scholarly journals Intentional internal drainage tube method for nonlocalized persistent pancreatic leakage: a case report

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kinji Furuya ◽  
Tatsuya Oda ◽  
Osamu Shimomura ◽  
Yusuke Ozawa ◽  
Kenichi Iwasaki ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Pancreatic Head ◽  
Radical Resection ◽  
Massive Bleeding ◽  
Drainage Tube ◽  
Fistula Formation ◽  
Distal Margin ◽  
Central Pancreatectomy ◽  
Internal Drainage ◽  
Pancreatic Leakage

Abstract Background Persistent pancreatic leakage (PL) due to disconnected pancreatic duct syndrome (DPDS) is associated with severe morbidity and mortality and it usually treated with internal drainage. However, in cases without localized fistula formation, internal drainage is challenging to perform. We report an original one-stage surgical approach for nonlocalized persistent PL, namely, the “intentional internal drainage tube method”. Case presentation A 49-year-old woman whose main pancreatic duct was penetrated during endoscopic retrograde cholangiopancreatography experienced severe PL. Peritoneal lavage and a second operation involving central pancreatectomy failed to relieve the symptoms, and nonlocalized PL persisted due to DPDS. Although we attempted a radical resection of the pancreatic remnants as a third strategy, the highly inflamed tissue and massive bleeding prevented the completion of the procedure. We sutured the pancreatic head margin and performed a pancreaticojejunostomy to the distal margin. Because these two cut margins could possibly be the source of the persistent PL, we created a hole at the Roux-en-Y jejunal limb, and a silicone drainage tube was inserted into the peritoneal space via this hole. Postoperatively, we continuously suctioned the intentional internal drainage tube, and the residual PL cavity gradually diminished. Even after removal of the tube, the residual PL drained internally into the jejunum through this hole. Conclusions We present this intentional internal drainage tube method as a novel alternative approach for the management of nonlocalized PL consequential of DPDS. Due to the simplicity and minimally invasive nature of this method, we propose this technique may also be used to treat various types of nonlocalized persistent PL or be used prophylactically for central pancreatectomy.

scholarly journals Retrospective analysis of risk factors for occurrence of pancreatic fistula in patients following pancreaticoduodenectomy

2018 ◽  
Vol 22 (3) ◽  
pp. 436-441
Author(s):  
K.G. Valikhnovska
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Retrospective Analysis ◽  
Pancreatic Head ◽  
Fistula Formation ◽  
Surgical Interventions ◽  
Periampullary Tumors ◽  
Pancreatic Fistulas

Pancreaticoduodenectomy still is a “gold standard” in treatment of hepatopancreaticobiliary tumors. The causes of pancreatic fistula were analyzed in 414 patients aged from 22 to 81 following pancreaticoduodenectomy due to periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve outcomes of pancreatic resection based on a retrospective analysis of the causes of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. Influence of risk factors of pancreatic fistula formation was evaluated by Pirson’s method (χ2). The factors contributing to the occurrence of pancreatic fistulas included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head; χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=17.83,1, p=0.0001, p<0.001) and technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage; χ2=16.40,1, p=0.0001, p<0.001). The detailed study of risk factors for the occurrence of pancreatic fistula is essential for improving the prognosis, prophylaxis and treatment of this pathology. The quality of the surgical intervention and the course of the postoperative period in patients with periampullary tumors depend on the choice of resection type, techniques for surgical interventions on the pancreas.

scholarly journals Efficacy of damage control surgery and staged endoscopic pancreatic ductal double stenting therapy for severe pancreatic head injury: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Futoshi Nagashima ◽  
Satoshi Inoue ◽  
Daisaku Matsui ◽  
Yuki Bansyoutani ◽  
Rina Tokuda ◽  
...  
Keyword(s):  
Head Injury ◽  
Pancreatic Duct ◽  
Damage Control ◽  
Pancreatic Head ◽  
Damage Control Surgery ◽  
Pancreatic Injury ◽  
Drainage Tube ◽  
High Grade ◽  
Endoscopic Nasopancreatic Drainage ◽  
Nasopancreatic Drainage

