RESUMO

El síndrome del ducto pancreático desconectado (SDPD) consiste en la disrupción del ducto pancreático principal con pérdida de continuidad entre el remanente pancreático distal viable y el tracto gastrointestinal, generalmente causado por necrosis ductal secundaria a pancreatitis aguda grave. Esto resulta en fuga de fluido pancreático, provocando un curso de enfermedad prolongado y complicaciones. La literatura sobre este tema es limitada, con algoritmos de tratamiento poco claros. Hemos realizado una revisión de la literatura sobre el tema. Revisión en Pubmed y Scielo (2011-2021) de artículos en inglés y español utilizando términos «síndrome del conducto pancreático desconectado», «DPDS» y «páncreas desconectado» encontrando 16 artículos relevantes. Dadas las pocas citas, se revisaron las referencias de estos artículos. Finalmente, revisamos un total de 21 artículos. Entre las referencias encontradas existe 1 metaanálisis, 4 estudios prospectivos y no existen ensayos aleatorizados.

Disconnected pancreatic duct syndrome (DPDS) is characterized by disruption of the main pancreatic duct with a loss of continuity between the viable upstream pancreatic parenchyma and the gastrointestinal tract, generally caused by ductal necrosis after severe acute necrotizing pancreatitis. This compromised ductal integrity leads to extraductal leakage of pancreatic secretions, causing a prolonged disease course and complications. The existing literature is limited, with unclear therapeutic algorithms. We have performed a review of the literature on DPDS. Review in Pubmed and Scielo (2011-2021) of articles in English and Spanish using the terms "disconnected pancreatic duct syndrome", "DPDS" and "disconnected pancreas" finding 16 relevant articles. Given the few citations, the references of these articles was reviewed. Finally, we found 21 articles. Among them, there is one meta-analysis, 4 prospective studies and no randomized trials.

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Enteric duplication cysts are rare congenital malformations with a low incidence and there are only a few reports in the literature. Their clinical presentation varies according to the location and the type of duplication. Their overall prognosis is good if early surgical intervention is provided. We report a 2-month-old boy who presented with a case of a giant gastroduodenal duplication cyst with a juxta-pancreatic communication and was successfully treated surgically. It is imperative to be aware of this rare congenital malformation that can present clinically with a wide range of non-specific symptoms that can cause significant morbidity and mortality if the treatment is delayed.

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Este estudo teve como objetivo avaliar achados ultrassonográficos de cães e gatos diagnosticados com colestase, correlacionando alterações concomitantes com espécies, sexo, idade, peso, sinais clínicos e dilatação das vias biliares. O sistema biliar de pequenos animais é composto pela vesícula biliar e a árvore biliar. Desta forma, os felinos apresentam mais alterações nestas estruturas devido à anatomia diferenciada. A redução do fluxo biliar, conhecida como colestase, ocorre por inúmeras situações, sendo o ultrassom o principal exame diagnóstico empregado na medicina veterinária. Ductos biliares de 4 e 3mm de diâmetro são considerados normais para felinos e caninos, respectivamente. Neste estudo, os sistemas biliares de 41 animais, incluindo felinos e caninos, foram avaliados por ultrassonografia no Setor de Diagnóstico por Imagem do Hospital Veterinário de janeiro de 2019 a fevereiro de 2020, demonstrando a presença de cálculos vesicais em ambas as populações, assim como alterações em ducto cístico associados à pancreatite em cães.

This study aimed to evaluate ultrasound findings of dogs and cats diagnosed with cholestasis, correlating concomitant alterations with species, sex, age, weight, clinical signs, and dilation of bile ducts. The biliary system of small animals is composed of the gallbladder and the biliary tree. Thus, the felines show more alterations in these structures due to their differentiated anatomy. The reduction of the bile flow, known as cholestasis, occurs as a result of numerous situations, with ultrasound being the main diagnostic exam applied in veterinary medicine. Bile ducts of 4 and 3mm diameter are considered normal for felines and canines, respectively. In this study, the biliary systems of 41 animals, including felines and canines, were evaluated using ultrasound at the Diagnostic Imaging Sector of the Veterinary Hospital from January 2019 to February 2020, demonstrating the presence of bladder stones in both populations, as well as changes in the cystic duct associated with pancreatitis in dogs.

