Recurrent pancreatitis secondary to pancreatic ascariasis

Ascaris lumbricoides infestations are endemic in tropical countries. Ascaris lumbricoides can occasionally cause biliary obstruction and result in obstructive jaundice or pancreatitis. We present a 34-year-old Bangladeshi woman with biliary ascariasis, resulting in recurrent pancreatitis. Her diagnosis was made with endoscopic retrograde cholangiopancreatography performed during an acute attack of pain.

Duodenal carcinoid: a rare cause of melaena in a cirrhotic patient

Small intestinal neuroendocrine tumours are relatively rare. Laboratory tests and diagnostic imaging are of help in diagnosis. Surgical resection is the standard approach. Metastatic disease has a poor prognosis. These are indolent tumours and hence role of chemotherapy is limited. Radionuclide and biological therapies are emerging. We report a 29-year-old man presenting with melaena and diagnosed as having a neuroendocrine tumour of the duodenum together with liver cirrhosis. Standard Whipple's procedure was done and he is doing well at follow-up.

An early experience of liver transplantation in portal vein thrombosis

Portal vein thrombosis (PVT) is a recognised complication of end-stage liver disease. As PVT is a relative contraindication to liver transplantation, potential candidates are often rejected due to increased risk and complexity of the surgical procedure. Thromboendovenectomy is a commonly-used technique for this vexing problem. We report a surgeon's experience of dealing with PVT at the time of liver transplantation. Two patients with liver cirrhosis and PVT underwent orthotopic liver transplantation (OLT) at the National University Hospital. The case notes of these two patients were retrospectively reviewed, along with a brief review of literature. Our early experience shows that with careful case selection and meticulous surgical technique, OLT can be safely done in patients with PVT without significant complications.

Minimally invasive retroperitoneal pancreatic necrosectomy in necrotising pancreatitis

With the marriage of surgery and technology, applications of minimal access surgery are increasing exponentially. Pancreatic diseases are no exception. Minimally invasive retroperitoneal pancreatic necrosectomy (MIRP), or percutaneous video-assisted necrosectomy, is a new technique to debride the necrotic pancreas. We report a 51- year-old male patient who successfully underwent MIRP for infected pancreatic necrosis, and briefly review of literature.

Long-term post-liver transplant complications of renal impairment and diabetes mellitus: data from Singapore

INTRODUCTION

Patients who survive the initial post-liver transplantation period face the development of chronic diseases in the long run. We studied two important complications of liver transplantation, namely: renal impairment and diabetes mellitus.

METHODS

We analysed adult patients followed-up for more than one year using data from our liver transplant clinical records. Long-term post-transplant renal impairment (RI) was defined as glomerular filtration rate (GFR) less than 60 ml/min/1.73 square metres and long-term post-transplant diabetes mellitus (DM) was defined as fasting blood glucose more than 7.8 mmol/L, that existed at least one year after liver transplantation. Pre- and post-transplant factors that could be associated with these conditions were examined.

RESULTS

Altogether, 35 patients were evaluated. Mean age at transplant was 50 years. Mean duration of follow-up was 58.4 months. There was 11.4 percent of pre-transplant RI and 17.0 percent of pre-transplant DM. Prevalence of post-transplant RI was 43.5 percent at one year and 45.0 percent at four years. Long-term post-transplant RI was associated with renal impairment at six months post-transplant (p-value is 0.033). Prevalence of severe post-transplant RI (GFR is less than 30 ml/min/1.73 square metres) at four years was 5.7 percent. Prevalence of post-transplant DM was 45.5 percent at two years but declined to 5.3 percent at four years.

CONCLUSION

Post-transplant renal impairment appears to be a potential long-term problem while post-transplant diabetes mellitus appears to improve with time.