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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
A 75-year-old man with periampullary (duodenal) adenocarcinoma (pT3N0M0) underwent a classical pancreatoduodenectomy. Intraoperatively, the pancreatic parenchyma was found to be soft and the main pancreatic duct was not dilated (2–3 mm in diameter). On postoperative day zero serum lipase was more than twice the upper limit of normal, which peaked at more than four times the upper limit of normal on postoperative day one and normalized on postoperative day three. On postoperative day six, a computed tomography (CT) scan showed a remnant pancreas with non-specific postoperative changes. On postoperative day 11, the patient’s serum C-reactive protein peaked at 273 mg/L (normal <5 mg/L). The patient deteriorated clinically despite aggressive resuscitation and antibiotics and on postoperative day 17 an exploratory laparotomy was performed. At the time of exploration, resection of the pancreaticojejunostomy was performed due to partial pancreatic necrosis and the pancreatic duct was externalized using a 5 mm pediatric nasogastric tube. The patient recovered slowly and was discharged from the hospital on postoperative day 62.
Gastroenterology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Long-term complications such as pancreatic exocrine insufficiency or diabetes mellitus may develop. If the pancreatic duct is dilated or pseudocyst or pancreatic ascites develops, pancreaticojejunostomy is beneficial. Other patients lead normal lives without surgery.
Alcoholic Pancreatitis
Published in Victor R. Preedy, Ronald R. Watson, Alcohol and the Gastrointestinal Tract, 2017
Surgery is often performed in an attempt to relieve pain or for complications such as pseudocysts and abscesses. Side-to-side pancreaticojejunostomy (Puestow procedure) totally or substantially relieves pain in more than 70% of patients.20 Unfortunately, only 30 to 50% of patients are suitable for this procedure.18 Although the mechanism of the pain is poorly understood, it may relate to duct obstruction leading to intraductal hypertension21 and/or elevated pancreatic tissue interstitial fluid pressure.22
Recognizing and Managing Pancreaticopleural Fistulas in Children
Published in Journal of Investigative Surgery, 2022
Konstantina Dimopoulou, Anastasia Dimopoulou, Nikolaos Koliakos, Andrianos Tzortzis, Dimitra Dimopoulou, Nikolaos Zavras
Surgical treatment should be considered where stenting is impossible owing to a distally located fistula or complete obstruction or disruption of the pancreatic duct, or if medical treatment fails after two to three weeks [1,10,25,34]. Other indications for surgery include the presence of multiple pseudocysts, bacterial infection of the pseudocyst and unfavorable ductal anatomy for endoscopic intervention [1,5,10]. The most frequently performed surgical interventions are distal pancreatectomy, longitudinal pancreaticojejunostomy and cystenterostomy [35]. Distal pancreatectomy should be performed in cases of distal ductal and parenchymal disease with pseudocyst removal, if present [12,35–37]. In contrast, proximal ductal pathology requires longitudinal pancreaticojejunostomy to decompress the ductal system by facilitating enzymatic drainage into the gastrointestinal tract away from the pleural space, resulting in fistulous tract closure [1,10,23,38]. The literature search revealed that 25 out of 47 children with PPF underwent surgery, leading to resolution of pleural effusion and control of symptoms without complications (Table 1).
The effect of bilateral U-sutures in pancreaticojejunostomy in 75 consecutive cases
Published in Acta Chirurgica Belgica, 2019
Shengjun Piao, Zhijia Pan, Changshi Qian, Xinglin Jin
The transection of the pancreatic neck was performed with a high frequency electric knife, and the pancreatic stump is freed over approximately 2 cm. After the main pancreatic duct was identified in the transection line, an appropriate diameter silicone catheter with 2–4 lateral holes was inserted in situ into the remnant pancreatic duct t (>2 mm in diameter is required) over 2–3 cm as a stent in 69 patients. In six patients with soft pancreas and very small pancreatic duct (<2 mm in diameter), silicone catheter was not used. There was no need to fix the support silicone catheter, so it is excreted naturally with the faeces. An incision was made on the side of the distal section of the jejunum and end-to-side an invaginated pancreaticojejunostomy was performed using bilateral U-sutures.
Pancreaticoduodenectomy for periampullary cancer: does the tumour entity influence perioperative morbidity and long-term outcome?
Published in Acta Chirurgica Belgica, 2018
Georg Wiltberger, Felix Krenzien, Georgi Atanasov, Hans-Michael Hau, Moritz Schmelzle, Michael Bartels, Christian Benzing
All patients who underwent pancreatic resection at the Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany from June 1994 to September 2013 were retrospectively analysed using an established database. We included all patients who received a Kausch–Whipple procedure or pylorus-preserving PD (PPPD) with curative intent (R0 or R1) with histopathologically confirmed periampullary cancer (i.e. cancer of the pancreas, distal bile duct, and ampulla). With regards to the surgical technique, standard reconstruction was performed with a retrocolic end-to-side pancreaticojejunostomy with pancreatic drainage at the surgeon’s discretion. Somatostatin was not routinely used. Patients were excluded in cases where the medical history and patient data were incomplete or unavailable. For the follow-up, we analysed the medical records of each patient. In case the patient did not come to the follow-up examinations in our institution, we gathered the follow-up information by contacting the patient or the patient’s family physician. Patients with an incomplete documentation were excluded from the analysis.