Introduction: pancreatic carcinoma is a common gastrointestinal malignancy. Accurate preoperative imaging helps to avoid unnecessary or unsuccessful surgical procedures and reduce the number of aborted pancreatic resections. MDCT is the most widely available and best validated tool for imaging patients with pancreatic adenocarcinoma. Objective: to evaluate the diagnostic value of resectability and local staging of Pancreatic Head Cancer by MDCTA. Materials and methods: This cross-sectional study was conducted on 20 patients referred to the Diagnostic Radiology and Medical Imaging Department at Tanta University Hospitals presenting with pancreatic head cancer. Results: Patients underwent exploratory laparoscopy or laparatomy with progression to a pancreaticoduodenectomy as deemed resectable in 7 (35%) patients, and 6 (30%) of patients underwent exploratory laparoscopy or laparatomy with progression to Gasterojejunostomy, 4 (20%) of patients underwent ERCP for biliary stenting and 3 (15 %) of patients were inoperable. In the studied patients, 15.4% of resectable by MDCTA found to be unresectable at laparoscopy exploratory with true positive was 100%. The MDCTA imaging sensitivity was 100%, specificity was 71%, NPV was 100% and PPV was 87% with accuracy of 90% to assess for resectability.

Background: Post-splenectomy portal venous thrombosis (PS-PVT) carries multiple threats to patients' lives. Different variables were identified as risk factors for PS-PVT in cirrhotic patients. The aim of this study was to prospectively assess the incidence, risk factors, clinical presentation and treatment outcomes of PS-PVT in cirrhotic patients. Patients and methods: Sixty cirrhotic patients of Child class A submitted to open splenectomy were observed, both clinically and by Duplex ultrasound (US) examination, for the development of PS-PVT. Results: Overall, 17 patients (28.3%) developed PS-PVT at a median interval of 4.5 days (21 hours-7 days) post-splenectomy. Univariate analysis showed that lower preoperative platelet count (P<0.0460) and white blood cell (WBC) count (P<0.0001) and wider splenic vein diameter (SVD) (P<0.0001) correlated with PS-PVT. Multivariate analysis identified lower preoperative WBC count [odds ratio (OR): 0.651, 95% confidence interval (CI): 0.245-0.893, P<0.005] and wider SVD (OR: 2.383, 95% CI: 1.558-3.646., P<0.001) as independent risk factors of PS-PVT. While 16 out of the 17 patients (94%) who had these 2 risk factors developed PS-PVT, only 1 out of the 43 patients (2.3%) who didn't have the same risk factors developed thrombosis. All 17 patients had complete resolution of their thrombosis on anticoagulation therapy within 3-6 months without complications or mortality. Conclusion: PVT is a common complication of splenectomy in cirrhotic patients. Patients with low WBC count and wide SVD are highly susceptible to develop this complication mandating close observation from the 1 st PO day and immediate anticoagulation after diagnosis.