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ABSTRACT: Infected pancreatic necrosis is a life-threatening complication of acute pancreatitis that has been traditionally managed with open surgical debridement. Over the last decade, minimally invasive techniques have been increasingly used for the treatment of infected pancreatic necrosis and their results are encouraging. Percutaneous retroperitoneal pancreatic necrosectomy is one of the minimally invasive approaches used for debridement of pancreatic necrosis. We report our technique of retroperitoneoscopic necrosectomy using a single-port access.
Surgical laparoscopy, endoscopy & percutaneous techniques 02/2012; 22(1):e8-11. · 1.23 Impact Factor
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ABSTRACT: To evaluate the management of pancreaticopleural fistulas involving early endoscopic instrumentation of the pancreatic duct.
Eight patients with a spontaneous pancreaticopleural fistula underwent endoscopic retrograde cholangiopancreatography (ERCP) with an intention to stent the site of a ductal disruption as the primary treatment. Imaging features and management were evaluated retrospectively and compared with outcome.
In one case, the stent bridged the site of a ductal disruption. The fistula in this patient closed within 3 wk. The main pancreatic duct in this case appeared normal, except for a leak located in the body of the pancreas. In another patient, the papilla of Vater could not be found and cannulation of the pancreatic duct failed. This patient underwent surgical treatment. In the remaining 6 cases, it was impossible to insert a stent into the main pancreatic duct properly so as to cover the site of leakage or traverse a stenosis situated downstream to the fistula. The placement of the stent failed because intraductal stones (n = 2) and ductal strictures (n = 2) precluded its passage or the stent was too short to reach the fistula located in the distal part of the pancreas (n = 2). In 3 out of these 6 patients, the pancreaticopleural fistula closed on further medical treatment. In these cases, the main pancreatic duct was normal or only mildly dilated, and there was a leakage at the body/tail of the pancreas. In one of these 3 patients, additional percutaneous drainage of the peripancreatic fluid collections allowed better control of the leakage and facilitated resolution of the fistula. The remaining 3 patients had a tight stenosis of the main pancreatic duct resistible to dilatation and the stent could not be inserted across the stenosis. Subsequent conservative treatment proved unsuccessful in these patients. After a failed therapeutic ERCP, 3 patients in our series developed superinfection of the pleural or peripancreatic fluid collections. Four out of 8 patients in our series required subsequent surgery due to a failed non-operative treatment. Distal pancreatectomy with splenectomy was performed in 3 cases. In one case, only external drainage of the pancreatic pseudocyst was done because of diffuse peripancreatic inflammatory infiltration precluding safe dissection. There were no perioperative mortalities. There was no recurrence of a pancreaticopleural fistula in any of the patients.
Optimal management of pancreaticopleural fistulas requires appropriate patient selection that should be based on the underlying pancreatic duct abnormalities.
World Journal of Gastroenterology 11/2011; 17(42):4696-703. · 2.47 Impact Factor
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ABSTRACT: Necrotizing fasciitis is a rare, but potentially fatal bacterial infection of the soft tissues. Establishing the diagnosis at the early stages of the disease remains the greatest challenge. We report a case of necrotizing fasciitis involving the upper extremity. Sonography revealed subcutaneous emphysema spreading along the deep fascia, swelling, and increased echogenicity of the overlying fatty tissue with interlacing fluid collections. The patient responded well to early surgical debridement and parenteral antibiotics.
