[Cephalic duodenopancreatectomy with pylorus sparing].
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Biomedical subjects
Publications and source records attributed to P Champetier.
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Congenital gastrointestinal duplications are uncommonly diagnosed in adult patients, and generally present as a cystic or occasionally tubular malformation. The duplication is composed of a smooth muscle wall continuous with the muscle layer of the intestinal wall and an inner mucosal lining. From December 1988 to May 1994, five patients were operated for gastrointestinal tract duplications [esophageal (1), gastric (2), duodenal (2)]. Duplications were symptomatic in three patients, and discovered incidentally in the other two. The diagnosis was established by ultrasonography (3 patients) and computed tomography (one patient). One female presented an adenocarcinoma arising in an esophageal duplication and died one year after surgical resection. Because of potential malignant transformation, these malformations must be resected. Preoperative diagnosis is important for conservative resection, except in the presence of malignancy when resection must be curative.
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Nine patients with pancreatic apudomas (seven gastrinomas, one glucagonoma, one tumor secreting a substance P-like component) and nine with metastasized carcinoid tumors were treated with a somatostatin analogue (SMS 201-995), administered subcutaneously twice daily for 3 days. Treatment was pursued for 2 to 12 months in nine patients in whom SMS was clinically and/or biologically beneficial. In gastrinomas, SMS decreased plasma gastrin in all but one patient, inhibited the residual gastric acid secretion under H2-blockers and improved diarrhea; in the glucagonoma patient, glucagonemia decreased and skin lesions disappeared. In carcinoid syndrome, clinical efficacy was partial and inconstant; daily 5-hydroxyindole acetic acid (5-HIAA) output was slightly decreased. Plasma substance P levels decreased in six patients with initially high concentrations. No antitumoral activity or side effects have been so far evidenced. SMS 201-995 is a useful, well-tolerated agent in secreting pancreatic apudomas and to a lesser extent in carcinoid syndrome, where high-dosage regimens may be required.
While cystic malformations of the main biliary tract are wellknown and classified, it is exceptional to find cystic malformations of the accessory biliary tract (cystic duct). An adolescent aged 15 years and an adult of 49 years were operated for cysts of the cystic duct revealed by associated lesions, a cyst of the common bile-duct and gallbladder stones respectively. Ultrasonography showed cystic lesions which opacification during intravenous cholangiography and endoscopic retrograde cholangiography (EPRC) proved to be related to the cystic duct. The radiography outline of the biliary pathways so obtained served as a guide to the operative procedure, consisting of excision of the accessory biliary tract in both cases combined with resection of the common bile-duct cyst in one case. The radiologic, anatomic and histologic findings distinguished the lesions encountered from other malformations of the accessory biliary tract and confirmed their derivation from the cystic duct.
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