Introduction During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. Methods From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34–82), 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57–70) underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. Results All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5). The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14–23). Conclusion Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy) are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery.

Introduction:Bleeding from isolated gastric varices, though uncommon, may be life threatening and may occur as a consequence of splenic vein thrombosis by tumoral compression and subsequent left-sided portal hypertension.Case overview:We report the case of a 37-year old woman, previously diagnosed with a benign pancreatic cyst, who presented with severe gastric variceal bleeding.Diagnosis, therapeutics interventions, and outcomes:Abdominal ultrasound (US) and computed-tomography (CT) revealed enlargement and changed morphology of the cystic tumor located on the body of the pancreas. Left-sided portal hypertension was disclosed resulting from splenic vein occlusion. Salvage left spleno-pancreatectomy with lymphadenectomy was undertaken with an excellent postoperative outcome. Histological analysis established the diagnosis of mucinous cystic neoplasm with foci of adenocarcinoma.Conclusion:Surgical treatment proved to be the election one, leading to a steady hemostasis, removal of the lesion, positive diagnosis, and resolution of the varices. Imaging follow-up of pancreatic cyst should also assess vascular patency to identify the patient at risk for gastric bleeding and to select patients who benefits from surgical resection.

Silicone implants are frequently used for breast augmentation and reconstruction. However, late complication, such as capsular contracture, remain the most important side effect. In this study we compare different methods for reducing the inflammatory reaction around the silicone implant by introducing one microtextured breast implant in wistar rats. The rats were dividing in 4 groups: the first one was the control group that received untreated implant; in the second we used silicone implants impregnated with rifampin solution, the third one had implant combined with intramuscular dexamethasone injection and the last one had silicone implant associated with autologous centrifuged fat introduced in the implant pocket. The implants and the capsular tissue surrounding were removed after eight weeks. Capsule samples were submitted to histological evaluations. The present study demonstrated that fat grafting may have a role in reducing and preventing capsular contractures after breast augmentation with silicone implants by decreasing the inflammatory process.

RezumatHematomul grefei este o complicaţie cu risc vital în transplantul hepatic şi nu există în literatură concluzii clare în privinţa tratamentului acestuia, cu excepţia celor din rarele prezentări de caz publicate. Hematomul grefei poate fi intrahepatic sau subcapsular, şi se poate dezvolta spontan sau ca urmare a unor injurii hepatice ori a unor manevre invazive transhepatice percutane. Prezentăm cazul unui pacient de 62 de ani care a beneficiat de un transplant hepatic ortotopic cu ficat întreg pentru hepatopatie cronică decompensată datorită unei ciroze etanolice. Procedura chirurgicală s-a desfăşurat fără evenimente. Ecografia Doppler de rutină şi examenul CT au depistat, la 7 zile posttransplant,un hematom extrahepatic paracav, care a fost tratat conservator şi a fost stabil timp de 11 zile. În ziua a 18-a, la aproximativ 6 ore după un episod de diaree acută, pacientul a prezentat o scădere a hemoglobinei serice până la 6,6 mg/dl, iar examenele imagistice au evidenţiat un hematom intrahepatic voluminos ocupând hemificatul drept, câteva alte hematoame extrahepatice, revărsat pleural în cantitate semnificativă şi ascită hemoragică. Pacientul a fost tratat conservator cu succes, cu revenirea lentă a funcţiei hepatice şi externat o lună mai târziu în stare generală bună.