Introduction During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. Methods From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34–82), 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57–70) underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. Results All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5). The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14–23). Conclusion Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy) are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.
The giant condyloma acuminatum, also known as Buschke- Lowenstein tumor (BLT), is a rare sexually-transmitted disease. Moreover, the condyloma acuminatum produced by Human Papilloma Virus (HPV) infection becomes one the most common sexually-transmitted infection which affects the perineal region. Under such situations, the first therapeutic option is surgical excision. The objective of this article is to present a case in which the tumor has reached giant dimensions and also to stress the importance of an in toto resection, taking into account the high rate of recurrence and the significant potential of malignant transformation of BLT.
Background. Pancreaticoduodenectomy is the potentially curative treatment for malignant and several benign conditions of the pancreatic head and periampullary region. While performing pancreaticoduodenectomy, early neck division may be impossible or inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels, intraductal papillary mucinous neoplasm, and pancreatic head bleeding pseudoaneurysm. Our work aims to highlight a particular hind right approach pancreaticoduodenectomy in selected indications and assess the preliminary results. Methods. We describe our early hind right approach to the retropancreatic vasculature during pancreaticoduodenectomy by mesopancreas dissection before any pancreatic or digestive transection. Results. We used this approach in 52 patients. Thirty-two had hepatic artery anatomic variant and 2 had bleeding pancreatic head pseudoaneurysm. The hepatic artery variant was preserved in all cases out of 2 in which arterial reconstruction was performed. In nine patients with intraductal papillary mucinous neoplasms the pancreaticoduodenectomy was extended to the body in 6 and totalized in 3 patients. Seven patients with adenocarcinoma involving the portomesenteric axis required venous resection and reconstruction. Conclusions. Early hind right approach is advocated in selected cases of pancreaticoduodenectomy to improve locoregional vascular control and determine, safely and early, whether there is mesopancreas involvement.
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Introducere: Leziunile diafragmatice sunt produse prin traumatisme toraco-abdominale închise sau deschise. Acestea sunt leziuni potenţial letale prin hernierea organelor abdominale în cavităţile pleurale şi prin severitatea leziunilor asociate. Scopul acestui studiu a fost analizarea manifestărilor clinice şi a managementului pacienţilor internaţi în clinica noastră cu diagnosticul de ruptura traumatică a diafragmului. Material şi metodă: Am efectuat un studiu retrospectiv pe o perioadă de 5 ani, în care am inclus pacienţii internaţi cu leziuni diafragmatice acute, internaţi în Clinica de Chirurgie Generală a Spitalului de Urgenţă "Bagdasar-Arseni". Am analizat repartiţia pe sexe şi vârstă, mecanismul traumei, localizarea, timpul până la diagnostic, leziunile concomitente, tratamentul chirurgical şi rezultatele. Rezultate: Au fost incluşi în studiu 15 pacienţi (8 bărbaţi, 7 femei, vârstă medie de 42 ani) cu rupturi diafragmatice (13 ale hemidiafragmului stâng, 2 ale celui drept), produse prin traumatisme închise (8 cazuri) sau deschise (7 cazuri). Leziunile diafragmatice închise au avut dimensiuni mai mari, producând hernierea viscerelor abdominale la 6 bolnavi. Sutura directă a fost efectuată la toţi cei 15 pacienţi, abordul prin laparotomie mediană fiind preferat de cele mai multe ori. Rata mortalităţii a fost de 20%, cauza principală fiind leziunile concomitente foarte grave. Concluzii: Deşi rupturile traumatice diafragmatice se asociază
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