No abstract

Background Biliary obstruction which is a major complication of pancreas and periampullary tumors could result in cholangitis, coagulopathies, gastrointestinal symptoms, and impaired wound healing. Pancreaticoduodenectomy (PD) is still the standard approach for pancreas resection and imposes high risk of morbidity and mortality to patients. To reduce the high risk of PD and address the biliary obstruction, the use of preoperative biliary stenting was increased. However, available literature doubts its efficiency. Methods A total of 147 patients who underwent PD between September 2012, and February 2022, at three medical centers were identified. Patients were grouped based on biliary stent placement. Non-jaundiced patients with and without preoperative biliary drainage (PBD) were compared. Results The incidence of overall complications (34.2% versus 45.8%) and mortality (17.8% versus 24.3%) did not differ in the PBD group compared to the no PBD group. There was no difference in complications and mortality in non-jaundiced patients with and without PBD. Patients with drainage duration of > 30 days experienced more overall complications compared to patients with less than 30 days drainage duration (12 (50.0%) and three (15.8%) patients, respectively, p-value = 0.019). Conclusions PBD does not significantly increase the post-operative burden on patients who undergo PD. However, we cannot overlook the financial burden that PBD places on the patient and the healthcare system, as well as the difficulties related to endoscopic retrograde cholangiopancreatography (ERCP). Therefore, biliary stenting should not be routinely practiced in the absence of a valid indication, such as severe jaundice, pruritus, cholangitis, delayed surgery for neoadjuvant treatment, or referral to a tertiary facility.

Introduction: The autonomic nervous system, a derivative of neural crest cells, may undergo the neoplastic transformation and give rise to paragangliomas, which can arise either at intra-adrenal or extra-adrenal sites, commonly referred to as pheochromocytomas and paragangliomas, respectively. Although indistinguishable at the cellular level and usually identical in clinical manifestation, these two tumors differ in means of malignancy risk, genetic testing, and the probability of detecting an associated neoplasm, highlighting the importance of making a correct diagnosis to prevent additional complications. Case Presentation: We report a 17-year-old female patient presented with sudden blurred vision and palpitation lasting for 1 week. The physical examination revealed tachycardia, hypertension, and a mildly tender mass on the left side of the umbilicus. A spiral abdominal and pelvic computed tomography (CT) scan was performed, which depicted a hypervascular retroperitoneal mass in the left infrarenal region. Mildly-elevated urine metanephrine and normetanephrine levels were suggestive of a paraganglioma (PGL). Iodine-131 metaiodobenzylguanidine (MIBG) scan was also in favor of PGL of the organ of Zuckerkandl. The mass was completely resected and the immunohistochemistry (IHC) study of the specimen confirmed the diagnosis. Conclusions: The diversity of manifestations and rarity of PGL can delay the diagnosis, which may lead to potential complications. This makes it compelling to include PGLs in differential diagnoses in a clinical setting compatible with catecholamine hypersecretion.

Background: pancreaticoduodenectomy is associated with higher morbidity and mortality rates. The leak of activated pancreatic enzymes can cause several complications which could be life threatening. One of the suggested methods, which can prevent complications, is double Roux anastomosis technique. Objectives: The aim of this study was to evaluate the outcomes and complications of double Roux anastomosis method. Methods: In this prospective study, patients who underwent pancreaticoduodenectomy with double Roux anastomosis were evaluated from 2013 to 2017. The outcomes and complications such as mortality rate, pancreatic leak or fistula, bile leakage, and abscess formation were evaluated. Results: A total of 12 patients were evaluated. The mean age was 53.08 ± 13.43 (19-70). Seven of them were male and five were female. Indications of surgery in the patients were periampullary cancer (6 patients), pancreatic head cancer (4 patients), distal cholangiocarcinoma (1 patient) and duodenal trauma (1 patient). There was no mortality, no pancreatic leak or fistula, no hemorrhage, and no abscess in any of the patient. There was one case of the biliary leakage, which was managed expectantly. Conclusions: The results of this study showed that use of separate double Roux, one for the pancreas and the other one for the stomach and bile duct reduces complications and mortality. Although this method requires more anastomosis and the operating time is prolonged, but ultimate outcome of the patient has great effects.