Pancreatic Vein Research Articles

A rare case of pancreatic pseudocyst-portal vein fistula in a patient with chronic pancreatitis.

A 60-year-old female with chronic pancreatitis and a history of splenectomy presented with epigastric pain, vomiting, and asthenia. Elevated pancreatic enzymes and CT imaging revealed a pseudocyst in the pancreatic head with suspected communication to the portal vein, confirmed by MR Cholangiopancreatography and endoscopic ultrasound (EUS). EUS-guided puncture revealed high amylase levels. Given her manageable symptoms, a conservative approach was adopted, leading to symptomatic relief and pseudocyst size reduction. Pancreatic pseudocyst-portal vein fistula is a rare pancreatitis complication, challenging to diagnose, with no gold-standard treatment. Endoscopic stenting offers a promising alternative to surgery for severe cases.

Natural history of spontaneous pancreatic portal vein fistulae: A systematic review of the literature

BackgroundSpontaneous pancreatic portal vein fistula (PPVF) - a rare complication of pancreatic inflammation – varies widely in presentation and means of diagnosis but has been previously associated with bleeding complications and mortality. A systematic review of published literature was performed to assess the frequency of outcomes. MethodsA search of electronic databases (PubMed, Ovid MEDLINE, Scopus, EMBASE, gray literature) resulted in 1667 relevant unique manuscripts; 52 met inclusion criteria. ResultsA total of 74 unique (male n = 47, 63.5 %) patients were included. Mean age was 53.5 (±11.9) years. History of alcohol use was reported in 55 (74.3 %). Underlying chronic pancreatitis (CP) was present in 49 (66.2 %). In cases where presenting symptoms were reported (n = 57, 77.4 %), the most frequent were abdominal pain (63.5 %), weight loss (14.9 %), rash (12.2 %), nausea/vomiting (12.2 %), and polyarthritis (9.5 %). Computed tomography was the most common imaging modality used to confirm the diagnosis (n = 20, 27.0 %), followed by magnetic resonance cholangiopancreatography (n = 14, 18.9 %). Portal vein thrombosis was reported in 57 (77.0 %), and bleeding events (luminal, variceal, or intra-pseudocyst) were reported in 13(17.6 %) patients. Younger age was associated with higher risk of bleeding events. Mortality was reported in 12 (16.2 %) patients at any time during follow up. Older age and polyarthritis at presentation were associated with mortality. ConclusionsPPVF is a rare and potentially fatal condition, though rates of bleeding complication and death were relatively low in this population. High-quality observational studies are needed to better understand the pathophysiology and natural history of this diagnosis.

Anti-diabetic activity of aqueous extract of Trichilia prieureana A. Juss leaves in fructose-fed streptozotocin-induced diabetic male Wistar rats

Background and aimEthanolic extract of Trichilia prieureana leaves have been reported to exhibit anti-hyperglycemic activities without detailed information on the anti-diabetic activities. This study investigated the anti-diabetic activity of aqueous extract of T. prieureana leaves (AETPL) in type 2 diabetic (T2DM) male rats. Experimental procedureT2DM rats (induced with 10 % fructose solution ad libitum for 2 weeks and streptozotocin [STZ]; 40 mg/kg body weight {BW}) in groups B, C, D, E, and F were also administered distilled water (DW), metformin (100 mg/kg BW), 11.2, 22.3, and 44.6 mg/kg BW of AETPL, respectively, whilst non-diabetic rats in Group A received DW only (Sham Control, SC) for 14 days. The T2DM-related parameters were then evaluated. ResultsThe fructose-fed streptozotocin-(FSTZ) treatment related significant (p < 0.05) increases in FBS, HbA1c, fructosamine, HOMA-IR, G6P, GP, TC, TG, LDL-C, urea, bilirubin, hepatic and pancreatic MDA levels; decreases in BW, serum insulin, creatinine, albumin, HOMA-β, glycogen, G6PD, HK, HDL-C, hepatic and pancreatic SOD, GPX, RG, catalase, Hb, PCV, MCH, MCHC, MCV, RBC, WBC, differentials and the destruction of the pancreatic β-cells, hepatocyte degeneration, and central hepatic vein congestion were reversed by AETPL, to values that compared well with SC in most cases. In the IpGGT model, the intraperitoneally administered AETPL reduced the blood glucose and elevated the plasma insulin levels. The AETPL at 44.6 mg/kg BW exhibited the most pronounced effects. ConclusionAETPL (44.6 mg/kg BW) restored T2DM-glycemic control and associated biochemical changes via up-regulation of insulin, carbohydrate metabolizing enzymes and restoration of pancreatic and hepatic histoarchitecture.

