Surgical management of pancreatic pseudocyst.

BACKGROUND: Pancreatic pseudocysts were once considered to be an unusual complication of acute chronic and traumatic pancreatitis. METHODS: This work was made in order to study the results of the operative methods in 24 patients with acute chronic and traumatic pancreatic pseudocysts, treated by external or internal drainage during the years 1990-1995 at the Athens Red Cross Hospital and compare these results with those of international literature. Pain was the common symptom for all patients. Gallstones were the most important aetiological agent in thirteen of the 24 patients, while alcoholic pancreatitis was diagnosed in only 6 of them. Fifteen patients (62.5%) were treated by surgical drainage or resection and 9 patients (37.5%) were treated by observation, one by percutaneous and one by endoscopic drainage. The rest had small cysts (less than 5 cm) and were treated by observation. RESULTS: The most frequent complication of internal cyst drainage was upper gastrointestinal haemorrhage. The rate of mortality was 7%. CONCLUSIONS: Anatomical considerations dictate the choice of operation. Cystogastrostomy, for example is inappropriate unless the stomach is closely applied to the front of the cyst. We preferred cystojejunostomy Rouen-y because the Roux loop can be anastomosed to the lower part of the cyst. Cystoduodenostomy should be reserved for pseudocyst in the head of the pancreas. Resection is an alternative to internal drainage for chronic pseudocyst of moderate proportions, for those that have largely replaced a portion of the pancreas.

Septic and other complications resulting from biliary stones placed in the abdominal cavity. Experimental study in rabbits.

BACKGROUND: The aim of this experimental study is to assess the consequences of biliary stones placed in the abdominal cavity of rabbits. METHODS: The animals were allocated to five groups. In group A a nonsterile gallstone was used. In group B animals with a nonsterile gallstone received preoperative chemoprophylaxis. In group C a sterile stone was placed in the abdomen. Group D served as control. In group E were animals with a nonsterile stone who had a prolonged follow-up period. Parameters studied postoperatively were temperature, white blood cell count, abscess formation, sepsis, peritonitis, adhesion formation, intestinal obstruction, and histological changes of the omentum enveloping the gallstones. RESULTS: There was no statistically significant difference among the five groups concerning morbidity, mortality, or histological findings. CONCLUSIONS: The prevalence of septic complications was higher among the four groups that received gallstones compared to the control group and thus an adverse effect of gallstone implantation can be suggested.

[Indications for prophylactic ovariectomy in patients with colorectal carcinoma]. / Indicazioni all'ovariectomia profilattica nelle pazienti con carcinoma colorettale.

Metastasis of colorectal cancer to the ovaries presents in 2-8% of patients. Prevention of these metastasis with bilateral oophorectomy at the initial operation is quite simple, but nevertheless it produces an early menopause in premenopausal women and may add the morbility of the operation. Prophylactic oophorectomy is evaluated in a prospective study of 130 women that underwent surgery for adenocarcinoma of the large bowel. Forty-four of these patients underwent unilateral (10 patients) or bilateral (34 patients) oophorectomy along with the large bowel resection. Fifty-five women were submitted to colectomy alone, while 31 with or without oophorectomy were lost to the follow-up. Of the 44 women that underwent oophorectomy, 8 were premenopausal, while 36 were postmenopausal. The tumor was situated at the right colon in 5 out of the 44 patients that underwent oophorectomy and at the left colon in the remaining 39. According to Dukes classification, 5 tumors were Dukes A, 22 Dukes B and 17 Dukes C. Two of the 44 patients were found to harbour metastasis to the ovaries (4.5%). One of these patients was premenopausal (12.5%) and 1 was postmenopausal (2.7%). Of the 55 women that underwent colectomy, only one developed metastasis to the ovaries during the follow-up period (1.8%). No metastasis was detected at the resected ovary or at the remaining ovary during the follow-up period, among the patients that underwent unilateral oophorectomy. No complication directly related to the oophorectomy was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchobiliary fistula due to echinococcosis of the liver.

In Greece, which has the second highest incidence of echinococcosis in the world, there has been an overall decrease in the frequency of this disease and its complications during the past 15 years. Between 1920 and 1960, approximately 46 patients per year were operated on for echinococcosis at the Hellenic Red Cross Hospital, and 1.8% of 1037 hepatic hydatid cysts had ruptured into the bronchi. From 1960 to 1975, the number of patients requiring operation decreased to approximately 25 per year, and incidence of rupture into the bronchi declined to 1% of 288 liver cysts. The reduction has resulted from improvements in preventive medicine and surgical care and a decrease in the frequency of infected cysts. Bronchobiliary fistula is a serious complication of hydatid cyst of the liver and it must be treated surgically. A right thoracotomy or thoracoabdominal approach offers the possibility of dealing simultaneously with the hepatic cyst and the pulmonary lesions. The choice of operation depends on the findings and ranges from simple drainage of the hepatic cavity with division of the bronchobiliary communication, to resection of the lung (usually lobectomy) when a chronically infected pulmonary cavity is present. If a hydatid cyst of the liver ruptures simultaneously into the lung and the extra-hepatic biliary tree with resultant obstruction of the common bile duct, unblocking of the common duct by evacuation of cysts and debris through a laparotomy takes priority over any other surgical action. Of 3 patients with bronchobiliary fistulas treated during the past 15 years, 2 were cured by simple drainage through a transabdominal approach.