scholarly journals Arteriovenous malformation in the pancreatic head initially mimicking a hypervascular mass treated with duodenum-preserving pancreatic head resection: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takahiro Korai ◽  
Yasutoshi Kimura ◽  
Masafumi Imamura ◽  
Minoru Nagayama ◽  
Ayumi Kanazawa ◽  
...  
Keyword(s):  
Bile Duct ◽  
Arteriovenous Malformation ◽  
Pancreatic Head ◽  
Pathological Examination ◽  
Resected Specimen ◽  
Papilla Of Vater ◽  
Pancreatic Head Resection ◽  
Pancreaticoduodenal Artery ◽  
Long Term Outcome ◽  
First Case

Abstract Background The mainstay treatment for arteriovenous malformation in the pancreatic head (Ph-AVM) is standard pancreatectomy, especially pancreaticoduodenectomy (PD), or interventional endovascular treatment. We report the first case of Ph-AVM treated with duodenum-preserving pancreatic head resection (DPPHR) performed to preserve the periampullary organs. Case presentation A 59-year-old man presenting with back pain underwent contrast-enhanced computed tomography followed by angiography of the anterior superior pancreaticoduodenal artery. He was diagnosed with Ph-AVM and indicated for DPPHR with preservation of the periampullary organs; Ph-AVM’s benign nature seldom requires lymph node dissection. During the operation, the right colon was mobilized and the omental bursa was released to expose the periampullary structures. The pancreas was transected just above the superior mesenteric vein. The inferior pancreaticoduodenal artery and papillary arteries branching from the posterior superior pancreaticoduodenal artery were carefully preserved to maintain the blood flow to the lower bile duct and papilla of Vater. The remnant pancreas was reconstructed with pancreaticogastrostomy using the modified Blumgart method. Pathological examination of the resected specimen revealed an irregular course of the arteries and veins concomitant with marked dilation throughout the pancreatic head. The patient was pathologically diagnosed with Ph-AVM. He developed hematemesis caused by a rupture of the pseudoaneurysm on postoperative day 20 and underwent coil embolization. A bilio-enteric fistula and stenosis of the common bile duct were found and treated by placement of an endoscopic biliary stent. At the 8-month follow-up, the Ph-AVM had not recurred. Conclusions Compared to PD, DPPHR confers the clinical benefit of preserving the periampullary organs, although further studies are needed to confirm this. Therefore, the choice of this procedure should be based on the surgical morbidities and long-term outcome of the patient.

Intraoperative bile duct cultures in patients undergoing pancreatic head resection: Prospective comparison of bile duct swab versus bile duct aspiration

Surgery ◽  
2021 ◽  
Author(s):  
Jennifer A. Yonkus ◽  
Roberto Alva-Ruiz ◽  
Amro M. Abdelrahman ◽  
Susan E. Horsman ◽  
Scott A. Cunningham ◽  
...  
Keyword(s):  
Bile Duct ◽  
Pancreatic Head ◽  
Pancreatic Head Resection ◽  
Prospective Comparison

M1559 Pancreatic Head Resection with Segmental Duodenectomy in Patients with Carcinoma of the Papilla of Vater

2009 ◽  
Vol 136 (5) ◽  
pp. A-896
Author(s):  
Laureano Fernández-Cruz ◽  
Raquel Garcia Sanchez ◽  
Mario A. Acosta Pimentel ◽  
Jaume Comas
Keyword(s):  
Pancreatic Head ◽  
Papilla Of Vater ◽  
Pancreatic Head Resection

Late morbidity after duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection cavity

2007 ◽  
Vol 95 (4) ◽  
pp. 447-452 ◽  
Author(s):  
G. Cataldegirmen ◽  
D. Bogoevski ◽  
O. Mann ◽  
J. T. Kaifi ◽  
J. R. Izbicki ◽  
...  
Keyword(s):  
Bile Duct ◽  
Pancreatic Head ◽  
Pancreatic Head Resection ◽  
Resection Cavity ◽  
Late Morbidity

scholarly journals Diagnosis and treatment of biliary hypertension syndrome in chronic pancreatitis

2016 ◽  
Vol 97 (6) ◽  
pp. 828-832
Author(s):  
R S Shaymardanov ◽  
R F Gubaev ◽  
I I Khamzin ◽  
I I Nuriev
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Biliary Tract ◽  
Pancreatic Head ◽  
Pancreatic Head Resection ◽  
Long Term Follow Up ◽  
The Common

Aim. To study the efficacy and pancreatic and biliodigestive bypass surgeries combined with or without resection of the pancreatic head in the surgical treatment of biliary hypertension syndrome in chronic pancreatitis.Methods. The analysis of surgical treatment of 87 patients with chronic pancreatitis complicated with biliary tract obstruction was performed. In 78 patients the strictures were tubular and had a length of 2-4 cm, 9 patients had «rat’s tail» shaped strictures and a length of 5-7 cm.Results. In 37 patients various biliodigestive anastomoses without intervention on the pancreas were performed. Unsatisfactory results of choledochoduodenal anastomosis in chronic pancreatitis in long-term follow-up were reported in 3 of 8 interviewed patients. The optimal variant of biliodigestive bypass in chronic pancreatitis with biliary hypertension syndrome is hepaticojejunal anastomosis. In 13 patients different interventions on biliary tract in combination with resection of pancreatic head by Frey were performed. In 13 patients with obstructive forms of chronic pancreatitis with severe pancreatic hypertension pancreaticojejunostomy without resection of the pancreatic head was performed. In the long-term follow up after these surgeries in 7 out of 10 patients the signs of biliary hypertension did not completely resolve. The best results were obtained by using draining pancreatic duct interventions with pancreatic head resection by Frey.Conclusion. In tubular pancreatogenic strictures of the common bile duct when the symptoms of biliary hypertension are severe, the method of choice is hepaticojejunal anastomosis; duodenum preserving resection of pancreatic head in chronic pancreatitis complicated with biliary hypertension should be combined with bile duct draining operations.

