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Acute Necrotizing Pancreatitis Post-Pancreatoduodenectomy
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Ibrahim Büdeyri, Onur Bayram, Christoph W. Michalski, Jörg Kleeff
Postoperative pancreatic fistula and postoperative acute pancreatitis are two different entities. Postoperative acute pancreatitis mostly occurs in the first two postoperative days, whereas postoperative pancreatic fistula tends to form later than that, and is classically characterized by a drain amylase level more than thrice the upper limit of institutional normal serum amylase [1]. In addition, severe postoperative pancreatic fistula is usually one of the consequences of postoperative acute pancreatitis.
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
A small number of patients present with symptoms months to years after the initial injury potentially with a retroperitoneal collection or pancreatic fistula. Magnetic resonance cholangiopancreatography (MRCP) is likely to be the initial investigation however ERCP can be used to assess the integrity of the duct and consider pancreatic duct stenting.
IVIM MRI of the Pancreas
Published in Denis Le Bihan, Mami Iima, Christian Federau, Eric E. Sigmund, Intravoxel Incoherent Motion (IVIM) MRI, 2018
Miriam Klauß, Philipp Mayer, Bram Stieltjes
significantly associated with postoperative pancreatic fistula [34]. In this study the perfusion-related IVIM DWI parameters (D* and f) were significantly decreased in patients with advanced pancreatic fibrosis (F2–F3). Decreased f in patients with advanced fibrosis may represent decreased blood volume, which is consistent with previous studies that showed decreased microvascular density in patients with pancreatic fibrosis [35].
Pancreatic fistula rates after internal and external stenting of the pancreatojejunostomy anastomosis following pancreatoduodenectomy
Published in Acta Chirurgica Belgica, 2020
Bülent Aksel, Hikmet Erhan Güven
Of 98 patients, 58 were male (59.2%) and 40 were female (40.8%). Mean age was 60.06 ± 13.475 (15–88). Tumors were located in the pancreatic head in 56 (57.1%), in the ampulla of Vater in 21 (21.4%), in the distal portion of the choledochus in 12 (12.2%) and in the duodenum in 9 (9.2%) patients. Except for four neuroendocrine tumors, the rest were pathologically adenocarcinoma of the periampullary region. The PJ anastomosis of 53 patients (54%) was stented internally whereas in 45 patients (46%) external stenting was preferred. The postoperative pancreatic fistula was observed in 29 patients (29.6%). Among them 19 (65.5%) were defined as a biochemical leak (BL), 8 (27.6%) were grade B and 2 (6.9%) were grade C pancreatic fistulas. The texture of the remnant pancreatic tissue was characterized as ‘soft’ in 26 patients (36.5%) and as ‘firm’ in 72 patients (73.5%). The clinical and demographic features of the patients are shown in Table 1.
Prognostic value and impact of cerebral metastases in pancreatic cancer
Published in Acta Chirurgica Belgica, 2020
Andreas Minh Luu, Beat Künzli, Philipp Hoehn, Johanna Munding, Carsten Lukas, Waldemar Uhl, Chris Braumann
A 70-year-old female patient underwent distal pancreatectomy with splenectomy and left-sided hemicolectomy with creation of a colostomy for locally advanced mucinous cystadenocarcinoma of the pancreatic tail. Complete resection of the tumor mass could not be performed. Tumor stage was T3, N1, M1 (peritoneal), R2, G3. CA 19-9 value was extremely elevated and reached a level >50,000 U/mL. Postoperatively the patient suffered from pancreatic fistula leading to delayed clinical recovery. General condition was too deficient for chemotherapy at that point. Four weeks after surgery the patient suffered from dizziness, recurrent confusion, and gait disturbances. MRI showed two brain metastases involving the parietal lobe as well as the cerebellum. General condition deteriorated rapidly omitting further treatment approaches. The patient died 2 months after primary diagnosis of pancreatic cancer and 4 weeks after diagnosis of brain metastases.
Recent advances in the management of pancreatic adenocarcinoma
Published in Expert Review of Anticancer Therapy, 2018
Yusuf Karakas, Sahin Lacin, Suayib Yalcin
Postsurgical complications have also been observed. One such complication is delayed gastric emptying (observed in 5–45% of cases), which can be managed by continual nasogastric decompression and prokinetic drugs, such as metoclopramide and erythromycin. Another complication is pancreatic fistula defined by the International Study Group of Pancreatic Surgery as a drain output of any measurable volume of fluid with an amylase level of >3 times the upper limit of institutional normal serum amylase activity. Despite all the advances and technical modifications, the incidence of pancreatic fistula still ranges from 3–45% at high volume centers, which have a usual clinical presentation of abdominal pain and fever. With the use of antibiotics, interventional radiologists can place a percutaneous drainage catheter, which treats pancreatic fistula adequately. Furthermore, patients who undergo total pancreatectomy require lifelong management for diabetes mellitus and pancreatic insufficiency [36,37]