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Li Z, Zhuo Q, Shi Y, Chen H, Liu M, Liu W, Xu W, Chen C, Ji S, Yu X, Xu X. Minimally invasive enucleation of pancreatic tumors: The main pancreatic duct is no longer a restricted area. Heliyon 2023; 9:e21917. [PMID: 38027678 PMCID: PMC10658339 DOI: 10.1016/j.heliyon.2023.e21917] [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: 02/27/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Tumors involving the main pancreatic duct (MPD) used to be a contraindication for enucleation. Methods Clinical data of consecutive patients with pancreatic tumors who received laparoscopic or robotic enucleation (LEN or REN) between January 2019 and December 2021 at Fudan University Shanghai Cancer Center were analyzed. Results Ninety-six patients were included in the analysis, with 55 in the LEN group and 41 in the REN group, and no conversion to laparotomy. Most tumors were located in the head of pancreas (71.9 %). The tumor diameter (3.1 vs. 1.9 cm) was larger, and more cystic tumors (92.7 % vs. 56.4 %) and more tumors involving the MPD (34.1 % vs. 3.6 %) were observed in the REN group. MPD support tube insertion was performed in 15 cases, with 11 in the REN group and 4 in the LEN group. The incidence of biochemical and grade B postoperative pancreatic fistula (POPF) was both 46.9 %, and no grade C POPF occurred. Among the 45 patients with grade B POPF, 28 cases (62.2 %) were due to carrying drainage tube >3 weeks without additional treatment, and only 4 cases required invasive treatment. For patients with MPD support tube implantation (n = 15), support tube fall-offs were observed in 12 cases, 2 patients had MPD dilatation, and no MPD stricture, stone formation or pancreatic atrophy was observed during follow-up. Conclusions The incidence of POPF was high but still controllable without serious complications after minimally invasive enucleation. The MPD is no longer a restricted area, and the robotic system has advantages in handling complex enucleations.
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Affiliation(s)
- Zheng Li
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Qifeng Zhuo
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Yihua Shi
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Haidi Chen
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Mengqi Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Wensheng Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Wenyan Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Chen Chen
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Shunrong Ji
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
| | - Xiaowu Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Shanghai Pancreatic Cancer Institute, Shanghai, 200032, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, 200032, China
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Yu X, Wang W, Yu S, Yang C, Huang X, Yuan Z. The role of main pancreatic duct stent in the enucleation of benign/borderline pancreatic head tumors: a cohort study. Langenbecks Arch Surg 2023; 408:198. [PMID: 37204475 DOI: 10.1007/s00423-023-02921-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE This study aimed to reveal the role of preoperative main pancreatic duct (MPD) stent placement in reducing the intraoperative main pancreatic duct injury rate and the incidence of postoperative pancreatic leakage following pancreatic tumor enucleation. METHODS A retrospective cohort analysis was performed for all patients with benign/borderline pancreatic head tumors who were treated with enucleation. The patients were divided into two groups (standard vs. stent) depending on whether they underwent main pancreatic duct stent placement prior to surgery. RESULTS Thirty-three patients were finally included in the analytical cohort. Compared with the standard group, patients in the stent group had a shorter distance between tumors and main pancreatic duct (p=0.01) and presented with larger tumors (p<0.01). The rates of POPF (grade B&C) were 39.1% (9/23) and 20% (2/10) in the standard and stent groups, respectively (p<0.01). Major postoperative complications occurred more frequently in the standard group than in the stent group (14 versus 2; p<0.01). No significant differences in mortality, in-hospital stay or medical cost were observed between the two groups (p>0.05). CONCLUSIONS MPD stent placement prior to surgery may facilitate pancreatic tumor enucleation, minimize MPD injury and decrease the occurrence of postoperative fistula.
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Affiliation(s)
- Xinzhe Yu
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yi-Shan Road 600, Shanghai, 200233, China
- Department of Hepato-Pancreato-Biliary Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Hepato-Pancreato-Biliary Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Yu
- Department of Hepato-Pancreato-Biliary Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanxin Yang
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yi-Shan Road 600, Shanghai, 200233, China
| | - Xinyu Huang
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yi-Shan Road 600, Shanghai, 200233, China.
- Department of Hepato-Pancreato-Biliary Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhou Yuan
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yi-Shan Road 600, Shanghai, 200233, China.
- Department of Hepato-Pancreato-Biliary Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Koretsune Y, Sone M, Sugawara S, Wakatsuki Y, Ishihara T, Hattori C, Fujisawa Y, Kusumoto M. Validation of a convolutional neural network for the automated creation of curved planar reconstruction images along the main pancreatic duct. Jpn J Radiol 2023; 41:228-234. [PMID: 36121623 PMCID: PMC9889432 DOI: 10.1007/s11604-022-01339-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/09/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the accuracy and time-efficiency of newly developed software in automatically creating curved planar reconstruction (CPR) images along the main pancreatic duct (MPD), which was developed based on a 3-dimensional convolutional neural network, and compare them with those of conventional manually generated CPR ones. MATERIALS AND METHODS A total of 100 consecutive patients with MPD dilatation (≥ 3 mm) who underwent contrast-enhanced computed tomography between February 2021 and July 2021 were included in the study. Two radiologists independently performed blinded qualitative analysis of automated and manually created CPR images. They rated overall image quality based on a four-point scale and weighted κ analysis was employed to compare between manually created and automated CPR images. A quantitative analysis of the time required to create CPR images and the total length of the MPD measured from CPR images was performed. RESULTS The κ value was 0.796, and a good correlation was found between the manually created and automated CPR images. The average time to create automated and manually created CPR images was 61.7 s and 174.6 s, respectively (P < 0.001). The total MPD length of the automated and manually created CPR images was 110.5 and 115.6 mm, respectively (P = 0.059). CONCLUSION The automated CPR software significantly reduced reconstruction time without compromising image quality.
