Epithelial ovarian cancer
J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan in An Atlas of Gynecologic Oncology, 2018
First the spleen should be mobilized to allow exposure and division of its ligamentous attachments. Traction in an inferior and medial direction will expose the filamentous attachments to the diaphragm (splenophrenic) and colon (splenocolic), and these may then be divided and ligated. Entry into the lesser sac then allows exposure of the pancreas and the gastrosplenic ligament, which contains the short gastric arteries (Figure 21.11). Division of the short gastric vessels leaves only the splenorenal ligament intact, containing the splenic vessels and the tail of the pancreas. Holding the splenic hilum between the fingers, the operator identifies and protects the tail of the pancreas while the peritoneum over the ligament is taken and the splenic artery identified and divided (Figure 21.12). Finally the large splenic vein is identified, ligated, and divided, and the spleen is delivered. Occasionally the tail of the pancreas is sacrificed and requires sutures in two layers to prevent leakage. A drain is mandatory.
Abdomen and pelvis cases
Lt Col Edward Sellon, David C Howlett, Nick Taylor in Radiology for Medical Finals, 2017
Complications of acute pancreatitis include:Pancreatic infection, abscess, and necrosis.Peripancreatic fluid collection and late stage pseudocyst formation (Figure 7.19D).Splenic vein thrombosis.Splenic artery pseudoaneurysm.Acute respiratory distress syndrome.Cullen’s sign (periumbilical bruising) and Grey Turner’s sign (flank bruising) are both clinical signs indicative of severe pancreatitis and suggest a poor prognosis.
Endoscopic therapy of oesophageal and gastric varices
David Westaby, Martin Lombard in Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
These cases require special consideration because of their near-normal liver function and otherwise excellent long-term prognosis. Patients are often younger and tolerate bleeding better than in the presence of cirrhosis, although gastric variceal and in particular fundal variceal haemorrhage may be more prevalent. Endoscopic techniques and pharmacological therapy are still effective and remain the first line. Although TIPS has been used in these cases it is usually considered a relative contraindication. Surgery is better tolerated in these cases, and in those with isolated splenic vein thrombosis is curative and the treatment of choice. Accurate anatomical assessment of the portomesenteric and splenic venous drainage by angiography is essential.
Long-Term Management of Vascular Access Ports in Nonhuman Primates Used in Preclinical Efficacy and Tolerability Studies
Published in Journal of Investigative Surgery, 2020
Lucas A. Mutch, Samuel T. Klinker, Jody J. Janecek, Melanie N. Niewinski, Rachael M. Z. Lee, Melanie L. Graham
The technique for portal VAP (PV) placement has also been previously been described by us [31]. Briefly, after surgical preparation, a small incision (1.5–2 cm) was made approximately 1.5 cm inferior to the left subcostal border, 2 cm from the midline. After entrance of the peritoneum and extrication of the spleen, a branch of the splenic vein was isolated and transected. The catheter was advanced through the transection 5.5 cm to reach the portal vein and was tied into position using the retention beads. The 5.5 cm measure is based on historical necropsy findings that evaluated both the average length from branch point at the splenic hilum to the union of the splenic vein and superior mesenteric vein as well as verification of proper catheter tip location (residing in the portal vein between the splenic vein and hilum of the liver) in transplant eligible animals, i.e. approximately 3–10 kg. After securing the catheter, patency was confirmed by aspirating blood and flushing normal saline. The spleen was then gently returned to abdominal cavity. Using the same incision, blunt dissection was used to create a port pocket over the left lateral rib cage. The catheter was trimmed to appropriate length and attached to the port head which was placed in pocket and the incision was closed in a normal fashion.
Laparoscopic Pancreatectomy in Rats: The Development of an Experimental Model
Published in Journal of Investigative Surgery, 2022
José Marcus Raso Eulálio, Manoel Luiz Ferreira, Paulo César Silva, Juan Miguel Renteria, Andrei Ferreira Costa Nicolau, Thales Penna de Carvalho, Adrielle Rodas Fernandes, Julia Radicetti de Siqueira Paiva e Silva, Alberto Schanaider, José Eduardo Ferreira Manso
In summary, the pancreas of the rat has the following relevant anatomical landmarks:Considering its limits, the duodenum on the right, the stomach anteriorly, the spleen on the left, and the colon attached to the anterior face of the mesoduodenum.Considering its parenchyma, an intraperitoneal layer inside the omental pouch, with mobility from the spleen, duodenum and stomach.Considering its vascularization, the superior mesenteric vein and the superior mesenteric artery crosses the parenchyma posteriorly at the junction between the splenic and duodenal lobes receiving the arterial and venous tributaries. The splenic vessels follow the splenic lobe on its upper margin, from the hilum of the spleen to the root of the mesentery, where the splenic vein merges with the superior mesenteric vein to form the portal vein.Considering the ductal structure, the pancreatobiliary duct has its intrapancreatic path toward the second duodenal portion, directly receiving the lobular and lobar ducts. There is a major duodenal papilla, where the pancreatobiliary duct flows and several small ducts drains directly to the duodenum.
Massive gastrointestinal bleeding due to ectopic varix in distal duodenum: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Patrick Mallea, Aaron Allen, Maureen Kim Lynch, Elsbeth Jensen-Otsu, David Tompkins
A forty-one-year-old man was admitted to our hospital with twelve hours of melena and non-bloody emesis. His medical history was significant for alcohol use disorder, prior acute pancreatitis complicated by splenic vein thrombosis, type II diabetes mellitus, and obstructive sleep apnea. A computerized tomography (CT) of the abdomen seventeen months earlier demonstrated splenic vein occlusion vs. marked narrowing with extensive collateral circulation in the upper abdomen. Prior to admission, he had been taking 1600 mg of ibuprofen daily and drinking six beers daily. On exam the patient was tachycardic (132 bpm), blood pressure was 120/70. He was pale, ill appearing and had mild epigastric tenderness on palpation. There were no stigmata of liver disease. On admission the hemoglobin and hematocrit were 8.4 g/dL and 25% respectively. The remaining laboratory results were significant for elevated lactate at 3.7 U/L, INR 1.3, PT 15.7 seconds, PTT 29 seconds, alkaline phosphatase 46 U/L, albumin 3.2 g/dL, total bilirubin 1.5 mg/dL, AST 34 U/L, ALT 30 U/L and platelets 178,000/mm3. He was resuscitated with IV fluids, started on IV proton pump inhibitor, IV octreotide, transfused 1 unit of packed red blood cells (pRBCs), and was admitted to the Medical Intensive Care Unit.