Successful Surgical Removal of Firmly Impacted Pancreatic Duct Stent: Two Case Report

Successful surgical removal of firmly impacted pancreatic duct stent: Two case report Recently, the self-expandable metallic and plastic stents are increasingly being used for management of different pancreatic disorders. The major indications for pancreatic stent placement are: pancreatic duct stones, chronic pancreatitis, pancreatic strictures, unresectable pancreatic cancer, preventing POPF and post-ERCP pancreatitis, papillary adenoma. Stent placement or retrieval and exchange is difficult process and sometimes it could be the serious clinical challenge. We report two cases of successful removal of firmly impacted pancreatic duct stent by open surgical intervention and transduodenal approach with lateral “side-to-side” pancreaticojejunostomy to prevent the risk of main pancreatic duct restenosis in the first case and with the sphincteroplasty in the second. Therefore, in these challenging cases of firmly impacted pancreatic duct stents, our choice seems to be the most optimal and effective surgical procedure, which could be considered like “parachute” option after failed attempts of stents removal by endoscopic and radiological procedures.

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Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions

Endoscopy International Open ◽

10.1055/a-1388-6964 ◽

2021 ◽

Vol 09 (06) ◽

pp. E888-E894

Author(s):

Nichol S. Martinez ◽

Sumant Inamdar ◽

Sheila N. Firoozan ◽

Stephanie Izard ◽

Calvin Lee ◽

...

Keyword(s):

Pancreatic Duct ◽

Medical Center ◽

Tertiary Care ◽

Plastic Stents ◽

Metal Stents ◽

Limited Data ◽

Sems Group ◽

Tertiary Care Medical Center ◽

Stent Type ◽

Pancreatic Duct Stent

Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.

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4621 Alterations in pancreatic ductal morphology following small diameter, long length, unflanged pancreatic duct stent placement.

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(00)14468-2 ◽

2000 ◽

Vol 51 (4) ◽

pp. AB185

Author(s):

Evan L. Fogel ◽

Stuart Sherman ◽

Benedict M. Devereaux ◽

Rungsun Rerknimitr ◽

Susan D. Phillips ◽

...

Keyword(s):

Pancreatic Duct ◽

Stent Placement ◽

Small Diameter ◽

Pancreatic Duct Stent

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Pazopanib-related secondary polycythemia in metastatic myxofibrosarcoma: A case report and review of the literature

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220950440 ◽

2020 ◽

pp. 107815522095044

Author(s):

Martina Fanelli ◽

Francesco Caputo ◽

Krisida Cerma ◽

Fabio Gelsomino ◽

Alessia Bari ◽

...

Keyword(s):

Case Report ◽

Kinase Inhibitor ◽

Smoking Habit ◽

Soft Tissue Sarcomas ◽

Drug Discontinuation ◽

Surgical Removal ◽

Related Condition ◽

Distant Relapse ◽

First Case ◽

Secondary Polycythemia

Introduction Pazopanib, a tyrosine kinase inhibitor (TKI), is a standard treatment for various tumours, including metastatic non-adipocytic soft-tissue sarcomas. In literature, erythrocytosis has been described as a TKI-related condition. Case report A 59-year-old man underwent surgical removal of a sub-scapular mass consistent with myxofibrosarcoma. After distant relapse, he first started chemotherapy, and then Pazopanib. He was found to have increased levels of hemoglobin (Hb) and hematocrit (Hct). He was asymphtomatic, with no history of pulmonary disease nor smoking habit. Erythropoietin (EPO) level was higher than normal. A polycythemia vera was ruled out. Management & outcome: The patient started a prophylactic therapy with lysine acetylsalicylate, and we observed a reduction of Hb, but not Hct. Due to disease progression, we interrupted Pazopanib. After a week from drug discontinuation, Hb levels got back to the normal range, Hct was lowering. We decided not to perform phlebotomy, considering the declining trend in Hb and Hct values and the absence of symptoms. Discussion We postulated a Pazopanib-related secondary erythrocytosis, since Hb and Hct levels increased from baseline during treatment, then normalized when Pazopanib was discontinued. We used the Naranjo Nomogram to assess the correlation between the adverse effect and Pazopanib, the correlation was “Probable”, a score of 5. To the best of our knowledge, this is the first case report of Pazopanib-related secondary polycythemia in a patient with sarcoma. It is important to pay attention to blood count and to any symptoms potentially related to erythrocytosis in patients treated with TKIs.

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Can Prophylactic Pancreatic Duct Stent Placement Reduce the Prevalence of Post-ERCP Pancreatitis in Patients with Difficult Cannulation of the Bile Duct?

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2007.03.534 ◽

2007 ◽

Vol 65 (5) ◽

pp. AB239 ◽

Cited By ~ 1

Author(s):

Kei Ito ◽

Naotaka Fujita ◽

Yutaka Noda ◽

Go Kobayashi ◽

Jun Horaguchi ◽

...

Keyword(s):

Bile Duct ◽

Pancreatic Duct ◽

Stent Placement ◽

Pancreatic Duct Stent

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Sa1490 The Safety and Efficacy of Pancreatic Duct Stent Placement in the Emergency ERCP of Acute Biliary Pancreatitis

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.03.406 ◽

2016 ◽

Vol 83 (5) ◽

pp. AB271-AB272

Author(s):

Hiroyuki Hisai ◽

Tamaki Sakurai ◽

Ryoya Seki ◽

Yutaka Koshiba ◽

Yusuke Kanari ◽

...