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Affiliation(s)
- Yuji Koretsune
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Miyuki Sone
- grid.272242.30000 0001 2168 5385Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo City, Japan
| | - Shunsuke Sugawara
- grid.272242.30000 0001 2168 5385Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo City, Japan
| | - Yusuke Wakatsuki
- grid.272242.30000 0001 2168 5385Department of Diagnostic Technology, National Cancer Center Hospital, Chuo City, Japan
| | - Toshihiro Ishihara
- grid.272242.30000 0001 2168 5385Department of Diagnostic Technology, National Cancer Center Hospital, Chuo City, Japan
| | - Chihiro Hattori
- grid.471046.00000 0001 0671 5048Canon Medical Systems Corp., Otawara, Japan
| | - Yasuko Fujisawa
- grid.471046.00000 0001 0671 5048Canon Medical Systems Corp., Otawara, Japan
| | - Masahiko Kusumoto
- grid.272242.30000 0001 2168 5385Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo City, Japan
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Abe K, Kitago M, Masugi Y, Iwasaki E, Yagi H, Abe Y, Hasegawa Y, Fukuhara S, Hori S, Tanaka M, Nakano Y, Yokose T, Shimane G, Sakamoto M, Kitagawa Y. Indication for resection and possibility of observation for intraductal papillary mucinous neoplasm with high-risk stigmata. Pancreatology 2021; 21:755-762. [PMID: 33632666 DOI: 10.1016/j.pan.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/22/2021] [Accepted: 02/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES According to the revised international intraductal papillary mucinous neoplasm (IPMN) guidelines (2017), the indication for surgery is based on risk classification. However, some IPMNs with high-risk stigmata (HRS) can be observed for long periods without resection. Hence, we need to reconsider the risk stratification, and this study aimed to propose a novel risk stratification for HRS-IPMNs. METHODS We enrolled 328 patients diagnosed with IPMN using endoscopic ultrasound between 2012 and 2019. We compared clinicopathological features between HRS and worrisome features (WF) and evaluated outcomes of HRS-IPMN. RESULTS Fifty-three patients (HRS 38, WF 15) underwent resection at initial diagnosis and 275 patients were observed. Following observation for 30 months, 22 patients (17 HRS, 5 WF) underwent resection. Analysis of resected IPMNs (n = 75) revealed that HRS had dominantly pancreatobiliary mucin subtype. Pancreatobiliary-type IPMN had larger nodule sizes and lymphatic invasion and high recurrence with poor prognosis. Seventy-four patients were diagnosed with HRS, 55 underwent resection, and 19 continue to be observed. The resected group had larger nodule sizes (median 8 mm vs. 5 mm; P = 0.060), whereas the observed group had more main pancreatic duct (MPD) dilation (median 10 mm vs. 5 mm; P = 0.005). In the resected HRS group, only patients with MPD dilation ≥10 mm (n = 10) had no recurrence but had a favorable prognosis compared with those nodule size ≥5 mm (n = 45). CONCLUSIONS Large nodule size may be associated with pancreatobiliary subtype and poor prognosis; however, patients with MPD dilation ≥10 mm with nodule size <5 mm did not require resection.
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Affiliation(s)
- Kodai Abe
- Department of Surgery, Keio University School of Medicine, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Japan.
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Japan
| | - Eisuke Iwasaki
- Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Keio University School of Medicine, Japan
| | - Seiichiro Fukuhara
- Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University School of Medicine, Japan
| | - Masayuki Tanaka
- Department of Surgery, Keio University School of Medicine, Japan
| | - Yutaka Nakano
- Department of Surgery, Keio University School of Medicine, Japan
| | - Takahiro Yokose
- Department of Surgery, Keio University School of Medicine, Japan
| | - Gaku Shimane
- Department of Surgery, Keio University School of Medicine, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Japan
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5
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Yamaguchi A, Hamada T, Wada K, Moriuchi R, Tao K, Konishi H, Tamaru Y, Kusunoki R, Kuwai T, Kouno H, Ishiyama K, Hadano N, Sudo T, Toyota N, Zaitsu J, Kuraoka K, Kohno H. A case of intraductal tubulopapillary neoplasm of the pancreas in a branch duct: a rare case report and literature review. BMC Gastroenterol 2021; 21:162. [PMID: 33849435 PMCID: PMC8045350 DOI: 10.1186/s12876-021-01744-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Intraductal tubulopapillary neoplasm (ITPN) of the pancreas is a new disease concept defined by the World Health Organization in 2010. ITPN progresses with tubulopapillary growth in the pancreatic duct and is known to have a fair prognosis. Localization in the main pancreatic duct (MPD) is one characteristic. There are few case reports of ITPN in a branch of the pancreatic duct (BD). CASE PRESENTATION We encountered a case of ITPN localized in BD. An 85-year-old man was followed after colonic surgery for rectal carcinoma. An abdominal computed tomography scan revealed a cystic mass in the pancreatic head and further examination was done. A T2 weighted intension picture in magnetic resonance imaging showed a 20 mm cystic lesion with an internal mass of 15 mm. Duodenal papilla were slightly open and endoscopic retrograde pancreatography revealed mild and diffuse dilatation of the main pancreatic duct and mucin in the MPD. In consideration with the image examinations, we diagnosed the tumor as an intraductal papillary mucinous neoplasm with carcinoma because of its large mural nodule (> 10 mm in size) in a cyst. Consequently, a pancreaticoduodenectomy was performed. Macroscopically, a white solid tumor sized 2.5 × 1.8 × 1.0 was identified in the head of the pancreas. The cut surface of the resected pancreas showed a side-branch type intraductal tumor with tubulopapillary architecture without mucin secretion. Immunohistochemical staining was positive for MUC1, and negative for MUC2 and MUC5AC. The final diagnosis was determined to be pancreatic ITPN from BD. At the time of this report (48 months post-surgery), the patient remains disease-free without evidence of recurrence. CONCLUSION ITPNs localized in BD are rare and diagnosis prior to surgery is difficult. In our case, the shape was round, not papillary, and with little fluid. These characteristics are different from a branch duct type IPMN and can be a clue to suspect ITPN in BD.
