how much to the push limits for multi-organ resection (en bloc resection with distal pancreatectomy, gastrectomy, splenectomy, colectomy, nephrectomy) with the intent of achieving R0 status in spite of the complexity of surgery in selected patients.

scholarly journals A Modified Technique for Laparoscopic Spleen Preserving Distal Pancreatectomy

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Andreas Papatriantafyllou ◽  
Theodoros Mavromatis ◽  
Theano Demestiha ◽  
Dimitrios Filippou ◽  
Panagiotis Skandalakis
Keyword(s):  
Distal Pancreatectomy ◽  
Surgical Techniques ◽  
Mucinous Cystadenoma ◽  
Laparoscopic Distal Pancreatectomy ◽  
Surgical Anatomy ◽  
The Body ◽  
Modified Technique ◽  
Promising Alternative ◽  
Spleen Preserving ◽  
First Choice

Spleen preserving laparoscopic distal pancreatectomy is considered as first choice operation for symptomatic benign or small malignant lesions located at the body or tail of the pancreas. The two main surgical techniques that have been proposed and widely adopted for spleen preserving laparoscopic distal pancreatectomy are the Warshaw and Kimura techniques. A novel modified approach for laparoscopic spleen preserving distal pancreatectomy is presented. The technique was initially performed in a 57-year-old female patient with mucinous cystadenoma. Following the surgical planes created by the fascia fusion and the organ rotation during embryogenesis (fascia of Toldt and renal fascia) with the patient in a right lateral decibutus position, the tumor was accessed retroperitoneally, without dividing the gastrocolic ligament and entering the lesser sac. The tail of the pancreas was mobilized anteriorly and medially, the lesion was visually identified and resected, and short gastric and left gastroepiploic vessels were preserved. We present the technical details and tips; we define the surgical anatomy of it and discuss the perioperative course of the patient as well as the possible benefits of the proposed technique. The proposed technique seems to be safe, easy to perform, and may present a promising alternative approach for patients with pancreatic disease that can be treated by laparoscopic pancreatectomy.

scholarly journals Spleen preserving distal pancreatectomy for solid pseudo-papillary tumour of the body and tail of the pancreas

2010 ◽  
Vol 27 (2) ◽  
pp. 49
Author(s):  
ASK Banagala ◽  
ACN Nanadasena ◽  
KCK Wasalaarachchi ◽  
MAY Ariyaratne ◽  
AS Liyanage
Keyword(s):  
Distal Pancreatectomy ◽  
The Body ◽  
Spleen Preserving ◽  
Papillary Tumour

scholarly journals Bronchogenic cyst of the abdomen

2005 ◽  
Vol 133 (5-6) ◽  
pp. 280-282
Author(s):  
Radoje Colovic ◽  
Marjan Micev ◽  
Vladimir Radak ◽  
Nikica Grubor ◽  
Mirjana Stojkovic ◽  
...  
Keyword(s):  
Open Surgery ◽  
Cystic Lesion ◽  
Bronchogenic Cyst ◽  
Epigastric Pain ◽  
Cystic Mass ◽  
The Body ◽  
Uneventful Recovery ◽  
Rare Congenital Anomaly ◽  
Colonic Fistula ◽  
Retrosternal Space

A bronchogenic cyst is a rare congenital anomaly that appears in the thorax, usually the lungs or the mediastinum, being much rarer in the retrosternal space, within the pericardium or the diaphragm, as well as in the neck, while localization within the abdomen is extremely rare, with only about 30 reported cases. We present the case of a 68-year-old woman. During an investigation for an epigastric pain, a cystic lesion in the area of the body and tail of the pancreas was found. During open surgery, a cystic lesion, spanning 95x75x70 mm, above the body and tail of the pancreas was excised. The wall of the cyst was 8-12mm thick; it contained viscous fluid, the culture of which stayed sterile. Histology determined that it was a bronchogenic cyst. After an early uneventful recovery, the patient developed a left colonic fistula, which healed spontaneously within 3 weeks, probably because of the unnoticed operative damage to the splenic flexure of the colon during splenectomy, which was adherent to the cystic mass and impossible to save during excision. Six months after surgery, the patient continued to remain symptom free.