scholarly journals A Rare Collision Tumor Composed of Follicular Lymphoma and Adenocarcinoma in the Ampulla of Vater: A Case Report

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Shioto Suzuki ◽  
Fumihiko Tanioka ◽  
Keisuke Inaba ◽  
Shingo Takatori ◽  
Hideto Ochiai ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Pancreatic Head ◽  
Ampulla Of Vater ◽  
Collision Tumor ◽  
Lymphoid Cells ◽  
Resected Specimen ◽  
Duodenal Wall ◽  
Regional Lymph Nodes ◽  
First Case ◽  
Old Japanese

The duodenum is infrequently affected by malignant lymphoma, and follicular lymphomas of the duodenum are rare histological subtypes. There are no reported cases of collision of follicular lymphoma and other tumors in the ampulla of Vater. A 57-year-old Japanese man presented with jaundice, and abdominal computed tomography revealed a tumor of the ampulla of Vater invading the pancreatic head with biliary dilatation and a thickened duodenal wall. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy. Histopathology of the resected specimen revealed lymphoid follicular formations with small-to-medium-sized centrocyte-like cells and some centroblast-like cells. The atypical lymphoid cells were immunohistochemically positive for CD10, CD20, and CD79a but negative for CD5 and cyclin D1. BCL2 protein was highly expressed in the follicle centers. The diagnosis was duodenal follicular lymphoma, Grade 1. The follicular lymphoma, 40 mm in diameter, involved duodenal submucosa and regional lymph nodes without distant metastasis. This duodenal follicular lymphoma was partially overlapped by adenocarcinoma of the ampulla of Vater, measuring25×20 mm, which involved the lower common bile duct, pancreas, and duodenum. We report the first case of a surgically treated collision tumor composed of a rare mass-forming follicular lymphoma and adenocarcinoma of the ampulla of Vater.

scholarly journals Papillo-Choledochectomy in the Operative Management of Mucosal Neoplasms of the Periampullary Region

HPB Surgery ◽  
1993 ◽  
Vol 6 (3) ◽  
pp. 211-217
Author(s):  
Kogoro Kasahara ◽  
Ken Saito ◽  
Yasuo Kondo ◽  
Toshihiko Yasuda ◽  
Yoshikazu Yasuda ◽  
...  
Keyword(s):  
Bile Duct ◽  
Frozen Section ◽  
Sphincter Of Oddi ◽  
Operative Management ◽  
Pathological Examination ◽  
Papilla Of Vater ◽  
Radical Cure ◽  
Mucosal Layer ◽  
Periampullary Region ◽  
Longitudinal Muscles

Two patients with mucosal cancer of the periampullary region were treated with papillocholedochectomy, which entails removal of the papilla of Vater and the whole length of the common bile duct. The neoplasm is dissected out through the plane between the duodenal circular and longitudinal muscles, deep to the sphincter of Oddi and the fibromuscular layer of the bile duct. Pathological examination showed that cancer was confined to the mucosal layer without stromal invasion, and that the operation achieved radical cure. For mucosal cancer, papillo-choledochectomy is an alternative to pancreatoduodenectomy, provided that repeated frozen-section studies confirm the completeness of excision.

scholarly journals Flat Papilla of Vater and Bleeding during Endoscopic Sphincterotomy: Two New Risk Factors for Post-Endoscopic Pancreatitis

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jamry A ◽  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Multivariate Regression ◽  
Pathological Examination ◽  
Papilla Of Vater ◽  
Bleeding Control ◽  
Endoscopic Retrograde ◽  
Bile Duct Stenosis ◽  
Duct Stenosis

Objective: To analyze the risk factors for post-endoscopic pancreatitis (PEP). Background: PEP occurs in 4%-42% of patients, depending on their risk factors. Over 56 risk factors were analyzed, but only 4were found to be repeated in most studies. Study: A single-center retrospective study analyzing 402 consecutive patients with naïve papillae who underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) was conducted. The significance of 14 potentially new risk factors was evaluated, and it was found that they were associated with the level of bile duct stenosis, papilla anatomy, bleeding during sphincterotomy, endoscopic bleeding control, and pathological examination. Furthermore, 13 of the most frequently published risk factors were re-analyzed. Results: Five risk factors (containing two new ones) were significant with the following univariate and multivariate regression values: flat papilla (odds ratio [OR] 5.1, p=0.0049; OR 4.59, p=0.0244) and bleeding during endoscopic sphincterotomy (OR 3.58, p=0.148; OR 4.07, p=0.0257), and significance of the three already known risk factors was confirmed: age <40 years (OR 6.89, p=0.0139; OR 4.96, p=0.0139), common bile duct (CBD) diameter < 9 mm (OR 5.35, p=0.0007; OR 3.98, p=0.0203), and difficulty in cannulation (OR 3.2, p=0.0298; OR 7.72, p=0.004). Conclusion: This study reaffirms the risk of PEP associated with age, difficulty in cannulation, and CBD diameter. It also identifies two new risk factors: flat papilla and bleeding during sphincterotomy. These results suggest the need for a change in ERCP methodology in patients with these risk factors, but this finding requires confirmation in subsequent studies.

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