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Affiliation(s)
- Atsushi Yamaguchi
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan.
| | - Takuro Hamada
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Kaoru Wada
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Riho Moriuchi
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Kanae Tao
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Hirona Konishi
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Yuzuru Tamaru
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Ryusaku Kusunoki
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Hirotaka Kouno
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Kohei Ishiyama
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Naoto Hadano
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Takeshi Sudo
- Department of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Naoyuki Toyota
- Department of Radiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Junichi Zaitsu
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Kazuya Kuraoka
- Department of Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
| | - Hiroshi Kohno
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima Prefecture, Japan
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Hadjizacharias T, Kaliviotis I, Kottakis G, Pavlides O, Papalouka D, Polydorou A. Distal pancreatectomy after pancreatic injury, in two pediatric patients. Int J Surg Case Rep 2020; 76:293-296. [PMID: 33065489 PMCID: PMC7567176 DOI: 10.1016/j.ijscr.2020.10.008] [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: 08/02/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 02/07/2023] Open
Abstract
Blunt trauma to the abdomen, accounts for the majority of abdominal injuries in children. Pancreas injury from blunt abdominal trauma in children is very rare. The emergent use of ERCP in children has not been implement widely. Operative vs non-operative management of blunt pancreatic trauma in children. A key is the status of pancreatic duct.
Introduction Although serious trauma is rare in pediatric patients, the management of blunt force trauma to the abdomen remains a challenge for Child Surgery Departments. Pancreatic injury comprises the fourth most common injury among the solid organs and cases accompanied by rupture of the main pancreatic duct (MPD) present a further challenge for physicians (Fayza Haider et al.; Wood et al., 2010; Jobst et al., 1999; Grosfeld et al., 2006). Case presentation Two adolescents, both 13 years old, where referred to our Pediatric Hospital, due to blunt force abdominal trauma. During admission, both patients were hemodynamically stable, in good general condition but suffering from abdominal pain and vomiting. After a full diagnostic check-up, grade IV pancreatic injury was diagnosed in both patients and they were taken to the operation room 3 and 6 days post-injury. Intra-operatively a distal pancreatectomy along with splenectomy was performed in both cases, with catheterization and ligation of the main pancreatic duct. Both patients were admitted to the pediatric ICU for 2 and 4 days. Both made an uneventful recovery and remain well 6 months postoperatively. Conclusion While hemodynamically stable, patients with Grade IV pancreatic injury, benefit from sub-acute management, allowing for planning of the surgical intervention. Distal pancreatectomy with splenectomy, along with catheterization and ligation of the main pancreatic duct, has excellent post-operative results. The chief of the Pediatric Hospital, said that in 35 years at pediatric surgery, is the first time with the need of operative management, in pancreatic injury. The hepatobiliary surgical expert in adults, who was consulted in both cases, said that without the surgeries, both children were going to die.
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Affiliation(s)
- Theodoros Hadjizacharias
- 2nd Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
| | - Ioannis Kaliviotis
- 1st Department of Pediatric Surgery, Panagioti kai Aglaia Kyriakou Pediatric Hospital, Athens, Greece.
| | - George Kottakis
- 1st Department of Pediatric Surgery, Panagioti kai Aglaia Kyriakou Pediatric Hospital, Athens, Greece.
| | - Orestis Pavlides
- 1st Department of Pediatric Surgery, Panagioti kai Aglaia Kyriakou Pediatric Hospital, Athens, Greece.
| | - Dimitra Papalouka
- 2nd Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
| | - Andreas Polydorou
- 2nd Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece.
