An atypical presentation of a multiloculated giant pseudocyst of pancreas

Giant pseudocysts of the pancreas are rare and difficult to manage. Pseudocysts are usually treated by cystogastrostomy but dependent drainage for giant pseudocysts may require alternative methods like cystojejunostomy. We report here a rare case of a multiloculated giant pseudocyst of pancreas which presented atypically with protrusion through the lesser omentum. The pseudocyst protruding through the lesser omentum filled the whole upper abdomen up to umbilical region and displaced the stomach inferiorly. The stomach which is usually displaced anteriorly by pseudocysts was unusually displaced and splayed on the inferior aspect of the pseudocyst. The anterior wall of the fundus and body of the stomach was adherent to the inferior aspect of the pseudocyst. The pseudocyst was managed by draining into the stomach in a different way by performing a cystogastrostomy to the anterior wall of the stomach. Giant pseudocysts are difficult to manage, and good imaging studies are helpful in selecting surgical options for dependent drainage. Cystogastrostomy on the anterior wall of the stomach is a feasible option to drain pseudocysts which are predominantly overlying and adherent to the anterior wall of the stomach.

THE ROLE OF LAPAROSCOPIC CONTACT THERMOMETRY IN THE DIAGNOSIS OF EDEMATOUS ACUTE PANCREATITIS

Summary. Objective: to identify the temperature of the abdominal organs and markers of the edematous form of acute pancreatitis using laparoscopic contact thermometry. Material and methods. In 27 patients aged 28–76 years with suspected acute abdominal surgical diseases, laparoscopy was performed using a Karl Storz (Germany) apparatus using the improved Kelling technique and an edematous form of acute pancreatitis was suspected. To expand the diagnostic capabilities of the method, laparoscopic contact thermometry of the abdominal organs was performed using a TPEM-M electrothermometer and a designed probe with a sensor at the end. Results. The highest temperature values were found in the area of the omentum (38.1 ± 0.2) °C), the mesentery root of the transverse colon (37.8 ± 0.16) °C and the lesser omentum (37.7 ± 0.13) °C. These anatomical regions are closest to the pancreas, where the pathological process develops. The highest temperature was found in the area of the stuffing box (38.1 ± 0.2) °C, and the lowest temperature was found in the appendix (36.4 ± 0.13) °C, which amounted to a temperature difference of 1.7 °C. The subsequent clinical course and the results of additional research methods confirmed the diagnosis of the edematous form of acute pancreatitis. Findings. The highest temperature values obtained during laparoscopic contact thermometry of the abdominal organs in the area of the omental foramen, the mesentery root of the transverse colon and the lesser omentum are markers of the edematous form of acute pancreatitis.

Assessment of the prognostic significance of clinical and morphological factors on the survival of patients with locally advanced gastric cancer after radical surgical treatment: The experience of the Russian Center.

e16062 Background: Various staging systems are used to form a prognosis and determine an effective treatment strategy in patients with locally advanced gastric cancer (GC). Among these, the most widely used is the TNM UICC/AJCC staging system. However, even within the same stage, GC can vary significantly in terms of prognosis after surgery. The aim of our study was to assess the influence of clinical and pathomorphological biomarkers on the survival rate of patients with locally advanced GC after radical surgical treatment. Methods: For retrospective analysis, 124 patients were selected at the age from 29 to 86 years (mean age 65.69±10.09; 95% CI 63.90-67.49) with a diagnosis of stage I-III of GC who received only surgical treatment from 2015 to 2018. In 32 (26.1%) patients, the primary tumor was localized in the region of the cardioesophageal junction, in 61 (48.9%) - in the region of the stomach body, in 31 (25.0%) - in the pylorus. All patients underwent radical surgical treatment with subsequent staging of the disease according to the TNM system (6th edition), additional assessment of the lesion of the greater/lesser omentum. In 18 (14.5%) patients, stage IA was registered, in 10 (8.1%) - IB, in 23 (18.5%) - IIA, in 15 (12.1%) - IIB, 27 (21.8%) - IIIA, 26 (21.0%) - IIIB and 5 (4.0%) - IIIC. Results: We had a significant predictive value of the degree of metastatic lesions of the lesser and greater omentum (p <0.0001). The median OS in patients without omentum lesions at the time of assessment was not reached (follow-up period 42.0-54.0 months). The median OS in patients with only the greater omentum was 55.0 months (95% CI 6.5-55.0), which was 21.0 months higher than the median OS in patients with isolated lesions of the lesser omentum (24.0 months, 95% CI 19.0-57.0) and by 41.0 months exceeded the median OS of patients with combined lesions of the lesser and greater omentum (14.0 months, 95% CI 25.5-57). All factors that showed a significant effect on OS in the course of univariate analysis were included in the Cox proportional hazards model: the size of the primary tumor (T), the level of lesion of the regional lymphatic system (N), and the presence of lesions of the greater or lesser omentum. In general, the significance of the entire model was undeniable: p <0.0001. Significant prognostic influence was exerted by indicators characterizing the prevalence of the tumor process: T criterion (p=0.0090) and N criterion (p=0.0016). Conclusions: Despite the fact that, in multivariate analysis, the lesion of the greater and lesser omentum did not show a significant effect on OS in patients with locally advanced GC, this issue requires further study, since in the Cox model, the lesion of the lesser omentum, rather than the greater omentum, had a more favorable effect on the OS index. which allows you to increase RH by 12-60% (p=0.4046).