Acute diverticulitis--an unusual cause of liver abcesses in a young man: a case report.

Liver abscess is a rare complication of sigmoid diverticulitis and must be considered within the differential diagnosis. We report a case of a male patient, age 42, admitted to our hospital with chief complaints of a dull pain in upper right abdominal quadrant, fever, weakness, diarrhoea and weight loss of approximately 3 weeks duration. Physical examination on initial work-up revealed tenderness on palpation in upper right abdomen, and left iliac fosa and a 39 degrees C fever. Biochemistry showed marked inflammatory syndrome, leukocitosis, increased level of platelets, altered liver function. Ultrasound examination revealed inhomogeneous liver nodules and the thickening of the sigmoid wall. Further CT scan examination and MRI confirmed the lesions as beeing abscesses and also revealed trombosis of right portal vein. The sigmoid wall lesions proved to be an acute diverticulitis with perisigmoiditis, stenosis and abscess. Patient underwent a surgical treatment of sigmoid resection, but the punction of the abscesses revealed no pus at aspiration, making the surgical excision of the lesions unnecessary. After the surgery, during the antibiotic treatment, the patient developed pseudomembranous colitis treated with specific antibiotics. The evolution under this treatment was positive and the aspect of the liver lesions was improuved.

[Upper digestive hemorrhage appearing after cephalic duodeno-pancreatectomy]. / Hemoragiile digestive superioare postduodenopancreatectomii cefalice.

The frequency of upper gastrointestinal hemorrhage as a postoperative complication of cephalic duodenopancreatectomy remained constant for decades despite the overall decrease in the incidence of mortality occuring after cephalic duodeno-pancreatomy. It is the second most common complication after anastomotic fistulas, but more frequently fatal, especially when the pancreas is anastomosed with the stomach. The case presented here is of a patient of 55 years age, diagnosed in our clinic with vaterian ampuloma for which was performed cephalic duodenopancreatectomy and gastrointestinal and hepatobiliary continuity was restored by performing terminolateral pancreato-gastric anastomosis, termino-lateral hepato-jejunal anatomosis and termino-lateral gastro-jejunal anastomosis on a jejunal loop ascended transmezocolic. Postoperative evolution of the patient was marked by appearance of two episodes of upper gastrointestinal hemorrhage, the first being solved by relaparotomy and the second benefiting from the contribution of an endoscopic intervention. From this case, we analyze risk factors for upper gastrointestinal hemorrhage appearing after cephalic duodeno-pancreatectomy and its therapeutic modalities, starting from the fact that currently there is no consensus among experts on this matter.

[Diagnosis, therapeutic attitude and prognostic factors of the tumors of body and tail of the pancreas--a case presentation and a review of the literature]. / Diagnostic, atitudine terapeutica si prognostic in tumorile pancreatice corporeocaudale--prezentare de caz si recenzia literaturii.

Neoplasms of the body and tail of the pancreas are rarer in comparison to those occurring in the head of the pancreas, representing only 10% of the total number of pancreatic malignancies. They poses even in present one of the greatest therapeutic challenge for the surgeon as their diagnosis and treatment are difficult to be done mainly due to specific anatomic position of the pancreas as well as due to the absence of any specific symptomatology belonging to the tumors of the body and tail of the pancreas having smaller dimensions. Here we are presenting two cases of neoplasms of the body and tail of the pancreas from the archives of 3rd Surgical Clinic, Cluj Napoca, hereby illustrating the experience of this clinic in the domain of high class pancreatic surgery. The two patients, having 55 and 43 years of age respectively, were diagnosed with neoplasm of the body and tail of the pancreas for which they had undergone the procedure of distal pancreatectomy along with the resection of the spleen. Out of those two cases, the first case had an invasive process of the tumor in the region of the superior mesenteric vein for what it was performed a segmental resection of the superior mesenteric vein with a termino-terminal anastomosis of the remaining two proximal and distal ends, while the second case inspite of its large dimension of the tumor (approximately 10 c.m in diameter) did not have any loco-regional invasion or any kind of distal metastasis which rendered it possible for a radical intervention. The aim of this case presentation as well as the reviews of the literatures belonging to this specialised domain is to sustain the idea that pancreatic surgery should be performed in those specialised surgical centres having profound knowledge as well as all the existing information about the diagnostic procedures, therapeutic attitude and prognostic factors of this specific pathology.