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7
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Dugic A, Nikolic S, Mühldorfer S, Bulajic M, Pozzi Mucelli R, Tsolakis AV, Löhr JM, Vujasinovic M. Clinical importance of main pancreatic duct variants and possible correlation with pancreatic diseases. Scand J Gastroenterol 2020; 55:517-527. [PMID: 32393143 DOI: 10.1080/00365521.2020.1760345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Except for pancreas divisum (PD), the prevalence of anatomic variants of the main pancreatic duct (MPD) seems to be insufficiently investigated. To date, their role in the occurrence of pancreatic exocrine insufficiency (PEI) and morphological changes suggestive of chronic pancreatitis (CP) has remained unclear.Methods: A systematic review was performed, searching MEDLINE and Web of Science, limited to articles published between 1960 and 1 June 2019.Results: Our review included a total number of 3234 subjects. The most common variant of MPD was type 3, followed by type 1, indicating MPD drainage pattern into major papilla (MP) as the most frequent. A sub-variant of type 3, known as 'reverse pancreas divisum' had a prevalence of 2.2%. Type 4 variant- PD, was found in 6.4% of all cases. The most common sub-variant of PD was complete PD, followed by incomplete PD and variant with MPD as only pancreatic duct. Type 5 variant (including ansa pancreatica) was present in 2.9% of subjects. Apart from one study with a significantly higher frequency of morphological changes suggestive of CP in patients with ansa pancreatica, the studies stated no significant association between pancreatic disease and MPD variants. Furthermore, only one study examined the influence of MPD variants on exocrine pancreatic function. Although equivocal, this association is most likely found to be insignificant.Conclusion: To elucidate linkage between MPD variants and the occurrence of chronic pancreatitis and impairment of pancreatic exocrine function, further clinical investigations are warranted.
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Affiliation(s)
- Ana Dugic
- Department of Internal Medicine, Clinic for Gastroenterology, Endocrinology and Metabolic Disorders, Bayreuth, Germany.,Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Sara Nikolic
- Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department of Gastroenterology, Division of Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Steffen Mühldorfer
- Department of Internal Medicine, Clinic for Gastroenterology, Endocrinology and Metabolic Disorders, Bayreuth, Germany
| | - Milutin Bulajic
- Gastroenterology and Digestive Endoscopy Department, Mater Olbia Hospital, Olbia, Italy
| | - Raffaella Pozzi Mucelli
- Department of Abdominal Radiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Apostolos V Tsolakis
- Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna (MedS, K2), Division of Clinical Medicine, Karolinska Institute, Stockholm, Sweden
| | - J-Matthias Löhr
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.,Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Miroslav Vujasinovic
- Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.,Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
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8
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Frøkjær JB, Olesen SS, Drewes AM, Collins D, Akisik F, Swensson J. Impact of age on the diagnostic performance of pancreatic ductal diameters in detecting chronic pancreatitis. Abdom Radiol (NY) 2020; 45:1488-1494. [PMID: 32296897 DOI: 10.1007/s00261-020-02522-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE In the diagnosis of chronic pancreatitis (CP), definition of main pancreatic duct (MPD) dilation is challenging due to lack of commonly accepted normal values. This study assessed the diagnostic performance of MPD diameters to detect CP including the impact of age. METHODS 274 patients with ERCP-verified CP and 262 healthy controls were included. All had magnetic resonance cholangiopancreatography (MRCP) with measurement of MPD diameters in the pancreatic head, body, and tail. CP disease stage was defined as patients with and without functional (exocrine and/or endocrine) impairment. Diagnostic performance of MPD diameter and corresponding cut-offs values to diagnose CP were determined, including an age-stratified analysis. RESULTS In healthy controls, an effect of age on MPD diameters was seen for the pancreatic head (P < 0.001), body (P = 0.006), and tail (P = 0.03). Patients with CP had increased MPD diameter compared to controls (all segments P < 0.001). Increased pancreatic head MPD diameter was seen in patients with functional pancreatic impairment compared to patients without (P = 0.03). The diagnostic performance of MPD diameter to detect CP was high (all segments ROC-AUC > 0.92). The optimal pancreatic MPD diameter cut-off values for diagnosing CP were: < 40 years: 2.0(head) and 1.8(body) mm; 40-60 years: 2.4(head) and 2.1(body) mm; > 60 years: 2.7(head) and 2.1(body) mm. CONCLUSION Age is an important factor when evaluating the diameter of the pancreatic ductal system. Our findings challenge the existing reported thresholds for defining an abnormal duct diameter and point at age-stratified assessments as an integrated part of future imaging-based diagnostic and grading systems for CP.
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Affiliation(s)
- Jens Brøndum Frøkjær
- Department of Radiology, Aalborg University Hospital, P.O. Box 365, 9100, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Søren Schou Olesen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - David Collins
- Department of Radiology, Indiana University, Indianapolis, USA
| | - Fatih Akisik
- Department of Radiology, Indiana University, Indianapolis, USA
| | - Jordan Swensson
- Department of Radiology, Indiana University, Indianapolis, USA
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9
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Lanke G, Lee JH. Similarities and differences in guidelines for the management of pancreatic cysts. World J Gastroenterol 2020; 26:1128-1141. [PMID: 32231418 PMCID: PMC7093312 DOI: 10.3748/wjg.v26.i11.1128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/21/2020] [Accepted: 02/29/2020] [Indexed: 02/06/2023] Open
Abstract
Accurate diagnosis of Pancreatic cysts (PC) is key in the management. The knowledge of indications for surgery, the role of endoscopic ultrasound-guided fine needle aspiration, cyst fluid analysis, imaging, and surveillance of PC are all important in the diagnosis and management of PC. Currently, there are many guidelines for the management of PC. The optimal use of these guidelines with a patient-centered approach helps diagnose early cancer and prevent the spread of cancer.