Endoscopic ultrasound-guided perivascular pancreatic radiofrequency ablation using a hydroxyethyl starch solution prior to pancreatectomy

Abstract Background and study aims Pancreatic surgery remains complex, particularly for borderline resectable and locally advanced tumors. Vascular invasion compromises resectability, and vascular resection entails increased morbidity and mortality. Following a feasibility and safety demonstration of augmented endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) using hydroxyethyl starch (HES) in porcine pancreatic parenchyma, the present study assesses whether this approach (EUS-sugar-RFA) in the pancreatic perivascular space is safe and creates a controllable margin of necrosis to enable a vessel-sparing resection. Methods EUS-sugar-RFA in the pancreatic parenchyma adjacent to the splenic artery and vein was performed in a live animal model. Following different survival periods (0–4 days) in the interventional group (n = 3), open pancreatectomy was carried out. The control group (n = 4) included open pancreatectomies in two pigs with non-treated pancreases and in two with pancreatic RFA alone on the same day. Results All procedures were completed successfully, without intraoperative or postoperative complications. Survival periods were uncomplicated. Histopathological examination showed local necrosis and inflammatory reaction at the ablation sites. Vascular wall integrity was preserved in all specimens. The untreated pancreatic zones in the interventional group were no different from the normal pancreases in the control group. Conclusions Preoperative perivascular augmented RFA using HES was safe, and in the pancreatic animal model, the best timeframe was within 24 hours before pancreatic surgery. This technique might improve resectability in selected borderline and locally advanced pancreatic cancers.

Comprehensive exploration of Biochanin A as an oncotherapeutics potential in the treatment of multivarious cancers with molecular insights.

Cancer is considered a leading cause of mortality. This rising cancer death rate and several existing limitations like side effects, poor efficacies, and high cost of the present chemotherapeutic agents have increased the demand for more potent and alternative cancer treatments. This review elucidated a brief overview of Biochanin A (BCA) and its potentiality on various cancers with details of anticancer mechanism. According to our review, a number of studies including in silico, in vitro, pre-clinical, and clinical trials have tested to evaluate the efficacy of BCA. This compound is effective against 15 types of cancer, including breast, cervical, colorectal, gastric, glioblastoma, liver, lung, melanoma, oral, osteosarcoma, ovarian, pancreatic, pharynx, prostate, and umbilical vein cancer. The general anticancer activities of this compound are mediated via several molecular processes, including regulation of apoptosis, cell proliferation, metastasis and angiogenesis, signaling, enzymatic pathways, and other mechanisms. Targeting both therapeutic and oncogenic proteins, as well as different pathways, makes up the molecular mechanism underlying the anticancer action. Many signaling networks and their components, such as EFGR, PI3K/Akt/mTOR, MAPK, MMP-2, MMP-9, PARP, Caspase-3/8/9, Bax, Bcl2, PDL-1, NF-κB, TNF-α, IL-6, JAK, STAT3, VEGFR, VEGF, c-MY, Cyclin B1, D1, E1 and CDKs, Snail, and E-cadherin proteins, can be regulated in cancer cells by BCA. Such kind of anticancer properties of BCA could be a result of its correct structural chemistry. The use of BCA-based therapies as nano-carriers for the delivery of chemotherapeutic medicines has the potential to be very effective. This natural compound synergises with other natural compounds and standard drugs, including sorafenib, 5-fluorouracil, temozolomide, doxorubicin, apigenin, and genistein. Moreover, proper use of this compound can reverse multidrug resistance through numerous mechanisms. BCA has better drug-likeness and pharmacokinetic properties and is nontoxic (eye, liver, kidney, skin, cardio) in human bodies. As having a wide range of cancer-fighting mechanisms, synergistic effects, and good pharmacokinetic properties, BCA can be used as a supplementary food until standard drugs are available at pharma markets.

