RESUMO
Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant disease characterized by a low incidence, a high risk of malignant transformation, and an uncertain prognosis. We hereby present the case of an 8-mm IPNB in the left liver lobe detected by endosonography in a 76-year-old woman followed for a dissociated asymptomatic cholestasis who was treated with a left hepatectomy. The resected IPNB had low-grade dysplasia and no nodal involvement in the surgical piece; however, signs of recurrence of the disease were observed in the right liver lobe a year and a half later. Therefore, given that it can be multifocal and recurrent, IPNB is a disease that requires close follow-up.
Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Carcinoma Papilar/cirurgia , Recidiva Local de Neoplasia/cirurgia , Idoso , Feminino , HumanosRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Cisto Epidérmico/diagnóstico , Cisto Epidérmico/patologia , Adenocarcinoma/diagnóstico , Apendicite/cirurgia , Síndrome de Gardner/diagnóstico , Pólipos/diagnóstico , Colonoscopia , Apendicite/radioterapia , Metastasectomia/métodos , Fluoruracila/administração & dosagem , Diagnóstico Diferencial , Núcleo Celular/patologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Baço/anormalidades , Anormalidades do Sistema Digestório/diagnóstico por imagem , Coristoma/diagnóstico por imagem , Baço/diagnóstico por imagem , Endossonografia/métodos , Neoplasias da Próstata/complicaçõesRESUMO
Accessory spleen is a frequent congenital abnormality (10-20%) resulting in the fusion failure of splenunculi. We present a case report of a 74 year-old man with a nodule identified in the tail of the pancreas of 1.8 cm x 1.5 cm in size. The CT scan showed soft tissue attenuation and arterial hyperenhancement with a lower uptake in the central area, low 18-FDG affinity and no evidence of 111-In-octretide uptake. A solid, round and well-circumscribed nodule was defined as an intrapancreatic accessory spleen (IPAS) by endoscopic ultrasound (EUS), due to shared ultrasonographic characteristics and a pattern of contrast enhancement with the spleen. The material obtained by EUS guided puncture was consistent with a lymph node. A distal pancreatectomy confirmed the presence of an IPAS.
Assuntos
Coristoma/diagnóstico por imagem , Pancreatopatias/diagnóstico por imagem , Baço/anormalidades , Idoso , Humanos , Masculino , Baço/diagnóstico por imagem , UltrassonografiaAssuntos
Cisto Epidérmico/patologia , Síndromes Neoplásicas Hereditárias/diagnóstico , Dermatopatias/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Apendicectomia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/genética , Neoplasias do Apêndice/terapia , Doenças Assintomáticas , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/genética , Tumor Carcinoide/terapia , Quimioterapia Adjuvante , Terapia Combinada , Diagnóstico Diferencial , Endoscopia do Sistema Digestório , Cisto Epidérmico/genética , Cisto Epidérmico/cirurgia , Fluoruracila/administração & dosagem , Síndrome de Gardner/diagnóstico , Síndrome de Gardner/genética , Cabeça , Hepatectomia , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Masculino , Terapia Neoadjuvante , Síndromes Neoplásicas Hereditárias/patologia , Oxaliplatina/administração & dosagem , Neoplasias Retais/diagnóstico , Neoplasias Retais/genética , Neoplasias Retais/cirurgia , Dermatopatias/genética , Dermatopatias/cirurgiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Perfuração Intestinal , Intestinos/lesões , Doença Celíaca , Linfoma Difuso de Grandes Células B/complicações , Neoplasias Intestinais , Intestinos/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodosAssuntos
Abscesso/diagnóstico , Abscesso/patologia , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/patologia , Salmonella/isolamento & purificação , Esplenopatias/diagnóstico , Esplenopatias/patologia , Abscesso/terapia , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Endoscopia do Sistema Digestório , Humanos , Masculino , Radiografia Abdominal , Infecções por Salmonella/terapia , Esplenectomia , Esplenopatias/terapia , Tomografia Computadorizada por Raios XAssuntos
Doença Celíaca/complicações , Perfuração Intestinal/etiologia , Doenças do Jejuno/etiologia , Linfoma Difuso de Grandes Células B/complicações , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença Celíaca/dietoterapia , Colectomia , Terapia Combinada , Ciclofosfamida/administração & dosagem , Dieta Livre de Glúten , Suscetibilidade a Doenças , Síndrome de Down/complicações , Doxorrubicina/administração & dosagem , Humanos , Perfuração Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias do Jejuno/prevenção & controle , Neoplasias do Jejuno/cirurgia , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/prevenção & controle , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prednisona/administração & dosagem , Rituximab/administração & dosagem , Tomografia Computadorizada por Raios X , Vincristina/administração & dosagemRESUMO
A 60-year-old male was operated upon in 2002 for liver hydatidosis, which included partial right hepatectomy with cholecystectomy and bilioduodenal anastomosis. He then developed liver cirrhosis secondary to left hepatic duct stricture. He presents at the emergency room with dry cough, which he had for a month and then became associated with yellowish, bitter-tasting "fluid" expectoration. A chest-abdominal CT scan revealed a 6 x 5-cm collection roughly located somewhere between the middle pulmonary lobe and subphrenic area . A fistula was suspected, which prompted a sputum biochemistry test that was positive for bilirubin. Given the patient's impaired liver function because of his liver disease conservative treatment was initiated with an inner-outer drain under transparietal hepatic cholangiography (TPHC) to promote bile outflow via the duodenum. Subsequently, TPHC was used to locate the point where contrast leaked from the biliary tree into a pleural cavity, and the fistula was sealed using cyanoacrylate glue, which resulted in improved symptomatology.