Abstract Background A high-grade pancreatic injury is a life-threatening injury that is associated with high mortality and morbidity. It is currently unclear which treatment strategy results in good clinical outcomes. Case presentation A 23-year-old Japanese woman sustained severe injury in a motor vehicle accident. Abdominal computed tomography revealed severe pancreatic head injury with extravasation of contrast media. Since it was not possible to insert an endoscopic pancreatic stenting tube into the main pancreatic duct, damage control surgery was performed. On day 3, we could insert the endoscopic pancreatic stenting tube from the ampulla of Vater and an endoscopic nasopancreatic drainage tube in the distal pancreatic duct from the accessory ampulla before the second operation. Drainage tubes were placed around the pancreatic head in the second operation. The endoscopic nasopancreatic drainage tube tube was converted to endoscopic pancreatic stenting tube on day 9. On day 51, the patient was discharged on foot from our hospital without serious complications. Conclusion Early and effective hemostasis, staged pancreatic duct drainage with stenting, and surgical external drainage around the pancreas in combination with an endoscopic procedure and damage control surgery were considered appropriate therapeutic strategy for high-grade pancreatic injury.

scholarly journals Improvement of the Diagnosis of Isoattenuating Pancreatic Carcinomas by Defining their Characteristics on Contrast Enhanced Computed Tomography and Endosonography with Fine-Needle Aspiration (EUS-FNA)

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 776
Author(s):  
Robert Psar ◽  
Ondrej Urban ◽  
Marie Cerna ◽  
Tomas Rohan ◽  
Martin Hill
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Pancreatic Duct ◽  
Fine Needle Aspiration ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Characteristic Analysis ◽  
Fine Needle ◽  
Contrast Enhanced ◽  
Secondary Signs

(1) Background. The aim was to define typical features of isoattenuating pancreatic carcinomas on computed tomography (CT) and endosonography and determine the yield of fine-needle aspiration endosonography (EUS-FNA) in their diagnosis. (2) Methods. One hundred and seventy-three patients with pancreatic carcinomas underwent multiphase contrast-enhanced CT followed by EUS-FNA at the time of diagnosis. Secondary signs on CT, size and location on EUS, and the yield of EUS-FNA in isoattenuating and hypoattenuating pancreatic cancer, were evaluated. (3) Results. Isoattenuating pancreatic carcinomas occurred in 12.1% of patients. Secondary signs of isoattenuating pancreatic carcinomas on CT were present in 95.2% cases and included dilatation of the pancreatic duct and/or the common bile duct (85.7%), interruption of the pancreatic duct (76.2%), abnormal pancreatic contour (33.3%), and atrophy of the distal parenchyma (9.5%) Compared to hypoattenuating pancreatic carcinomas, isoattenuating carcinomas were more often localized in the pancreatic head (100% vs. 59.2%; p < 0.001). In ROC (receiver operating characteristic) analysis, the optimal cut-off value for the size of isoattenuating carcinomas on EUS was ≤ 25 mm (AUC = 0.898). The sensitivity of EUS-FNA in confirmation of isoattenuating and hypoattenuating pancreatic cancer were 90.5% and 92.8% (p = 0.886). (4) Conclusions. Isoattenuating pancreatic head carcinoma can be revealed by indirect signs on CT and confirmed with high sensitivity by EUS-FNA.

scholarly journals Acute Pancreatitis Secondary to an Incarcerated Paraoesophageal Hernia: A Rare Cause for a Common Problem

2014 ◽  
Vol 7 ◽  
pp. CCRep.S13079 ◽  
Author(s):  
Kathryn Boyce ◽  
William Campbell ◽  
Mark Taylor
Keyword(s):  
Acute Pancreatitis ◽  
Case Report ◽  
Pancreatic Duct ◽  
Rare Case ◽  
Open Repair ◽  
Pancreatic Head ◽  
Good Recovery ◽  
Type Iv ◽  
Rare Case Report ◽  
Paraoesophageal Hernia