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Affiliation(s)
- Gandhi Lanke
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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10
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Omura T, Matsushita K, Arase M, Yagi T. Three cases of paediatric pancreatic injury involving the main pancreatic duct. Trauma Case Rep 2019; 24:100253. [PMID: 31872024 PMCID: PMC6911926 DOI: 10.1016/j.tcr.2019.100253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/03/2019] [Revised: 08/22/2019] [Accepted: 09/19/2019] [Indexed: 12/26/2022] Open
Abstract
We report on 3 patients aged 9–12 years with pancreatic injury involving the main pancreatic duct. None of them presented with shock. They were initially transported to secondary emergency care facilities, leading to delays in diagnosis and treatment. Two patients underwent organ (spleen and pancreatic tail)-preserving surgery and one underwent non-operative management (NOM). They recovered and were discharged without major complications. Although the indications for NOM for paediatric pancreatic injury might increase in the future, we believe that it is preferable for patients to be transferred to the tertiary care hospital from the very beginning to recieve appropriate diagnosis and treatment.
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Affiliation(s)
- Takeshi Omura
- Department of Surgery, Tokushima Prefectural Central Hospital, Kuramotocho, 1-10-3, Tokushima-city, Tokushima, Japan.,Emergency Surgery and Trauma Center, Tokushima Prefectural Central Hospital, Kuramotocho, 1-10-3, Tokushima-city, Tokushima, Japan
| | - Kenta Matsushita
- Department of Surgery, Tokushima Prefectural Central Hospital, Kuramotocho, 1-10-3, Tokushima-city, Tokushima, Japan
| | - Miharu Arase
- Department of Emergency Medicine, Tokushima Prefectural Central Hospital, Kuramotocho, 1-10-3, Tokushima-city, Tokushima, Japan
| | - Toshiyuki Yagi
- Department of Surgery, Tokushima Prefectural Central Hospital, Kuramotocho, 1-10-3, Tokushima-city, Tokushima, Japan
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11
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Wang Q, Swensson J, Hu M, Cui E, Tirkes T, Jennings SG, Akisik F. Distribution and correlation of pancreatic gland size and duct diameters on MRCP in patients without evidence of pancreatic disease. Abdom Radiol (NY) 2019; 44:967-975. [PMID: 30600375 DOI: 10.1007/s00261-018-1879-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To use MRCP to investigate age-related changes and gender differences of the pancreas and to correlate pancreatic gland size and duct diameter. METHODS In this institutional review, board-approved, HIPAA-compliant study, 280 patients (age 20-88 years) without a history of pancreatic or liver disease who had undergone MRI/MRCP from 2004 to 2015 were identified. The anteroposterior size and main duct diameter of the pancreatic head, body, and tail were measured. The pancreatic gland and duct sizes were compared between genders, and among seven age subgroups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89). RESULTS The pancreatic head and body were significantly larger in males than females (head, p < 0.01; body, p = 0.03), while the tail and the duct diameters of the pancreatic head, body, and tail showed no gender difference. As the age of male participants increased, there was an associated increase in size of the pancreatic gland initially (largest at age 50-59 (body) and 60-69 (head)), followed by subsequent decline in size thereafter. Additionally, the pancreatic duct diameter was found to increase gradually. In females, the size of the pancreatic gland decreased, while the diameter of the pancreatic duct increased with age. Moderate positive correlation for gland size and strong positive correlation for duct diameter among different pancreatic regions were found. Weak negative correlation was found between gland size and duct diameter. CONCLUSIONS There are gender differences in the gland size of the pancreatic head and body. The pancreatic gland size increases until the sixth decade in males, with a more continuous decrease in gland size with age in females. Both males and females demonstrate a marked decrease in gland size after the eighth decade. The duct diameter increases with age in both males and females.
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Affiliation(s)
- Qiushi Wang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhong Shan Er Road, Guangzhou, 510080, Guangdong, China
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Jordan Swensson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Maoqing Hu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
- Department of Radiology, Jiangmen Central Hospital, No. 23 Haibang Street, Jiangmen, 529030, Guangdong, China
| | - Enming Cui
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
- Department of Radiology, Jiangmen Central Hospital, No. 23 Haibang Street, Jiangmen, 529030, Guangdong, China
| | - Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Samuel G Jennings
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA
| | - Fatih Akisik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N University Blvd, Indianapolis, IN, 46202, USA.
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12
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Singh HJ, Aggarwal A, Kochhar RK, Yadav TD, Gupta T, Sahni D. Closed loop of main duct of pancreas: a rare variant configuration. Surg Radiol Anat 2017; 39:1405-1407. [PMID: 28523348 DOI: 10.1007/s00276-017-1873-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/15/2017] [Indexed: 11/26/2022]
Abstract
During routine dissection, duplication of main pancreatic duct extending from body to head region of pancreas was observed in a 78-year-old formalin fixed male cadaver. Main pancreatic duct gave a prominent branch which joined back the parent duct in head resulting in the formation of a closed loop. This gave the appearance of focal duplication in the form of a closed loop, an unusual variant. This was an incidental finding. Such cases usually remain asymptomatic; however, if undetected may be the cause of postoperative pancreatic fistula following pancreaticobiliary surgery. Knowledge of variable anatomy of pancreatic duct system became important to reduce the risk of postoperative complication and during various endoscopic guided procedures like drainage of pseudocyst or placement of stent into the duct.
