BACKGROUND Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei.Most patients present with nonspecific symptoms,and routine laboratory and imaging examination results also lack specificity.The...BACKGROUND Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei.Most patients present with nonspecific symptoms,and routine laboratory and imaging examination results also lack specificity.The diagnosis often relies on invasive manipulation,pathological examination,and molecular techniques.These difficulties in diagnosing Whipple’s disease often result in misdiagnosis and inappropriate treatments.CASE SUMMARY This paper reports on the case of a 58-year-old male patient who complained of fatigue and decreased exercise capacity.The results of routine blood tests indicated hypochromic microcytic anemia.Results of gastroscopy and capsule endoscopy showed multiple polypoid bulges distributed in the duodenal and proximal jejunum.A diagnosis of small intestinal adenomatosis was initially considered;hence,the Whipple procedure,a pylorus-preserving pancreaticoduodenectomy,was performed.Pathological manifestations showed many periodic acid-Schiff-positive macrophages aggregated in the intestinal mucosa of the duodenum,upper jejunum,and surrounding lymph nodes.Based on comprehensive analysis of symptoms,laboratory findings,and pathological manifestations,the patient was finally diagnosed with Whipple’s disease.After receiving 1 mo of antibiotic treatment,the fatigue and anemia were significantly improved.CONCLUSION This case presented with atypical gastrointestinal manifestations and small intestinal polypoid bulges,which provided new insight on the diagnosis of Whipple’s disease.展开更多
AIM: To analyze whether pancreaticoduodenectomy with simultaneous resection of tumor-involved vessels is a safe approach with acceptable patient survival.
AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pa...AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.展开更多
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
文摘BACKGROUND Whipple’s disease is a rare systemic infection caused by Tropheryma whipplei.Most patients present with nonspecific symptoms,and routine laboratory and imaging examination results also lack specificity.The diagnosis often relies on invasive manipulation,pathological examination,and molecular techniques.These difficulties in diagnosing Whipple’s disease often result in misdiagnosis and inappropriate treatments.CASE SUMMARY This paper reports on the case of a 58-year-old male patient who complained of fatigue and decreased exercise capacity.The results of routine blood tests indicated hypochromic microcytic anemia.Results of gastroscopy and capsule endoscopy showed multiple polypoid bulges distributed in the duodenal and proximal jejunum.A diagnosis of small intestinal adenomatosis was initially considered;hence,the Whipple procedure,a pylorus-preserving pancreaticoduodenectomy,was performed.Pathological manifestations showed many periodic acid-Schiff-positive macrophages aggregated in the intestinal mucosa of the duodenum,upper jejunum,and surrounding lymph nodes.Based on comprehensive analysis of symptoms,laboratory findings,and pathological manifestations,the patient was finally diagnosed with Whipple’s disease.After receiving 1 mo of antibiotic treatment,the fatigue and anemia were significantly improved.CONCLUSION This case presented with atypical gastrointestinal manifestations and small intestinal polypoid bulges,which provided new insight on the diagnosis of Whipple’s disease.
文摘AIM: To analyze whether pancreaticoduodenectomy with simultaneous resection of tumor-involved vessels is a safe approach with acceptable patient survival.
文摘AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.
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.
