In summary, there is an increasing body of literature emerging from multiple centers highlighting the benefits and persistent challenges of TPIAT for chronic pancreatitis and RAP. Ongoing study will be critical to optimizing the success of this procedure.

Ependymoma is a type of glial tumor that arises from the ependymal lining of the ventricular system of the central nervous system. These tumors may present as a rare extraspinal variety at the sacrococcygeal region, and may be misdiagnosed as pilonidal disease in the post-sacral area or present with mass-effect symptoms on the bowel or bladder in the pre-sacral region. This is a case of soft tissue swelling at the post-sacral area that, after clinical examination, was diagnosed as pilonidal disease. Surgical excision and pathologic examination revealed a subcutaneous sacrococcygeal ependymoma.

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Our case represents the missed diagnosis of 4 magnets ingested separately over time. Emergency department providers may benefit from a clinical algorithm guiding the management of these increasingly prevalent patient presentations to prevent delayed diagnoses and to decrease morbidity.

Metabolic outcomes after total pancreatectomy with islet autotransplantation (TPIAT) are influenced by the islet mass transplanted. Preclinical and clinical studies indicate that insulin and C-peptide levels measured after intravenous administration of the beta cell secretagogue arginine can be used to estimate the available islet mass. We sought to determine if preoperative arginine stimulation test (AST) results predicted transplanted islet mass and metabolic outcomes in pediatric patients undergoing TPIAT. We evaluated the association of preoperative C-peptide and insulin responses to AST with islet isolation metrics using linear regression, and with postoperative insulin independence using logistic regression. Twenty-six TPIAT patients underwent preoperative AST from 2015 to 2018. The acute C-peptide response to arginine (ACRarg) was correlated with isolated islet equivalents (IEQ; r = 0.59, P = 0.002) and islet number (IPN; r = 0.48, P = 0.013). The acute insulin response to arginine (AIRarg) was not significantly correlated with IEQ (r = 0.38, P = 0.095) or IPN (r = 0.41, P = 0.071). Neither ACRarg nor AIRarg was associated with insulin use at 6 months postoperatively. Preoperative C-peptide response to arginine correlates with islet mass available for transplant in pediatric TPIAT patients. AST represents an additional tool before autotransplant to provide counseling on likely islet mass and to inform quality improvements of islet isolation techniques. K E Y W O R D Sautotransplantation, clinical decision-making, insulin / C-peptide, islet isolation