The authors report their experience with 18 patients who underwent liver resection for alveolar echinococcosis of the liver from June, 1982 to January, 1989. Preparation for surgery included transhepatic biliary external-internal drainage in order to alleviate jaundice in 8 cases and catheterization of infected necrotic cavities in 7 cases. Resection was radical in 9 patients who underwent either right lobectomy (5 cases) or right trisegmentectomy (4 cases) with "en bloc" extension to the bifurcation of the hepatic ducts in 3 cases. Resection was nonradical in another group of 9 patients who had either atypical right hepatectomy (6 cases) or atypical left hepatectomy (3 cases). All patients were submitted to a periodic follow-up. The 9 patients treated by radical resection are alive and symptom-free and appear to be disease-free at radiologic imaging, except for 1 patient who had a small area of parasitic recurrence on computed tomography scan 4 years after operation. Among the 9 patients treated by palliative resection, 3 patients died during the follow-up period, the cause of the death having been related to the disease in 2 cases and nonrelated in 1 case. The 6 surviving patients had no noticeable growth of the parasitic mass during the period of follow-up. When feasible, radical liver resection is the best form of therapy. When massive parasitic invasion of both lobes of the liver and the porta hepatis and vena cava precludes radical hepatectomy, palliative resection associated with percutaneous procedures has to be considered before embarking on orthotopic liver transplantation.

Adult↗

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Case report. CT and ultrasound of gastric and duodenal duplications.

We present the radiological findings of gastric and duodenal duplications in four adults, in whom abdominal ultrasound, endoscopic ultrasound (EUS), and CT were primarily used for diagnosis. The diagnosis was surgically confirmed in all cases. Preoperative diagnosis of duplications was possible with ultrasound in three patients, in whom CT showed a nonspecific cystic structure. Ultrasound demonstrated a pathognomonic multilayered wall appearance suggestive of a digestive origin, including an echogenic inner mucosal layer and a hypoechoic muscular layer, better appreciated using EUS in one patient. In one case, digestive origin was confirmed by direct visualization of a peristaltic activity within the cystic wall after water ingestion. In the last patient, a non-specific heterogeneous mainly solid mass of the esophagogastric junction was found to be an adenocarcinoma arising from a duplication on the histological analysis of the surgical specimen.

Adenocarcinoma↗

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[Recurrent acute pancreatitis from the rupture of a solitary pancreatic hydatid cyst into Wirsung's canal].

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Acute Disease↗

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[Cephalic duodenopancreatectomy for endocrine tumor of the ampulla of Vater and of the minor papilla].

OBJECTIVES: Endocrine tumors of the ampulla of Vater and minor papilla are rare. This study describes the mode of presentation and evaluates the correlation between pathological features and prognosis. PATIENTS: Between 1982 and 1998, 6 patients (3 M, 3 F, mean age: 47.6 years, range: 36-58) for whom a diagnosis of endocrine tumor of the ampulla of Vater or minor papilla was made between 1982 and 1998 after histological examination of an operative specimen of pancreaticoduodenectomy. RESULTS: One patient was detected incidentally, two had a Zollinger-Ellison syndrome, two had pain and one had obstructive jaundice with pain. The tumor was located in the ampulla of Vater in 5 cases and at the minor papilla in 1 case. All patients underwent a pancreaticoduodenectomy, with histological examination showing tumor diameter varying from 5 to 40 mm and positive lymph nodes. Five patients had a well differentiated endocrine tumor and one a poorly differentiated tumor. All patients had positive Grimelius staining. The secretory profile analyzed by immunohistochemistry was heterogeneous. Median duration of follow-up was 51 months (range: 6 months-16 years) with all patients currently still alive. The patient with a poorly differentiated tumor had diffuse liver metastases, the others were disease-free. CONCLUSION: This study demonstrates the frequency of metastatic spread to adjacent lymph nodes and the inconsistent secretory profiles of these tumors. Pancreaticoduodenectomy may offer long term disease-free survival in well differentiated tumors, and such histology may be useful in advising on prognosis.

Adult↗

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Pancreaticoduodenectomy for metastatic ampullary and pancreatic tumors.

BACKGROUND/AIMS: To report the clinical presentation, diagnosis and results of aggressive surgical management in patients with metastatic ampullary and pancreatic tumors. METHODOLOGY: Twelve patients underwent pancreaticoduodenectomy for ampullary or pancreatic metastases from January 1, 1987, to June 30, 1998, in 2 institutions. The primary cancer was renal cell carcinoma (n = 5), melanoma (n = 2), venous leiomyosarcoma (n = 1), carcinoid tumor (n = 1), colon carcinoma (n = 1), breast carcinoma (n = 1) and small-cell lung carcinoma (n = 1). The mean interval between primary treatment and metachronous pancreatic metastasis was 88 months. In 3 cases, pancreatic metastases were synchronous with the primary tumor. The main symptoms were jaundice (n = 8) and upper gastrointestinal tract bleeding (n = 2). The principal investigations were computed tomography scan (n = 9), arteriography (n = 7), duodenoscopy (n = 6) and fine-needle aspiration (n = 4). A correct preoperative diagnosis was made for 8 patients. RESULTS: In all cases, the pancreatic tumor was resected with intention to cure or provide useful palliation, using pancreaticoduodenectomy for isolated tumors (n = 11) or total pancreatectomy for multiple lesions (n = 1). Three out of 12 patents had positive lymph nodes, and the resection margin was free of disease in all cases. There was no postoperative mortality. Survival after pancreaticoduodenectomy averaged 26 months. Overall survival of patients undergoing pancreaticoduodenectomy was 35% at 2 years and 17% at 5 years. One patient is still alive more than 10 years after pancreaticoduodenectomy. CONCLUSIONS: Pancreaticoduodenectomy can be performed safely, representing a suitable option for resection in patients with symptomatic or late isolated pancreatic metastases in the absence of widely metastatic disease. The best indications are solitary metastases from renal cell carcinoma, sarcoma and neuroendocrine tumors. However, there is no evidence of survival benefit after pancreaticoduodenectomy for synchronous tumors or metachronous tumors from melanoma or colon carcinoma.

Adult↗

PubMedDate not supplied

Portal vein aneurysm: report of two cases.

Portal vein aneurysm is a rare entity. We present two cases of extrahepatic portal vein aneurysms, which were incidentally discovered in patients with no evidence of liver disease. Those were assumed to be congenital lesions. Diagnosis was made by Doppler ultrasound. Both patients were managed expectantly.

Aged↗