We describe a family in which 5 of its members of 2 successive generations presented with multiple giant liver hemangiomas (GLH). A 30-year-old woman in 2013 presented with abdominal pain, increasing abdominal distension, and respiratory discomfort. Multidetector computed tomography revealed multiple (8-10) hepatic hemangiomas (HH) involving almost the entire right hemiliver and caudate lobe with the largest measuring 33 3 19 3 15 cm (Figure 1), which was complicated by Kasabach-Merritt syndrome. In an attempt to reduce the hemangioma volume for safer resection, transcatheter arterial embolization of the right hepatic artery was performed but failed to cause sustained regression. Right hepatectomy was performed through a thoracoabdominal approach, without any complication (Figure 2). A histopathology report confirmed the diagnosis. She lost follow-up after 3 years and again presented in 2019 with another fresh giant hemangioma of 23 3 12 3 15 cm size arising from segments 2 and 3. Enucleation was performed successfully preserving the functional liver volume (Figure 3).
This study aimed to determine if neutrophilto-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were predictive of malignancy in pancreatic cystic neoplasms (PCN) and if these improved the performance of the international consensus guidelines (ICG) in the initial triage of these patients. Methods: 318 patients with surgically-treated suspected PCN were retrospectively reviewed. Malignant neoplasms were defined as neoplasms harbouring invasive carcinoma. The optimal cut-off for NLR and PLR were determined by plotting the receiver operating characteristics (ROC) curves of NLR/PLR in predicting malignant PCN and utilizing the Youden index. Results: The optimal NLR and PLR cut-offs were determined to be 3.33 and 205, respectively. Univariate analyses demonstrated that symptomatic PCNs, obstructive jaundice, presence of solid component, dilatation of main pancreatic duct 10 mm, high NLR and high PLR were predictive of a malignant PCN. Multivariate analyses demonstrated that obstructive jaundice, presence of solid component, MPD 10 mm and high PLR but not NLR were independent predictors of a malignant PCN. A high PLR significantly predicted invasive carcinoma in patients classified within the ICG HR group. Comparison between the ROC curves of the ICG versus ICG plus PLR in predicting malignant PCN demonstrated a significant improvement in the accuracy of the ICG when PLR was included [AUC 0.784 (95% CI: 0.740e0.829) vs AUC 0.822 (95% CI: 0.772e0.872) (p = 0.0032)]. Conclusions: High PLR is an independent predictor of malignancy in PCN. The addition of PLR as a criterion to the ICG improved the accuracy of these guidelines in detecting invasive neoplasms.
Background: Visceral artery pseudoaneurysms (VAP) are defined as those affecting celiac, superior or inferior mesenteric arteries and their branches. In this study, role of various therapeutic modalities in the management of VAP caused by acute and chronic pancreatitis were analysed which can influence choice of treatment for a given patient.Methods: The study was conducted in institute of surgical gastroenterology, Madras medical college and Rajiv Gandhi government general hospital Chennai, based on retrospective analysis of 41 patients diagnosed with VAP caused by acute and chronic pancreatitis admitted between the periods of September 2014 and January 2020. The medical records of all patients were retrieved and descriptive statistical analyses was carried out regarding various details including demographics, presentation, management and complications.Results: This study includes 41 patients with mean age of 39.73±10.54 (SD) years and 40 (97.56%) of them were males. Fifteen patients (36.59%) had acute pancreatitis and 26 patients (63.41%) had chronic pancreatitis. Pseudocysts were found in 25 (60.98%) patients. Pseudoaneurysm arose most commonly from splenic artery (n=32; 78.04%). The most common symptom was abdominal pain (n=40) followed by gastrointestinal bleeding (n=28). Sixteen patients (39%) received primary radiological reintervention (n=16). Twenty-five patients (60.98%) underwent primary surgical treatment (n=25). Rebleeding was seen in 3 patients (7.32%). Twenty-three patients (56.1%) developed complications. Mortality rate was 5/41 (12.2%).Conclusions: Pseudoaneurysms are fatal complications of pancreatitis. Angiographic embolization, when available, is the initial treatment of choice in hemodynamically stable patients. Surgery in experienced hands will still remain main modality in treating these patients in centres that lack a full-fledged angiographic facility with acceptable outcomes.
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