False aneurisms of visceral arteries: radiology methods in diagnostics and treatment

Abstract

Background: Laparoscopic distal pancreatic resection has gained acceptance and being practised in major HPB units. Laparoscopic pancreatico-duodenal resections are technically demanding and benefit of this approach has been a matter of debate over the past decade. We aim to analyse our early experience in laparoscopic pancreatico -duodenal resections. Methods: From November 2012 to August 2015, we have performed 8 pancreatico-duodenal resections. There were 2 total pancreatectomies and 6 Whipple's resections. The laparoscopic approach was using 5 ports with patient in supine position. We describe the patient characteristics, techniques and short-term outcomes. Results: The median age was 56 years (39e75) and M:F was 2:1. The Median BMI was 21 (17.5e23.5). The major indication was ampullary carcinoma. Two of the Whipple's resections had early conversion during dissection because of adjacent visceral invasion requiring extended resections. One Whipple's resection was totally laparoscopic and rest of them required a small incision to complete the anastomosis. The mean operating time was 598 min (425e689). One patient had grade A pancreatic leak that was managed conservatively. The median length of stay was 11 days (6e 22). The median tumour size was 19.3 mm (9e30).The mean lymph node yield was 20 (10e24). There was one case of R1 resection margin because of tumour within 1 mm SMV margin. There were no postoperative mortality. Conclusion: Laparoscopic pancreaticoduodenectomy is feasible and safe in selected group of patients performed by experienced surgeons. The oncological and the short term outcomes are similar to open resections.

Endovascular Occlusion of Giant Posttraumatic Pseudo-Aneurysm of Superior Mesenteric Artery Connected to Mesenteric Arteriovenous Fistula

“…Currently, apart from clinical signs of the volume overload of the portal system and liver insufficiency under portal hypertension, radiodiagnostics plays a key role in mesenteric AVF diagnosis. Most authors suggest duplex scanning and MSCT with contrast enhancement (MSCT-angiography) as screening methods [ 4 , 8 , 10 ]. An invasive survey and selective angiography are used to keep data current or as a treatment stage [ 4 , 5 , 11 ].…”