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Resumen Se presentan 6 pacientes con disrupción ductal del páncreas (DDP) tratados mediante drenaje percutáneo guiado por imágenes con apoyo de la endoscopia. Inicialmente, los pacientes presentaron necrosis pancreática infectada tratada con drenaje percutáneo transgástrico y luego de resolver la infección desarrollaron DDP. En el estudio por imágenes se diagnosticaron 4 pacientes con disrupción ductal parcial y 2 con disrupción total, a quienes se les indicó la colocación de una prótesis transgástrica percutánea para lograr el drenaje del líquido pancreático hacia el estómago. La duración promedio de la prótesis fue de 183 días; no hubo casos de mortalidad. Se pudo evidenciar que esta opción terapéutica mínimamente invasiva tiene baja morbimortalidad, por lo que se plantea el abordaje percutáneo transgástrico apoyado por la endoscopia como posible tratamiento de la DDP.

Abstract A total of six patients with pancreatic ductal disruption (PDD), treated with image-guided endoscopy percutaneous drainage were enrolled. Initially, patients had infected pancreatic necrosis, treated with transgastric percutaneous drainage, and after the infection was controlled, they developed PDD. In the imaging study process, four patients were diagnosed with partial duct disruption and two patients with complete duct disruption. In both cases the placement of a percutaneous transgastric prosthesis to drain the pancreatic fluids to the stomach was indicated. The prosthesis remained 183 days on average and there were no mortality cases. This therapeutic minimally invasive alternative has low rates of morbimortality and thus, the endoscopy percutaneous transgastric approach is considered as a viable treatment in PPD.

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Resumen Objetivo: Presentar el caso de un paciente masculino adulto joven, con ascitis pancreática secundaria a lesión del conducto pancreático por trauma abdominal cerrado, tratado con éxito con terapia conservadora. Materiales y Método: Datos e imágenes recopilados de la historia clínica del Hospital Universitario de Santander, previo consentimiento informado. Resultados: Sexo masculino de 21 años con antecedente de trauma abdominal cerrado, quien consulta por distensión, dolor abdominal progresivo y pérdida de peso no cuantificada. Ante sospecha de lesión de conducto pancreático se solicitó pancreatografía por resonancia magnética que evidencia una alteración del segmento proximal del conducto pancreático principal asociado a lesión quística en el borde anterior de la unión de la cabeza con el cuerpo pancreático. Se decidió manejo conservador por 4 semanas con colocación de dren abdominal, reposo intestinal, asociado a nutrición parenteral total y análogos de somatostatina. Discusión: Un 5% del trauma abdominal cerrado puede provocar pancreatitis y fugas en el conducto pancreático. Conclusión: La lesión del conducto pancreático principal debe sospecharse en todos los pacientes con trauma abdominal cerrado. El manejo debe realizarse con una planificación cuidadosa y exhaustiva.

Aim: To present the case of a young adult male patient, with pancreatic ascites secondary to pancreatic duct injury due to blunt abdominal trauma, treated successfully with conservative therapy. Materials and Method: Data and images were obtained from the clinical chart of the "Hospital Universitario de Santander" with prior informed consent. Results: 21-year-old male patient with a blunt abdominal trauma background, who consulted for distension, progressive abdominal pain, and subjective weight loss. Due to suspicion of a pancreatic duct injury, a magnetic resonance cholangiopancreatography was requested, which showed an alteration of the proximal segment of the main pancreatic duct associated with a cystic lesion at the anterior border of the junction between the pancreatic head and body. Treatment consisted of a 4-week conservative therapy with the placement of an abdominal drain, bowel rest, associated with total parenteral nutrition and somatostatin analogs. Discussion: A 5% of blunt abdominal trauma can cause pancreatitis and pancreatic duct leaks. Conclusión: Pancreatic duct injury should be suspected in every patient with blunt abdominal trauma. Management must be done with careful and thorough planning.

