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Tian W, Hu T, Luo S, Zhao G, Zhao R, Zhao Y, Li Q, Yao Z, Huang Q. Postoperative pancreatic fistula is higher in patients with necrotizing pancreatitis who develop a colon-transverse fistula. Langenbecks Arch Surg 2025; 410:88. [PMID: 40044910 PMCID: PMC11882662 DOI: 10.1007/s00423-024-03578-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 12/09/2024] [Indexed: 03/09/2025]
Abstract
BACKGROUND This study explores the association between the need for open necrosectomy (ON) during infected necrotizing pancreatitis (INP) treatment and the development of postoperative pancreatic fistula (POPF) following definitive surgery (DS) for transverse colonic fistulas. MATERIALS AND METHODS This study was conducted at two tertiary hospitals and included patients who underwent DS for colonic fistula secondary to INP from January 2009 to December 2023. Patients were followed until hospital discharge. The primary outcome was the incidence of POPF. RESULTS A total of 135 patients were included. The median age was 38 years (interquartile range [IQR]: 32-44 years), with 85 (62.9%) being male. ON was required in 52 patients (38.5%), with 24 patients developing POPF post-DS. The need for ON (odds ratio [OR] = 2.78, 95% confidence interval [CI]: 1.03-7.58, p = 0.040) and the interval from INP resolution to DS (OR = 0.82, 95% CI: 0.68-0.92, p = 0.011) were associated with POPF. CONCLUSION The need for ON during INP treatment is significantly associated with an increased risk of POPF following DS for transverse colonic fistulas.
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Affiliation(s)
- Weiliang Tian
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Zhongshan Road NO.E.305, Nanjing, Jiangsu, China
| | - Tao Hu
- Department of General Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China
| | - Shikun Luo
- Department of General Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China
| | - Guoping Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China.
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China.
| | - Yunzhao Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China.
| | - Qiurong Li
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Zhongshan Road NO.E.305, Nanjing, Jiangsu, China.
| | - Zheng Yao
- Department of General Surgery, Jiangning Hospital, Hushan Road NO.169, Nanjing, Jiangsu, China.
| | - Qian Huang
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Zhongshan Road NO.E.305, Nanjing, Jiangsu, China.
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Lukasiewicz AD, Mauro KD, Assenmacher TD. Pancreatic torsion in a puppy with an acute abdomen. J Vet Emerg Crit Care (San Antonio) 2024; 34:579-584. [PMID: 39494857 DOI: 10.1111/vec.13433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 08/31/2023] [Accepted: 09/27/2023] [Indexed: 11/05/2024]
Abstract
OBJECTIVE To describe the treatment of a unique cause of acute abdomen in a puppy. CASE SUMMARY An 11-week, 5-day-old female intact Alaskan Malamute was presented to an emergency service for an acute onset of vomiting. On evaluation, the puppy was found to have cranial abdominal pain with an otherwise normal physical examination. An inflammatory leukogram with no other clinically significant findings was found on the initial diagnostics. An abdominal ultrasound showed peritoneal effusion and a lobulated structure in the left cranial abdomen. An emergency exploratory celiotomy was performed, during which evidence of torsion was found in the left limb of the pancreas, which was subsequently excised from the abdomen. The puppy was hospitalized overnight and discharged the next day. Histopathology of the pancreas was consistent with torsion. UNIQUE INFORMATION PROVIDED Pancreatic torsion is a rare but potential cause of acute abdomen in dogs and can be successfully treated with surgical excision.
