No abstract

In order to describe the CT findings in pancreatic injury and to evaluate the sensitivity of this technique, we performed a retrospective study. During a 5-year period (1993-1997), eight patients (five males and three females: age range 10-47 years) were investigated with CT. Endoscopicretrograde cholangiopancreatography (ERCP) was obtained in two patients, pre- and intra-operatively, respectively. Among the standard laboratory tests obtained at admission, the value of serum amylase was reviewed. The imaging findings, especially those obtained with CT, were correlated with the surgical findings, when available (in seven of eight patients). At admission, diagnosis of pancreatic injury was missed at CT in three of eight patients (37.5%); thus, the sensitivity of CT for pancreatic injury was 62.5%. ERCP showed rupture of the pancreatic duct in the two cases in which it was performed. Serum amylase was elevated at admission in four of eight patients, resulting in a sensitivity of 50%. After surgery, an enterocutaneous fistula developed in one case, and was managed conservatively. One patient died from brain injury. Proper implementation of the CT technique and accurate film reading is mandatory to establish the diagnosis of pancreatic contusion. No correlation between CT features and type of outcome of surgical management could be established. On retrospective review of the CT examinations, it appeared that two of the three false-negative results could have been avoided. Therefore, proper CT technique and accurate film reading are mandatory in establishing the diagnosis of pancreatic injury.

The aim of this study was to describe catheterization techniques and report the results of percutaneous drainage of external pancreatic fistulas. Twenty patients with external pancreatic fistulas in whom medical therapy had failed, were referred for radiologically guided treatment. Fifteen patients had postoperative and five primary fistulas. Sixteen were high-output fistulas (H-OF) and four were low-output fistulas (L-OF). All patients were treated percutaneously. Percutaneous catheter drainage was successful in 16 of 20 patients (80 %). The fistula healed in 13 of 15 postoperative cases (86.6 %) and in three of five primary fistulas (60 %). Treatment was successful in 14 of 16 patients (87.5 %) with H-OF and in two of four patients with L-OF. Percutaneous catheterization of the pancreatic ducts was successful in eight of 20 patients (40 %); seven of these patients were cured. Catheterization was not achieved in 12 patients and treatment failed in three (25 %). Conservative treatment of external pancreatic fistulas with percutaneous catheter-directed drainage is thus a reasonable alternative to surgery, particularly in patients with H-OF.

Chronic nonischemic disturbance of mesenteric venous blood flow is reported in 11 patients with a mean age of 19 years. This entity, rarely discussed in the literature, is different from acute thrombosis and chronic thrombotic forms with portal hypertension or hypercoagulopathy. In eight patients this syndrome was secondary to organic lesions of different origin: mesenteric vein squeezed by fibrous bands or an abnormal jejunal artery (four cases), lymphoma involving the distal superior mesenteric veins (three cases), hemangioma causing microthrombi (one case). In three patients no etiology or predisposing factor was found. All patients presented with rectal hemorrhage. Small bowel enema showed a constant pattern in 11 patients: small nodules, modified by compression or peristalsis, involving the mesenteric border of the jejunoileal segment, and associated with thick, straight but regular folds. Mesenteric varices were suspected and led to angiographic studies which were normal in three cases, confirmed varices in eight cases, and thrombosis in four cases. Laparotomy was normal in three cases and established the etiological diagnosis in eight cases. Varices were shown in six cases. Arteriography and laparotomy were unable to reach a complete diagnosis.

No abstract