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OVERVIEW: Pancreaticobiliary maljunction (PBM) is a congenital malformation characterized by a long common pancreaticobiliary channel which causes sphincter of Oddi malfunction. In children, it is typically diagnosed using magnetic resonance cholangiopancreatography (MRCP). It is associated with congenital biliary dilatation, pancreatitis, and gallbladder and bile duct tumors at adulthood. Studies in the western population are rare. Given its morbidity rate, it should be searched for in the western pediatric population. The objective of this study was to look for and identify the presence of pancreaticobiliary maljunction through MRCP in pediatric patients with biliary or pancreatic disease, as well as to find out other associated factors. METHODS: MRCP was used to measure common channel length, pancreatic duct length, and bile duct diameter in 41 pediatric patients with biliary or pancreatic disease. RESULTS: The common channel could only be measured in 17.6% of cases, 50% of which were >8 mm long. All patients were female and had congenital biliary dilatation. No age-related differences were found in terms of bile duct length. CONCLUSIONS: PBM is present in the western pediatric population, but prevalence and morbidity are unknown. Larger studies are required to identify morbidity and mortality, as well as prevalence among patients.

OBJETIVO: La unión biliopancreática anómala (UBPA) es una malformación congénita caracterizada por un canal común pancreatobiliar largo que impide el adecuado funcionamiento del esfínter de Oddi. Su diagnóstico en niños se realiza comúnmente mediante colangiopancreatografía por resonancia magnética (CPRM). Se asocia a dilatación biliar congénita, pancreatitis y tumores de la vesícula y la vía biliar en la edad adulta. Los estudios en población occidental son escasos; debido a su morbilidad resulta de relevancia la búsqueda en población pediátrica occidental. Este estudio pretende buscar e identificar la presencia de unión biliopancreática anómala mediante CPRM de pacientes pediátricos con enfermedad de la vía biliar o pancreática, al igual que identificar otros factores asociados. METODOS: Se midió por CPRM la longitud del canal común, el conducto pancreático y el diámetro de la vía biliar de 41 pacientes pediátricos con patología biliar o pancreática. RESULTADOS: El canal común solo pudo ser medido en el 17,6% de los casos, de los cuales el 50% tuvo una longitud >8 mm, siendo todos ellos pacientes femeninos con dilatación biliar congénita; no se encontraron diferencias en la longitud de la vía biliar relacionado con la edad. CONCLUSIONES: La UBPA es una malformación que se encuentra presente en población pediátrica occidental con prevalencia y morbilidad desconocida; se requieren estudios a mayor escala para identificar morbimortalidad y prevalencia de pacientes con esta malformación.

