RESUMO
OBJECTIVES: Suprapancreatic biliary stricture associated with blunt abdominal trauma is extremely rare. Therefore, no definitive treatment modality for this stricture has been fully established. This study was designed to evaluate the efficacy and long-term follow-up of endoscopic treatment for suprapancreatic biliary stricture following blunt abdominal trauma. METHODS: Data from the institution's prospectively collected endoscopic retrograde cholangiopancreatography (ERCP) database, medical records, radiological findings, and trauma registry with operative records were used to identify patients with suprapancreatic biliary stricture associated with blunt abdominal trauma. RESULTS: Eight patients (six men and two women) with a median age of 36 yr (interquartile range [IQR] 29-53 yr) were included in this study. The median interval between the initial trauma and the onset of symptoms was 23 days (IQR 16-51 days). The median length of biliary stricture was 1 cm (IQR 0.6-1 cm). Endoscopic plastic stent placement was successfully performed in all patients included in the study. The median duration of stent placement was 2 months (IQR 2-2.8 months). Follow-up ERCP showed improved or resolved biliary stricture in all patients. There was no recurrence of symptoms after the removal of the stents; therefore, surgery was unnecessary in these patients. Long-term follow-up (median 33 months) was also excellent. CONCLUSIONS: Endoscopic plastic stent placement may be a good candidate for first-line management for suprapancreatic biliary strictures following blunt abdominal trauma. Furthermore, the long-term results for this type of biliary stricture with endoscopic stent placement may be excellent.
Assuntos
Traumatismos Abdominais/complicações , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestase Extra-Hepática/cirurgia , Ductos Pancreáticos/cirurgia , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Adulto , Colestase Extra-Hepática/diagnóstico , Colestase Extra-Hepática/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Pancreáticos/lesões , Estudos Prospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Índices de Gravidade do Trauma , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgiaRESUMO
Carcinoid tumors derived from neuroendocrine cells can release serotonin and other vasoactive substances into the systemic circulation, resulting in carcinoid syndrome. Testicular carcinoid, a rare disease accounting for less than 1% of all testicular neoplasms, rarely manifests symptoms of carcinoid syndrome. We describe a case of carcinoid syndrome arising from a primary testicular carcinoid tumor. A 21-year-old male patient presented with facial flushing and diarrhea for 5 years. He had an enlarged left testis and a 1-cm, ill-defined, hard, non-tender mass in his right testis. His 24 h urinary excretion of 5-hydroxyindoleacetic acid was elevated (16.1 mg/day). Somatostatin receptor scintigraphy correlated with carcinoid tumor in both testes. Following bilateral orchiectomy, the patient's facial flushing and diarrhea disappeared.