Duodenal Transection Research Articles

Gastric conduit reconstruction after esophagectomy.

A high risk of complications still accompanies gastric conduit reconstruction after esophagectomy. In this narrative review, we summarize the technological progress and the problems of gastric conduit reconstruction after esophagectomy. Several types of gastric conduits exist, including the whole stomach and the narrow gastric tube. The clinical outcomes are similar between the two types of conduits. Sufficient blood supply to the conduit is mandatory for a successful esophageal reconstruction. Recently, due to the availability of equipment and its convenience, indocyanine green angiography has been rapidly spreading. When the blood perfusion of the planning anastomotic site is insufficient, several techniques, such as the Kocher maneuver, pedunculated gastric tube with duodenal transection, and additional microvascular anastomosis, exist to decrease the risk of anastomotic failure. There are two different anastomotic sites, cervical and thoracic, and mainly two reconstructive routes, retrosternal and posterior mediastinal routes. Meta-analyses showed no significant difference in outcomes between the anastomotic sites as well as the reconstructive routes. Anastomotic techniques include hand-sewn, circular, and linear stapling. Anastomoses using linear stapling is advantageous in decreasing anastomosis-related complications. Arteriosclerosis and poorly controlled diabetes are the risk factors for anastomotic leakage, while a narrow upper mediastinal space and a damaged stomach predict leakage. Although standardization among the institutional team members is essential to decrease anastomotic complications, surgeons should learn several technical options for predictable or unpredictable intraoperative situations.

Robotic distal gastrectomy using a novel pre-emptive supra-pancreatic approach without duodenal transection in the dissection of D2 lymph nodes for gastric cancer.

Robot-assisted surgery has shown remarkable progress as a minimally invasive procedure for gastric cancer. This study aimed to compare the pre-emptive suprapancreatic approach without duodenal transection and the conventional approach in terms of perioperative feasibility and short-term surgical outcomes. We retrospectively analyzed all patients who underwent robotic distal gastrectomy with D2 lymph node dissection using the da Vinci Xi robotic system between December 2021 and April 2023 and categorized them into two groups for comparison. Patients treated using the pre-emptive suprapancreatic approach (observation group) were compared with those who received the conventional approach (control group). Employing one-to-one propensity score matching, we evaluated the postoperative morbidity and short-term outcomes in these two distinct groups to assess the efficacy and safety of the novel surgical technique. This study enrolled 131 patients: 70 in the observation group and 61 in the control group. After propensity score matching, the operative times were significantly longer in the control group than in the observation group (229.10 ± 33.96 vs. 174.84 ± 18.37, p <0.001). The mean blood loss was lower in the observation group than in the control group (25.20 ± 11.18 vs. 85.00 ± 38.78, p<0.001). Additionally, the observation group exhibited a higher number of retrieved lymph nodes, including suprapyloric, perigastric, and superior pancreatic lymph nodes (28.69 ± 5.48 vs. 19.21 ± 2.89, p <0.001; 4.98 ± 1.27 vs. 4.29 ± 1.21, p = 0.012; 10.52 ± 2.39 vs. 5.50 ± 1.62, p <0.001; 6.26 ± 2.64 vs. 5.00 ± 1.72, p = 0.029). Drain amylase levels in the observation group were significantly lower than those in the control group (30.08 ± 33.74 vs. 69.14 ± 66.81, p <0.001). This study revealed that using the pre-emptive suprapancreatic approach without duodenal transection in the dissection of D2 lymph nodes for gastric cancer is a safe and feasible procedure in terms of surgical outcomes.

Modified SADI-S in non-obese diabetic rats: Description of the surgical technique

BackgroundSingle anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a predominantly malabsorptive technique that has shown excellent results in morbid obese patients. The aim of this study is to establish a rodent model modifying the SADI-S technique by performing a proximal duodenojejunal anastomosis. This model can be useful for the study of glucose metabolism without malabsorption observed after the SADI-S technique. MethodsGoto-Kakizaki rats, a genetic model of non-obese and non-hypertensive type 2 diabetes mellitus, that develop hyperglycemia at an early age was used. Surgery consisted in a sleeve gastrectomy, duodenojejunal anastomosis and duodenal exclusion using three different techniques: duodenal transection (DT), duodenal ligation with hem-o-lock (DLH), and duodenal ligation with suture (DLS). Surgery time, weight loss, morbidity and mortality were recorded. ResultsA total of 16 animals were subjected to surgical intervention and overall mortality was 25 %, with the DT group showing the highest mortality rate (42.9 %). No differences were observed among groups in terms of weight loss. ConclusionThe surgical technique described in this work is feasible and reproducible. Weight loss is comparable regardless of the technique used for duodenal exclusion.