Spontaneous Pancreatic Pseudocyst-Superior Mesenteric Vein Fistula

ABSTRACT Pancreatic pseudocyst formation is a common complication of chronic pancreatitis. Rarely, a fistula develops between the pseudocyst and the portal venous system. We present a case of a 50-year-old man who was found to have a pancreatic pseudocyst-superior mesenteric vein fistula after being evaluated for several months of abdominal pain and weight loss. The patient was treated with endoscopic stenting of the pancreatic duct along with early enteral nutrition and suppressive antibiotics, which resulted in improvement in his condition. This case report highlights clinical presentation and the complexity of treatment of this rare diagnosis.

Hepatic Arterial Buffer Response in Liver Transplant Recipients: Implications and Treatment Options.

The liver blood supply portrays one of the most sophisticated archetypes of circulation. Despite its weight (representing only 2.5% of body weight), the liver receives 25% of the cardiac output, allowing the hepatic parenchyma to be the most richly perfused of any organ. The anatomical distinctiveness of the double afferent blood supply is established between the hepatic artery and the portal vein, ensuring a total blood flow of 100 to 130 mL/min per 100 g of liver. Approximately 20 to 25% of the blood perfusing the liver is well oxygenated, and is provided by the hepatic artery. In addition to hepatic parenchymal cells, the hepatic artery provides the exclusive blood supply to the intrahepatic bile ducts. The portal vein, formed by the confluence of the splenic vein, mesenteric veins, gastric veins, and pancreatic vein, supplies around 75 to 80% of the afferent blood, which is partially deoxygenated.[1] [2] Mixing of arterial and portal blood occurs in the sinusoids, an exclusive, dynamic microvascular structure that serves as the principal site of exchange between the blood and the perisinusoidal space.[3] The hepatic veins (typically three—right, middle, and left) drain the blood from those locations into the inferior vena cava.

Gastric vein preservation to minimize gastric venous congestion following total pancreatectomy

Brittle diabetes, malabsorption, and liver steatosis are the most common adverse consequences of total pancreatectomy （TP）. While some authors have described gastric venous congestion and bleeding, details of gastric venous drainage following TP remain incompletely known. We examined the effectiveness of our methods for avoiding gastric venous congestion in five patients who recently underwent TP. During TP, our standard practice is preservation of at least one vein providing gastric drainage. When no pancreatic vein draining the stomach can be preserved, a relatively extensive gastrectomy is added. Among five patients who underwent TP, preservation of the left gastric vein was possible in three patients, whereas the posterior and short gastric veins and the splenic vein were preserved in one patient. These four patients underwent subtotal stomach-preserving TP or TP with distal gastrectomy in two patients each. One patient requiring sacrifice of all gastric drainage veins additionally underwent TP with subtotal gastrectomy. No patient developed gastric venous congestion or bleeding; patency of drainage veins in four patients was confirmed by postoperative three-dimensional computed tomography. Postoperative body weight decreased compared with preoperative weight in three patients; however, nutritional parameters on postoperative blood tests did not significantly change compared with preoperative values. The favorable outcomes of our strategy for gastric vein preservation in TP should encourage more frequent use of TP when required.

