scholarly journals Cavitojejunostomy for post-traumatic disconnected pancreatic duct syndrome presenting as persistent external pancreatic fistula: A case report

2021 ◽  
pp. 497-499
Author(s):  
Kelu Sreedharan Sreesanth ◽  
Valiya Kambrath Prathapan ◽  
Mathew Joseph ◽  
Chandran Nirmala Vyshakh
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Multidisciplinary Approach ◽  
Resonance Imaging ◽  
Initial Management ◽  
Distal Pancreas ◽  
Post Traumatic ◽  
Operative Recovery ◽  
Duct Syndrome

Post-traumatic disconnected pancreatic duct syndrome (DPDS) can present as persistent external pancreatic fistula following percutaneous drainage (PCD) of pancreatic collection. Management of these cases can be difficult and involves a multidisciplinary approach. Here, we present a case of a 16-year-old boy who presented with persisted pancreatic fistula following initial management including PCD of peripancreatic collection following polytrauma 3 months prior. Magnetic resonance imaging showed a disconnected pancreatic duct. Intraoperatively, there was a disconnected and viable distal pancreas with a defect cavity measuring 2 × 2 cm at the neck of the pancreas. The wall of the cavity was anastomosed with a Roux limb of the jejunum (cavitojejunostomy). Post-operative recovery was uneventful and the patient remains asymptomatic at 2 months of follow-up. Cavitojejunostomy is a feasible and safe surgical option in DPDS with a well-formed cavity. This avoids dissection in difficult anatomical planes and preserves pancreatic parenchyma.

Mo1362 Multidisciplinary Approach to Disconnected Pancreatic Duct Syndrome (DPDS) in Acute Pancreatitis (AP) - A Single Tertiary Center Experience

2015 ◽  
Vol 148 (4) ◽  
pp. S-683
Author(s):  
Guru Trikudanathan ◽  
Elizabeth Aby ◽  
Rajeev Attam ◽  
Stuart K. Amateau ◽  
Shawn Mallery ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Duct ◽  
Multidisciplinary Approach ◽  
Tertiary Center ◽  
Duct Syndrome

scholarly journals Resolution of Radiation-Induced Necrosis in Arteriovenous Malformation with Bevacizumab: A Case Report and Review of Current Literature

2021 ◽  
pp. 297-304
Author(s):  
Forrest Kwong ◽  
Daphne B. Scarpelli ◽  
Ramon F. Barajas ◽  
Debra Monaco ◽  
James A. Tanyi ◽  
...  
Keyword(s):  
Linear Accelerator ◽  
Symptom Control ◽  
Resonance Imaging ◽  
Initial Management ◽  
Radiation Induced ◽  
Added Benefit ◽  
Martin Grade ◽  
Magnetic Resonance Imaging Mri ◽  
Viable Treatment

Stereotactic radiosurgery (SRS) is a proven treatment modality for inoperable arteriovenous malformations (AVMs). However, the rate of radiation-induced necrosis (RIN) is as high as 10%. A 6-year-old female patient presented with severe headache, emesis, and syncope, and workup revealed a Spetzler-Martin grade 4 AVM with intraventricular hemorrhage and hydrocephalus. The patient underwent a right frontal ventriculostomy followed by a linear accelerator-based SRS of 16.9 Gy. At 19 years, she developed progressive neurological symptoms. Diagnostic magnetic resonance imaging (MRI) revealed a recurrent parietal AVM nidus. We delivered the linear accelerator-based SRS of 18.5 Gy to the AVM nidus. Within 9 months, she experienced episodic headaches and left-sided weakness and spasticity; symptoms were initially managed with dexamethasone. Follow-up MRI was notable for edema and nondetectable blood flow, consistent with RIN and AVM obliteration. The second course of steroids did not provide the symptom control. Persistent RIN was noted on MRI, and she had stigmata of steroid toxicity (centripetal obesity, depression, and sleep disorder). Two infusions of bevacizumab (5 mg/kg) were administered concurrently with a tapering dose of dexamethasone. The patient noted a near immediate improvement in her headaches, and 2 months following the second bevacizumab infusion, she reported a near-complete resolution of her symptoms and displayed improved ambulation. The development of RIN remains a noteworthy concern post-SRS of AVMs. While steroids aid with initial management of RIN, for persistent and recurrent symptoms, bevacizumab infusions serve as a viable treatment course, with the added benefit of reducing the likelihood of adverse effects resulting from prolonged steroid therapy.