Esophageal replacement with pedunculated gastric conduit interposition and duodenal transection for refractory anastomotic leakage after esophagectomy

BackgroundLeakage of cervical esophagogastric anastomosis is a serious complication of esophagectomy. However, there is no established way to treat the anastomosis leakage.Case presentationThe case is a 69-year-old man with locally advanced esophageal and two early gastric cancers. After induction chemotherapy, we performed minimally invasive esophagectomy, but on postoperative day 11, the anastomotic leakage was observed. Nutritional therapy, negative-pressure wound therapy, and suture closure could not treat it. Therefore, we performed pedunculated gastric conduit interposition with duodenal transection. In this procedure, the main trunk of the right gastroepiploic artery and vein was preserved, and the duodenum and gastric antrum are resected with cutting the branch from the right gastroepiploic artery and vein to gastric antrum, which dramatically improved the flexibility of the gastric conduit, and it is pulled up through the subcutaneous route. Improved blood supply and flexibility of the gastric conduit enabled a tension-free and safe anastomosis.ConclusionsThe flexibility and favorable blood flow of pedunculated gastric conduit interposition with duodenal transection can be an effective treatment option for refractory anastomotic leakage after esophagectomy.

Safety and Efficacy of Sleeve Gastrectomy with Sleeve Jejunal Bypass: An Advantage over Other Bypass Procedures – Multicenter 3 and 5 year Data

Abstract Background: The sleeve gastrectomy with sleeve jejunal (SG + SJ) bypass is a single anastomosis, sleeve plus procedure which was introduced as a loop modification of the transit bipartition and the single-anastomosis sleeve-ileal bypass, continuing with the original idea of maintaining biliary access by avoiding duodenal transection, while creating a functional bypass to achieve weight loss and resolution of the metabolic syndrome. Objectives: This study was done to evaluate the extent of weight reduction, control of type 2 diabetes mellitus (T2DM), their maintenance up to 5 years, nutritional stability, and documentation of any complications, following this procedure. Methods: This is a retrospective analysis of prospectively collected data of patients who underwent SG + SJ bypass, with a follow-up of 1–5 years, in three centers, amounting to 112 patients. A SG is followed by anastomosis of a loop of jejunum, usually at 200 cm distal to the duodenojejunal flexure (sometimes at 150 cm or even 100 cm depending on total small bowel length [TSBL]), with the antrum. The cohort included 41 male and 71 female patients with a mean age of 42 years and mean preoperative body mass index (BMI) of 45.8 kg/m2 (range: 30.15–74.6 kg/m2). Seventy-three (65.2%) patients had T2DM, with mean glycated hemoglobin (HbA1c) of 7.5% (range: 4.9%–16%). The primary outcome of this study was weight loss and remission of T2DM, and the secondary outcome was its safety and nutritional stability. Results: Of these 112 patients analyzed in this study, 110 (98.2%) followed up at 1 year, 45 out of 58 (77.6%) at 3 years, and 14 out of 25 (56%) at 5 years. Operative duration was 120–180 min with an average hospital stay of 2–4 days with no postoperative problems. The mean TSBL was 793 cm (range: 530–1035 cm); the mean common channel (CC) was 587 cm (range: 330–835). Reduction in BMI was observed from 45.8 to 28.2 kg/m2 at 1 year, 27.4 kg/m2 at 3 years, and 27.3 at 5 years. The mean percentage of total body weight loss was 37.9% at 1 year, 40.7% at 3 years, and 40.6% at 5 years. Remission of diabetes was seen in 98.6% at 1 year, 97% at 3 years, and 91.7 at 5 years, with a mean fall in HbA1c from 7.5% to 5.2% at 1 year, 5% at 3 years, and 4.96% at 5 years. No mortality was seen in any of these 112 patients. Four patients had complications such as nausea, vomiting, diarrhea, dumping syndrome, hypoproteinemia, and hypoalbuminemia. Two patients required a partial reversal of the procedure (disconnection of the jejunal bypass while retaining the sleeve), while the rest were managed conservatively. Conclusions: This procedure was found to be safe and effective in achieving and maintaining weight loss and diabetes remission, along with nutritional stability, even at 3 and 5-year follow-up; long-term data are awaited. It has the advantage of maintaining biliary access and if necessary a partial reversal can be done in a simpler manner compared to other bypass procedures.

