Hemoperitoneum in segmental portal hypertension caused by pancreatic pseudocyst

A case of haemoperitoneum during segmentary portal hypertension due to pancreatic pseudocyst is reported. After a short general review, certain physiopathological and therapeutic aspects of particular practical interest are presented.     

Traumatic pancreatic fistula with sinistral portal hypertension: Surgical management

Combined ductal and vascular injuries are awesome complications of pancreatic injury. We report on a 29-year-old male unrestrained driver who sustained a blunt abdominal injury from the steering wheel in a high velocity head-on car collision. He developed a pancreatic fistula, portosplenic venous thrombosis and sinistral portal hypertension as a result of complete duct disruption at the pancreatic neck. We describe a safe surgical strategy of spleen-preserving distal pancreatectomy after failed medical and endoscopic management.     

Pseudocystectomy: An unusual operation for an atypical pancreatic pseudocyst

Pancreatic pseudocyst is an amylase‐rich peri‐pancreatic fluid collection devoid of epithelial lining. Occasionally, it cannot be differentiated from cystic neoplasm of pancreas and resections are required. We report a case of pancreatic pseudocyst masquerading cystic neoplasm treated with distal pancreatectomy. The investigation strategy and management of cystic lesions of the pancreas are also discussed.     

Bilharzial portal fibrosis: an important cause of portal hypertension

Thirty consecutive cases of portal hypertension seen in a surgical unit in Lusaka, Zambia, are reported. Of these cases 70% were due to portal fibrosis caused by Schistosoma mansoni infestation. Portacaval shunting was undertaken in most cases. Patients with portal fibrosis responded more favourably to portal decompression than did patients with cirrhosis. It is probable that the condition is more common than is generally reconigzed in areas where S. mansoni infestation is endemic.     

Case report of a pancreatic pseudocyst ruptured into the splenic vein causing extrahepatic portal hypertension

In a 42 year old female, a fistula developed between the splenic vein and the pancreatic duct through the cavity of a pseudocyst in the tail of the pancreas and resulted in an extrahepatic portal hypertension. The fistula was visualized by endoscopic retrograde cholangiopancreatography and percutaneous transhepatic portography, then was successfully resected by surgery. The possible etiology of extended obstruction of both splenic and portal veins in chronic pancreatitis with pseudocyst was discussed.     

Phaeochromocytoma: an unusual cause of hypertension in pregnancy

A primiparous, full-term, 28-year-old woman underwent an emergency lower segment Caesarean section under epidural anaesthesia for failure to progress in the first stage. Despite an uneventful pregnancy and delivery, she developed a hypertensive crisis in the postoperative period complicated by acute pulmonary oedema requiring ventilation for 48 h in the intensive care unit. Intravenous magnesium sulphate infusions and hydralazine boluses were used to control the blood pressure, which was associated with clonus, hyperreflexia, tachycardia and profuse sweating. The patient made a good recovery. Later measurement of urinary catecholamines in the recovery phase showed greatly elevated levels of norepinephrine, dopamine and vanillyl mandelic acid. Further investigations included a normal abdominal computed tomography scan and a I-123 meta-iodo-benzyl-guanidine scintigraphy scan which revealed a 3- to 4-cm irregular tumour located at the level of the lower pole of the right kidney and further liver hot spots. Intravenous magnesium sulphate infusion proved successful in controlling hypertension caused by a phaeochromocytoma in the postpartum period.     

A massive left paraduodenal fossa hernia as an unusual cause of small bowel obstruction

We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia, containing over 30% of the small bowel, presenting with a history of recurrent incomplete small bowel obstruction.     