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Affiliation(s)
- Andrew D Lukasiewicz
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Katie D Mauro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
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Gaballah AH, Algazzar M, Kazi IA, Badawy M, Guys NP, Mohamed EAS, Sammon J, Elsayes KM, Liu PS, Heller M. The Peritoneum: Anatomy, Pathologic Findings, and Patterns of Disease Spread. Radiographics 2024; 44:e230216. [PMID: 39088361 DOI: 10.1148/rg.230216] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
Disease spread in the abdomen and pelvis generally occurs in a predictable pattern in relation to anatomic landmarks and fascial planes. Anatomically, the abdominopelvic cavity is subdivided into several smaller spaces or compartments by key ligaments and fascial planes. The abdominal cavity has been traditionally divided into peritoneal, retroperitoneal, and pelvic extraperitoneal spaces. Recently, more clinically relevant classifications have evolved. Many pathologic conditions affect the abdominal cavity, including traumatic, inflammatory, infectious, and neoplastic processes. These abnormalities can extend beyond their sites of origin through various pathways. Identifying the origin of a disease process is the first step in formulating a differential diagnosis and ultimately reaching a final diagnosis. Pathologic conditions differ in terms of pathways of disease spread. For example, simple fluid tracks along fascial planes, respecting anatomic boundaries, while fluid from acute necrotizing pancreatitis can destroy fascial planes, resulting in transfascial spread without regard for anatomic landmarks. Furthermore, neoplastic processes can spread through multiple pathways, with a propensity for spread to noncontiguous sites. When the origin of a disease process is not readily apparent, recognizing the spread pattern can allow the radiologist to work backward and ultimately arrive at the site or source of pathogenesis. As such, a cohesive understanding of the peritoneal anatomy, the typical organ or site of origin for a disease process, and the corresponding pattern of disease spread is critical not only for initial diagnosis but also for establishing a road map for staging, anticipating further disease spread, guiding search patterns and report checklists, determining prognosis, and tailoring appropriate follow-up imaging studies. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Ayman H Gaballah
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Maged Algazzar
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Irfan A Kazi
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Mohamed Badawy
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Nicholas Philip Guys
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Eslam Adel Shehata Mohamed
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Jennifer Sammon
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Khaled M Elsayes
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Peter S Liu
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
| | - Matthew Heller
- From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (A.H.G., M.B., K.M.E.); Department of Radiology, University of Menoufia, Menoufia, Egypt (M.A.); Department of Radiology, University of Missouri, Columbia, Mo (I.A.K., E.A.S.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (N.P.G.); Department of Radiology, Cork University Hospital, Cork, Ireland (J.S.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (P.S.L.); and Department of Diagnostic Imaging, Mayo Clinic, Jacksonville, Fla (M.H.)
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Guler I, Kavak RP. Pancreatic morphology/contour variations should be recognized and remembered. Niger J Clin Pract 2023; 26:749-755. [PMID: 37470648 DOI: 10.4103/njcp.njcp_619_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background Pancreatic contour variations can be detected incidentally on computed tomography (CT). Recognition and remembering of these variations are important in volumetric measurements and surgery as well as in preventing misdiagnosis. Aim This study aims to evaluate the morphology/contour variations in the pancreas head-neck, body-tail, and uncinate process with multi-detector CT (MDCT) examinations (triple phase CT abdomen). Material and Method Around 1662 adult age (>18 years old) patients were evaluated retrospectively, and after exclusion criteria, 945 patients were included in the study. Aplasia and hypoplasia of the uncinate process were determined, and pancreatic contour variances were categorized according to the Ross et al. and Omeri et al. classifications. Pancreatic head-neck variants were categorized into Type I-anterior, Type II-posterior, and Type III-horizontal variations. Pancreatic body-tail variants were sectioned into Type Ia-anterior protrusion, Type Ib-posterior protrusion, and Types IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail. Results Of the 945 patients, 481 (50.9%) were female. The mean age was 43.28 ± 10.49 (min. 20-max. 68). In the evaluations made according to the uncinate process morphology variant, hypoplasia was detected in 66 (7%) patients and aplasia in 12 (1.3%) patients. Pancreatic head-neck and body-tail contour variations were observed in 596 (63.1%) patients. The most common head-neck variation was Type II in 233 (24.6%) patients, followed by type III in 96 (10.2%). There were Type Ia in 83 (8.8%) patients and Type Ib in 14 (1.5%) patients. The pancreatic tail configuration was normal in 792 (83.8%) patients; it was Type IIa in 62 (6.6%) patients and IIb in 50 (5.3%) patients. The most common variation was head and tail in 33 (3.5%) patients. Discussion Pancreatic variations detected in CT examinations for distinct reasons are not rare; these variations should be recognized and remembered.
