RESUMEN
Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic disorder, which may be idiopathic or secondary to a variety of diseases. However, there are very few reports of TTP in the context of pancreatic neoplasms. We report a case of relapsing TTP after initial treatment with plasmapheresis, corticosteroids, and rituximab, in a 59-year-old woman. During diagnostic work-up, a pancreatic lesion 35 × 25 mm in size was discovered incidentally and splenopancreatectomy was performed. The pathological diagnosis was benign glucagonoma. The hematological symptoms resolved completely after the procedure and 3 years later, the patient is well with no sign of recurrence of TTP or glucagonoma. To our knowledge, this represents the first documented case of a non-secreting benign pancreatic neuroendocrine tumor (glucagonoma) associated with TTP that is refractory to standard treatment.
Asunto(s)
Glucagonoma/complicaciones , Glucagonoma/diagnóstico , Hallazgos Incidentales , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/diagnóstico , Púrpura Trombocitopénica Trombótica/etiología , Púrpura Trombocitopénica Trombótica/terapia , Femenino , Glucagonoma/patología , Glucagonoma/terapia , Humanos , Persona de Mediana Edad , Pancreatectomía , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/terapia , Plasmaféresis , Prednisolona/análogos & derivados , Prednisolona/uso terapéutico , Recurrencia , Rituximab/uso terapéutico , Esplenectomía , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Various laparoscopic techniques have been described for the insertion of peritoneal dialysis catheters. However, most use 3 to 4 ports, thus multiplying the potential risk for abdominal wall complications (hemorrhage, hernia, leaking). METHODS: A Tenckhoff catheter was placed laparoscopically, using just 1 port, in 13 consecutive patients with end-stage renal failure. All catheters were fixed in the abdominal cavity with no additional ports for this purpose. RESULTS: After a follow-up of 76 patient-months, all catheters are working properly. There were no postoperative wall hemorrhages, early leaking, or hernias. There was 1 case of catheter migration and 2 cases of late leaking in 2 patients in total, due to severe constipation. There were no exit site or tunnel infections. One episode of peritonitis was successfully treated with antibiotics. CONCLUSION: The simplicity and the rapidity of the method justifies serious consideration for its use as the standard Tenckhoff catheter placement.