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Asian consensus statements on endoscopic management of walled-off necrosis. Part 2: Endoscopic management

Isayama H, Nakai Y, Rerknimitr R, Khor C, Lau J, Wang HP, et al.

J Gastroenterol Hepatol, 2016 Sep;31(9):1555-65.
PMID: 27042957 DOI: 10.1111/jgh.13398

Walled-off necrosis (WON) is a new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 2 of this statement focused on the endoscopic management of WON.

Matched MeSH terms: Pancreatectomy/adverse effects; Pancreatectomy/methods
Fulltext Traumatic pseudocyst of the pancreas--a case report

Tay SKS, Abdul Wahab Y

Med J Malaysia, 1989 Dec;44(4):357-60.
PMID: 2520050

Blunt trauma to the pancreas is not common. The pancreatic injury can range from simple bruising to complete transection often associated with other visceral injuries. Pseudocyst of the pancreas is a late complication presenting usually within six weeks of the injury. The treatment of choice is distal pancreatectomy.

Matched MeSH terms: Pancreatectomy
A modified technique of pancreaticogastrostomy with short internal stent: A single surgeon's experience

Yap PY, Hwang JS, Bong JJ

Asian J Surg, 2017 Mar 10.
PMID: 28286020 DOI: 10.1016/j.asjsur.2017.01.003

BACKGROUND/OBJECTIVE: Postoperative pancreatic fistula (POPF) remains an important cause of morbidity and mortality after pancreaticoduodenectomy. Pancreaticogastrostomy (PG) as a reconstruction method after pancreaticoduodenectomy is a safe and optional surgical technique in decreasing the risk of POPF. In this study, a retrospective analysis was carried out to evaluate a new modification of PG technique that uses a two-layer anastomoses with an internal stent.
METHODS: Forty-seven patients underwent this newly modified PG technique between February 2012 and August 2016. Demographics, histopathological findings, type of surgery performed, perioperative parameters, postoperative length of stay, postoperative complications and interventional procedures, follow-up, and mortality data were collected and analyzed. Clavien-Dindo classification was used to grade the complications' severity.
RESULTS: Postoperative mortality was 4.25%, unrelated to POPF, and postoperative morbidity was 44.68%. Thirteen patients had severe (>Grade IIIa) complications, according to Clavien-Dindo classification. As classified in accordance to the International Study Group of Pancreatic Fistula, 24 (51.06%) patients developed Grade A POPF, and no occurrence of Grade B/C POPF was noted. All patients recovered uneventfully with successful treatment interventions.
CONCLUSION: The reported PG anastomotic technique is a safe and dependable reconstruction procedure with acceptable morbidity and mortality.

Matched MeSH terms: Pancreatectomy
Fulltext Total pancreatectomy for diffuse pancreatic adenocarcinoma

Azlanudin, A., Razman, J.

Journal of Surgical Academia, 2011;1(1):39-41.
MyJurnal

A 64-year-old lady presented with a brief history of abdominal pain associated with obstructive jaundice. Endoscopic retrograde cholangiopancreaticography (ERCP) revealed a short segment stricture with contact bleeding and the brush cytology confirmed presence atypical cells. Ca 19.9 levels were markedly elevated. She was planned for a Whipple’s procedure but was instead subjected to a total pancreatectomy based on intraoperative findings of a diffusely hard and nodular pancreas. Histopathological examination confirmed our diagnosis of diffuse pancreatic adenocarcinoma. This rare presentation of a locally contained and fully resectable diffuse pancreatic adenocarcinoma is being discussed.

Matched MeSH terms: Pancreatectomy
Fulltext Intraductal papillary mucinous neoplasm (IPMN) in association with autosomal dominant polycystic kidney disease (ADPKD)

Ikhwan Sani Mohamad, Nishioka, Yujiro, Shindoh, Junichi, Hashimoto, Masaji

Malaysian Journal of Medicine and Health Sciences, 2017;13(2):71-74.
MyJurnal

Intraductal Papillary Mucinous Neoplasm (IPMN) of the pancreas in association with Autosomal Dominant Polycystic Kidney Disease (ADPKD) is extremely rare, even though 10% of ADPKD patients may develop simple pancreatic cyst. The first case report was published by Yasunori Sato from Japan in 2009. Since then less than 10 case reports are available worldwide to describe about this condition. We reported such a rare case of a 67-year-old man with ADPKD who was referred to our centre because of chronic abdominal pain and diagnosed as IPMN based on the serial imaging procedures. Despite of the high risk comorbidities, he successfully underwent pylorus preserving total pancreaticoduodenectomy with splenectomy.

Matched MeSH terms: Pancreatectomy
Fulltext Solid-pseudopapillary carcinoma: a case study and literature review

Mat Zin AA, Shakir KA, Aminuddin AR, Mahedzan MR, Irnawati WA, Andee DZ, et al.

BMJ Case Rep, 2012;2012.
PMID: 22927280 DOI: 10.1136/bcr-2012-006495

Solid-pseudopapillary tumour (SPT) is a rare exocrine tumour of the pancreas and is considered to have low malignant potential. Few morphological criteria are used to predict malignant behaviour such as equivocal perineural invasion, angioinvasion and invasion to surrounding tissue, and should be designated as solid-pseudopapillary carcinoma (SPC). We report a case of SPC. Clinical and radiological findings are typical for SPT with no metastatic disease. There is no tumour recurrence after 4&emsp14;months postresection. Clinical history and radiological findings were retrieved from the patient's record sheet and Viarad system. H&E staining and few immunoproxidase staining were reviewed by several pathologists. The histological findings are typical for SPT, with additional perineural invasion. There is no angioinvasion or capsular invasion identified. This is our first experience in diagnosing and managing SPC. We look forward to seeing the patient's disease status during her next routine follow-up. We expect good disease-free survival and very low risk of tumour recurrence, in view of only one risk factor (perineural invasion) and uninvolved surgical margins by the tumour.