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Affiliation(s)
- I Guler
- Department of General Surgery, Ministry of Health, General Directorate of Public Hospitals, Ankara, Türkiye
| | - R P Kavak
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
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Li G, Yang J, Huang MF, Ye B, Zhou J, Diao Q, Ke L, Liu YX, Tong ZH, Li WQ. Involvement of transverse mesocolon is associated with development of colonic fistula in patients with acute necrotizing pancreatitis. Pancreatology 2023; 23:314-320. [PMID: 36878824 DOI: 10.1016/j.pan.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Involvement of transverse mesocolon (TM) during acute necrotizing pancreatitis(ANP) indicates that inflammation has spread from retroperitoneal space to peritoneum. Nevertheless, the impact of TM involvement, as confirmed by contrast-enhanced computed tomography (CECT), on local complications and clinical outcomes was poorly investigated. PURPOSE This study aimed to explore the association between CECT-diagnosed TM involvement and the development of colonic fistula in a cohort of ANP patients. METHODS This is a single-center, retrospective cohort study involving ANP patients admitted from January 2020 to December 2020. TM involvement was diagnosed by two experienced radiologists. The study subjects were enrolled consecutively and divided into two groups: TM involvement and non-TM involvement. The primary outcome was colonic fistula during the index admission. Clinical outcomes were compared between the two groups, and the association between the TM involvement and the development of colonic fistula was assessed using multivariable analysis to adjust for baseline unbalances. RESULTS A total of 180 patients with ANP were enrolled, and 86 (47.8%) patients had TM involvement. The incidence of the colonic fistula is significantly higher in patients with TM involvement (16.3% vs. 5.3%;p = 0.017). Moreover, the length of hospital stay was 24(13,68) days in patients with TM involvement and 15(7,31) days in those not (p = 0.001). Analysis of multivariable logistic regression revealed that TM involvement is an independent risk factor for the development of colonic fistula (odds ratio: 10.253, 95% CI: 2.206-47.650, p = 0.003). CONCLUSION TM involvement in ANP patients is associated with development of colonic fistula in ANP patients.
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Affiliation(s)
- Gang Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China
| | - Jie Yang
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China
| | - Ming-Feng Huang
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China
| | - Bo Ye
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China
| | - Jing Zhou
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China
| | - Qiang Diao
- Department of Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China
| | - Yu-Xiu Liu
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China
| | - Zhi-Hui Tong
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China.
| | - Wei-Qin Li
- Department of Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu Province, China.
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Arslan OE. Peritoneal Organ-Anatomical and Physiological Considerations. EXPLORING DRUG DELIVERY TO THE PERITONEUM 2023:1-36. [DOI: 10.1007/978-3-031-31694-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Mayorga Pérez IM, Aponte Ortiz JA, Ortiz Justiniano VN. Spontaneous jejunal perforation in the setting of acute pancreatitis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Awiwi MO, Ramanan RV, Elshikh M, Vikram R. Imaging of Gastric Carcinoma. Part One: Diagnosis and Staging. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1735217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractGastric cancer is one of the leading causes of death from malignancy. Despite the enormous advancement in medical oncology over the past decade, surgical resection of early tumors remains the most effective treatment. Accurate interpretation of radiologic imaging studies is crucial for staging local disease spread, predicting possible lymphatic involvement, and identifying metastatic disease, thereby guiding management plans. This article reviews imaging patterns of the normal stomach along with appearances of gastric cancer, its local spread patterns and distant metastasis, and also describes key features pertaining to preoperative staging.
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Affiliation(s)
- Muhammad O. Awiwi
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Texas, United States
| | | | - Mohamed Elshikh
- Department of Radiology, The University of Texas Medical Branch, Texas, United States
| | - Raghunandan Vikram
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Texas, United States
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Karin M, Bogut A, Romic I, Silovski H, Figl J, Pravdic D, Volaric M, Babic E, Bakula B, Romic R. Rare Complication of Necrotizing Pancreatitis: Extension of Retroperitoneal Abscess into Femoral Region. ACTA MEDICA (HRADEC KRALOVE) 2021; 64:46-49. [PMID: 33855959 DOI: 10.14712/18059694.2021.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Distant abscesses are uncommon during the episode of acute pancreatitis (AP). However, these are possible sequalae of necrotizing pancreatitis and should be treated appropriately to prevent serious septic complications. We demonstrate a case of a 56-year-old male patient who presented with severe necrotizing pancreatitis and distant retroperitoneal abscess that reached femoral region and was detected on diagnostic imaging scans. Combination of surgical and supportive therapy was employed, and the patient recovered well with no permanent consequences. Our article highlights the importance of quick and accurate diagnosis and timely intervention in this rare type of pancreatitis complication.
