Trifidum anomaly of the main pancreatic duct.

BACKGROUND: Embryology of the human pancreas is very complex and any alteration in its development may lead to congenital biliopancreatic malformations and anomalies not thoroughly studied in literature. We here report a case of trifurcation of the Wirsung duct, avery unusual variant of the main pancreatic duct. METHOD: An 80- year-old woman underwent a magnetic resonance imaging (MRI) of the abdomen and a magnetic resonance cholangiopancreatography (MRCP) to characterize a hypoechoic lesion of the pancreas detected with ultrasonography. RESULTS: MRI and MRCP showed a 24-mm multicystic lesion communicating with a prominent main pancreatic duct, consistent with an intraductal papillary mucinous neoplasm, as well as an ansa pancreatica. Moreover a bifidity of the distal pancreatic duct and a further accessory duct of the body of the pancreas draining into the main pancreatic duct were identified. The pancreatic tail presented normal size and morphology on axial imaging. This anomaly, not reported yet in the literature, can be categorized as a number of a duplication anomaly, in which the main pancreatic duct is trifurcated along its length. CONCLUSION: Congenital anomalies of the pancreas and pancreatic duct are rare but not uncommonly detected on diagnostic imaging. MRI and MRCP are the non-invasive imaging modalities of choice for diagnosing congenital anomalies of the pancreas and the pancreatic duct.

Impact of body mass index in liver transplantation for nonalcoholic fatty liver disease and alcoholic liver disease.

BACKGROUND: This study evaluates long-term outcomes and body mass index (BMI) following liver transplantation (LT) for non-alcoholic fatty liver disease (NAFLD) in comparison with alcoholic liver disease (ALD). METHODS: Patient and graft survival were compared using Kaplan Meier curves and log rank test. Multivariable analysis of recipient and donor characteristics was performed as determinants of patient survival. BMI at listing was compared with BMI post-LT. RESULTS: Patient survival at 1-, 3-, 5- and 10 years post-LT was similar in the ALD group (n = 195) compared with the NAFLD group (n = 84) (93% vs. 93%, 91% vs. 89%, 86% vs. 77%, 64% vs. 66% respectively, p = 0.21). One patient in the NAFLD group was re-transplanted and none in the ALD group therefore graft survival was also similar (p = 0.20). Multivariable analysis didn't identify any significant predictors of reduced survival. In comparison with the ALD group, BMI was significantly higher in the NAFLD group at listing (31 vs. 27, p < 0.001), 3-months post-LT (28 vs. 26, p < 0.05) and 6-months post-LT (29 vs. 27, p < 0.05) but was equivalent by 5-years post-LT (29 vs. 30, p = 0.80). CONCLUSIONS: NAFLD patients had similar patient and graft survival post-LT compared to ALD. NAFLD patients returned to listing BMI by one-year post-LT but by 5-years post-LT there was no difference in BMI between the groups.

Scoring System to Predict Pancreatic Fistula After Pancreaticoduodenectomy: A UK Multicenter Study.

OBJECTIVE: To validate a preoperative predictive score of postoperative pancreatic fistula (POPF). Other risk factors for POPF were sought in an attempt to improve the score. BACKGROUND: POPF is the major contributor to morbidity after pancreaticoduodenectomy (PD). A preoperative score [using body mass index (BMI) and pancreatic duct width] to predict POPF was tested upon a multicenter patient cohort to assess its performance. METHODS: Patients undergoing PD at 8 UK centers were identified. The association between the score and other pre-, intra-, and postoperative variables with POPF was assessed. RESULTS: A total of 630 patients underwent PD with 141 occurrences of POPF (22.4%). BMI, perirenal fat thickness, pancreatic duct width on computed tomography and at operation, bilirubin, pancreatojejunostomy technique, underlying pathology, T stage, N stage, R status, and gland firmness were all significantly associated with POPF. The score predicted POPF (P < 0.001) with a higher predictive score associated with increasing severity of POPF (P < 0.001). Stepwise multivariate analysis of pre-, intra-, and postoperative variables demonstrated that only the score was consistently associated with POPF. A table correlating the risk score to actual risk of POPF was created. CONCLUSIONS: The predictive score performed well and could not be improved. This provides opportunities for individualizing patient consent and selection, and treatment and research applications.