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Background Duodenal diverticula affect a large part of the population. It is a congenital abnormality that develops over time. The incidence of duodenal diverticulum is estimated at 22% of the population in autopsies. Only 5% of patients present symptoms, and of those only 1%–2% require surgery.Material and methodsTwo patients are described who underwent surgery due to duodenal diverticulum perforation mimicking acute cholecystitis.ResultsPerforation of the duodenal diverticulum, combined the difficulty of treatment and potential for complications, is a disease with a high mortality rate. It is subtle and difficult to diagnose due to the lack of generalized peritonitis and unspecific symptoms. The rarity and the wide spectrum of the disease, in combination with additional factors to be considered in treating this disease, mean there is no standard treatment. Depending on the patient's general condition, disease advancement, age and pathological findings observable only during surgery, we can choose between conservative treatment and a wide spectrum of surgeries.ConclusionsDuodenal diverticular disease rarely gives any symptoms. However, even after the onset of symptoms, only 1-2% of patients require surgery. Our work is unique because we present two cases, each featuring different approaches - conservative and surgical.
Content available remote Internal Pancreatic Fistulae - Management Review
Content available remote Chronic pancreatitis with Numerous Exacerbations - Surprising Final
The authors presented a case of 62-year old caucasian race male patient that was repeatedly admitted to hospitals, in 3 last years, with exacerbations of the chronic pancreatitis. During two last hospitalisations, according to the ERCP examination and high level of CEA and Ca 19.9 in pancreatic juice, a hypothesis of IPMN was put. Patient underwent a distal pancreatectomy with splenectomy. Postoperative specimen examination revealed dilated Wirsung duct in distal part of the pancreas. Small cysts and multiple papillas in the lumen of MPD were found. Microscopy reveal Intraductal Papillary Mucinous Neoplasm with medium grade dysplasia without cancer.When we confronted the reported case with available literature, we found that IPMN is not a frequent cause of recurrent pancreatitis, but those patiets require separate treatment strategy to other chronic pancreatitis patients.
Content available remote Pancreatogastrostomy After Pancreatoduodenectomy
Pancreatoduodenectomy has almost a hundred years of history. After resection, the pancreatic stump requires an anastomosis with the digestive tract. There is ongoing discussion about the optimal standard of digestive tract reconstruction. Two major groups of pancreatic anastomosis are used: pancreatogastrostomy and pancreatojejunostomy, but after some randomized and several other documented series there is no agreement on the superiority one over another method.The important feature related to pancreatic anastomosis' complication rate is the number of procedures performed each year in a facility.This manuscript summarizes the experience of the Gdansk Surgical Department with pancreatogastrostomy.
In this article we introduce a novel technique of repeated single-port transgastric debritment of walledoff pancreatic necrosis using TriPort ™ Access System. The presented technique seems an appealing and innovative approach to the treatment of walled-off pancreatic necrosis in acute pancreatitis patients. Studies proving feasibility, safety and efficiency are necessary to elucidate real value of the technique
Content available remote The Use of the Laser-Doppler Method in Surgery
When compared with other EU countries, Poland is in the last place in terms of efficacy of rectal cancer treatment. In order to remedy this situation, in 2008 Polish centres were given the opportunity to participate in an international programme for evaluating the treatment efficacy.The aim of the study was to present the results obtained during the first two years of research.Material and methods. The study protocol covered 71 questions concerning demographic data, diagnostics, risk factors, peri- and post-operative complications, histopathology, and treatment plan at discharge. The patient and unit data were kept confidential.Results. From 1 January 2008 to 30 December 2009, there were 709 patients recorded, of which 55.9% were males. At least one risk factor was found in approx. 3/4 of patients, while approx. 1/3 of patients were classified to group 3 and 4 according to ASA. The mean distance of the tumour from the anal margin was 8.5 cm; approx. 70% of patients were in the clinical stages cT3 and cT4; metastases were observed in 18.8%. Transrectal endoscopic ultrasonography (TREUS) was performed in 23.7% of patients, magnetic resonance imaging (MRI) in 2.5% and computed tomography (CT) scan - in 48.1%. In close to half of the patients, anterior or low anterior resection of the rectum was performed, and abdominoperineal resection in 1/4 of the patients. Anastomotic leakage was seen in 3.8% of patients, while 1.8% died during hospitalisation.Conclusions. It should be strived after that all the centres undertaking the treatment of rectal cancer should participate in the quality assurance programme. This should enable the achievement of good therapeutic results in patients with rectal cancer treated in Polish centres.
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