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Affiliation(s)
- Maja Karin
- Internal Medicine Clinic with Dialysis Center, University Clinical Hospital Mostar, Bosnia and Herzegovina
| | - Ante Bogut
- Internal Medicine Clinic with Dialysis Center, University Clinical Hospital Mostar, Bosnia and Herzegovina
| | - Ivan Romic
- Surgery Department, University Clinical Hospital Zagreb, Croatia.
| | - Hrvoje Silovski
- Surgery Department, University Clinical Hospital Zagreb, Croatia
| | - Josip Figl
- Surgery Department, University Clinical Hospital Zagreb, Croatia
| | - Danijel Pravdic
- Internal Medicine Clinic with Dialysis Center, University Clinical Hospital Mostar, Bosnia and Herzegovina
| | - Mile Volaric
- Internal Medicine Clinic with Dialysis Center, University Clinical Hospital Mostar, Bosnia and Herzegovina
| | - Emil Babic
- Internal Medicine Clinic with Dialysis Center, University Clinical Hospital Mostar, Bosnia and Herzegovina
| | - Branko Bakula
- Surgery Department, University Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Renata Romic
- Family Medicine Department, Health centre Zagreb, Zagreb, Croatia
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Elbanna KY, Jang HJ, Kim TK. Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review. Insights Imaging 2020; 11:58. [PMID: 32335790 PMCID: PMC7183518 DOI: 10.1186/s13244-020-00861-y] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has continued to have a poor prognosis for the last few decades in spite of recent advances in different imaging modalities mainly due to difficulty in early diagnosis and aggressive biological behavior. Early PDAC can be missed on CT due to similar attenuation relative to the normal pancreas, small size, or hidden location in the uncinate process. Tumor resectability and its contingency on the vascular invasion most commonly assessed with multi-phasic thin-slice CT is a continuously changing concept, particularly in the era of frequent neoadjuvant therapy. Coexistent celiac artery stenosis may affect the surgical plan in patients undergoing pancreaticoduodenectomy. In this review, we discuss the challenges related to the imaging of PDAC. These include radiological and clinical subtleties of the tumor, evolving imaging criteria for tumor resectability, preoperative diagnosis of accompanying celiac artery stenosis, and post-neoadjuvant therapy imaging. For each category, the key imaging features and potential pitfalls on cross-sectional imaging will be discussed. Also, we will describe the imaging discriminators of potential mimickers of PDAC.