Journal of Clinical Ultrasound 05/2011; 39(4):236-9. · 0.81 Impact Factor
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ABSTRACT: Groove pancreatitis is a rare form of chronic pancreatitis involving the anatomic plane between the pancreatic head and duodenum. The radiographic diagnosis remains challenging, and most patients undergo exploratory laparotomy on suspicion of a periampullary malignancy. The appearance of groove pancreatitis on transabdominal and intraoperative sonography has rarely been reported in the literature. The sonographic findings in our 2 patients included a hypoechoic thin area between the pancreatic head and duodenum, a hyperechoic and thickened wall of the adjacent duodenum, and a heterogeneous or hyperechoic dorsocranial part of the pancreatic head.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2011; 30(1):111-5. · 1.25 Impact Factor
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Marek Wronski,
Bogna Ziarkiewicz-Wroblewska,
Maciej Slodkowski, Wlodzimierz Cebulski,
Barbara Gornicka,
Ireneusz W Krasnodebski,
Katedra I Klinika,
Chirurgii Ogolnej,
Gastroenterologicznej,
Onkologicznej Wum,
Ul Banacha
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ABSTRACT: Disclosure: No potential conflicts of interest were disclosed. Introduction. Mesenteric fibromatosis or intra-abdominal desmoid tumour is a rare proliferative disease affecting the mesentery. It is a locally aggressive tumour that lacks metastatic potential, but the local recurrence is common. Mesenteric fibromatosis with the intestinal involvement can be easily confused with other primary gastrointestinal tumours, especially with that of the mesenchymal origin. Case report. We report a case of a 44-year-old female who presented with an abdominal mass that radiologically and pathologically mimicked a gastrointestinal stromal tumour. Conclusions. The diagnosis of mesenteric fibromatosis should always be considered in the case of mesenchymal tumours apparently originating from the bowel wall that diffusely infiltrate the mesentery.
Radiology and Oncology 01/2011; 45:59-63. · 0.91 Impact Factor
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ABSTRACT: Necrotizing fasciitis is a rare, but potentially fatal bacterial infection of the soft tissues. Establishing the diagnosis at the early stages of the disease remains the greatest challenge. We report a case ofnecrotizing fasciitis involving the upper extremity. Sonography revealed subcutaneous emphysema spreading along the deep fascia, swelling, and increased echogenicity of the overlying fatty tissue with interlacing fluid collections. The patient responded well to early surgical debridement and parenteral antibiotics. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2011
Journal of Clinical Ultrasound 11/2010; 39(4):236 - 239. · 0.81 Impact Factor
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ABSTRACT: The purpose of this series was to determine the spectrum of findings on gray scale trans-abdominal ultrasonography (TAUS) in pathologically proven cases of primary gastrointestinal stromal tumors (GISTs) and correlate them with gross morphologic and pathologic findings.
The series included 18 patients with a primary GIST tumor detected on preoperative TAUS. The ultrasonographic findings were evaluated for features such as tumor size, shape, margin, echogenicity, and presence of fluid components, and the features were compared with morphologic and pathologic findings.
All of the primary GISTs were hypoechoic extraluminal masses with well-delineated margins. Eight GISTs were homogeneously solid masses, and 8 were heterogeneously solid masses that contained a large central area of lower echogenicity (n = 4) or multiple internal hypoechoic irregular spaces (n = 4) corresponding to necrosis and hemorrhage. Other tumors had a cystic appearance (n = 1) or showed a dual hyperechoic-hypoechoic echo structure (n = 1). Three tumors showed intratumoral gas due to fistulization into the bowel lumen, which appeared as hyperechoic foci or a linear hyperechoic area with acoustic shadowing. The heterogeneous tumors were significantly larger (P = .03) and had higher mitotic counts (P = .05). Gastrointestinal stromal tumors with high malignant potential tended to be large and showed intratumoral heterogenicity with areas of lower echogenicity.
Gastrointestinal stromal tumors showed varied patterns on TAUS. The ultrasonographic pattern depended on the tumor size and mitotic activity. Ultrasonographic features suggesting high malignant potential were size and internal heterogenicity with the presence of intratumoral hypoechoic areas.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2009; 28(7):941-8. · 1.25 Impact Factor
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ABSTRACT: To review clinical and pathologic features of Gastrointestinal stromal tumors (GISTs) occurring synchronously with other primary gastrointestinal neoplasms.
Twenty-eight patients with primary GIST were treated at our institution between 1989 and 2005. Clinical and pathologic records were reviewed.
The gastrointestinal stromal tumor occurred simultaneously with other primary GI malignancies in 14% of all patients with GIST. The synchronous stromal tumors were located in the stomach and were incidentally found during the operation. The coexistent neoplasms were colon adenocarcinoma, gastric cancer (2 cases) and gastric lymphoma.
The synchronous occurrence of GISTs and other gastrointestinal malignancies is more common than it has been considered. The development of gastrointestinal stromal tumors and other neoplasms may involve the same carcinogenic agents.
World Journal of Gastroenterology 10/2006; 12(33):5360-2. · 2.47 Impact Factor