Application of the Falciform Ligament Patch for the Prevention of Duodenal Stump Leakage After Gastrectomy: Technical Report on a Case Series.

Background: Duodenal stump leakage (DSL) is a serious complication after gastrectomy. In this study, we developed a novel prevention technique using a falciform ligament patch (FLP) to prevent DSL among high-risk patients after gastrectomy. Materials and Methods: From January 2019 to July 2021, 14 patients who were judged to be at high risk for DSL during preoperative examinations or surgery were included in this retrospective study, and the FLP was applied to the duodenal stump. The falciform ligament was separated from the liver after duodenal transection during gastrectomy; the end part was used to cover the duodenal stump and was fixed using nonabsorbable polypropylene sutures. Results: In total, 14 patients who underwent FLP had one or two risk factors that were identified: 5 patients, gastric cancer duodenal invasion; 4 patients, gastric outlet obstruction (GOO); 1 patient, cancer involving the distal resection margin; 1 patient, duodenal gastrointestinal stromal tumor involving the distal resection margin; 1 patient, gastric cancer duodenal invasion and GOO; and 2 patients, cancer involving the distal resection margin and GOO. FLP construction was successful, and no patient developed complications of DSL. The average hospital stay was 11.9 days, and the patients were discharged without any morbidities after surgery. Conclusions: Therefore, the FLP can be used to prevent DSL among high-risk patients after gastrectomy.

Duodenal transection following a seat belt injury: A case report.

Introduction and importanceThe rare presentation of duodenal injuries has led to a lack of guidelines for managing and diagnosing such cases. In most duodenal injuries, intramural hematoma and perforation are seen; however, complete resection of the duodenum is rare, which is seen in our case.Case presentationWe report a rare case of a 6-year-old boy who suffered from a complete isolated duodenal transection at the pylorus and a 90% transection at D3 and D4 following a seat-belt injury. The surgeon performed a primary anastomosis for the first part of the duodenum with pyloric exclusion. Then, primary repair with controlled fistula for the second transection at D3 and D4 and a gastrojejunostomy were performed. After further management, the patient was discharged with no further complaints.Clinical discussionDue to the retroperitoneal location of the duodenum, it is challenging to diagnose a duodenal injury. CT scan with contrast is considered the best diagnostic tool in the case of a duodenal injury. Treatment of duodenal injuries depends on the type of injury and the present level of damage. It is imperative to differentiate between a duodenal hematoma, a duodenal perforation, or a duodenal transection as the management for each complication differs.ConclusionNo official guidelines have been set in the case of management or diagnosis of duodenal transection. Based on our experience with this patient and similar literature, guidelines for managing and diagnosing duodenal transection should be set, and further studies on the matter are warranted.

Thoraco-omphalopagus twins with complex biliary tree, pancreatic and intestinal anatomy: Planning behind successful separation, “the Santorini difference”

Here we report the separation of thoraco-omphalopagus twins at week 17th after birth, that are already 11-year-old and performing satisfactorily at the family, school, and social level. At birth, hearts shared a common pericardium and livers were fused along the anterior edge. Small bowel was common from duodenum down to the terminal ileum and invested by a dual mesentery. From the bifurcation bowels were normal. Bile and pancreatic ducts discharged into the duodenum but whether they were fused, or not, and details of the terminal ducts did not show up in the study. Vasculatures were independent. Teams -anesthesia, reconstructive, cardio-surgery, digestive, management-were formed and given specific tasks. Separation, programed for week 24, was performed at week 17 due to an emergency. In the intervention, the central step was the exploration of bile and pancreatic discharges. The duct of Santorini was searched for and identified; it discharged at the minor papilla in the duodenum prior to fusion. Both Wirsungs and the already fused common bile duct discharged in a single major papilla in a fused duodenum. The distance between papillae allowed for a duodenal transection between them. This scenario, considered during planning, commanded the separation. T1 kept the major papilla, while T2, the minor papilla complemented with a cholecystojejunostomy. Careful planning and management were keys to overcome both emergency and incomplete preoperative information.