Matched MeSH terms: Pancreatectomy*
Fulltext Rapid progression of scoliosis curve in a mature patient with undiagnosed pituitary macroadenoma: A rare case report

Chung WH, Chiu CK, Wei Chan CY, Kwan MK

Acta Orthop Traumatol Turc, 2020 Sep;54(5):561-564.
PMID: 33155569 DOI: 10.5152/j.aott.2020.19144

Growth hormone secreting pituitary tumor or gigantism has not been previously reported to be associated with rapid progression of scoliosis in the literature. However, there are some reports indicating scoliosis can be worsened by growth hormone therapy in children and adolescents. A 19-year-old boy was referred to our institution for the treatment of a right thoracolumbar scoliosis. The Cobb angle had worsened from 29° to 83° over two years' duration. He attained puberty at the age of 13. He had a previous history of slipped upper femoral epiphysis (SUFE), which was operated in 2015, with no clinical features of gigantism. Preoperative assessment was performed. He was diagnosed with growth hormone secreting pituitary macroadenoma by magnetic resonance imaging with a high serum level of insulin-like growth factor-I (IGF-I). Computed tomography (CT) of the pancreas showed a pancreatic endocrine tumor. The patient was later diagnosed with multiple endocrine neoplasia type 1 (MEN 1). He underwent endoscopic endonasal excision of the pituitary mass and distal pancreatectomy. This case indicates that growth hormone secreting pituitary macroadenoma could result in rapid progression of scoliosis.

Matched MeSH terms: Pancreatectomy/methods
Carcinoma of the pancreas: resection outcome at the University Hospital Kuala Lumpur

Shahrudin MD

Int Surg, 1997 Jul-Sep;82(3):269-74.
PMID: 9372373

Recent studies have demonstrated a reduction in the morbidity and mortality of pancreatic resection and improvement in the actuarial 5-year survival for patients with resected ductal adenocarcinoma. We reviewed the clinico-pathological characteristics of patients who underwent resection with curative intent for ductal adenocarcinoma of the pancreas between 1980 and 1993.

Matched MeSH terms: Pancreatectomy
Severe mental retardation following asymptomatic hypoglycaemia in an infant with nesidioblastosis

Rahmah, R., Wu, L.L., Roziana, A., Swaminathan, M., Kuhnle, U.

Malaysian Journal of Child Health, 1997;9(1):93-96.
MyJurnal

Nesidioblastosis is a rare metabolic disease characterised by inappropriate insulin secretion often associated with life-threatening hypoglycaemia. While severe cases present in the newborn period, patients have been described later in infancy. Familial cases suggest an autosomal recessive trait, and recently mutations in the sulphonlurea receptor gene, possibly a regulator of insulin secretion, have been identified and associated with disease expression. We report a twin boy who developed normally until the age of six months when he was noted to regress. The boy is the older twin born to non-consanguinous parents. He presented to a hospital first at the age of 13 months with fever and generalised seizures. Low blood glucose was noted, but he recovered easily and was able to maintain euglycaemia during a 48-hour period of observation. Microcephaly and developmental delay were documented and anticonvulsant therapy was started. At 18 months, low blood glucose with high C-peptide was documented during reevaluation. Follow-ing a short trial of subcutaneous long-acting somatostatin analogue, the child was subjected to near-total pancreatectomy. The histology revealed findings consistent with nesidioblastosis. The child's condition improved but he remained significantly delayed This case emphasises the importance of recognising and treating hypoglycaemia early to avoid irreversible brain damage. It is interesting to note that the twin brother has always been well and is developmentally normal. Further studies to identify the inheritance pattern in the family would be of great interest.

Matched MeSH terms: Pancreatectomy
Pancreatic hemangioma mimicking a malignant pancreatic cyst

Lee J, Raman K, Sachithanandan S

Gastrointest Endosc, 2011 Jan;73(1):174-6.
PMID: 20932519 DOI: 10.1016/j.gie.2010.07.038
Matched MeSH terms: Pancreatectomy
Fulltext Management and short-term outcome of persistent hyperinsulinaemic hypoglycaemia of infancy (nesidioblastosis)

Rahmah R, Hayati AR, Kuhnle U

Singapore Med J, 1999 Mar;40(3):151-6.
PMID: 10402893

Persistent hyperinsulinaemic hypoglycaemia is a rare metabolic disorder of glucose regulation. It is however the most common cause of persistent hypoglycaemia in the neonatal period. Various drugs have been used with generally poor results, but diazoxide and a long-acting somatostatin analogue, octreotide, have been found to be rather successful. When medical therapy fails, early pancreatectomy is recommended to maintain euglycaemia. Since pancreatectomy seems to carry the long-term risk of diabetes mellitus, some authors recommend long-term medical therapy as an alternative to surgery. The outcome of treatment seems to correlate with neurological status prior to surgery. Even in early recognised and treated patients, publications suggest that a subtle neurological deficit may be present despite apparently normal intelligence. In view of the varying recommendations on treatment and the variations in outcome, we reviewed our experience over a period of three years (1992-1995) to determine whether we could formulate a rational approach to the management.

Matched MeSH terms: Pancreatectomy