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Fulltext Rare presentation of idiopathic duodenoduodenal intussusception

Loo GH, Mohamad Abu Zeid WM, Lim SL, Ismail AM

Ann R Coll Surg Engl, 2017 Jul;99(6):e188-e190.
PMID: 28660832 DOI: 10.1308/rcsann.2017.0104

Enteroenteric intussusception is a condition in which the full-thickness bowel wall becomes telescoped into the lumen of distal bowel. Intussusception in adult occurs infrequently and varies from childhood intussusception, particularly in its presentation, aetiology and treatment. Duodenoduodenal intussusception is rare because the duodenum is fixed in the retroperitoneal position. It usually occurs secondary to tumour, lipoma, Brunner's gland hamartomatous polyp or adenoma. The diagnosis in adults is usually made at laparotomy, where presentation is with intestinal obstruction. In non-emergency presentation, it may be difficult to arrive at an accurate diagnosis as symptoms may be vague, self-limiting intermittent abdominal pain. Clinical examinations and investigations may not be conclusive and another working diagnosis such as irritable bowel syndrome would be made. We describe a case where a patient initially presented with symptoms mimicking pancreatitis but his symptoms persisted over the course of 2 weeks. When a laparotomy was performed, duodenoduodenal intussusception was discovered and confirmed with histopathology. In this case, a discernible leading point could not be identified.

Matched MeSH terms: Pancreaticoduodenectomy
Fulltext Incidental hepatic tuberculosis during planned resection of locally advanced ampullary carcinoma: a case report

Hoe VC, Khairuddin A, Tan JS, Sharif MS, Azizan N, Hayati F

BMC Surg, 2020 Jun 30;20(1):145.
PMID: 32605613 DOI: 10.1186/s12893-020-00806-8

BACKGROUND: Tuberculosis (TB) is classified according to the site of disease as pulmonary or extrapulmonary. Extrapulmonary TB is less common than its counterpart in which it can be found anywhere in the body including the liver. Similar to ampullary carcinoma, TB liver can manifest with jaundice and deranged liver function tests, particularly in the obstructed biliary systems.
CASE PRESENTATION: A 43-year-old gentleman with locally advanced ampullary carcinoma was noticed to have multiple suspicious liver nodules intraoperatively during curative ampulla resection. The surgery was then abandoned after a biopsy. The histology was consistent with chronic granulomatous inflammation. He was then subjected to a Whipple pancreaticoduodenectomy procedure after initiation of anti-tubercular treatment. He recovered well with no evidence of tumour recurrence and worsening TB.
CONCLUSIONS: A high index of suspicion and quick decision making can help to diagnose a possible extrapulmonary TB masquerading as a malignant disease in a patient with curative intention of ampullary carcinoma.

Matched MeSH terms: Pancreaticoduodenectomy
A modified technique of pancreaticogastrostomy with short internal stent: A single surgeon's experience

Yap PY, Hwang JS, Bong JJ

Asian J Surg, 2017 Mar 10.
PMID: 28286020 DOI: 10.1016/j.asjsur.2017.01.003

BACKGROUND/OBJECTIVE: Postoperative pancreatic fistula (POPF) remains an important cause of morbidity and mortality after pancreaticoduodenectomy. Pancreaticogastrostomy (PG) as a reconstruction method after pancreaticoduodenectomy is a safe and optional surgical technique in decreasing the risk of POPF. In this study, a retrospective analysis was carried out to evaluate a new modification of PG technique that uses a two-layer anastomoses with an internal stent.
METHODS: Forty-seven patients underwent this newly modified PG technique between February 2012 and August 2016. Demographics, histopathological findings, type of surgery performed, perioperative parameters, postoperative length of stay, postoperative complications and interventional procedures, follow-up, and mortality data were collected and analyzed. Clavien-Dindo classification was used to grade the complications' severity.
RESULTS: Postoperative mortality was 4.25%, unrelated to POPF, and postoperative morbidity was 44.68%. Thirteen patients had severe (>Grade IIIa) complications, according to Clavien-Dindo classification. As classified in accordance to the International Study Group of Pancreatic Fistula, 24 (51.06%) patients developed Grade A POPF, and no occurrence of Grade B/C POPF was noted. All patients recovered uneventfully with successful treatment interventions.
CONCLUSION: The reported PG anastomotic technique is a safe and dependable reconstruction procedure with acceptable morbidity and mortality.

Matched MeSH terms: Pancreaticoduodenectomy
Fulltext Total pancreatectomy for diffuse pancreatic adenocarcinoma

Azlanudin, A., Razman, J.

Journal of Surgical Academia, 2011;1(1):39-41.
MyJurnal

A 64-year-old lady presented with a brief history of abdominal pain associated with obstructive jaundice. Endoscopic retrograde cholangiopancreaticography (ERCP) revealed a short segment stricture with contact bleeding and the brush cytology confirmed presence atypical cells. Ca 19.9 levels were markedly elevated. She was planned for a Whipple’s procedure but was instead subjected to a total pancreatectomy based on intraoperative findings of a diffusely hard and nodular pancreas. Histopathological examination confirmed our diagnosis of diffuse pancreatic adenocarcinoma. This rare presentation of a locally contained and fully resectable diffuse pancreatic adenocarcinoma is being discussed.

Matched MeSH terms: Pancreaticoduodenectomy
Fulltext Intraductal papillary mucinous neoplasm (IPMN) in association with autosomal dominant polycystic kidney disease (ADPKD)

Ikhwan Sani Mohamad, Nishioka, Yujiro, Shindoh, Junichi, Hashimoto, Masaji

Malaysian Journal of Medicine and Health Sciences, 2017;13(2):71-74.
MyJurnal

Intraductal Papillary Mucinous Neoplasm (IPMN) of the pancreas in association with Autosomal Dominant Polycystic Kidney Disease (ADPKD) is extremely rare, even though 10% of ADPKD patients may develop simple pancreatic cyst. The first case report was published by Yasunori Sato from Japan in 2009. Since then less than 10 case reports are available worldwide to describe about this condition. We reported such a rare case of a 67-year-old man with ADPKD who was referred to our centre because of chronic abdominal pain and diagnosed as IPMN based on the serial imaging procedures. Despite of the high risk comorbidities, he successfully underwent pylorus preserving total pancreaticoduodenectomy with splenectomy.

Matched MeSH terms: Pancreaticoduodenectomy
Management of a rare case of arteriovenous malformation of the head of the pancreas

Shahrudin MD, Noori SM

Hepatogastroenterology, 1997 Jan-Feb;44(13):284-7.
PMID: 9058160

Arterio-venous malformation (AVM) of the head of the pancreas is a rare condition that may cause upper gastro-intestinal tract (GIT) bleeding. A 45-year-old man with a large AVM at the pancreato-biliary region is described. The patient had recurrent episodes of hematemesis and melena. Enlargement of the AVM was documented by serial abdominal CT scans performed after each bleed. Whipple procedure was successfully performed in this patient.

Matched MeSH terms: Pancreaticoduodenectomy*
A rare case of intussusception associated with metastasized small cell carcinoma of lung

Jarmin R, Azman A, Rahim R, Kosai NR, Das S

Acta Med Iran, 2012;50(11):782-4.
PMID: 23292632

Intussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, the diagnosis may be difficult because of asymptomatic nature of this bowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness, loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he was transfused with packed cells. On gastrointestinal (GI) endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CT) scan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed, 'Whipple's procedure' was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding.

Matched MeSH terms: Pancreaticoduodenectomy/methods