Effects of duodenal transection timing on clinical short-term outcomes of patients with laparoscopic spleen-preserving splenic hilar lymphadenectomy for advanced proximal gastric cancer

BackgroundTo determine the optimal timing of duodenal transection in patients undergoing laparoscopic-assisted total gastrectomy (LATG) in combination with laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) for advanced proximal gastric cancer (APGC).MethodsOne hundred twenty-seven patients with APGC who received LATG with duodenal transection as well as LSPL between January 2017 and July 2018 were retrospectively recruited in this study. According to the different transection timing, the patients were allocated into two groups: a conventional group (CG) who received the duodenal transection prior to the LSPL and an experimental group (EG) who were given LSPL before the duodenum was transected. Clinical short-term outcomes were compared in the two groups.ResultsAnalysis of the demographical and clinical characteristics showed that the two groups were comparable with no significant differences between CG and EG in the study patients regardless of their body mass indices (BMI). The intraoperative and postoperative indicators for clinical short-term outcomes were compared between the CG and EC, and results indicated that the EG had significant shorter mean time of LSPL and total operation time than those in the CG (P < 0.05). Of note, the numbers of patients with intraoperative injury and the volume of blood loss during the LSPL procedure were significantly reduced in the EG versus CG (P < 0.05). For the obese APGC patients, administration of LSPL prior to duodenal transection significantly increased the number of dissected No.10 lymph nodes (LNs) (P < 0.05). The other intraoperative and postoperative indicators did not show any differences between the two comparison groups.ConclusionsOur findings demonstrated that duodenal transection timing was significantly associated with clinical short-term outcomes of APGC patients. The duodenal transection prior to the LSPL is superior overall to the conventional transection timing in the treatment of APGC patients with LATG and LSPL in combination.

Short-term clinical effects of selecting duodenal transection timing on laparoscopic-assisted distal gastrectomy: a multicentre retrospective study (A report of 239 cases)