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Affiliation(s)
- Harsimran Jit Singh
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Rakesh K Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - T D Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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13
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Gao H, Song Q, Lv F, Wang S, Wang Y, Li X, Luo Y, Mei X, Tang J. Protection Provided by a Gabexate Mesylate Thermo-Sensitive In Situ Gel for Rats with Grade III Pancreatic Trauma. Gut Liver 2017; 11:156-163. [PMID: 27646597 PMCID: PMC5221874 DOI: 10.5009/gnl15281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background/Aims This study investigated the protection provided by gabexate mesylate thermo-sensitive in-situ gel (GMTI) against grade III pancreatic trauma in rats. Methods A grade III pancreatic trauma model with main pancreatic duct dividing was established, and the pancreas anatomical diagram, ascites, and serum biochemical indices, including amylase, lipase, C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α), were examined. The pancreas was sliced and stained with hematoxylin eosin and subjected to terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. Results Ascites, serum amylase, lipase, CRP, IL-6, and TNF-α levels were significantly increased in the pancreas trauma (PT) groups with prolonged trauma time and were significantly decreased after GMTI treatment. The morphological structure of the pancreas was loose, the acinus was significantly damaged, the nuclei were irregular and hyperchromatic, and there was inflammatory cell invasion in the PT group compared to the control. After GMTI treatment, the morphological structure of the pancreas was restored, and the damaged acinus and inflammatory cell invasion were decreased compared to the PT group. Moreover, the cell apoptosis index was significantly increased in the PT group and restored to the same levels as the control group after GMTI treatment. Conclusions GMTI, a novel formulation and drug delivery method, exhibited specific effective protection against PT with acute pancreatitis therapy and has potential value as a minimally invasive adjuvant therapy for PT with acute pancreatitis.
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Affiliation(s)
- Hanjing Gao
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, 161th Hospital of Chinese PLA, Wuhan, China
| | - Qing Song
- Department of Radiology, General Hospital of Beijing Military Region, Beijing, China
| | - Faqin Lv
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Shan Wang
- Department of Pharmaceutics, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yiru Wang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyan Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xingguo Mei
- Department of Pharmaceutics, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Jie Tang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
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14
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Miyamoto R, Oshiro Y, Nakayama K, Kohno K, Hashimoto S, Fukunaga K, Oda T, Ohkohchi N. Three-dimensional simulation of pancreatic surgery showing the size and location of the main pancreatic duct. Surg Today 2016; 47:357-364. [PMID: 27368278 DOI: 10.1007/s00595-016-1377-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/17/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE We performed three-dimensional (3D) surgical simulation of pancreatic surgery, including the size and location of the main pancreatic duct on the resected pancreatic surface. METHODS The subjects of this retrospective analysis were 162 patients who underwent pancreatic surgery. This cohort was sequentially divided into a "without-3D" group (n = 81) and a "with-3D" group (n = 81). We compared the pancreatic duct diameter and its location, using nine sections in a grid pattern, with the intraoperative findings. The perioperative outcomes were also compared between patients who underwent pancreaticoduodenectomy (PD) and those who underwent distal pancreatectomy (DP). RESULTS There were no significant differences in the main pancreatic duct diameter between the 3D-simulated values and the operative findings. The 3D-simulated main pancreatic duct location was consistent with its actual location in 80 % of patients (65/81). In comparing the PD and DP groups, the intraoperative blood loss was 1174 ± 867 and 817 ± 925 ml in the without-3D group, and 828 ± 739 and 307 ± 192 ml in the with-3D group, respectively (p = 0.024, 0.026). CONCLUSION The 3D surgical simulation provided useful information to promote our understanding of the pancreatic anatomy, including details on the size and location of the main pancreatic duct.
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Affiliation(s)
- Ryoichi Miyamoto
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Oshiro
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Ken Nakayama
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Keisuke Kohno
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinji Hashimoto
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kiyoshi Fukunaga
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tatsuya Oda
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Nobuhiro Ohkohchi
- Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, Department of Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Abstract
INTRODUCTION Pancreatic trauma (PT) is associated with high morbidity and mortality; the therapeutic options remain debated. MATERIAL AND METHODS Retrospective study of PT treated in the University Hospital of Grenoble over a 22-year span. The decision for initial laparotomy depended on hemodynamic status as well as on associated lesions. Main pancreatic duct lesions were always searched for. PT lesions were graded according to the AAST classification. RESULTS Of a total of 46 PT, 34 were grades II or I. Hemodynamic instability led to immediate laparotomy in 18 patients, for whom treatment was always drainage of the pancreatic bed; morbidity was 30%. Eight patients had grade III injuries, six of whom underwent immediate operation: three underwent splenopancreatectomy without any major complications while the other three who had simple drainage required re-operation for peritonitis, with one death related to pancreatic complications. Four patients had grades IV or V PT: two pancreatoduodenectomies were performed, with no major complication, while one patient underwent duodenal reconstruction with pancreatic drainage, complicated by pancreatic and duodenal fistula requiring a hospital stay of two months. The post-trauma course was complicated for all patients with main pancreatic duct involvement. Our outcomes were similar to those found in the literature. CONCLUSION In patients with distal PT and main pancreatic duct involvement, simple drainage is associated with high morbidity and mortality. For proximal PT, the therapeutic options of drainage versus pancreatoduodenectomy must be weighed; pancreatoduodenectomy may be unavoidable when the duodenum is injured as well. Two-stage (resection first, reconstruction later) could be an effective alternative in the emergency setting when there are other associated traumatic lesions.