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Affiliation(s)
- Khaled Y Elbanna
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
| | - Hyun-Jung Jang
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tae Kyoung Kim
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
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11
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Sharma M, Patil A, Kumar A, Pathak A, Somani P, Sreesh SS, Rameshbabu CS. Imaging of infracolic and pelvic compartment by linear EUS. Endosc Ultrasound 2019; 8:161-171. [PMID: 31134898 PMCID: PMC6590000 DOI: 10.4103/eus.eus_25_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The peritoneal cavity is subdivided into supracolic and infracolic compartments by transverse mesocolon, which attaches the colon to the posterior abdominal wall. Infracolic compartment is subdivided into right and left compartment by small bowel mesentery. Left infracolic space freely communicates with pelvic compartment. The infracolic compartment contains the coils of small bowel which is separated from paracolic gutter on either side by ascending and descending colon. Pelvic compartment mainly contains bladder, rectum and genital organ (prostate, seminal vesicle in male and uterus in female). The evaluation of different compartments of peritoneum is gaining importance in multimodality imaging. It has become essential that clinicians and endosonographers thoroughly understand the peritoneal spaces and the ligaments and mesenteries that form their boundaries in order to localize disease to a particular peritoneal/subperitoneal space and formulate a differential diagnosis on the basis of that location. In this article we describe the applied EUS anatomy of peritoneal ligaments, infracolic and pelvic compartments of peritoneum and there technique of imaging from stomach, duodenum, sigmoid colon and rectum. Imaging from stomach images the infracolic compartment through transverse mesocolon, imaging from duodenum images the infracolic compartment through the mesentery and imaging from rectum and sigmoid images the infracolic and pelvic compartments through the sigmoid mesocolon and pelvic peritoneum.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Amol Patil
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Avinash Kumar
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Amit Pathak
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Srijaya S Sreesh
- Department of Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India
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New Risk Factors for Infected Pancreatic Necrosis Secondary to Severe Acute Pancreatitis: The Role of Initial Contrast-Enhanced Computed Tomography. Dig Dis Sci 2019; 64:553-560. [PMID: 30465178 DOI: 10.1007/s10620-018-5359-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/29/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Pancreatic necrosis is a risk factor for poor prognosis of acute pancreatitis (AP). However, the associations between the findings on initial contrast-enhanced computed tomography (CT) of the pancreas and infected pancreatic necrosis (IPN) are unclear. METHODS This was a retrospective cohort study. Patients with severe AP (SAP) from January 2014 to December 2016 at the First Affiliated Hospital of Nanchang University were enrolled and assigned to an IPN group and a non-IPN group. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and IPN development. A receiver operating characteristic (ROC) curve was generated for the qualified independent risk factor. RESULTS Forty-two patients with IPN were compared with 100 patients without IPN. Contrast-enhanced CT was performed 7 (range 3-10) days after AP onset. Multivariate stepwise logistic regression analyses showed that the number of acute peripancreatic fluid collections (APFCs) (OR 1.328, P = 0.006), presence of peripancreatic and pancreatic parenchymal necrosis (OR 4.001, P = 0.001), and gastrointestinal wall thickening (OR 3.353, P = 0.006) were independent risk factors for IPN secondary to SAP. The area under an ROC curve for the number of APFCs was 0.714, the sensitivity was 78.60%, and the specificity was 57.30% at a cutoff value of 4.5. CONCLUSIONS The number of APFCs, presence of peripancreatic and pancreatic parenchymal necrosis, and gastrointestinal wall thickening were independent risk factors associated with IPN. As initial contrast-enhanced CT (about 7 days from AP onset) plays an important role in predicting IPN, it is important for clinicians to consider initial imaging of the pancreas.
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Ding L, Deng F, Yu C, He WH, Xia L, Zhou M, Huang X, Lei YP, Zhou XJ, Zhu Y, Lu NH. Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis. World J Gastroenterol 2018; 24:4054-4060. [PMID: 30254409 PMCID: PMC6148429 DOI: 10.3748/wjg.v24.i35.4054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/17/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the incidence and risk factors of portosplenomesenteric vein thrombosis (PSMVT) in the early stage of severe acute pancreatitis (SAP).
METHODS Patients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography (CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic (ROC) curve was generated for the qualifying independent risk factors.
RESULTS Twenty-five of the one hundred and forty (17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis (AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar’s CT severity index (CTSI) scores [odds ratio (OR): 2.742; 95% confidence interval (CI): 1.664-4.519; P = 0.000], hypoalbuminemia (serum albumin level < 25 g/L) (OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening (OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar’s CTSI scores was 0.777 (P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.
CONCLUSION High Balthazar’s CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.