Objective To investigate the short-term clinical effects of selecting duodenal transection timing on laparoscopic-assisted distal gastrectomy (LADG). Methods The retrospective cohort study was conducted. The clinicopathological data of 239 gastric cancer (GC) patients undergoing LADG in the 5 medical centers between March 2016 and March 2018 were collected, including 104 in the First Affiliated Hospital of Xiamen University, 45 in Zhangzhou Affiliated Hospital of Fujian Medical University, 35 in Quanzhou Affiliated Hospital of Fujian Medical University, 30 in the Second Affiliated Hospital of Xiamen Medical College, 25 in Zhongshan Hospital of Xiamen University. Of 239 patients undergoing LADG + D2 lymph node dissection, 107 receiving duodenal transection and then lymph node dissection in the upper region of pancreas after lymph node dissection in the lower region of pylorus and 132 receiving lymph node dissection in the upper region of pancreas and then duodenal transection were respectively divided into anterior approach group and posterior approach group. Sixty-four, 8, 16, 14 and 5 patients in the anterior approach group and 40, 37, 19, 16 and 20 patients in the posterior group respectively came from the First Affiliated Hospital of Xiamen University, Zhangzhou Affiliated Hospital of Fujian Medical University, Quanzhou Affiliated Hospital of Fujian Medical University, Second Affiliated Hospital of Xiamen Medical College and Zhongshan Hospital of Xiamen University. Observation indicators: (1) surgical and postoperative situations; (2) postoperative complications; (3) stratified analyses of surgical and postoperative situations in patients with different TNM staging, body mass index (BMI) and maximum tumor dimension; (4) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival and tumor recurrence or metastasis up to April 2018. Measurement data with normal distribution were represented as ±s, and comparison between groups was analyzed using the independent-samples t test. Measurement data with skewed distribution were described as M (Q), and comparison between groups was analyzed using the nonparametric test. Comparisons of count data were analyzed using chi-square test or Fisher exact probability. Comparison of ordinal data was done by the rank-sum test. Results (1) Surgical and postoperative situations: all the patients underwent successful operation, without perioperative death. Number of lymph node dissection in the upper region of pylorus in the anterior and posterior approach groups were respectively 3.9±2.6 and 3.0±2.5, with a statistically significant difference between groups (t=2.778, P 0.05). (2) Postoperative complications: cases with overall complications, anastomotic leakage, anastomotic stenosis, anastomotic bleeding, pancreatic fistula, postoperative gastroparesis, intra-abdominal hemorrhage, incision infection, pneumonia, intra-abdominal infection, bacteremia, intestinal obstruction, endolymphatic leakage, Clavien-Dindo grade Ⅰ, Ⅱ, Ⅲa, Ⅲb and Ⅳa of postoperative complications were respectively 15, 1, 1, 1, 0, 3, 1, 2, 3, 0, 1, 3, 0, 3, 9, 1, 2, 0 in the anterior approach group and 25, 3, 0, 1, 2, 2, 2, 5, 7, 3, 2, 3, 1, 6, 14, 1, 2, 2 in the posterior approach group, with no statistically significant difference between groups (χ2=1.027, 0.643, 0.022, 0.479, 0.161, 0.765, 0.921, 0.161, 0.063, Z=-1.055, P>0.05). Patients in 2 groups with complications were cured by symptomatic treatment. (3) Stratified analyses of surgical and postoperative situations in patients with different TNM staging, BMI and maximum tumor dimension: operation time, dissected times of lymph nodes in upper region of pancreas, cases with visible port vein, number of overall lymph node dissection, numbers of lymph node dissection in upper region of pylorus and upper region of pancreas were respectively (236.0±41.0)minutes, (33.9±6.2)minutes, 32, 36.0±12.0, 3.8±3.0, 13.4±5.5 in patients of the anterior approach group with Ⅲ stage of TNM staging and (253.0±45.0)minutes, (36.5±7.0)minutes, 29, 31.0±9.0, 2.5±2.0, 11.4±4.6 in patients of the posterior approach group with Ⅲ stage of TNM staging, with statistically significant differences between groups (t=-1.988, -2.066, χ2=4.686, t=2.472, 2.757, 2.016, P 0.05). Conclusions Both of anterior approach and posterior approach are safe and feasible in LADG, with equivalent short-term efficacies. The anterior approach in LADG has an advantage of the lymph node dissection in the upper region of pylorus compared with posterior approach, and it also is better for patients with later tumor staging, higher BMI and bigger tumor. Key words: Gastric neoplasms, distal; Radical resection; Duodenal transection timing; Surgical approach; Laparoscopy; Multicenters; Retrospective researches

Traumatic duodenal transection in children: A report of two cases

Duodenal injury following blunt abdominal trauma in children is extremely rare. It commonly has a delayed presentation, thus leading to increased mortality and morbidity. We report two cases of isolated duodenal injury following blunt abdominal trauma in children.

1042 Endoscopic Salvage of a Duodenal Stump Leak and Surgical Transection of the Ampulla

1042 Endoscopic Salvage of a Duodenal Stump Leak and Surgical Transection of the Ampulla

A safer and simpler technique of duodenal dissection and transection of the duodenal bulb for duodenal switch

/10.10 16 A mmo ence: outh, nielco One common reasons that many surgeons do not perform a duodenal switch (DS) is lack of experience with the dissection over the head of the pancreas [1]. We have developed a more tolerable and simpler technique for this dissection that allows any surgeon who has the skills to perform a gastric bypass to perform this dissection easily. One of the most common fears with this dissection is injury to the portal triad [2]. This can result in serious injuries. Our technique offers the surgeon complete exposure so that injury to the portal triad is rare. The second most common fear is a duodenal stump leak [3,4]. In the past, papers have reported duodenal leak rates after DS of 1.5% [3,5]. We believe this occurs when there are injuries to the supraduodenal artery and vein or the superior pancreaticoduodenal artery and vein, leading to ischemia [1,6]. These injuries can be avoided using our technique, preserving the blood supply to the duodenal stump. Briefly, the technique involves taking down all the perforating gastroepiploic vessels from 4 cm proximal to the pylorus, thus raising the antrum and providing exposure of the pancreas and portal triad. When the dissection is carried down to the head of the pancreas, the superior pancreaticoduodenal artery branches are seen rising from the body of the pancreas onto the posterior duodenal surface. These vessels are always 2–4 cm beyond the pylorus and afford a safe and vascularized spot to perform the duodenal transection. This is also safely above the