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Resumen Hemos visto con preocupación que, en el postquirúrgico de la colangiopancreatografía retrógrada endoscópica (CPRE), existe confusión en cuanto a la aparición de pancreatitis y a la elevación transitoria de las amilasas (hiperamilasemia sin repercusión clínica), por lo que nos dimos a la tarea de realizar esta investigación, cuyo objetivo principal era determinar la prevalencia del incremento de niveles séricos de amilasas y de pancreatitis en los pacientes sometidos a colangiopancreatografía retrógrada endoscópica, según variables demográficas, clínicas y procedimentales. Es un estudio descriptivo, prospectivo, analítico y observacional, la población de estudio estuvo integrada por 98 pacientes atendidos en Unión de Cirujanos SAS, quienes requirieron colangiopancreatografía retrógrada endoscópica. Resultados: la frecuencia de pancreatitis aguda después de la CPRE fue del 2%, en 2 de los 98 casos estudiados; el 30% presentó hiperamilasemia (30 pacientes); la canulación del conducto pancreático mostró asociación con pancreatitis post-CPRE, con un valor de p<0,05. De los 2 pacientes que presentaron pancreatitis post-CPRE, a uno de ellos se le realizó contraste del conducto pancreático. La dilatación con balón se asoció con la hiperamilasemia (p<0,041). Conclusiones: la pancreatitis post-CPRE se presentó en un 2% de los pacientes, y este porcentaje se encuentra incluido dentro de los pacientes que presentaron hiperamilasemia, uno de los criterios para el diagnóstico de pancreatitis. Nuestro grupo se encuentra en el rango inferior del promedio internacional (1,8% al 7,2%). La hiperamilasemia asintomática se presentó en un 30%. Recomendamos que, si después de la CPRE, el paciente no presenta dolor, no se midan las amilasas, porque estas van a estar elevadas en gran número de los casos y, entonces, solo causaría confusión.

Abstract We have seen with concern that there is confusion regarding the appearance of pancreatitis and the transient elevation of amylases (hyperamylasemia without clinical repercussions) in the postoperative period following ERCP (endoscopic retrograde cholangiopancreatography). For this reason, we embarked on the task of determining the prevalence of increased serum amylases and pancreatitis in patients who have undergone endoscopic retrograde cholangiopancreatography according to demographic, clinical and procedural variables. This is a descriptive, prospective, analytical and observational study. The study population consisted of 98 patients treated in the Union of SAS Surgeons who required endoscopic retrograde cholangiopancreatography. Results: Acute pancreatitis was found in 2% of the patients who had undergone ERCP (Two of the 98 cases studied). Thirty patients (30%) presented hyperamylasemia. Cannulation of the pancreatic was associated with post-ERCP pancreatitis (p <0.05). Pancreatic duct contrast had been used in one of the two patients who presented post-ERCP pancreatitis. Balloon dilation was associated with hyperamylasemia (p <0.041). Conclusions: Post-ERCP pancreatitis was found in two patients (2%), both of whom also presented hyperamylasemia which is one of the criteria for diagnosis of pancreatitis. The rate in our group is at the lower end of the international range of averages from 1.8% to 7.2%. Asymptomatic hyperamylasemia was present in 30% of our group. Following ERCP, we recommend that there is no need to measure amylases in patients who do not present pain. Amylase levels will be elevated in a large number of cases and will only cause confusion.

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O diagnóstico da pancreatite é um desafio contínuo na medicina veterinária, visto que a mesma não apresenta sinais clínicos patognomônicos, sendo diagnosticada, em cães e gatos, como um achado acidental durante a necropsia. O exame ultrassonográfico é uma técnica de diagnóstico por imagem para visibilização de alterações do pâncreas, analisando de forma segura e não invasiva. O estudo teve como objetivo analisar e comparar as características e dimensões ultrassonográficas do pâncreas nos cães e gatos filhotes hígidos, estabelecendo padrões de normalidade e de referência. Foram utilizados no estudo 15 cães filhotes e 15 gatos filhotes com idade entre cinco e seis meses, sem raça definida e peso médio de 3 kg e 2 kg, respectivamente. Os animais foram submetidos ao exame ultrassonográfico do pâncreas, para visibilização das características internas do órgão e sua mensuração. O corpo e ambos os lobos pancreáticos foram observados em todos os grupos do estudo. Em ambos os grupos, o pâncreas foi visibilizado como uma estrutura linear e com ecotextura homogênea, hipoecogênica e com margens definidas. O lobo pancreático direito foi visibilizado ligeiramente hiperecogênico em relação ao lobo caudato hepático, enquanto o lobo pancreático esquerdo e o corpo pancreático foram visibilizados hipoecogênicos em relação ao parênquima esplênico, isoecoicos em relação ao fígado e hipoecogênicos em relação à gordura mesenterica. O corpo pancreático dos cães e dos gatos filhotes mediram 4,2 mm ± 0,10 mm e 4,1 mm ± 0,09 mm, respectivamente. Os lobos pancreáticos direito e esquerdo dos cães filhotes mediram 5,4 mm ± 0,20 mm (sagital), 5,4 mm ± 0,10 mm (transversal), e 4,4 mm ± 0,20 mm, respectivamente. Nos gatos filhotes mediram 2,7 mm ± 0,01 mm (sagital e transversal), e 3,6 mm + 0,02 mm, respectivamente. Os valores das mensurações do corpo e lobos pancreáticos dos cães filhotes foram maiores em relação aos gatos filhotes. O estudo forneceu valores de referência de dimensões do corpo e lobos pancreáticos para cães e gatos filhotes hígidos com idade entre 5 e 6 meses.