scholarly journals Laparoscopic Spleen-Preserving Distal Pancreatectomy for Epidermoid Cyst in An Intrapancreatic Accessory Spleen: A Case Report

2020 ◽  
Author(s):  
Xiang Zheng ◽  
Bo Zhou ◽  
Qing jing Sun ◽  
Ming Jin ◽  
Sheng Yan
Keyword(s):  
Distal Pancreatectomy ◽  
Epidermoid Cyst ◽  
Correct Diagnosis ◽  
Accessory Spleen ◽  
Uneventful Recovery ◽  
Imaging Features ◽  
Cystic Lesions ◽  
Intrapancreatic Accessory Spleen ◽  
Pancreatic Tail ◽  
Spleen Preserving

Abstract BACKGROUNDPancreatic tail cystic lesions are increasingly encountered in clinical practice, however it is difficult to make a correct diagnosis preoperatively because there are many types of pancreatic neoplastic and non-neoplastic cysts. Epidermoid cyst in an intrapancreatic accessory spleen (ECIPAS) is a rare non-neoplastic cyst and located in the pancreatic tail. Therefore, it should be considered in the differential diagnosis of pancreatic tail cystic lesions. CASE PRESENTATION A 51-year-old man was admitted for investigation of abdominal pain. The physical examination and laboratory tests found no abnormalities, except for an elevation of carbohydrate antigen (CA)19-9. Imaging revealed a 2.6-cm cystic lesion within the pancreatic tail, and the solid component surrounding the cyst was enhanced similarly to those of the splenic tissue. ECIPAS was speculated. With regards to the symptoms and difficulty to completely exclude a malignant tumor, laparoscopic spleen-preserving distal pancreatectomy was performed. The final pathological diagnosis was epidermoid cyst arising from an intrapancreatic accessory spleen. The patient was discharged at day 5 postoperatively after an uneventful recovery. CA19-9 returned to normal after surgery. During 2-years follow-up, there was no evidence of tumor recurrence.CONCLUSIONWe describe typical imaging features of ECIPAS and showed that laparoscopic distal pancreatectomy was safe and effective for treating ECIPAS.

Microsurgical resection of a glioblastoma multiforme of the medulla oblongata with intraoperative subcortical stimulation and mapping

2019 ◽  
Vol 1 (2) ◽  
pp. V1
Author(s):  
Sima Sayyahmelli ◽  
Jian Ruan ◽  
Bryan Wheeler ◽  
Mustafa K. Başkaya
Keyword(s):  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Medulla Oblongata ◽  
Cranial Nerves ◽  
The Body ◽  
Fine Motor ◽  
Surgical Video ◽  
Inferior Aspect ◽  
Hyperintense Signal ◽  
Microsurgical Resection

Primary glioblastoma multiforme tumors of the medulla oblongata are rare, especially in the adult population. Perhaps due to this rarity, we are not aware of any previous reports addressing the resection of these tumors or their clinical outcomes.In this surgical video, we present a 43-year-old man with a 1-month history of left-sided paresthesia. The paresthesia initiated in the left hand, along with weakness and reduced fine motor control, and then spread to the entire left side of the body. He had recent weight loss, imbalance, difficulty in swallowing, and hoarseness in his voice. He also had a diminished gag reflex, and significant atrophy of the right side of the tongue with an accompanying deviation of the uvula and fasciculations of the tongue. MRI showed an infiltrative expansile mass within the medulla with peripheral enhancement and central necrosis. In T2/FLAIR sequences, a hyperintense signal extended superiorly into the left inferior aspect of the pons and left inferior cerebellar peduncle and inferiorly into the upper cervical cord.The decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of this infiltrative expansile intrinsic mass in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials and monitoring of lower cranial nerves IX, X, XI, and XII. A gross-total resection of the enhancing portion of the tumor was performed, along with a subtotal resection of the nonenhancing portion. The surgery and postoperative course were uneventful. Histopathology revealed a grade IV astrocytoma. The patient received radiation therapy.In this surgical video, we demonstrate important steps for the microsurgical resection of this challenging glioblastoma multiforme of the medulla oblongata.The video can be found here: https://youtu.be/QHbOVxdxbeU.

Sign in / Sign up

Export Citation Format

Share Document