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Affiliation(s)
- E Girard
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - J Abba
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - C Arvieux
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - B Trilling
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Y Sage
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - N Mougin
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - S Perou
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Lavagne
- Réanimation post-chirurgicale, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - C Létoublon
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
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16
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Yamamoto S, Inui K, Yoshino J, Miyoshi H, Kobayashi T. Air in the main pancreatic duct associated with a pancreatic intraductal papillary mucinous neoplasm. Clin J Gastroenterol 2013; 6:454-8. [PMID: 26182136 DOI: 10.1007/s12328-013-0408-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/15/2013] [Indexed: 11/24/2022]
Abstract
A 62-year-old man was referred to our hospital after ultrasonographic mass screening detected a pancreatic cyst that proved to be an intraductal papillary mucinous neoplasm. Computed tomography additionally demonstrated air in the main pancreatic duct. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography delineated a filling defect in the main pancreatic duct in the body of the pancreas. The sphincter of Oddi was open. The main pancreatic duct was dilated by viscous mucin; air in the duct was attributed to consequent dysfunction of the sphincter. Laboratory findings included no significant abnormality. The patient has remained asymptomatic during follow-up. Of 25 previously reported cases with air in the duct, only 1 involved an intraductal papillary mucinous neoplasm.
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Affiliation(s)
- Satoshi Yamamoto
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan.
| | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Junji Yoshino
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Hironao Miyoshi
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Takashi Kobayashi
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
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17
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Mahmud MS, May GR, Kamal MM, Khwaja AS, Sun C, Vitkin A, Yang VXD. Imaging pancreatobiliary ductal system with optical coherence tomography: A review. World J Gastrointest Endosc 2013; 5:540-550. [PMID: 24255746 PMCID: PMC3831196 DOI: 10.4253/wjge.v5.i11.540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/23/2013] [Accepted: 10/16/2013] [Indexed: 02/05/2023] Open
Abstract
An accurate, noninvasive and cost-effective method of in situ tissue evaluation during endoscopy would be highly advantageous for the detection of dysplasia or early cancer and for identifying different disease stages. Optical coherence tomography (OCT) is a noninvasive, high-resolution (1-10 μm) emerging optical imaging method with potential for identifying microscopic subsurface features in the pancreatic and biliary ductal system. Tissue microstructure of pancreaticobiliary ductal system has been successfully imaged by inserting an OCT probe through a standard endoscope operative channel. High-resolution OCT images and the technique’s endoscopic compatibility have allowed for the microstructural diagnostic of the pancreatobiliary diseases. In this review, we discussed currently available pancreaticobiliary ductal imaging systems to assess the pancreatobiliary tissue microstructure and to evaluate varieties of pancreaticobiliary disorders and diseases. Results show that OCT can improve the quality of images of pancreatobiliary system during endoscopic retrograde cholangiopancheatography procedure, which may be important in distinguishing between the neoplastic and non-neoplastic lesions.
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Lee HY, Ha HI, Kim MJ, Lim HK. Compression of the main pancreatic duct by the intrapancreatic-replaced common hepatic artery. Korean J Radiol 2013; 14:412-5. [PMID: 23690706 PMCID: PMC3655293 DOI: 10.3348/kjr.2013.14.3.412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/22/2012] [Accepted: 02/08/2013] [Indexed: 11/23/2022] Open
Abstract
We describe a unique case of a patient who presented with a linear, transverse, and incidentally-detected main pancreatic duct dilatation that was caused by the intrapancreatic-replaced common hepatic artery, detected on the MDCT, MRCP and endoscopic retrograde cholangiopancreatography. We believe this case to be the first of its kind reported in the literature.
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Affiliation(s)
- Ha-yeon Lee
- Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, Anyang 431-070, Korea
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Ogawa M, Kawaguchi Y, Maruno A, Ito H, Nakagohri T, Hirabayashi K, Yamamuro H, Yamashita T, Mine T. Small serotonin-positive pancreatic endocrine tumors caused obstruction of the main pancreatic duct. World J Gastroenterol 2012; 18:6669-73. [PMID: 23236243 PMCID: PMC3516203 DOI: 10.3748/wjg.v18.i45.6669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/01/2012] [Accepted: 08/03/2012] [Indexed: 02/06/2023] Open
Abstract
We report 2 cases of pancreatic endocrine tumors that caused obstruction of the main pancreatic duct (MPD). A 49-year-old asymptomatic man was referred to our institution because dilation of the MPD was revealed by abdominal ultrasonography (US). No tumor was detected by endoscopic ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). The diameter of the MPD was > 20 mm at the body, and no dilation was noted at the head. Although malignancy was not confirmed through cytology or imaging, pancreatic cancer was strongly suspected. Pancreaticoduo- denectomy was performed. Pathological and immunohistochemical examination revealed a 5 mm × 3 mm serotonin-positive endocrine tumor. Fibrosis was present around the MPD and seemed to cause stricture. A 32-year-old asymptomatic man had elevated serum amylase, and US demonstrated dilation of the MPD. No tumor was detected by CT and MRI. Pancreatic cancer was suspected due to stricture and dilation of the MPD. Pancreatectomy of middle part of pancreas was performed. Pathological and immunohistochemical examination revealed a serotonin-positive endocrine tumor sized 5 mm × 4 mm. We report 2 cases of serotonin-positive pancreatic endocrine tumors that caused stricture of the MPD in spite of the small size of the tumor.