The diagnosis of pancreatitis is a challenge in veterinary medicine because there are no pathognomonic clinical signs, and the diagnostic in dogs and cats is an incidental finding during necropsy. The ultrasonography is an imaging technique which visualize the pancreas changes safely and noninvasively. The aim of the study was to analyze and compare the ultrasonographic characteristics and dimensions of the pancreas in health puppies and kittens, establishing standards of normality and references. Fifteen healthy puppies with mean weight of 3 kg and fifteen healthy kittens with mean weight of 2 kg, with age between five and six months, cross breed, were included in the study. All animals were submitted to ultrasound exam of pancreas for visualization of their internal characteristics. In both groups, the pancreas was visualized. In puppies and kittens were observed the body and the both pancreatic lobes. The pancreas was visualized as a linear structure with homogeneous hypoechoic echotexture and defined margins. The right pancreatic lobe was visualized slight hyperechoic relative to the liver caudate lobe, while the left pancreatic lobe and pancreatic body were observed hypoechoic in relation to the spleen, isoechoic in relation to the liver parenchyma and hypoechoic in relation to the mesenteric fat. The puppies and kittens pancreatic body measured 4.2 mm ± 0.10 mm and 4.1 mm ± 0.09 mm, respectively. The puppy's pancreatic lobes right and left measured 5.4 mm ± 0.20 mm (sagittal), 5.4 mm ± 0.10 mm (transversal), and 4.4 mm, respectively. In kittens was measured 2.7 mm ± 0.01 mm (sagittal and transversal), and 3.6 mm ± 0.02 mm, respectively. The puppies' body and pancreatic lobes was observed bigger than the kittens. The study provided reference values of body and pancreatic lobes for healthy puppies and kittens with age between 5 and 6 months.

El diagnóstico de la pancreatitis es un desafío permanente en la medicina veterinaria, ya que no tiene signos clínicos patognomónicos y lo se diagnostica en perros y gatos como un hallazgo incidental durante la necropsia. La ecografía es la técnica de imagen para la visualización de los cambios en el páncreas y capaz de analizar de forma segura y no invasiva. El objetivo del estudio fue analizar y comparar las características y dimensiones del páncreas ecográficos en cachorros y cachorros de gato sanos, estableciendo los rangos normales y de referencia. Fueran utilizados en el estudio 15 cachorros e 15 cachorros de gato de entre cinco y seis meses y peso entre 3 kg y 2 kg, respectivamente. Los animales fueron sometidos a examen ultrassonográfico del páncreas para la visualización de las características internas del órgano y su medición. En cachorros y cachorros de gato se observó el cuerpo y ambos lóbulos del páncreas. En ambos grupos, el páncreas se visualizó como una estructura lineal, homogénea y hipoecoica y márgenes definidos. El lóbulo derecho de páncreas se visualizó ligeramente hiperecoico en relación con el lóbulo caudado del hígado, mientras que el lóbulo pancreático izquierdo y el cuerpo de páncreas se observaron hipoecoica en relación al bajo, isoecoicos en relación al parénquima del hígado y hipoecoica con relación a la grasa mesenterica. O cuerpo del páncreas de cachorros y cachorros de gato mide 4,2 mm ± 0,10 mm y 4,1 mm ± 0,09 mm, respectivamente. Los lóbulos derecho e izquierdo del páncreas de cachorro miden 5,4 mm ± 0,20 mm (sagital), 5,4 mm ± 0,10 mm (horizontal) y 4,4 mm ±0, 20 mm, respectivamente. En los cachorros de gato medido 2,7 mm ± 0,01 mm (sagital y transversal) y 3,6 mm ± 0,02 mm, respectivamente. Los cuerpos e lobos del páncreas de los cachorros fueran mayores en relación los gatos. O estudio revelo los valores de referencia del para el tamaño del cuerpo y lobos pancreáticos para cachorros y cachorros de gato sanos con edad entre de 5 a 6 meses.