Conservative treatment as an option in the management of pancreatic pseudocyst

BACKGROUND: Management of pancreatic pseudocysts is associated with considerable morbidity (15-25%). Traditionally, pancreatic pseudocysts have been drained because of the perceived risks of complications including infection, rupture or haemorrhage. We have adopted a more conservative approach with drainage only for uncontrolled pain or gastric outlet obstruction. This study reports our experience. PATIENTS AND METHODS: A consecutive series of 36 patients with pancreatic pseudocysts were treated over an 11-year period in one district general hospital serving a population of 310,000. This study group comprised of 19 men and 17 women with a median age of 55 years (range, 10-88 years). Twenty-two patients had a preceding attack of acute pancreatitis whilst 12 patients had clinical and radiological evidence of chronic pancreatitis. The aetiology comprised of gallstones (16), alcohol (5), trauma (2), tumour (2), hyperlipidaemia (1) and idiopathic (10). RESULTS: All patients were initially managed conservatively and intervention, either by radiological-assisted external drainage or cyst-enteric drainage (by surgery or endoscopy), was only performed for persisting symptoms or complications. Patients treated conservatively had 6 monthly follow-up abdominal ultrasound scans (USS) for 1 year. Fourteen of the 36 patients (39%) were successfully managed conservatively, whilst 22 patients required intervention either by percutaneous radiological drainage (12), by endoscopic cystogastrostomy (1) or by open surgical cyst-enteric anastomosis (9). Median size of the pancreatic pseudocysts in the 14 patients managed conservatively (7 cm) was nearly similar to that of the 22 patients requiring intervention (8 cm). The most common indications for invasive intervention in the 22 patients were persistent pain (16), gastric outlet obstruction (4), jaundice (1) and dyspepsia with weight loss (1). Although one patient required surgery for persistent pain, no other patients required urgent or scheduled surgery for complications of untreated pancreatic pseudocysts. Two of the 12 patients treated by percutaneous radiological drainage had recurrence of pancreatic pseudocysts requiring surgery. Two patients developed an intra-abdominal abscess following cyst-enteric drainage of pancreatic pseudocysts and one patient had a pulmonary embolism. On the mean follow-up of 37.3 months, one patient with alcoholic pancreatitis died 5 months after surgical cyst-enteric bypass. CONCLUSIONS: These results suggest that many patients with pancreatic pseudocysts can be managed conservatively if presenting symptoms can be controlled.     

Traumatic rupture of median artery an unusual cause for acute median nerve compression

Previous case reports of haemorrhage into the carpal tunnel causing median nerve compression were extraneural and usually associated with a blood dyscrasia although Watson Jones reported one due to direct trauma and Hayden recorded spontaneous intraneural haemorrhage not associated with trauma. We describe a case of intraneural haemorrhage, involving the median nerve in the carpal tunnel, due to indirect trauma and not associated with a blood dyscrasia. The condition required intraneural decompression to obtain relief.     

胰源性门脉高压症的研究进展

胰源性门脉高压症是以上消化道出血为主要表现的临床比较少见的疾病。引起胰源性门脉高压症的原因很多，主要是急、慢性胰腺炎，胰腺假性囊肿，胰腺肿瘤，造成脾静脉回流受阻，使左侧门静脉压力升高，胃底静脉曲张。治疗上主要针对病因处理，脾切除和原发胰腺疾病的处理（包括胰体尾切除）是治愈本病的关键。     

Sympathetic paraganglioma as an unusual cause of Horner's syndrome

BACKGROUND: Paragangliomas are rare tumors arising from paraganglionic tissue of neural crest origin. They are present in any location where autonomic ganglia are found. The most common location in the head and neck is the carotid body, followed by the jugular bulb and vagus nerve. METHODS: A 30-year-old woman with a slowly growing left neck mass, aniscoria, and left eyelid ptosis was found to have a vascular tumor consistent with a paraganglioma arising near the left carotid bifurcation. After preoperative embolization, the patient underwent resection of the tumor. RESULTS: The tumor was found to be arising from the left sympathetic trunk and did not involve any other surrounding structures. Histopathologic analysis revealed the typical findings of a paraganglioma. CONCLUSIONS: Sympathetic paragangliomas are exceedingly rare tumors in the head and neck and should be considered in the differential diagnosis when clinical and radiographic evidence suggest a paraganglioma. The presentation is typically a slow-growing neck mass with the presence of an ipsilateral Horner's syndrome.     

Osteochondroma as an unusual cause of metatarsus primus varus

A solitary osteochondroma of the metatarsale II of an adolescent is presented which led to a painful Metatarsus primus varus. After resection of the tumor the patient was free of symptoms, the postoperative resulting form of the foot was normal. One should be aware of a tumor as a possible cause of foot deformities.