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Affiliation(s)
- Ling Ding
- Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Feng Deng
- Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Chen Yu
- Department of medical image, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Wen-Hua He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Liang Xia
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Mi Zhou
- Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xin Huang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yu-Peng Lei
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Jiang Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Nong-Hua Lu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Sharma M, Rameshbabu CS, Dietrich CF, Rai P, Bansal R. Endoscopic ultrasound of the hepatoduodenal ligament and liver hilum. Endosc Ultrasound 2018; 7:168-174. [PMID: 27824022 PMCID: PMC6032695 DOI: 10.4103/2303-9027.193584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/22/2016] [Indexed: 01/12/2023] Open
Abstract
The porta hepatis and hepatoduodenal ligament (HDL) are important anatomical pathways of extension of disease to and from the liver. The imaging of this area is difficult. The role of endoscopic ultrasound (EUS) as an imaging modality for hepatoduodenal ligament has not been established so far. All images in the present study have been generated from a detailed review of real time recordings using the curved linear scanning echoendoscope EG -3830 UT (Pentax Corporation, Tokyo, Japan), coupled with a Hitachi avius and Hitach 7500 processor (Hitachi Aloka Medical, Tokyo Japan). Our image orientation is with the cranial aspect of the patient directed toward the right side of the screen. We have illustrated that with a careful technique, a detailed EUS evaluation of the HDL and hepatic hilum is possible. A thorough understanding of the HDL anatomy by curved linear EUS probe may play a crucial role in the accurate diagnosis of a broad spectrum of pathologic conditions of the porta hepatis. EUS examination of the HDL should be a part of the upper abdominal EUS studies. The description and the images described in this article are useful for beginners who want to start imaging of the porta hepatis and hepatoduodenal ligament. This information is useful for staging of malignancies involving common bile duct.
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Affiliation(s)
- Malay Sharma
- Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | | | - Christoph F Dietrich
- Caritas Krankenhaus Bad Mergentheim Internist, Gastroenterologe und Proktologe Hämatologe-Onkologe, Pneumologe Geriater/Arzt für Palliativmedizin Chefarzt der Med, Bad Mergentheim, Germany
| | - Praveer Rai
- Sanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, Uttar Pradesh, India
| | - Raghav Bansal
- Mount Sinai Elmhurst Hospital Center, Elmhurst, New York, USA
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15
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Sharma M, Madambath JG, Somani P, Pathak A, Rameshbabu CS, Bansal R, Ramasamy K, Patil A. Endoscopic ultrasound of peritoneal spaces. Endosc Ultrasound 2017; 6:90-102. [PMID: 28440234 PMCID: PMC5418973 DOI: 10.4103/2303-9027.204816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The peritoneal cavity is subdivided into supracolic and infracolic compartments by transverse colon and its mesocolon. The supracolic compartment contains the liver, spleen, stomach, and lesser omentum. The infracolic compartment contains the coils of small bowel surrounded by ascending, transverse, and descending colon and the paracolic gutters. The imaging of different compartments is possible by various methods such as ultrasound (US) and computerized tomography. The treating physicians should be familiar with the relevant radiological anatomy of different compartments and spaces as accurate localization of fluid collection/lymph node in peritoneal cavity greatly aids in selection of a treatment strategy. The role of endoscopic US (EUS) is emerging for detail evaluation of all parts of peritoneal cavity as it provides an easy access for fine-needle aspiration from different compartments of peritoneal cavity. In this review, we describe the techniques of evaluation of different parts of supracolic compartments of peritoneum by EUS.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | | | - Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Amit Pathak
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | | | | | | | - Amol Patil
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
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16
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Balachandran A, Bhosale PR, Charnsangavej C, Tamm EP. Imaging of pancreatic neoplasms. Surg Oncol Clin N Am 2015; 23:751-88. [PMID: 25246049 DOI: 10.1016/j.soc.2014.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Ductal adenocarcinoma accounts for 85% to 90% of all solid pancreatic neoplasms, is increasing in incidence, and is the fourth leading cause of cancer-related deaths. There are currently no screening tests available for the detection of ductal adenocarcinoma. The only chance for cure in pancreatic adenocarcinoma is surgery. Imaging has a crucial role in the identification of the primary tumor, vascular variants, identification of metastases, disease response assessment to treatment, and prediction of respectability. Pancreatic neuroendocrine neoplasms can have a distinctive appearance and pattern of spread, which should be recognized on imaging for appropriate management of these patients.
