1/18. Pancreatoduodenectomy for locally advanced or recurrent colon cancer: report of two cases.A 66-year-old man, who had ascending colon cancer which invaded the duodenum, pancreas, and superior mesenteric vein, underwent a curative resection including an extended right hemicolectomy, pylorus-preserving pancreatoduodenectomy, and a partial resection of the superior mesenteric vein. The pathological examination revealed adenocarcinoma of the colon, which directly invaded the duodenum and pancreas, thus causing duodenocolic fistula. Tumor infiltration to the superior mesenteric vein was not histologically proven. Two out of 40 lymph nodes were also involved. The patient is still alive and disease-free 37 months after the operation. A 72-year-old man, with a history of surgery two previous times for ascending colon cancer and its recurrence, underwent a third operation including a resection of the former ileocolic anastomosis en bloc by means of a pylorus-preserving pancreatoduodenectomy with a curative intent. The pathological examination revealed adenocarcinoma of the colon, which directly invaded the duodenum and pancreas. Seven out of 31 lymph nodes were also involved. The patient died of recurrence 24 months after the third operation. These two cases demonstrated the usefulness of a resection of the colon en bloc by means of a pancreatoduodenectomy in patients with either locally advanced colon cancer or locally advanced recurrent colon cancer.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/18. Spontaneous pyeloduodenal fistula: an unusual presentation in advanced renal transitional cell carcinoma.Spontaneous pyeloduodenal fistula is extremely rare. Most of the etiologies belong to chronic renal inflammatory disease, especially in patients with renal calculi. In published studies, only 2 cases have been reported in association with renal malignancy. We report a case of spontaneous pyeloduodenal fistula associated with transitional cell carcinoma, which has not been previously described in published reports.- - - - - - - - - - ranking = 6keywords = fistula (Clic here for more details about this article) |
3/18. A clinical case of duodenal gastrointestinal stromal tumor with a peculiarity in the surgical approach.We describe a case of duodenal, third portion, segmental resection for gastrointestinal stromal tumor. A 76-year-old man was referred for gastrointestinal bleeding, dyspnea and asthenia. Esophagogastroduodenoscopy showed a duodenal bleeding fistula. Computerized tomography demonstrated a retroperitoneal mass that compressed and displaced forward the third duodenal tract. Segmental resection of the third portion of the duodenum with a subtotal gastrectomy was performed. The patient was reconstructed with a termino-terminal duodenal anastomosis of the second and the fourth tract and with a Roux-en-Y gastrojejunum anastomosis. There were no postoperative complications. This duodenectomy procedure could be useful as a less extensive resection for duodenal gastrointestinal stromal tumor located in the third portion of the duodenum when the tumor is well capsulated, when the surrounding structures are not infiltrated and when there are no vascular difficulties. The technique reduces the morbidity and mortality correlated with duodenocefalopancreasectomy and improves postsurgical quality of life without worsening the risk of recurrence.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
4/18. Upper gastrointestinal bleeding due to superior mesenteric artery to duodenum fistula: rare complication of metastatic lung carcinoma.Although metastases from primary carcinoma of the lung to the small intestine appear to be more common than previously suspected, they rarely produce symptoms. Such metastases may present as bowel perforations. Overt gastrointestinal bleeding has been described only as a prelude to perforation. We describe the case of a 55-yr-old man with carcinoma of the lung that had metastasized to the brain and to the third part of the duodenum. The duodenal metastasis presented with massive upper gastrointestinal hemorrhage. The metastasis was seen to be actively bleeding at endoscopy, and a direct fistula from a branch of the superior mesenteric artery to the third part of the duodenum was shown angiographically. Arterial invasion and destruction by tumor was confirmed at postmortem examination. This complication of metastatic carcinoma of the lung has not been previously described in the English literature.- - - - - - - - - - ranking = 5keywords = fistula (Clic here for more details about this article) |
5/18. A paraprosthetic-enteric fistula associated with a duodenal tumor.An unusual etiology and presentation of a paraprosthetic-enteric fistula is reported involving a duodenal tumor. review of the possible mechanisms of graft-enteric fistula formation and diagnostic evaluation is presented. Initial insertion of an extraanatomic bypass followed by graft excision was performed in the present case and is encouraged in hemodynamically stable patients. Additionally, resection of the eroded duodenum with end-to-end anastomosis was performed in order to restore intestinal continuity.- - - - - - - - - - ranking = 6keywords = fistula (Clic here for more details about this article) |
6/18. Perioperative use of long-acting somatostatin analog (SMS 201-995) in patients with endocrine tumors of the gastroenteropancreatic axis.The clinical manifestations of hormone excess caused by functioning neuroendocrine tumors of the gastroenteropancreatic (GEP) axis can be life threatening and frequently prove refractory to conventional antisecretory drugs. Administration of a long-acting somatostatin analog (SMS 201-995) proved effective in three patients with complex management problems related to GEP tumors. A patient with an insulinoma was maintained euglycemic intraoperatively with a single 100 micrograms dose of SMS given before surgery. Gastric suction in two patients with gastrinomas caused hypochlorhydric alkalosis that was preventable with preoperative SMS. Iatrogenic pancreatic fistula occurring after resection of a benign insulinoma healed within 4 days of SMS administration. This drug may be a useful adjunct in the perioperative management of patients with GEP endocrine tumors. Caution is advised regarding potential hazards related to malabsorption and gastric dysmotility.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
7/18. hamartoma of Brunner's gland causing pyloric obstruction and a biliary fistula. Case report.hamartoma of Brunner's gland is rare. They have previously been described as a cause of gastrointestinal haemorrhage and obstruction. This is the first report of a hamartoma causing pyloric obstruction and a biliary fistula.- - - - - - - - - - ranking = 5keywords = fistula (Clic here for more details about this article) |
8/18. diagnosis and management of massive gastrointestinal bleeding owing to duodenal metastasis from renal cell carcinoma.We report 3 cases in which duodenal metastases from renal cell carcinoma caused massive upper gastrointestinal bleeding. In 2 patients the initial symptom was melena and 1 experienced hematobilia. In 2 patients the diagnosis was not suspected until a hypervascular mass was seen on arteriography and the bleeding was controlled by embolization of the gastroduodenal artery. In the third patient an aorto-enteric fistula was suspected on contrast-enhanced computerized tomography but arteriography showed hypervascular metastases in the duodenum.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
9/18. Malignant duodenocolic fistula. Report of a case and review of the literature.Malignant duodenocolic fistulas are rare; the most common cause is carcinoma of the ascending or hepatic flexure of the right colon. Thirteen cases reported to date have been treated by right hemicolectomy combined with a Whipple procedure, with a 46 percent 2.5-year survival. A case is reported in which stapling devices facilitated an extended Whipple procedure.- - - - - - - - - - ranking = 5keywords = fistula (Clic here for more details about this article) |
10/18. Pyloric exclusion in the management of complicated duodenal and pancreatic disease.Pyloric exclusion with gastrojejunostomy has been shown to be an effective adjuvant in the treatment of severe duodenal and pancreatic trauma. The authors have successfully applied this technique to the treatment of two patients with complicated pancreatic pseudocysts drained by cyst duodenostomy. A third patient with malignant duodenocolic fistula was palliated with this modality but eventually succumbed to his advanced disease.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
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