Keyword(s):

Pancreatic Duct ◽

Stent Placement ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Safety And Efficacy ◽

Pancreatic Duct Stent

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Prophylactic Pancreatic Stents in High-Risk Population and Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Galen Medical Journal ◽

10.31661/gmj.v4i2.234 ◽

2015 ◽

Vol 4 (2) ◽

pp. 67-71

Author(s):

Hossein Ajdarkosh ◽

Gholamreza Hemasi ◽

Farhad Zamani ◽

Masoudreza Sohrabi ◽

Mohammad Mahdi Zamani ◽

...

Keyword(s):

High Risk ◽

Pancreatic Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Stent Placement ◽

Guide Wire ◽

High Risk Population ◽

Pancreatic Stent ◽

Stent Group ◽

Endoscopic Retrograde ◽

Pancreatic Duct Stent

Background: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several medical and surgical procedures have been analyzed in prevention of post-ERCP pancreatitis as a major post-ERCP complication, so we conducted a study to assess the role of prophylactic pancreatic stents on prevention and severity of post-ERCP pancreatitis. Materials and Methods: This case control studied adult patients undergoing ERCP at the ERCP unit of a referral educational hospital. Data of the case (stent, N=90) and control (non-stent) (N=105) groups were retrieved from medical records. In our center, sphinctrerotomy was performed for 103 patients of non-stent group and successful pancreatic stent placement was done in 86 patients of stent group in a standard fashion. In stent group, a 5F, 4 centimeter pancreatic stent was emplaced over a guide wire under fluoroscopic guidance. All post–ERCP pancreatitis and major complications of all patients were retrieved too. Results: Of 255 enrolled patients, 195 were at high risk of post-ERCP pancreatitis allocated in two groups of this study. Successful pancreatic stent placement was done in 86 patients (95.6%) of stent group. There was no major complication during procedures. The migration of pancreatic duct stent was diagnostic in 3 (3.5%) patients. The overall post ERCP pancreatitis was 4.0% and 16.6% in stent and non-stent groups, respectively. Conclusion: Based on our findings in this study, we strongly recommended pancreatic duct stent placement in high-risk patients; although the experience of endoscopist plays a crucial role. [GMJ.2015;4(2):67-71]

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A rare presentation of genital self-mutilation in a patient of schizophrenia

International Surgery Journal ◽

10.18203/2349-2902.isj20170878 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1131

Author(s):

Md. Omar Tabrez ◽

Md. Tabrez Aziz

Keyword(s):

Case Report ◽

Clinical Evaluation ◽

Local Anaesthesia ◽

Clinical Entity ◽

Surgical Removal ◽

Rare Presentation ◽

Self Mutilation ◽

First Case ◽

Psychiatric State ◽

Type Of Injury

Genital self-mutilation (GSM) is an uncommon self-inflicted injury. GSM is not a single clinical entity, and it can occur in any psychiatric state or condition. The instruments that are used for self-mutilation can vary, and treatment of these injuries requires a detailed clinical evaluation and multi-disciplinary approach. We report here a case report of a 28-year-old psychotic man who came to our emergency with complaint of self-hammered nails in his both scrotum with fear of not able to reproduce child after marriage. He underwent surgical removal of nail under local anaesthesia and was promptly reviewed by the psychiatrists who managed appropriately. To our knowledge this is the first case reported in literature and the rarest type of injury presented as a bilateral scrotal self-mutilation as should be managed wisely.

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Endoscopic sphincterotomy and pancreatic duct stent placement before endoscopic papillectomy: Are they necessary and safe procedures?

Gastrointestinal Endoscopy ◽

10.1067/mge.2002.120885 ◽

2002 ◽

Vol 55 (2) ◽

pp. 0302-0303 ◽

Cited By ~ 12

Author(s):

Sung Koo Lee ◽

Myung-Hwan Kim ◽

Dong Wan Seo ◽

Sang Soo Lee ◽

Ju Sang Park

Keyword(s):

Pancreatic Duct ◽

Stent Placement ◽

Endoscopic Sphincterotomy ◽

Pancreatic Duct Stent ◽

Endoscopic Papillectomy

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Robot-assisted Thoracoscopic Resection of a Benign Mediastinal Neurogenic Tumor: Technical Note

Neurosurgery ◽

10.1227/01.neu.0000044460.17286.11 ◽

2003 ◽

Vol 52 (2) ◽

pp. 462-464 ◽

Cited By ~ 34

Author(s):

Jelle P. Ruurda ◽

Patrick W. Hanlo ◽

Adriaan Hennipman ◽

Ivo A.M.J. Broeders

Keyword(s):

Case Report ◽

Thoracoscopic Surgery ◽

Technical Note ◽

Neurogenic Tumor ◽

Magnetic Resonance Imaging Scan ◽

Surgical Removal ◽

Robot Assisted ◽

Thoracoscopic Resection ◽

Neurogenic Tumors ◽

First Case

Abstract OBJECTIVE Robotic surgery systems were introduced recently with the objective of enhancing the dexterity and view during procedures that use a videoscope. The first case report of robot-assisted thoracoscopic removal of a benign neurogenic tumor in the thorax is presented. METHODS A 46-year-old woman presented with a history of paravertebral pain. A chest x-ray revealed a left paravertebral mass. A magnetic resonance imaging scan revealed a well-encapsulated mass that was suspected to be a neuroma at the level of T8–T9, separate from vascular structures, without extension in the foramina, and without a spinal canal component. RESULTS A left robot-assisted thoracoscopic resection of the tumor was performed. After placement of six trocars, the tumor was carefully dissected and removed through one of the trocar openings. The histopathological findings revealed an ancient schwannoma. CONCLUSION This case report demonstrates the feasibility of robot-assisted thoracoscopic extirpation of a thoracic neurogenic tumor. Robot-assisted surgery may prove to be of additional value in challenging thoracoscopic surgery, such as the delicate surgical removal of benign neurogenic tumors, because of the support in manipulation and visualization during videoscopic interventions.

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