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Affiliation(s)
- Aparna Balachandran
- Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA.
| | - Priya R Bhosale
- Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA
| | - Chuslip Charnsangavej
- Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Eric P Tamm
- Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA
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17
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Sharma M, Rai P, Rameshbabu CS, Senadhipan B. Imaging of peritoneal ligaments by endoscopic ultrasound (with videos). Endosc Ultrasound 2015; 4:15-27. [PMID: 25789280 PMCID: PMC4361999 DOI: 10.4103/2303-9027.151317] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/13/2014] [Indexed: 02/06/2023] Open
Abstract
Double layered peritoneal folds or ligaments act as conduits for the passage of blood vessels in intraperitoneal organs and also provide a pathway for the spread of disease. It is difficult to identify these normal peritoneal folds at imaging. Computed tomography is the most common imaging modality used to detect diseases of the peritoneum. The ultrasound (US) has been also used for evaluation of diseases involving ligaments. Endoscopic ultrasound (EUS) is being increasingly used both for diagnostic and interventional purposes in abdomen. In this article, we have described the normal EUS anatomy of the peritoneal ligaments.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute, Lucknow, India
| | | | - Baiju Senadhipan
- Trivandrum Institute of Digestive Diseases and Minimal, Access, Surgery, Trivandrum, Kerala, India
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18
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Subperitoneal extension of disease processes between the chest, abdomen, and the pelvis. ACTA ACUST UNITED AC 2014; 40:1858-70. [DOI: 10.1007/s00261-014-0297-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sharma M, Rai P, Rameshbabu CS. Techniques of imaging of nodal stations of gastric cancer by endoscopic ultrasound. Endosc Ultrasound 2014; 3:179-90. [PMID: 25184125 PMCID: PMC4145479 DOI: 10.4103/2303-9027.138793] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/06/2014] [Indexed: 12/12/2022] Open
Abstract
Nodal staging is of crucial importance in the management of gastric cancer (GC). The available modalities of nodal imaging in GC do not provide a high sensitivity and specificity of lymph node status. Comparative study of endoscopic ultrasonography (EUS) and multislice spiral computed tomography in GC has shown greater accuracy of EUS for N staging. EUS is not used routinely in patients with GC as it is not available at all centers, and its accuracy is operator dependent. Standard techniques of identification of nodal station (as suggested by Japanese Research Society for the Study of Gastric Cancer) by EUS have not been described so far. Identification of each nodal station by EUS requires adequate knowledge of anatomy as well as understanding the proper technique to perform EUS. This review presents a method to identify the regional nodal stations of GC by linear EUS and hence will help in appropriate N staging of GC.
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Affiliation(s)
- Malay Sharma
- Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Praveer Rai
- Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
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20
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Yagublu V, Caliskan N, Lewis AL, Jesenofsky R, Gasimova L, Löhr JM, Keese M. Treatment of experimental pancreatic cancer by doxorubicin-, mitoxantrone-, and irinotecan-drug eluting beads. Pancreatology 2012; 13:79-87. [PMID: 23395574 DOI: 10.1016/j.pan.2012.11.305] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 11/07/2012] [Accepted: 11/08/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Peritoneal carcinomatosis is a common cause of death in pancreatic cancer patients. In this metastatic stage of the disease, few patients show a sustained response to therapy. In the palliative situation, targeted and compartment restricted delivery of drugs offers the opportunity to focus drugs directly to the tumor site, which is a prerequisite for avoiding toxic side effects. Here, we demonstrate the therapeutic efficiency of biocompatible polyvinyl-alcohol hydrogel drug eluting beads (DEBs) containing doxorubicin, mitoxantrone and irinotecan in vitro and in vivo in a syngenic model of experimental pancreatic cancer. METHODS Panc02 murine pancreatic carcinoma cells were exposed to doxorubicin, mitoxantrone and irinotecan DEBs and free compounds. The effect on cell proliferation and apoptosis induction was compared. Using this cell line, peritoneal carcinomatosis was induced in C57 black6 mice. Mortality, tumor load and therapy-associated weight loss were compared after treatment of tumor-bearing mice with DEBs or free compounds. RESULTS In vitro treatment with DEBs decreases tumor cell proliferation and induces apoptosis. The effect is less pronounced than with corresponding doses of the free drug. Repeated applications of the free drugs in vivo, however, induce significantly higher lethality and weight loss than corresponding doses of DEBs. No relevant differences in antitumoral activity were observed. Using computer tomography and HE-histology after subcutaneous and intraperitoneal injection of radiopaque beads no systemic spread of the beads could be found. CONCLUSION DEBs show the advantage of delivering potent cytotoxic activity to the intraperitoneal tumor manifestation while maintaining a low systemic toxicity.
