Annular pancreas (AP) is a rare congenital anomaly. Coexisting malignancy has been reported only in a few cases. We report what is, to the best of our knowledge, the first case in the English literature of duodenal ad...Annular pancreas (AP) is a rare congenital anomaly. Coexisting malignancy has been reported only in a few cases. We report what is, to the best of our knowledge, the first case in the English literature of duodenal adenocarcinoma in a patient with AP. In a 55-year old woman with duodenal outlet stenosis magnetic resonance cholangiopancreatography showed an aberrant pancreatic duct encircling the duodenum. Duodenojejunostomy was performed. Eight weeks later she presented with painless jaundice. Duodenopancreatectomy revealed a duodenal adenocarcinoma, surrounded by an incomplete AP. Thus, co-existent malignancy with AP can be present without obstructive jaundice and without being visible through preoperative diagnostics.展开更多
AIM To evaluate upper abdominal computed tomography(CT) scan as primary follow-up after laparoscopic Rouxen-Y gastric bypass(LRYGB). METHODS This prospective study was approved by the Ethical Committee of the State of...AIM To evaluate upper abdominal computed tomography(CT) scan as primary follow-up after laparoscopic Rouxen-Y gastric bypass(LRYGB). METHODS This prospective study was approved by the Ethical Committee of the State of Zurich, and informed consent was obtained from all patients. Sixty-one patients who underwent LRYGB received upper abdominal CT on postoperative day 1, with the following scan parameters: 0.6 mm collimation, 1.2 mm pitch, Care KV with reference 120 m As and 120 kV, and 0.5 s rotation time. Diluted water-soluble radiographic contrastmedium(50 mL) was administered to achieve gastric pouch distension without movement of the patient. 3 D images were evaluated to assess postoperative complications and the radiation dose received was analysed. RESULTS From the 70 patients initially enrolled in the study, 9 were excluded from analysis upon the intraoperative decision to perform a sleeve gastrectomy and not a LRYGB. In all of the 61 patients who were included in the analysis, CT was feasible and there were no instances of aspiration or vomiting. In 7 patients, two upper abdominal scans were necessary as the pouch was not distended by contrast medium in the first acquisition. Radiologically, no leak and no relevant stenosis were found on the first postoperative day. These early postoperative CT findings were consistent with the findings at clinical follow-up 6 wk postoperatively, with no leaks, stenosis or obstructions being diagnosed. The average total dose length product in CT was 536.6 m Gycm resulting in an average effective dose of 7.8 m Sv. The most common surgical complication, superficial surgical site infections(n = 4), always occurred at the upper left trocar site, where the circular stapler had been introduced. CONCLUSION Early LRYGB postoperative multislice spiral CT scan is feasible, with low morbidity, and provides more accurate anatomical information than standard upper gastrointestinal contrast study.展开更多
文摘Annular pancreas (AP) is a rare congenital anomaly. Coexisting malignancy has been reported only in a few cases. We report what is, to the best of our knowledge, the first case in the English literature of duodenal adenocarcinoma in a patient with AP. In a 55-year old woman with duodenal outlet stenosis magnetic resonance cholangiopancreatography showed an aberrant pancreatic duct encircling the duodenum. Duodenojejunostomy was performed. Eight weeks later she presented with painless jaundice. Duodenopancreatectomy revealed a duodenal adenocarcinoma, surrounded by an incomplete AP. Thus, co-existent malignancy with AP can be present without obstructive jaundice and without being visible through preoperative diagnostics.
文摘AIM To evaluate upper abdominal computed tomography(CT) scan as primary follow-up after laparoscopic Rouxen-Y gastric bypass(LRYGB). METHODS This prospective study was approved by the Ethical Committee of the State of Zurich, and informed consent was obtained from all patients. Sixty-one patients who underwent LRYGB received upper abdominal CT on postoperative day 1, with the following scan parameters: 0.6 mm collimation, 1.2 mm pitch, Care KV with reference 120 m As and 120 kV, and 0.5 s rotation time. Diluted water-soluble radiographic contrastmedium(50 mL) was administered to achieve gastric pouch distension without movement of the patient. 3 D images were evaluated to assess postoperative complications and the radiation dose received was analysed. RESULTS From the 70 patients initially enrolled in the study, 9 were excluded from analysis upon the intraoperative decision to perform a sleeve gastrectomy and not a LRYGB. In all of the 61 patients who were included in the analysis, CT was feasible and there were no instances of aspiration or vomiting. In 7 patients, two upper abdominal scans were necessary as the pouch was not distended by contrast medium in the first acquisition. Radiologically, no leak and no relevant stenosis were found on the first postoperative day. These early postoperative CT findings were consistent with the findings at clinical follow-up 6 wk postoperatively, with no leaks, stenosis or obstructions being diagnosed. The average total dose length product in CT was 536.6 m Gycm resulting in an average effective dose of 7.8 m Sv. The most common surgical complication, superficial surgical site infections(n = 4), always occurred at the upper left trocar site, where the circular stapler had been introduced. CONCLUSION Early LRYGB postoperative multislice spiral CT scan is feasible, with low morbidity, and provides more accurate anatomical information than standard upper gastrointestinal contrast study.