Three Lumens Full of Blood—An Unusual Case of Gastrointestinal Bleeding

Question: A 58-year-old man was initially referred to our gastroenterology outpatient clinic for investigation of iron-deficiency anemia and positive fecal occult blood test (FOBT). His medical history was significant for simultaneous pancreas-kidney transplants 9 years earlier in the context of type 1 diabetes, for which he remained on triple immunosuppressive therapy with prednisolone, mycophenolate, and tacrolimus. His transplants were complicated by biopsy-proven chronic antibody-mediated rejection 4 years earlier, for which he received 6 months of intravenous immunoglobulin. There was no history of chronic liver disease or nonsteroidal medication use. Investigations demonstrated iron-deficiency anemia with a hemoglobin of 88 g/L, ferritin 14 μg/L, transferring saturation 5%, and a positive FOBT (1 of 3 samples). The patient underwent further evaluation with gastroscopy and colonoscopy, which were both unremarkable and did not identify a cause for iron-deficiency anemia. One month later, the patient re-presented to the emergency department with several days of melena and symptomatic anemia with a hemoglobin of 78 g/L. The patient underwent repeated gastroscopy, which did not reveal a cause for his symptoms. He received a blood transfusion and was referred for outpatient capsule endoscopy. Several weeks later, the patient represented with 3 days of melena and symptomatic anemia with a hemoglobin level of 45 g/L. The patient underwent an urgent push enteroscopy. What are the differential diagnoses of gastrointestinal bleeding in this patient? Look on page 335 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting to Gastro Curbside Consult. A pediatric colonoscope was inserted 60 cm beyond the pylorus. There was no evidence of esophageal varices, esophagitis, or gastric varices. There was no ulceration or stigmata of recent hemorrhage found in the stomach or duodenum. At 55 cm distal to the pylorus, the anastomosis of the pancreatic transplant was encountered. It demonstrated a side-to-side duodenojejunostomy with 2 short blind duodenal limbs and the native efferent jejunal limb (Figure A). At the anastomosis, multiple varices were noted, of which one vessel was actively bleeding (Figure B). Hemostasis was achieved with the injection of adrenaline (2 mL, 1:10,000) and 2 through-the-scope hemostatic clips (Figure C). The patient then underwent a computed tomographic scan with pancreas protocol to characterize the anatomy and vasculature at the duodenojejunal anastomosis. Multiple venous varices were identified that communicated with a distended transplant pancreatic vein (Figure D). The transplant pancreatic vein anastomoses with the proximal right common iliac vein, and therefore the varices were not due to portal venous hypertension. There was no anastomotic stenosis, no venous thrombosis, and no arteriovenous fistulae. The hemoglobin remained stable after endoscopy and the patient was discharged home 3 days later. At outpatient follow-up 2 months after discharge, there was no evidence of further gastrointestinal bleeding and the hemoglobin level was stable. The patient will continue to be closely observed in the outpatient setting, with a view to endovascular intervention if further gastrointestinal bleeding occurs. Ectopic variceal bleeding from anastomotic varices between the donor duodenum and recipient small bowel are rare, with only 3 cases reported in the literature.1Gopal J.P. Jackson J.E. Palmer A. Taube D. Rathnasamy Muthusamy A.S. Gastrointestinal bleeding in a pancreas transplant recipient: a case to remember.Am J Case Rep. 2020; 21e923197Crossref PubMed Scopus (3) Google Scholar, 2Rostambeigi N. Shrestha P. Dunn T.B. et al.Recurrent ectopic variceal bleed after pancreas transplantation with no portal hypertension: case report and outcomes of endovascular onyx embolization.Vasc Endovasc Surg. 2019; 53: 415-419Crossref PubMed Scopus (5) Google Scholar, 3Fontana I. Bertocchi M. Di Domenico S. et al.Percutaneous embolization of periduodenal varix due to portal hypertension in a patient with kidney-pancreas transplantation: a case report.Transplant Proc. 2010; 42: 2162-2163Crossref PubMed Scopus (5) Google Scholar The mechanism by which ectopic varices develop after pancreas transplantation are not clear. Potential explanations include portal hypertension secondary to cirrhosis, increased vascular resistance, rejection of pancreatic transplant, and chronic venous obstruction. In our case, the mechanism was not elucidated.

Abstract 3460: Overlooking the obvious - paradox of gastrointestinal carcinomas metastasis to portal vein

