[Autoimmune hepatitis with elevation of CA 19-9 and normalization with immunosuppressant [corrected]treatment: case report and review of the literature]. / Hepatitis autoinmune con elevacion de CA 19-9 y normalización con tratamiento inmunosupresor: reporte de caso y revisión de la literatura.

We describe the case of an 81 year old woman that presented with jaundice, bile duct dilation, hepatic liver tests abnormalities and elevated levels of CA-19-9 (741 UI). Intestinal and pancreatic neoplasia were ruled out. Hepatic biopsy revealed chronic inflammation, cirrhosis and findings consistent with autoimmune hepatitis. The patient was given a course of corticoids and the disease as well as levels of CA-19-9 returned to normal levels.

Hepatitis Autoinmune con elevacion de CA 19-9 y Normalización con tratamiento inmunosupresor: Reporte de Caso y Revisión de La Literatura / Autoimmune hepatitis with elevation of CA 19-9 and Normalization with immunosuppressive treatment: Case Report and Review of Literature

Describimos el caso de una mujer de 82 anos que se presento con ictericia, dilatación de colédoco, alteración de la bioquímica hepática y niveles elevados de CA-19.9 (741 UI). Se descartaron neoplasias pancreáticas e intestinales. La biopsia hepática mostróinflamación crónica, cirrosis y hallazgos consistentes con hepatitis autoinmune. La paciente recibió tratamiento con corticoides y tanto la enfermedad como los niveles de CA -19-9 regresaron a niveles normales.

We describe the case of an 81 year old woman that presented with jaundice, bile ductdilation, hepatic liver tests abnormalities and elevated levels of CA-19-9 (741 UI). Intestinaland pancreatic neoplasia were ruled out. Hepatic biopsy revealed chronic inflammation,cirrhosis and findings consistent with autoimmune hepatitis. The patient was given a courseof corticoids and the disease as well as levels of CA-19-9 returned to normal levels.

[T-L mucosa to mucosa pancreatojejunal anastomosis for pancreatic reconstruction following a duodenopancreatectomy]. / Anastomosis pancreatoyeyunal termino-lateral mucosa mucosa para la reconstrucción pancreática luego de la duodenopancreatectomía.

INTRODUCTION: The pancreatojejunal anastomosis is considered the weak spot when carrying out a duodenopancreatectomy, because it causes most of the complications following a Whipple surgery. Here we present a series of cases using a single technique for performing this anastomosis. MATERIAL AND METHODS: During the period between October 2002 and August 2005, 49 duodenopancreatectomies were performed at the 3AII Department of the National Hospital Edgardo Rebagliati Martins - H.N.E.R.M., in 31 of these cases a lateral mucosa to mucosa pancreatojejunal anastomosis was carried out by the same surgeon. RESULTS: The most frequent complication was infection of the operating wound followed by pancreatic fistula and intra-abdominal hemorrhage and the overall morbidity was 29%. Pancreatic fistula developed in 13% of the cases; however, no patient required additional treatment and the fistula closed maximum twenty days after the surgery. On average, patients resumed oral food intake after 6 days and remained hospitalized for 16 days. Mortality was 3%, because a patient developed a pseudo-aneurism of the hepatic artery, which ruptured 17 days after the operation. CONCLUSIONS: The mucosa to mucosa pancreatojejunal anastomosis is a safe technique with a low index of pancreatic fistula and mortality.

Anastomosis pancreatoyeyunal termino-lateral mucosa mucosa para la reconstrucción pancreática luego de la duodenopancreatectomía / Pancreatoyeyunal anastomosis finish-lateral mucous mucous for the pancreatic reconstruction after duodenopancreatectomic

Introducción: La anastomosis pancreatoyeyunal es considerada como el punto débil al realizar una duodenopancreatectomia, siendo responsable de la mayoría de las complicaciones luego de realizar una cirugía de Whipple. Aquí presentamos una serie de casos con una misma técnica quirúrgica para efectuar esta anastomosis. Material y método: Durante el periodo comprendido entre Octubre del 2002 a Agosto del 2005 se realizaron 49 duodenopacreatectomías en el servicio 3AII del H.N.E.RM. de las cuales a 31 se les realizó una anastomosis pancreato yeyunal término lateral con técnica mucosa mucosa, por el mismo cirujano. Resultados: La complicación más frecuente fue la infección de la herida operatoria, seguida de la fístula pancreática y la hemorragia intra abdominal, teniendo una morbilidad global de 29 por ciento, La fístula pancreática se presentó en 13 por ciento de los casos no requiriendo tratamiento complementario en ningún paciente, cerrando espontáneamente como máximo a los 20 días del acto quirúrgico. El reinicio de la vía oral fue a los 6 días en promedio y la estancia hospitalaria post-operatoria fue de 16 días. La mortalidad fue de 3 por ciento la cual se presentó en un paciente que desarrollo un pseudoaneurisma de la arteria hepática que se rompió a los 17 días de operado. Conclusiones: La anastomosis pancreatoyeyunal mucosa mucosa es una técnica segura con bajo índice de fístula pancreática y de mortalidad.

Introduction: The pancreatojejunal anastomosis is considered the weak spotwhen carrying out a duodenopancreatectomy, because it causes most of the complicationsfollowing a Whipple surgery. Here we present a series of cases using asingle technique for performing this anastomosis. MATERIAL AND METHODS.- During the period between October 2002 and August 2005, 49 duodenopancreatectomies were performed at the 3AII Department of theÑational Hospital Edgardo Rebagliati Martins - H.N.E.R.M.,in 31 of these cases a lateral mucosa to mucosa pancreatojejunal anastomosis was carried out by the same surgeon.RESULTS.- The most frequent complication was infection of the operating wound followed by pancreatic fistula and intra-abdominal hemorrhage and the overall morbidity was 29 percent. Pancreatic fistula developed in 13 percent of the cases; however, nopatient required additional treatment and the fistula closed maximum twenty days after the surgery. On average, patients resumed oral food intake after 6 days and remained hospitalizedfor 16 days. Mortality was 3 percent, because a patient developed a pseudo-aneurism of the hepatic artery, which ruptured 17 days after the operation.CONCLUSIONS.- The mucosa to mucosa pancreatojejunal anastomosis is a safe technique with a low index of pancreatic fistula and mortality.