Indwelling double-pigtail plastic stents for treating disconnected pancreatic duct syndrome-associated peri-pancreatic fluid collections: long-term safety and efficacy

Endoscopy ◽  
2020 ◽  
Author(s):  
Paraskevas Gkolfakis ◽  
Arnaud Bourguignon ◽  
Marianna Arvanitakis ◽  
Arthur Baudewyns ◽  
Pierre Eisendrath ◽  
...  
Keyword(s):  
Success Rate ◽  
Pancreatic Duct ◽  
Endoscopic Treatment ◽  
Late Complications ◽  
Safety And Efficacy ◽  
Short And Long Term ◽  
Fluid Collections ◽  
Duct Syndrome

Background and study aims: Long-term transmural double-pigtail stent (DPS) placement is recommended for patients with disconnected pancreatic duct syndrome (DPDS) and peripancreatic fluid collections (PFC). Long-term safety and efficacy of indwelling DPS were evaluated. Patients and methods: Medical files of patients treated with DPS for DPDS-associated PFC and a follow-up ≥48 months were reviewed. Early (<30 days) and late complications of DPS placement were evaluated and the primary endpoint –the incidence rate of late complications per 100 patients-years– was calculated. Short- and long term success rate of endoscopic treatment and PFC recurrence rate were among secondary endpoints. Results: From 2002 to 2014 we identified 116 patients [follow-up: 80.6 (34.4) months]. Among early complications (n=20), 6 occurred peri-interventionally. Late complications (n=17) were mainly pain due to DPS-induced ulcer or erosion (n=10) and 14 of these were treated conservatively or by stent removal. Two gastro-pancreatico-colo-cutaneous fistulas and one persisting bleed required surgical intervention. No DPS-related deaths were recorded. The incidence rate of late complications was 2.18 per 100 patient-years of follow-up; 95%CI [1.27, 3.49]. Short- and long-term success rate of endoscopic treatment was 97.4% [94.5, 100) and 94% [89.6, 98.3], respectively. The PFC recurrence rate was 28% [20.1, 35.9] and 92.3% of them occurred within the first two years. Stent migration, chronic pancreatitis and length of stent size (>6cm) were independently associated with higher rates of PFC recurrence. Conclusions: Long-term transmural drainage with DPS is a safe and effective treatment for DPDS-associated PFCs. However, about one fourth of PFC will recur.

scholarly journals Pancreatic Duct Occlusion: A Safe and Valid Alternative to Duct Anastomosis After Pancreaticoduodenectomy in a Low Volume Centre

2020 ◽  
Author(s):  
Antonio Giuliani ◽  
Aldo Rocca ◽  
Anna Lucia Segreto ◽  
Marianna Paccone ◽  
Maria Lucia Izzo ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Pancreatic Enzyme ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Stump ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion ◽  
Whipple’S Procedure ◽  
Low Volume

Abstract Background: Pancreaticoduodenectomy is the only possible choice of treatment for peri-ampoullar neoplasms. Morbidity in pancreatic surgery is mainly related to the development of a postoperative pancreatic fistula (POPF). According to International Study Group on Pancreatic Fistula it is possible to grade POPF based on clinical variables. Three main different surgical strategies have been proposed to deal with the pancreatic stump following pancreaticoduodenectomy: pancreatojejunostomy, pancreatogastrostomy and pancreatic duct occlusion, but none of them has been clearly demonstrated to be superior to the others. The aim of our study is to evaluate the feasibility of duct occlusion and its correlations with postoperative pancreatic fistula, “brittle diabetes” and overall survival in a low volume centre. We decided to review our previous experience in the light of the recent Covid pandemic where, in our country, it has been forced in many regions to displace treatment of oncological patients in low volume hospitals with limited experienceMethods: We retrospectively reviewed 56 consecutive patients, from a prospective maintained database, who underwent Whipple’s procedure from January 2007 to December 2014 in a tertiary Hepatobiliary Surgery and Liver Transplant Unit with a low volume of pancreatic resections. The mean follow-up was 24.5 months. Results: The overall incidence of postoperative pancreatic fistula was 66.6%: 15 patients had a Grade A (31.25%), 13 a Grade B fistula (27.03%), and 4 (8.3%) suffered from a life-threatening Grade C fistula. At the last follow-up, 24 of the 28 patients who were alive (85.6%) habitually used substitutive pancreatic enzyme. Conclusion: Duct occlusion can be a safe alternative to pancreatic anastomosis especially in low volume centres and for those patients (age >75 years, obese, hard pancreatic texture, small pancreatic duct) at higher risk of clinically relevant POPF.Trial registration: 'retrospectively registered'

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