This is a rare case report of acute pancreatitis secondary to a massive incarcerated paraoesophageal hernia. The pathogenesis resulted from obstruction of the distal pancreatic duct after displacement of the pancreatic head and body into the thorax as part of a Type IV paraoesophageal hernia. Although this condition is rare, the patient made steady progress following laparotomy and open repair of hernia. She made a good recovery after prompt therapy, therefore, this report can be a guide to the diagnosis and treatment of similar conditions.

scholarly journals Well differentiated endocrine carcinomas of the pancreas

2011 ◽  
Vol 139 (9-10) ◽  
pp. 625-630
Author(s):  
Radoje Colovic ◽  
Nikica Grubor ◽  
Marjan Micev ◽  
Vladimir Dugalic ◽  
Dejan Stojakov ◽  
...  
Keyword(s):  
Distal Pancreatectomy ◽  
Pancreatic Head ◽  
Distant Metastases ◽  
Massive Bleeding ◽  
R0 Resection ◽  
Gastric Bleeding ◽  
Poorly Differentiated ◽  
The Difference ◽  
Well Differentiated ◽  
Endocrine Carcinomas

Introduction. For the difference from poorly differentiated, well differentiated endocrine carcinomas of the pancreas are the tumours in whom with aggressive surgery and chemotherapy fair results can be achieved. Objective. The aim of the study was to point out the importance of such treatment. Methods. Over a 6-year period eight patients (seven female and one male) of average age 51 years (ranging from 23 to 71 years) were operated on for well differentiated endocrine carcinoma: six of the head and two of the tail of the pancreas. There were two functional and six nonfunctional tumours. Pain in the upper part of the abdomen in seven, mild loss in weight in two, strong heartburn in two, obstructive jaundice in three, diarrhoea in one, sudden massive bleeding from gastric varicosities due to prehepatic portal hypertension caused by pancreatic head tumour in one, and bruise in one patient were registered preoperatively. US and CT in all, angiography in one, octreoscan in two and PET scan in one patient were performed. Whipple?s procedure was performed in six and distal pancreatectomy in two patients, as well as systemic lymphadenectomy in all and excision of liver secondary tumours in two patients. In the patient with massive gastric bleeding a total gastrectomy was performed first, followed by Whipple?s procedure a month later. Results. R0 resection was achieved in all patients. Lymph nodes metastases were found in six patients. Six patients were given chemotherapy. One patient died 3 years after surgery, seven are still alive, on average 2.5 years. A local recurrence after distal pancreatectomy that occurred 5 years after surgery was successfully reresected and the patient is on peptide-receptor radiotherapy. In other six patients there were no local recurence or distant metastases. Conclusion. With aggressive surgery and chemotherapy fair results can be achieved in well differentiated endocrine carcinomas of the pancreas.

scholarly journals Pancreatic fistulae following pancreatic resection. Analysis of causes and prevention methods

2018 ◽  
Vol 22 (4) ◽  
pp. 640-646
Author(s):  
K.G. Valikhnovska
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Pancreatic Resection ◽  
Pancreatic Head ◽  
Preoperative Period ◽  
External Drainage ◽  
Distal Pancreatic Resection ◽  
Glycemic Level ◽  
Prevention Methods

The causes of pancreatic fistula were analyzed in 503 patients aged from 22 to 81who underwent pancreaticoduodenectomy for pancreatic and periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve the outcomes of pancreatic resection based on a retrospective analysis of the risk factors of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. The influence of factors on the risk of pancreatic fistula was investigated by Pearson method (χ2). The factors contributing to the occurrence of pancreatic fistulae included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head, χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=12.75,1, p<0.001), technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage, χ2=44.01,1, p<0.0001), resection of venous vessels following distal pancreatic resection (χ2=8.350,1, p=0.0039, p<0.01), glycemic level in the preoperative period (P=0.0344,U=15061), the presence of concomitant diseases in patients (χ2=15.62,1, p=0.0001, p<0.001). Preoperative glycemic level and the presence of concomitant diseases in patients are factors that can be influenced to prevent the onset of pancreatic fistula in the postoperative period in patients who are scheduled for pancreatic resection. Prevention of this complication involves the correction of glycemic level and treatment of concomitant pathology in patients in the preoperative period.