Closed circuit refeeding biliary drainage in a complex blunt hepatobiliary trauma: A novel technique

Blunt trauma to the abdomen is common in children causing injuries of varying severity. We present a complex case of hepatobiliary, gastrointestinal, and renal artery injuries needing a tailored management strategy and a novel technique of nutrition for the best possible outcome for the patient. Our patient in this case report had extensive hepatobiliary trauma with complete biliary duct and duodenal transection and renal artery thrombosis. He was managed by staged surgeries comprising biliary diversion and duodenal repair in the first stage and undiversion of the system in the second surgery. This is a novel technique as the nutrition was maintained by a closed circuit of bile redrainage into the jejunostomy tube achieving a physiological drainage pattern and circumventing the need of parental nutrition.

Reconstruction Using a Pedunculated Gastric Tube with Duodenal Transection After Esophagectomy and Pharyngolaryngectomy.

Gastric conduit ischemia is sometimes correlated with anastomosis-related morbidities after esophagectomy and pharyngolaryngectomy.1 (-) 5 A lack of connection between the right and left gastroepiploic vessels and intraoperative injury to these vessels could cause conduit ischemia. In addition, tensioned anastomosis due to a short gastric tube also could contribute to anastomotic leaks. This report introduces a reconstruction technique using a pedunculated gastric tube with duodenal transection for these cases. Creation of a gastric tube in the greater curvature of the stomach is performed with linear staplers. Only the right gastroepiploic vessels are preserved. The gastric tube is finally fashioned with a width of approximately 4 cm. The peripheral right gastroepiploic vessels to the pylorus are sacrificed. After the bulbs are transected, a pedunculated gastric tube is moved, with confirmation whether it has sufficient length for anastomosis in the neck. After the anal side of the gastric tube is transected, Roux-en-Y gastrointestinal anastomosis is performed. Finally, esophagogastric or pharyngogastric anastomosis is performed. Between November 2011 and September 2014, 18 patients underwent the reported reconstruction technique due to short gastric tubes in 10 patients and a lack of connection between the right and left gastroepiploic vessels in 8 patients. Anastomotic leaks occurred in three patients (16.7 %), conduit necrosis in no patients, and strictures in no patients, respectively. Two patients had an anastomotic grade 2 leak, and one patient had an anastomotic grade 3 leak. The current reconstruction technique is a good alternative for patients at risk of conduit ischemia and patients with a short gastric tube after esophagectomy and pharyngolaryngectomy.

Motor vehicle collision patient with simultaneous duodenal transection and thoracic aorta injury: a case report and review of the literature.

Blunt polytrauma can present complex management decisions. Here we report the case of a 31-year-old male involved in a high speed motor vehicle collision resulting in both duodenal and thoracic aorta injury that was managed collaboratively between the trauma, vascular, and cardiothoracic surgical teams. The patient went on to a full recovery. We also review the management of such injuries which has evolved over the past two decades resulting in less morbidity and mortality.

Gastrointestinal stromal tumors of the duodenum: Surgical management and survival results