Assuntos
Fístula Biliar/diagnóstico por imagem , Fístula Brônquica/diagnóstico por imagem , Adesivos , Fístula Biliar/terapia , Fístula Brônquica/terapia , Cianoacrilatos , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Fístula Biliar/cirurgia , Fístula Biliar , Fístula Brônquica/terapia , Fístula Brônquica , Cirrose Hepática/complicações , Cirrose Hepática , Colangiografia , Sucção , Stents Metálicos Autoexpansíveis/tendências , Stents Metálicos AutoexpansíveisRESUMO
Isolated polycystic liver disease (IPLD) is a rare genetic condition characterized by the presence of multiple liver cysts with no association with polycystic kidney disease. Most patients are asymptomatic and acute complications (cyst torsion, bleeding, infection) are uncommon.Imaging techniques, including abdominal ultrasounds, computerized axial tomography, and magnetic resonance imaging, represent a vital diagnostic modality. They are also useful for therapy support in this disease. Below we report a peculiar case of a female patient recentlydiagnosed with IPLD who, having received treatment with ultrasoundguided percutaneous drainage and sclerotherapy for a giant liver cyst, showed symptom and laboratory improvement.
Assuntos
Cistos/diagnóstico por imagem , Cistos/terapia , Drenagem/métodos , Hepatopatias/diagnóstico por imagem , Hepatopatias/terapia , Escleroterapia/métodos , Cistos/genética , Feminino , Humanos , Hepatopatias/genética , Pessoa de Meia-Idade , Ultrassonografia de IntervençãoRESUMO
La enfermedad hepática poliquística aislada (EHPA), es una rara entidad genética que se caracteriza por la presencia de múltiples quistes hepáticos, sin estar asociada a la poliquistosis renal. La mayoría de los pacientes son asintomáticos, y son infrecuentes las complicaciones agudas (torsión quística, hemorragia e infecciones). Las técnicas de imagen, como la ecografía abdominal, tomografía axial computarizada y resonancia magnética, son un método diagnóstico fundamental. Además, son útiles como apoyo terapéutico en esta enfermedad. A continuación les presentamos un caso clínico peculiar de una paciente recientemente diagnosticada de enfermedad hepática poliquística aislada, quien tras recibir un tratamiento con drenaje percutáneo de un quiste hepático gigante y escleroterapia guiada por ecografía, presentó mejoría sintomática y analítica
Isolated polycystic liver disease (IPLD) is a rare genetic condition characterized by the presence of multiple liver cysts with no association with polycystic kidney disease. Most patients are asymptomatic and acute complications (cyst torsion, bleeding, infection) are uncommon. Imaging techniques, including abdominal ultrasounds, computerized axial tomography, and magnetic resonance imaging, represent a vital diagnostic modality. They are also useful for therapy support in this disease. Below we report a peculiar case of a female patient recently diagnosed with IPLD who, having received treatment with ultrasound-guided percutaneous drainage and sclerotherapy for a giant liver cyst, showed symptom and laboratory improvement
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cistos/terapia , Drenagem/métodos , Escleroterapia/métodos , Hepatopatias/genética , Transtornos Cromossômicos/terapia , Cirurgia Assistida por Computador/métodos , Rim Policístico Autossômico Dominante/complicaçõesRESUMO
BACKGROUND AND OBJECTIVE: To establish the nasogastric enteral nutrition tolerance in patients with severe acute pancreatitis. PATIENTS AND METHOD: A total of 12 patients with severe acute pancreatitis (> or = 3 Ranson criteria; C-reactive protein > 210 mg/dl) and adverse clinical course were included during 2006. When we verified the disease severity, nasogastric (10 F) enteral nutrition was initiated. We used a low fat semi-elemental feed (Dietgrif) in a slow infusion rate. We evaluated the enteral nutrition tolerance and the adverse events. RESULTS: The patient (4 women and 8 men) mean age (standard deviation) was 70 (11) years and the mean hospital stay was 86 days (range: 14-405 days). The etiology of pancreatitis was: gallstones 8, alcohol abuse one and unknown 3. All patients had medical and/or pancreatic complications. Seven had significant pancreatic necrosis detected in the abdominal computed tomography. Three patients were admitted in the critical care unit and 2 died. The nasogastric enteral nutrition was well tolerated in 8 out of 12 patients (67%) regardless of their medical or pancreatic complications. Only in 3 patients we had initially to discontinue the feeding because of ileus and total parenteral nutrition was provisionally necessary. Enteral nutrition was impossible in one patient because of duodenal stenosis. CONCLUSIONS: Nasogastric enteral nutrition is well tolerated in patients with severe acute pancreatitis and it is an alternative to others nutritional routes.