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Kim YJ, Kim HK, Cho YS, Kim SS, Chae HS, Kim SK, Kim ES, Lee SY. Air in the main pancreatic duct: A case of innocent air. World J Gastroenterol 2012; 18:5142-4. [PMID: 23049228 PMCID: PMC3460346 DOI: 10.3748/wjg.v18.i36.5142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 05/16/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
Air in the main pancreatic duct has been reported only rarely and might be associated with either a spontaneous or a surgically induced alteration of the anatomy of the biliary tract. We report a case of “innocent” air found incidentally in the main pancreatic duct. To our knowledge, this is only the third such case reported. A 54-year-old woman presented with hemoptysis that had lasted for 3 d. She underwent a chest computed tomography scan, which revealed not only focal bronchiectasis in the left lower lobe, but also air in the main pancreatic duct and dilatation of the common bile duct. She was managed conservatively for the hemoptysis and no further problems developed. She had no specific gastrointestinal symptoms and had no history of surgery or medication. Her laboratory parameters were normal. Magnetic resonance cholangiopancreatography also demonstrated air in the main pancreatic duct and a dilated common bile duct (CBD). Duodenoscopy revealed separate biliary and pancreatic orifices with patulous openings and some air bubbles appearing in the pancreatic orifice. Endoscopic retrograde cholangiopancreatography (ERCP) showed the dilated CBD and pancreatic duct with some air bubbles, but no other abnormal lesions. She was discharged with no further problems. Most patients with air in the main pancreatic duct have had a pancreatobiliary disease, or a history of pancreatobiliary disease, pancreatobiliary surgery or sphincterotomy. If the air is innocent, as in our case, ERCP should be performed to evaluate any altered sphincteric function or anatomy such as patulous openings.
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Abstract
The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo, entering the duodenum at the minor duodenal papilla (MIP). With the growth, the duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal end. Patency of the APD in 291 control cases was 43% as determined by dye-injection endoscopic retrograde pancreatography. Patency of the APD in 46 patients with acute pancreatitis was only 17%, which was significantly lower than in control cases (P < 0.01). The terminal shape of the APD was correlated with APD patency. Based on the data about correlation between the terminal shape of the APD and its patency, the estimated APD patency in 167 patients with acute pancreatitis was 21%, which was significantly lower than in control cases (P < 0.01). A patent APD may function as a second drainage system for the main pancreatic duct to reduce the pressure in the main pancreatic duct and prevent acute pancreatitis. Pancreatographic findings of 91 patients with pancreaticobiliary maljunction (PBM) were divided into a normal duct group (80 patients) and a dorsal pancreatic duct (DPD) dominant group (11 patients). While 48 patients (60%) with biliary carcinoma (gallbladder carcinoma, n = 42; bile duct carcinoma, n = 6) were identified in PBM with a normal pancreatic duct system, only two cases of gallbladder carcinoma (18%) occurred in DPD-dominant patients (P < 0.05). Concentration of amylase in the bile of DPD dominance was significantly lower than that of normal pancreatic duct system (75 403.5 ± 82 015.4 IU/L vs 278 157.0 ± 207 395.0 IU/L, P < 0.05). In PBM with DPD dominance, most pancreatic juice in the upper DPD is drained into the duodenum via the MIP, and reflux of pancreatic juice to the biliary tract might be reduced, resulting in less frequency of associated biliary carcinoma.
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Abstract
Endoscopic ultrasonography (EUS) is well suited for assessment of the pancreas due to its high resolution and the proximity of the transducer to the pancreas, avoiding air in the gut. Evaluation of chronic pancreatitis (CP) was an early target for EUS, initially just for diagnosis but later for therapeutic purposes. The diagnosis of CP is still accomplished using the standard scoring based on nine criteria, all considered to be of equal value. For diagnosis of any CP, at least three or four criteria must be fulfilled, but for diagnosis of severe CP at least six criteria are necessary. The Rosemont classification, more restrictive, aims to standardize the criteria and assigns different values to different features, but requires further validation. EUS-fine needle aspiration (EUS-FNA) is less advisable for diagnosis of diffuse CP due to its potential side effects. Elastography and contrast-enhanced EUS are orientation in differentiating a focal pancreatic mass in a parenchyma with features of CP, but they cannot replace EUS-FNA. The usefulness of EUS-guided celiac block for painful CP is still being debated with regard to the best technique and the indications. EUS-guided drainage of pseudocysts is preferred in non-bulging pseudocysts or in the presence of portal hypertension. EUS-guided drainage of the main pancreatic duct should be reserved for cases in which endoscopic retrograde cholangiopancreatography has failed owing to difficult cannulation of the papilla or difficult endotherapy. It should be performed only by highly skilled endoscopists, due to the high rate of complications.
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