Abstract All carcinomas are characterized by metastases to distant organs, accounting for 90% of cancer-associated deaths. This analysis highlights a paradox of gastrointestinal carcinomas metastasis into portal vein: colorectal, pancreatic, small bowel and gastric carcinomas invariably release cancer cells to portal vein, which is the primary dissemination route, but very rarely form intraportal metastasis. On the contrary, hepatocellular carcinoma rarely releases cancer cells into portal vein, but very often forms intraportal metastasis. This disproportional frequency of HCC portal metastasis cannot be rationalized by hepatofugal (reverse) portal blood flow due to accompanying liver cirrhosis because: 1) reverse portal flow occurs in about 10% of cirrhotic patients, while portal metastasis occurs in 40-100% of HCC cases, and 2) portal vein prevalence of HCC metastasis is also the characteristic of non-cirrhotic patients. The ‘portal paradox’ becomes a logical event in light of comparative morphology and phylogeny of the chordate lineage: the formation of the unique portal venous system preceded the appearance of liver in evolution of chordates. The analysis suggests that the appearance of the portal venous system, draining blood from caudal intestine and supplying hormones and growth factors of pancreatic family (HGFPF) to midgut diverticulum in the early evolution of ancestral chordates, promoted differentiation of the diverticulum’s enterocytes into the hepatocyte phenotype and further formation of the liver in evolution of vertebrates. These promotional-dependent interactions are conserved in the vertebrate lineage but attributed to hepatocyte-derived cells only; the rest of gastrointestinal endodermal derivatives occurred independently from portal system in chordate phylogeny. Therefore, non-HCC gastrointestinal carcinomas’ cells do not have this affinity to and dependence on portal blood and portal blood does not promote attachment and growth of non-HCC gastrointestinal carcinomas’ cells in the portal conduit. I hypothesize that selective homing and proliferation of HCC cells in the portal vein environment are due to a uniquely high concentration of HGFPF in portal blood: portal vein formed by merging superior mesenteric and pancreatic veins. HGFPF are also necessary for liver function and renewal and are extracted by hepatocytes from passing blood, creating a concentration gradient of HGFPF between the portal blood and hepatic vein outflow, making post-liver organs less favorable spaces for HCC metastasis. This also suggests that the portal vein environment (i.e., high concentration of HGFPF) promotes the differentiation and selection of more aggressive HCC clones from already-seeded portal HCC cells, explaining the worse outcome of HCC patients with portal metastasis. Citation Format: Vladimir M. Subbotin. Overlooking the obvious - paradox of gastrointestinal carcinomas metastasis to portal vein [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3460.

The Trunk of Henle and its Variants

OjectiveIn colon, pancreatic and hepatobiliary surgical research, an increasing interest developed in the Gastrocolic Trunk of Henle (GTH) due to its broad variability and its importance especially for right hemicolectomy with complete mesocolic excision. The purpose of this study was to further corroborate details of the anatomical variants of the Gastrocolic Trunk, in particular with respect to pancreaticoduodenal veins and the jejunal drainage into the superior mesenteric vein.MethodsIn 15 cadaveric bodies the venous drainage into the superior mesenteric vein was dissected first in a ventral, in situ approach as well as by a subsequent dorsal approach following careful abdominal exenteration.ResultsThe most frequent configuration was the tripodal gastropancreaticocolic trunk (GPCT) with an occurrence of 54.5%, followed by the gastropancreatic trunk (GPT) with 36.4% (figure 1). The right gastroepiploic vein was a constant structure draining into the trunk of Henle in 100% of the cases. During the dissection of the pancreatic drainage, a previously undescribed, middle anterior pancreatic vein, was found in 46.67% of the specimens, which drained in 85.71% into the trunk of Henle.ConclusionThe trunk of Henle drains blood from several abdominal organs and bundles them into a short and vulnerable structure. The most common variant is a tripodal trunk, collecting veins from the pancreas, right colon, and the stomach. Dependent on the surgical approach, the right gastroepiploic vein or the superior right colic vein may serve as guiding structures towards the trunk of Henle. Preoperative imaging in conjunction with awareness of variants is essential for a personalized surgical pocedure. In addition, the finding of a middle anterior pancreatic vein prompts for further studies regarding venous drainage of the pancreatic head.

Huaier increases the antitumor effect of gemcitabine on pancreatic cancer in vitro and in vivo.

BackgroundPancreatic cancer has a high degree of malignancy and poor prognosis. As the first-line chemotherapy drug for pancreatic cancer, gemcitabine is widely used but is limited in its efficacy due to the development of chemoresistance. Huaier is a traditional Chinese medicine with anticancer effects. This present study explored the antitumor effect of gemcitabine combined with Huaier on pancreatic cancer in vitro and in vivo.MethodsAfter treatment with gemcitabine combined with Huaier in PaTu8988 pancreatic cancer cells, including 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay, wound healing, and Transwell invasion in vitro assays were performed to investigate the proliferation, migration and invasion of cells, respectively. The apoptotic rate of cells was detected by propidium iodide—annexin V staining and flow cytometry. In vivo PaTu8988 pancreatic cancer xenograft and tail vein injection into lung metastasis nude mice models were used to determine the tumor growth and lung metastasis efficiency.ResultsHuaier could not only inhibit the proliferation, migration, and invasion of cancer cells, but could also induce the apoptosis of pancreatic cancer in vitro and suppress tumor growth and lung metastasis in vivo. It further significantly increased the tumor suppressing effects of gemcitabine, and combined use of the two drugs exhibited a synergistic effect.ConclusionsOur present study concluded that Huaier was capable of enhancing the antitumor effect of gemcitabine in pancreatic cancer in vitro and in vivo. Therefore, Huaier may be a potential drug to increase the therapy sensitivity of gemcitabine and improve the prognosis of pancreatic cancer patients.

Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review.

Minimally invasive distal pancreatectomy (MIDP) is increasingly performed worldwide; however, the surgical anatomy required to safely perform MIDP has not yet been fully considered. This review evaluated the literature concerning peripancreatic vascular anatomy, which is considered important to conduct safe MIDP. A database search of PubMed and Ichushi (Japanese) was conducted. Qualified studies investigating the anatomical variations of peripancreatic vessels related to MIDP were evaluated using SIGN methodology. Of 701 articles yielded by our search strategy, 76 articles were assessed in this systematic review. The important vascular anatomy required to recognize MIDP included the pancreatic parenchymal coverage on the root and the running course of the splenic artery, branching patterns of the splenic artery, confluence positions of the left gastric vein and the inferior mesenteric vein, forms of pancreatic veins including the centro-inferior pancreatic vein, characteristics of the left renal vein, and collateral routes perfusing the spleen following Warshaw's technique. Very few articles evaluating the relationship between the anatomical variations and surgical outcomes of MIDP were found. The precise knowledge of peripancreatic vessels is important to adequately complete MIDP. More detailed anatomic analyses and descriptions will benefit surgeons and their patients who are facing these operations.

Pressure-Enabled Drug Delivery Approach in the Pancreas with Retrograde Venous Infusion of Lipiodol with Ex Vivo Analysis

PurposeTo determine the safety and feasibility of pancreatic retrograde venous infusion (PRVI) utilizing a microvalvular infusion system (MVI) to deliver ethiodized oil (lipiodol) by means of the Pressure-Enabled Drug Delivery (PEDD) approach.MethodsUtilizing transhepatic access, mapping of the pancreatic body and head venous anatomy was performed in 10 swine. PEDD was performed by cannulation of veins in the head (n = 4) and body (n = 10) of the pancreas with a MVI (Surefire® Infusion System (SIS), Surefire Medical, Inc (DBA TriSalus™ Life Sciences)) followed by infusion with lipiodol. Sets of animals were killed either immediately (n = 8) or at 4 days post-PRVI (n = 2). All pancreata were harvested and studied with micro-CT and histology. We also performed three-dimensional volumetric/multiplanar imaging to assess the vascular distribution of lipiodol within the glands.ResultsA total of 14 pancreatic veins were successfully infused with an average of 1.7 (0.5–2.0) mL of lipiodol. No notable change in serum chemistries was seen at 4 days. The signal-to-noise ratio (SNR) of lipiodol deposition was statistically increased both within the organ in target relative to non-target pancreatic tissue and compared to extra pancreatic tissue (p < 0.05). Histological evaluation demonstrated no evidence of pancreatic edema or ischemia.ConclusionsPEDD using the RVI approach for targeted pancreatic infusions is technically feasible and did not result in organ damage in this pilot animal study.

