RESUMEN
Cystic duct duplication with a single gallbladder is one of the most uncommon abnormalities of the biliary tract, with fewer than 15 instances published. The authors describe a 49-year-old patient undergoing a laparoscopic cholecystectomy in whom a second cystic duct was found, initially misdiagnosed as the biliary tract. The cholecystectomy was performed successfully with the aid of intraoperative cholangiography. It is the first time a duplicated cystic duct has been treated successfully using a laparoscopic approach.
Asunto(s)
Colecistectomía Laparoscópica , Colelitiasis/cirugía , Conducto Cístico/anomalías , Femenino , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Preoperative radiologic localization of insulinomas often fails because of the small size of these tumors. Endoscopic ultrasound (EUS) can localize insulinomas in up to 80% of the cases. The aim of this study was to compare EUS and computed tomography (CT) diagnostic accuracy for insulinomas. METHODS: We reviewed medical records from 12 patients (10 women) with a biochemical diagnosis of hypoglycemia and hyperinsulinism from 1 university hospital and 1 community hospital. A diagnosis of insulinoma was ultimately made in all cases and before surgery the patients underwent abdominal US, spiral CT and EUS in an attempt to precisely localize the tumor. Surgery was considered the standard for tumor localization. RESULTS: Ten tumors were benign (83.3%) and 2 were malignant (16.7%). The overall sensitivity of EUS in identifying insulinomas was 83.3% compared with 16.7% for CT. Tumors not detected by EUS had a mean size of 0.75 cm. EUS-guided fine-needle aspiration was possible in only 3 patients, with a positive cytologic diagnosis in 2 (66.6%). Tumors located in the head and body of the pancreas were identified by EUS in all patients, but those located in the tail were diagnosed in only 50% of the cases. CONCLUSIONS: EUS is superior to spiral CT and should replace it for the detection of pancreatic insulinomas. EUS identification depends on the site and size of the tumor.
Asunto(s)
Endosonografía , Insulinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
To study the risk of postoperative complications and technical failure to remove stones from common bile duct, 101 patients with symptomatic cholecystolithiasis andcholedocholithiasis and papillary obstruction due to stone or inflammatory process were randomized and considered in two groups: Group I (n = 50) underwent preoperative endoscopic papillotomy and open cholecystectomy in the same hospitalization; Group II (n = 51) underwent open cholecystectomy, common bile duct exploration, T-tube drainage and transduodenal papillotomy. Multivariate analysis showed that surgical team (p=0.032) was related to postoperative complications and greater hospitalization in the conventional surgery (Group II); surgical risk (p = 0.053) was related to systemic postoperative complications in the conventional surgery (Group II); distal choledochal stenosis (p = 0.014) was related to technical failure, complications and death in the preoperative endoscopic procedures (Group I). We believe that preoperative endoscopic papillotomy should remain the procedure of choice for common bile duct clearance in patients with comorbid illnesses and cholecystectomy and common bile duct exploration should be performed in no clinical risk patients.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Colecistectomía , Cálculos Biliares/cirugía , Esfinterotomía Endoscópica , Anciano de 80 o más Años , Análisis Multivariante , Complicaciones PosoperatoriasRESUMEN
We report a case of malignant schwannoma of the duodenum, a neural tumor, which rarely occurs in the gastroduodenal tract. The diagnosis was done after an hemorragic episode of the upper gastrointestinal tract and the treatment done was a local resection. Two years later the patient had no symptoms, but the control endoscopy showed a recurrence of the tumor in the second portion of the duodenum and the patient was submitted to a gastroduodenopancreatectomy. The authors reported the case and make a revision on intestinal schwannomas.