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Affiliation(s)
- Vugar Yagublu
- Surgical Clinic, University Medicine Mannheim, Mannheim, Germany
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21
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Common primary tumours of the abdomen and pelvis and their patterns of tumour spread as seen on multi-detector computed tomography. Insights Imaging 2011; 2:205-214. [PMID: 22347948 PMCID: PMC3259344 DOI: 10.1007/s13244-011-0089-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 01/09/2011] [Accepted: 03/14/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND: Multidetector computed tomography (MDCT) has become the main investigation of choice for staging of many cancers. AIM: The purpose of this pictorial review is to discuss the imaging appearances on CT of some of the more common cancers arising within the abdomen and pelvis and to describe their typical sites of local, nodal and haematogenous tumour spread. METHODS: Cancers arising from the stomach, pancreas, colon, kidney, ovary and prostate will be reviewed. RESULTS: Awareness of the characteristic sites of tumour spread is important to allow accurate identification of all sites of disease. CONCLUSION: This will clearly have an impact on both patient management and prognosis.
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22
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Vikram R, Balachandran A. Imaging in staging and management of pancreatic ductal adenocarcinoma. Indian J Surg Oncol 2010; 2:78-87. [PMID: 22693399 DOI: 10.1007/s13193-010-0017-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 11/01/2010] [Indexed: 12/13/2022] Open
Abstract
Pancreatic cancer is a relatively common malignancy of the gastrointestinal tract for which complete surgical excision remains the only curative option. Being infiltrative in nature and bearing a complex anatomical relationship with various organs, peritoneal ligaments and vascular structures, accurate anatomical staging is key in treatment of these patients. In this article, we will discuss and provide a brief overview of anatomy and use of imaging in staging pancreatic cancer.
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Affiliation(s)
- Raghunandan Vikram
- Department of Diagnostic Radiology, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX 77030 USA
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Gastric cancer: Patterns of disease spread via the perigastric ligaments shown by CT. AJR Am J Roentgenol 2010; 195:398-404. [PMID: 20651196 DOI: 10.2214/ajr.09.3070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The stomach is suspended in the abdominal cavity by perigastric ligaments, which are derived from the dorsal and ventral mesogastrium. These ligaments provide a direct contiguous pathway for the peritoneal spread of gastric cancer. In this article, we discuss the embryology and anatomy of the stomach and describe the specific ligamentous routes along which gastric cancers may spread by direct invasion. CONCLUSION Extragastric disease alters the prognosis and treatment options available to patients with gastric cancer. Familiarity with the stomach's embryology will help the radiologist understand its anatomy and, therefore, the patterns of regional spread of gastric cancer. The location of the primary tumor can predict involvement of specific perigastric ligaments because locoregional spread of gastric cancer occurs along the arteries, veins, nerves, and lymphatic channels within those ligaments. Thus, identifying the location of the primary tumor can potentially improve patient outcomes.
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Desai G, Filly RA. Sonographic anatomy of the gastrohepatic ligament. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:87-93. [PMID: 20040779 DOI: 10.7863/jum.2010.29.1.87] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this presentation is to illustrate anatomic and pathologic features of the gastrohepatic ligament (GHL) and to show its usefulness for precise localization of abnormalities, particularly in relation to the lesser peritoneal cavity and diseases occurring within the confines of the ligament itself. METHODS Cases were selected that illustrate the objectives above. RESULTS Illustrations show various anatomic and pathologic features meant to enhance interpretation of left upper quadrant sonograms. CONCLUSIONS Illustrations seen in the sonographic literature vaguely interpret the relationships of the GHL. Misunderstanding has led not only to improper nomenclature but also to the use of inappropriate indicators of lesser omental diseases. With a clear understanding of the anatomy of the GHL and its use as a pivotal marker for structures around and within it, one can avoid these pitfalls and better evaluate adult and pediatric lesser omental anatomy.
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Affiliation(s)
- Gaurav Desai
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California 94143-0628 USA
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