Case 17.24

2014 ◽  
pp. 835-836
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Duct ◽  
Hepatic Metastases ◽  
Pancreatic Head ◽  
Hepatobiliary Phase ◽  
Gadoxetate Disodium ◽  
Biliary Dilatation

64-year-old woman with pancreatic cancer and suspected hepatic metastases VR image from 3D MRCP (Figure 17.24.1) demonstrates moderate dilatation of intrahepatic ducts and marked extrahepatic biliary dilatation extending to the pancreatic head, where there is also obstruction of the pancreatic duct. Axial hepatobiliary phase 3D SPGR images obtained 20 minutes following gadoxetate disodium (Eovist) injection (...

Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic duct disruption during extirpation of a pancreatic head tumor

2007 ◽  
Vol 194 (4) ◽  
pp. 553-555 ◽  
Author(s):  
Tatsuo Shimura ◽  
Taketoshi Suehiro ◽  
Hideki Suzuki ◽  
Yasushi Mochida ◽  
Koji Okada ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Pancreatic Head ◽  
Pancreatic Duct Disruption ◽  
Pancreatic Head Tumor ◽  
Duct Disruption

scholarly journals Placebo controlled trial of enteric coated pancreatin microsphere treatment in patients with unresectable cancer of the pancreatic head region

Gut ◽  
1998 ◽  
Vol 42 (1) ◽  
pp. 92-96 ◽  
Author(s):  
M J Bruno ◽  
E B Haverkort ◽  
G P Tijssen ◽  
G N J Tytgat ◽  
D J van Leeuwen
Keyword(s):  
Weight Loss ◽  
Confidence Interval ◽  
Pancreatic Duct ◽  
Pancreatic Head ◽  
Pancreatic Enzymes ◽  
High Dose ◽  
Head Region ◽  
Biliary Endoprosthesis ◽  
The Difference ◽  
Enteric Coated

Background—Impeded flow of pancreatic juice due to mechanical obstruction of the pancreatic duct in patients with cancer of the pancreatic head region causes exocrine pancreatic insufficiency with steatorrhoea and creatorrhoea. This may contribute to the profound weight loss that often occurs in these patients.Aims—To investigate whether pancreatic enzyme replacement therapy prevents this weight loss.Patients—Twenty one patients with unresectable cancer of the pancreatic head region with suspected pancreatic duct obstruction, a biliary endoprosthesis in situ, and a Karnofsky performance status greater than 60.Methods—Randomised double blind trial of eight weeks with either placebo or high dose enteric coated pancreatin enzyme supplementation. All patients received dietary counselling.Results—The mean difference in the percentage change of body weight was 4.9% (p=0.02, 95% confidence interval for the difference: 0.9 to 8.9). Patients on pancreatic enzymes gained 1.2% (0.7 kg) body weight whereas patients on placebo lost 3.7% (2.2 kg). The fat absorption coefficient in patients on pancreatic enzymes improved by 12% whereas in placebo patients it dropped by 8% (p=0.13, 95% confidence interval for the difference: –6 to 45). The daily total energy intake was 8.42 MJ in patients on pancreatic enzymes and 6.66 MJ in placebo patients (p=0.04, 95% confidence interval for the difference: 0.08 to 3.44).Conclusions—Weight loss in patients with unresectable cancer of the pancreatic head region and occlusion of the pancreatic duct can be prevented, at least for the period immediately after insertion of a biliary endoprosthesis, by high dose enteric coated pancreatin enzyme supplementation in combination with dietary counselling.

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