ESTUDIO ANATÓMICO DEL TRONCO VENOSO GASTROCÓLICO

Introducción: el tronco venoso gastrocólico, según lo descrito por Henle en 1868 se forma de la confluencia de las venas gastroepiploica derecha, cólica derecha y pancreático duodenal anteroinferior. Su localización y conocimiento anatómico es de importancia quirúrgica en la movilización duodeno pancreática y colo-epiploica. Material y métodos: se utilizaron 13 cadáveres formolados, adultos, de ambos sexos. Se registró: formación del tronco venoso gastrocólico, calibre de los afluentes y del tronco, distancias entre: cuello del páncreas y borde superior del duodeno III, vena mesentérica superior a duodeno II. Se topografió el tronco venoso en relación a las estructuras mencionadas. Se registró largo del tronco, distancia al borde superior del duodeno III y al borde inferior del cuello de Páncreas. Resultados: la conformación más frecuente fue por confluencia de las venas cólica derecha, gastroepiploica derecha y pancreático duodenal anteroinferior. El calibre medio del tronco venoso fue 5,65mm (3,3mm-10mm). La distancia media entre duodeno III y cuello de páncreas fue de 31,34mm (13,2mm-51mm). La distancia media entre vena mesentérica superior y duodeno II fue de 34,23mm (23,8mm-45,7mm). El largo medio del tronco venoso fue 9,43mm (3,2mm-16,3mm). Conclusión: se constató, en la mayoría de los casos, que la confluencia de formación del tronco venoso se daba según lo descrito clásicamente. Este se situó más frecuentemente de disposición oblicua hacia abajo y adentro, y en el cuadrante ínfero-interno respecto al cuadrilátero dado por una línea vertical desde cuello del páncreas a duodeno III y una horizontal desde duodeno II hasta la vena mesentérica superior.

Pancreatic Duct – Portal Vein Fistula in Acute on Chronic Alcoholic Pancreatitis: A Case Report and Literature Review

Chronic pancreatitis and significant alcohol use are common conditions and known risk factors for the development of pancreatic duct-portal vein (PD-PV) fistulas with a risk of subsequent liver necrosis accompanied by significant morbidity and mortality. PD-PV fistulas can occur due to disruption of the PD and erosion of pancreatic enzymes into the wall of the PV. This is facilitated by the presence of a large pseudocyst (PC) in the vicinity of the PV, eventually creating a connection between the two structures. Ductal anatomy should be evaluated with contrast enhanced CT and/or MRI when there is high clinical suspicion and a complex fluid density is visualized in the Portal vein on initial imaging. This will increase the odds of early identification of fistulization and subsequent planning for further management which is typically endoscopic or surgical depending on the severity of the presentation.

COMPARATIVE ANALYSIS IMAGE RESULTS OF PANCREAS IN PORTAL VEIN PHASE ON CT SCAN ABDOMEN CONTRAST WITHOUT AND WITH MINIMUM INTENSITY PROJECTION IN CT SCAN 64 SLICE

Background: Minimum Intensity Projection is a post-proccesing technique on CT Scan that useful for showing structures with low Hounsfiled Unit (HU) values such as pancreas. To demonstrate the anatomy and pathology of the pancreatic organs, a contrast CT scan was performed on pancreatic phase but pancreatic phase was rarely used, so it was replaced by the portal venous phase, but this technique is still rarely used among the radiographers. Objective: This study aimed to prove the image of the portal venous pancreatic vein on contrast contrast CT scan by using minimum intensity projection (MinIP) on CT scan 64 slices will produce a more optimal image than without the minimum intensity projection (MinIP). Methods: This study is a retrospective study with an observational analytic method to assess differences of pancreatic image in contrasting contrast CT scans with and with MinIP reforms on CT 64 slice modalities Philips Briliance. 30 images as samples, with the criteria set by the researchers. The image will be post proccesing without and by using MinIP reformat. Image results will be evaluated by two radiologist, then the data obtained will be tabulated and processed using SPSS software version 17. Result: From this research obtained the result that MinIP reformat able to produce pancreas image more optimal than image without MinIP reformat on CT scan 64 slice and shows a significant difference. Overall assessment of the image has an improvement with the MinIP but for the homogeneity of pancreatic images decreased. Conclusions: There was a significant difference between pancreatic venous porta port results in contrasting CT scans of the abdomen without and with MinIP reformat.

Feasibility of Laparoscopic Combined Para-Orthotopic Pancreas and Orthotopic Kidney Transplantation: Initial Research with a Pig Model.