Assuntos
Atitude Frente a Saúde , Nutrição Enteral/métodos , Intubação Gastrointestinal/métodos , Pancreatite/fisiopatologia , Doença Aguda , Idoso , Feminino , Humanos , Masculino , Pancreatite/diagnóstico , Índice de Gravidade de DoençaRESUMO
Fundamento y objetivo: Valorar la tolerancia a la nutrición por sonda nasogástrica de los pacientes con pancreatitis aguda grave. Pacientes y método: Incluimos a 12 pacientes con pancreatitis aguda grave (3 o más criterios de Ranson; proteína C reactiva > 210 mg/dl) y evolución clínica desfavorable ingresados durante el año 2006. Una vez establecida la gravedad de la pancreatitis, se inició alimentación por sonda nasogástrica (10 F) con dieta polipeptídica pobre en grasas (Dietgrif®) mediante bomba de perfusión continua. Se valoraron la tolerancia a la dieta y las complicaciones. Resultados: La edad media (desviación estándar) de los pacientes (4 mujeres y 8 varones) era de 70 (11) años y la estancia media fue de 86 días (intervalo: 14-405 días). La etiología de la pancreatitis fue biliar en 8 casos, alcohólica en uno y desconocida en 3. Todos los pacientes desarrollaron complicaciones médicas y/o pancreáticas. Siete presentaban necrosis pancreática significativa en la tomografía computarizada. Tres ingresaron en la unidad de cuidados intensivos y 2 fallecieron. Ocho de los 12 pacientes (67%) toleraron perfectamente la dieta por sonda nasogástrica independientemente de sus complicaciones. En 3 hubo que interrumpir inicialmente la dieta por íleo paralítico y precisaron nutrición parenteral total de forma transitoria. Sólo en un caso fue imposible la nutrición enteral debido a estenosis duodenal. Conclusiones: La nutrición por sonda nasogástrica en los pacientes con pancreatitis aguda grave es bien tolerada y podría plantearse como una alternativa a las otras formas de nutrición
Background and objetive: To establish the nasogastric enteral nutrition tolerance in patients with severe acute pancreatitis. Patients and method: A total of 12 patients with severe acute pancreatitis ($ 3 Ranson criteria; C-reactive protein > 210 mg/dl) and adverse clinical course were included during 2006. When we verified the disease severity, nasogastric (10 F) enteral nutrition was initiated. We used a low fat semi-elemental feed (Dietgrif®) in a slow infusion rate. We evaluated the enteral nutrition tolerance and the adverse events. Results: The patient (4 women and 8 men) mean age (standard deviation) was 70 (11) years and the mean hospital stay was 86 days (range: 14-405 days). The etiology of pancreatitis was: gallstones 8, alcohol abuse one and unknown 3. All patients had medical and/or pancreatic complications. Seven had significant pancreatic necrosis detected in the abdominal computed tomography. Three patients were admitted in the critical care unit and 2 died. The nasogastric enteral nutrition was well tolerated in 8 out of 12 patients (67%) regardless of their medical or pancreatic complications. Only in 3 patients we had initially to discontinue the feeding because of ileus and total parenteral nutrition was provisionally necessary. Enteral nutrition was impossible in one patient because of duodenal stenosis. Conclusions: Nasogastric enteral nutrition is well tolerated in patients with severe acute pancreatitis and it is an alternative to others nutritional routes
