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Lakmal K, Nagasinghe SU, Niruban G, Chandraguptha MR, Kalaiyukan S, Wijesinghe K, Nandasena M. Volvulus of a wandering enlarged pelvic spleen involving pancreatic tail: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231205812. [PMID: 37860287 PMCID: PMC10583505 DOI: 10.1177/2050313x231205812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Splenic volvulus of wandering spleen is a rare clinical condition. It causes significant morbidity and mortality, especially if undetected. Here, we report a case of 32-year-old female who presented with worsening abdominal pain for 1-week duration. Contrast-enhanced computed tomography scan of the abdomen showed splenic volvulus with infarction and involvement of the pancreatic tail. She underwent exploratory laparotomy and splenectomy with preservation of the pancreatic tail. Patient progressed favourably. Our case report describes a rare clinical entity of a splenic volvulus with a twisted pancreatic tail. This is a life-threatening condition that requires prompt diagnosis and treatment.
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Affiliation(s)
- Kasun Lakmal
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Shalika Upendra Nagasinghe
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Ganesarajah Niruban
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | | | - Sathasivam Kalaiyukan
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Kanchana Wijesinghe
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Malith Nandasena
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
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Perera P, Nandasena M, Beneragama D, Jayarajah U. An unusual presentation of accessory spleen mimicking a pancreatic neoplastic lesion in a splenectomized patient: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231201722. [PMID: 37780179 PMCID: PMC10536837 DOI: 10.1177/2050313x231201722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Accessory spleen is a relatively common occurrence. However, an intrapancreatic accessory spleen can get hypertrophied following splenectomy and rarely mimic a pancreatic neoplasm leading to misdiagnosis. Here we present a 64-year-old male who had undergone left radical nephrectomy and splenectomy for renal cell carcinoma 14 years back, presenting with upper abdominal discomfort. He was found to have a mass in the pancreatic tail on imaging, suggesting an intrapancreatic neoplastic lesion. After a multidisciplinary team decision based on contrast-enhanced computed tomography and magnetic resonance imaging, he underwent an uncomplicated distal pancreatectomy, and the histology revealed an intrapancreatic accessory spleen. Contrast-enhanced computed tomography, magnetic resonance imaging, and positron emission tomography alone is not specific enough to confidently differentiate an accessory spleen preoperatively. Nuclear scintigraphy fused with contrast-enhanced computed tomography provides more specific and better anatomically localized evidence. Ultrasound-guided fine needle sampling showing lymphocytes with subsets of histiocytes, plasma cells, and immunohistochemistry showing CD8 positivity can be used to guide the definitive diagnosis. Differentiating an accessory spleen from a pancreatic neoplasm may be challenging preoperatively. Accessory spleen needs to be considered in the differential diagnosis of upper abdominal masses especially in patients who have undergone splenectomy.
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Affiliation(s)
- Pasindu Perera
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Malith Nandasena
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
- Faculty of Medical Sciences, Department of Surgery, University of Sri Jayewardenepura, Sri Lanka
| | - Dulani Beneragama
- Faculty of Medical Sciences, Department of Pathology, University of Sri Jayewardenepura, Sri Lanka
| | - Umesh Jayarajah
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
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5
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Wijesinghe K, Lunuwila S, Gamage H, Gooneratne T, Munasinghe B, Harikrishanth S, Nandasena M, Perera N, Jayarajah U. Medical students' perception and attitudes on operating theatre learning experience in Sri Lanka. Surg Open Sci 2023; 15:12-18. [PMID: 37601891 PMCID: PMC10433003 DOI: 10.1016/j.sopen.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Objective The operating room is a unique learning experience that has visual, aural, kinesthetic learning stimuli and provides benefits to the medical students such as development of sound clinical knowledge and skills, and gaining personal insight into ones' career choice. However, this can be a challenging place due to the unfamiliar learning environment. We aimed to study the Sri Lankan Medical students' perception and attitudes on operating theatre learning experience. Design and setting A descriptive cross-sectional survey was carried out among medical students undergoing surgical clinical training on the perspectives of the teaching and learning experience in the operating theatre in Sri Lanka. Participants Our study group consisted of 390 medical students from four different medical faculties in Sri Lanka representing all levels of surgical clinical rotations. Results A majority of the students had actively participated in the operating theater. Despite this, the students' clarity of the learning outcomes and expectations in a theatre varied greatly. Majority of the students felt that the surgeons were willingly to teach but also noted that there was no standardization in teaching. This study clearly shows a significant correlation between positive emotions and surgical teams welcoming attitude towards the medical students. Long standing hours were considered a negative emotion by a majority of students. We also observed that theatre environment can be physically and mentally exhausting. Conclusions Thus, empathy, feeling welcome and giving breaks to refresh can go a long way in making the learning experience better. Regular feedback to trainers on students' perception of the theatre experience is important to value the students' opinion and improve the quality of the surgical theatre. We strongly recommend initiation of clear induction sessions with introduction of well-structured teaching learning activities in the operating theatre.
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Affiliation(s)
- Kanchana Wijesinghe
- Department of Surgery, Faculty of Medical sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Shashini Lunuwila
- Department of Surgery, Faculty of Medical sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Hasangi Gamage
- Department of Surgery, Faculty of Medical sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Thushan Gooneratne
- Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
| | - B.N.L. Munasinghe
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | | | - Malith Nandasena
- Department of Surgery, Faculty of Medical sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Nilushika Perera
- Department of Surgery, Faculty of Medical sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Umesh Jayarajah
- University surgical Unit, Colombo South Teaching Hospital, Sri Lanka
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6
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Ranaweera K, Nandasena M, de Silva U, Jayarajah U, Delwatta S, de Silva C, Pathirana A. Solid pseudopapillary neoplasm of the pancreas with multiple liver metastases successfully managed with staged resection. SAGE Open Med Case Rep 2022; 10:2050313X221101995. [PMID: 35646369 PMCID: PMC9136567 DOI: 10.1177/2050313x221101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/04/2022] [Indexed: 12/03/2022] Open
Abstract
Due to the rarity of the disease, there are no guidelines or consensus for the management of solid pseudopapillary neoplasm of the pancreas with liver metastasis. We describe a patient with solid pseudopapillary neoplasm of the pancreas with multiple liver metastases who was successfully managed with staged resection. A previously healthy 50-year-old female presented to the clinic with dull epigastric pain. The contrast-enhanced computed tomography showed a well-defined cystic lesion at the distal body and tail of the pancreas with multiple liver deposits. A core needle liver biopsy was suspicious of a hepatic epithelioid hemangioendothelioma. A distal pancreatectomy with splenectomy and a left hemi-hepatectomy were performed with a subsequent staged right posterior sectionectomy to address the inadequate future liver remnant. The final histology with immunohistochemistry revealed a pancreatic solid pseudopapillary neoplasm. The patient had satisfactory surgical and oncological outcomes with no recurrence. As these are slow growing tumours, appropriately spaced staged liver resection was feasible to allow hypertrophy of the liver remnant and physiological recovery of the patient. The discrepancy in the histology and cross-sectional imaging led to a pre-operative diagnostic dilemma, and the final diagnosis was reached after surgical resection. Thus, resectable metastatic solid pseudopapillary neoplasm of the pancreas may be offered a primary curative radical surgery before considering other treatment modalities.
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Affiliation(s)
- Kasun Ranaweera
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Malith Nandasena
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Upul de Silva
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Umesh Jayarajah
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Shehani Delwatta
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Chandu de Silva
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Aloka Pathirana
- University Surgical Unit, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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