To provide long-term survival results of operable duodenal gastrointestinal stromal tumors (DGISTs) in a tertiary center in China. In this retrospective study, the pathological data of 28 patients with DGISTs who had been treated surgically at the Second Department of General Surgery, Sir Run Run Shaw Hospital (SRRSH) from June 1998 to December 2006 were reviewed. All pathological slides were examined by a single pathologist to confirm the diagnosis. In patients whose diagnosis was not confirmed by immunohistochemistry at the time of resection, representative paraffin blocks were reassembled, and sections were studied using antibodies against CD117 (c-kit), CD34, smooth muscle actin (SMA), vimentin, S-100, actin (HHF35), and desmin. Operative procedures were classified as wedge resection (WR, local resection with pure closure, without duodenal transection or anastomosis), segmental resection [SR, duodenal transection with Roux-Y or Billroth II gastrojejunostomy (G-J), end-to-end duodenoduodenostomy (D-D), end-to-end or end-to-side duodenojejunostomy (D-J)], and pancreaticoduodenectomy (PD, Whipple operation with pancreatojejunostomy). R0 resection was pursued in all cases, and at least R1 resection was achieved. Regional lymphadenectomy was not performed. Clinical manifestations, surgery, medical treatment and follow-up data were retrospectively analyzed. Related studies in the literature were reviewed. There were 12 males and 16 females patients, with a median age of 53 years (20-76 years). Their major complaints were "gastrointestinal bleeding" (57.2%) and "nonspecific discomfort" (32.1%). About 14.3%, 60.7%, 17.9%, and 7.1% of the tumors originated in the first to fourth portion, respectively, with a median size of 5.8 cm (1.6-20 cm). Treatment was by WR in 5 cases (17.9%), SR in 13 cases (46.4%), and by PD in 10 cases (35.7%). The morbidity and mortality rates were 35.7% and 3.6%, respectively. The median post-operative stay was 14.5 d (5-47 d). During a follow-up of 61 (23-164) mo, the 2-year and 5-year relapse-free survival was 83.3% and 50%, respectively. Eighty-four related articles were reviewed. Surgeons can choose to perform limited resection or PD for operable DGISTs if clear surgical margins are achieved. Comprehensive treatment is necessary.

A Case of Duodenal Transection Caused by Blunt Trauma

A Case of Duodenal Transection Caused by Blunt Trauma

Reconstruction of a traumatic duodenal transection with a pedicled ileal loop: a case report

IntroductionBlunt duodenal injuries do not occur often. A patient with damage to the duodenal tissue around the pancreatic and common bile duct presents a challenge to surgeons. The choice of procedure must be tailored to the nature of the defect and the amount of tissue lost.Case presentationWe describe the case of a 16-year-old Caucasian boy with a blunt duodenal injury after a motor vehicle accident. On admission, the patient had stable vital signs and a normal laboratory workup. Gradually his clinical condition deteriorated and a computed tomography scan showed a retroperitoneal haematoma at the level of his duodenum. A fully circumferential rupture of the second part of his duodenum was found during laparotomy, with the intact Vater's papilla lying adjacent to the defect and a superficial laceration of the head of his pancreas. The retroperitoneal haematoma was thoroughly drained and a pedicled ileal loop was interposed between the duodenal stumps to restore the continuity of the patient's duodenum. Apart from a mild postoperative pancreatitis, the patient's postoperative course evolved with no further problems. The patient was discharged on the 22nd postoperative day in excellent condition and has remained so to date (after five years).ConclusionIn our case report, where the second part of the patient's duodenum was completely transected, our choices for reconstruction were limited. Important factors for the successful management of this patient were prompt surgical intervention and the accurate assessment of the nature of the duodenal and associated injuries. We believe that the technique we used was a reasonable choice because the anatomical continuity of the patient's duodenum was restored.

Lethal visceral traumatic injuries secondary to child abuse: A case of practical application of autopsy, radiological and microscopic studies

A 3-year-old boy child died at home. The circumstances of death appeared unclear to the police investigators and a medicolegal autopsy was carried out. External examination revealed diffuse ecchymoses of varying colours. Postmortem imaging using plain X-rays and multislice computed tomography (MSCT) was performed prior to autopsy and pathological study. These investigations revealed fractures at the posterior arch of the ninth left rib. No cerebral and pericerebral traumatic lesions were diagnosed. In the abdomen, haemoperitoneum and pneumoperitoneum secondary to duodenal perforation and liver laceration were observed. At autopsy, a complete pancreatic fracture and duodenal transection were noted, accounting for the MSCT appearance. Furthermore, autopsy revealed the presence of bilateral intramuscular intercostal haemorrhages and a fracture of the eighth left rib at its posterior arch. This case report illustrates the valuable assistance rendered by MSCT as well as its limitations in diagnosing abuse when a child dies in unclear circumstances.