BackgroundThe aim of this study was to investigate the feasibility of laparoscopic combined para-orthotopic pancreas and orthotopic kidney transplantation in a pig model.Material/MethodsTwelve white female pigs, (4–5 months old, weight range 40–45 kg) were used as donors and recipients, and 6 laparoscopic-combined pancreas and kidney transplantations were performed. After bilateral nephrectomy, the pancreatic artery and vein were anastomosed to the right renal artery and vein, respectively, and the pancreatic fluid was diverted to the duodenum or jejunum. The renal artery and vein were anastomosed to the left renal artery and vein, respectively. The ureter (or kidney pelvis) was anastomosed to the left native ureter (or kidney pelvis). The data of the operations were recorded, and grafts were inspected at autopsy.ResultsFour of the 6 recipient pigs underwent the entire procedure. The duodenum-to-duodenum anastomosis was unfinished in 1 case, and both the duodenum-to-duodenum and renal pelvis-to-pelvis anastomoses were left unperformed in another case. The mean recipient operative time was 429±43 minutes. The mean venous and arterial anastomotic times were 69±15 minutes and 37±18 minutes, respectively, for pancreas transplantation and 56±09 minutes and 42±06 minutes, respectively, for kidney transplantation. The time for renal pelvis-to-pelvis anastomosis was 56±13 minutes and for duodenum-to-duodenum anastomosis was 90±13 minutes. The mean blood loss for recipient pigs was 98±35 mL. An immediate viable blood supply was seen in the 4 pancreatic grafts and in the 5 kidney grafts during the operation by the appearance of a bright red color after revascularization. Five pancreatic grafts had autopsy-proven reliable artery anastomoses and 4 reliable vein anastomoses. All 6 kidney grafts had autopsy-proven reliable artery anastomoses; however, 1 had a vein anastomotic stricture.ConclusionsOur study showed that laparoscopic-combined para-orthotopic pancreas and orthotopic kidney transplantation in pigs is surgically possible.

Neoadjuvant FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer: An intention to treat analysis

ObjectiveTo assess clinical and pathologic efficacy of neoadjuvant FOLFIRINOX for locally advanced (LAPC) and borderline resectable pancreatic cancer (BRPC). MethodsPatients receiving neoadjuvant FOLFIRINOX for LAPC and BRPC treated between 2014 and 2017 were identified. Post-treatment patients achieving resectability were referred for surgery, whereas unresectable patients continued chemotherapy. Clinical and pathological data were retrospectively compared with control group consisting of 47 consecutive patients with BRPC undergoing pancreatic and portal vein resection between 2008 and 2017. ResultsThirty LAPC and 23 BRPC patients were identified. Reasons for unresectability included disease progression (70%), locally unresectable disease (18%), and poor performance status (11%). Three patients (10%) with LAPC, and 20 (87%) with BRPC underwent curative surgery. Compared with control group, perioperative complication rate (4.3% versus 28.9%, p = 0.016), and pancreatic fistula rate (0 versus 14.8%, p = 0.08) were lower. Peripancreatic fat invasion (52.2% vs 97.8%, p = 0.001), lymph node involvement (22% vs 54.3%, p = 0.01), and surgical margin involvement (0 vs 17.4%, p = 0.04) were higher in the control group. Median survival was 34.3 months in BRPC patients operated after FOLFIRINOX and 26.1 months in the control group (p = 0.07). Three patients (13%) with complete pathological response are disease-free after mean follow-up of 19 months. ConclusionsWhereas neoadjuvant FOLFIRINOX rarely achieves resectability in patients with LAPC (10%), most BRPC undergo resection (87%). Neoadjuvant FOLFIRINOX leads to complete pathological response in 13% of cases, tumor downstaging, and a trend towards improved survival compared with patients undergoing up-front surgery.

Disappearance of recurrent pancreatitis after splenectomy in familial chylomicronemia syndrome

Background and aimsRecurrent pancreatitis is a severe complication of familial chylomicronemia syndrome (FCS) mainly secondary to lipoprotein lipase deficiency. The mechanism and interindividual variability of pancreatitis in FCS are not fully understood, but abnormalities in the drainage system of pancreatic veins could be involved. Methods and resultsTwo cases of typical FCS are described with a past history of recurrent pancreatitis that dramatically improved after splenectomy performed in both cases for reasons non-related to FCS. ConclusionsThese are the first reports of the disappearance of pancreatitis after splenectomy in FCS and they should be considered of anecdotal nature at this time. The disappearance of pancreatitis following splenectomy could be in part due to subsequent improvements in pancreatic drainage. Extrahepatic portal hypertension induced by hypertriglyceridemic splenomegaly leading to pancreatic congestion could also be a contributing factor.