[Autoimmune hepatitis with elevation of CA 19-9 and normalization with immunosuppressant [corrected]treatment: case report and review of the literature]

We describe the case of an 81 year old woman that presented with jaundice, bile duct dilation, hepatic liver tests abnormalities and elevated levels of CA-19-9 (741 UI). Intestinal and pancreatic neoplasia were ruled out. Hepatic biopsy revealed chronic inflammation, cirrhosis and findings consistent with autoimmune hepatitis. The patient was given a course of corticoids and the disease as well as levels of CA-19-9 returned to normal levels.

[T-L mucosa to mucosa pancreatojejunal anastomosis for pancreatic reconstruction following a duodenopancreatectomy]

INTRODUCTION

The pancreatojejunal anastomosis is considered the weak spot when carrying out a duodenopancreatectomy, because it causes most of the complications following a Whipple surgery. Here we present a series of cases using a single technique for performing this anastomosis.

MATERIAL AND METHODS

During the period between October 2002 and August 2005, 49 duodenopancreatectomies were performed at the 3AII Department of the National Hospital Edgardo Rebagliati Martins - H.N.E.R.M., in 31 of these cases a lateral mucosa to mucosa pancreatojejunal anastomosis was carried out by the same surgeon.

RESULTS

The most frequent complication was infection of the operating wound followed by pancreatic fistula and intra-abdominal hemorrhage and the overall morbidity was 29%. Pancreatic fistula developed in 13% of the cases; however, no patient required additional treatment and the fistula closed maximum twenty days after the surgery. On average, patients resumed oral food intake after 6 days and remained hospitalized for 16 days. Mortality was 3%, because a patient developed a pseudo-aneurism of the hepatic artery, which ruptured 17 days after the operation.

CONCLUSIONS

The mucosa to mucosa pancreatojejunal anastomosis is a safe technique with a low index of pancreatic fistula and mortality.