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The AA. observed the pancreatic duct system of 19 Jaffarabadi buffaloes (10 males and 3 females), in order to study: 1. a possible accessory communication with duodenum through the bile duct; 2. the arrangement of the main pancreatic ducts. The results of this investigation showed: a) it has not a secondary communication of the pancreatic duct system with the duodenum through the bile duct; b) the duct of Santorini, when passing through the right lobe of the gland, receives eight (26,3% ), four (21,0%), seven (15,8%), five (10,5%), six (10,5%) and less frequently, three (5,3%), nine (5,3%) and ten (5,3%) main ducts, besides many small ones earning from the whole pancreas.

Examinou-se o sistema excretor do pâncreas de 19 búfalos da raça Jaffarabadi (10 machos e 9 fêmeas), com o objetivo de estudar: 1. a possibilidade de comunicação de suas vias integrantes, com o duodeno através do colédoco; 2. o arranjo geral dos principais duetos glandulares. Os resultados desta investigação mostram: a) não há comunicação secundária do sistema excretor pancreático com o duodeno por intermédio da via biliar; b) o dueto de Santorini, ao atravessar o lobo direito da glândula, recebe oito (26,3%), quatro (21,0%), sete (15,8%), cinco (10,5%), seis (10,5%) e menos frequentemente três (5,3%), nove (5,3%) e dez (5,3%) ductos conspícuos afora outros, pequenos, que procedem de todo o pâncreas.

RESUMO

The AA. observed the pancreatic duct system of 19 Jaffarabadi buffaloes (10 males and 3 females), in order to study: 1. a possible accessory communication with duodenum through the bile duct; 2. the arrangement of the main pancreatic ducts. The results of this investigation showed: a) it has not a secondary communication of the pancreatic duct system with the duodenum through the bile duct; b) the duct of Santorini, when passing through the right lobe of the gland, receives eight (26,3% ), four (21,0%), seven (15,8%), five (10,5%), six (10,5%) and less frequently, three (5,3%), nine (5,3%) and ten (5,3%) main ducts, besides many small ones earning from the whole pancreas.

Examinou-se o sistema excretor do pâncreas de 19 búfalos da raça Jaffarabadi (10 machos e 9 fêmeas), com o objetivo de estudar: 1. a possibilidade de comunicação de suas vias integrantes, com o duodeno através do colédoco; 2. o arranjo geral dos principais duetos glandulares. Os resultados desta investigação mostram: a) não há comunicação secundária do sistema excretor pancreático com o duodeno por intermédio da via biliar; b) o dueto de Santorini, ao atravessar o lobo direito da glândula, recebe oito (26,3%), quatro (21,0%), sete (15,8%), cinco (10,5%), seis (10,5%) e menos frequentemente três (5,3%), nove (5,3%) e dez (5,3%) ductos conspícuos afora outros, pequenos, que procedem de todo o pâncreas.