The solid and papillary epithelial neoplasm of the pancreas is a relatively uncommon disease. It accounts for approximately 1 to 2 percent of all exocrine pancreatic tumors. This benign or low grade malignant tumor is reported to occur predominantly in young women and rarely in men. Recurrence and development of metastasis after resection are found only in a small fraction of the general population. A case is herein reported involving a solid and papillary epithelial neoplasm of the pancreas which extensively spread to nearby organs, in a 34 year-old man. Chief complaints were black stool. Physical examination revealed tenderness on the left upper quadrant of the abdomen. Esophagogastroduodenoscopy revealed multiple cardiac variceal bleeding. Abdominal sonography and CAT scan findings showed a huge lobulated mass on the left upper quadrant area with an internal necrotic portion. Surgical findings showed determined a splenic vein tumor thromboembolus, portal vein involvement, distal stomach involvement, and multiple colonic invasion. Therefore, distal pancreatectomy, wedge resection of the stomach, splenetomy, segmental resection of the transverse colon, and excision of the mass were all performed. Pathologic examination revealed a solid and papillary epithelial neoplasm in the pancreatic tail with a marked dilated splenic vein filled with tumor thromboembolus. The patient has been under chemotherapy since then, and is being closely observed.
Abdomen ; Adult ; Animals ; Cats ; Colon ; Colon, Transverse ; Drug Therapy ; Endoscopy, Digestive System ; Esophageal and Gastric Varices ; Female ; Humans ; Male ; Neoplasm Metastasis ; Neoplasms, Glandular and Epithelial* ; Pancreas* ; Pancreatectomy ; Physical Examination ; Portal Vein ; Recurrence ; Splenic Vein ; Stomach

The occurrence of papillary restenosis following endoscopic sphincterotomy is uncommon and usually reported as a late complication. Its frequency varies from 0.8% to 3% and at present, only a few reports describe the late complication rate for a mean follow-up exceeding 10 years. The diameter of the sphincterotomy opening diminishes by about 30% in the first year without further narrowing, suggesting that restenosis occurs mainly during the first post-sphincterotomy year. Papillary restenosis may be promoted by insufficient cutting and may depend on the indication for EST such as common bile duct stones, papillary stenosis, duodenal diverticular, sphincter of Oddi dysfunction. A bleeding sphincterotomy requiring a sclerosing injection is considered a potential risk factor for papillary stenosis. However, stenosis may develop in the absence of specific predisposing factors. A case of papillary restenosis following endoscopic sphincterotomy for gollstone pancreatitis in a 33-year-old female patient is herein reported.
Adult ; Causality ; Common Bile Duct ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Pancreatitis ; Risk Factors ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic

A Pancreaticobiliary fistula is a rare complication of acute necrotizing pancreatitis or pancreatic abscess. One case is herein reported of pancreaticobiliary fistula that was found following removal of pancreatic duct stones by extracorporeal shock-wave lithotripsy and endoscopic sphincterotomy. The patient was a 53-year old woman who was admitted with epigastric pain and fever. Endoscopic retrograde pancreatography revealed multiple stones in the main pancreatic duct. Pus from the pancreatic duct was drained through the major papilla during cannulation. On balloon cholangiogram obtained after removal of the stones, a direct fistulous connection between the main pancreatic duct and distal common bile duct was noted. It is speculated that pancreatic abscess or mechanical compression of pancreatic duct stones may contribute to the destruction of the intrapancreatic bile duct, which leads to the formation of a pancreaticobiliary fistula.
Abscess ; Bile Ducts ; Catheterization ; Common Bile Duct ; Female ; Fever ; Fistula* ; Humans ; Lithotripsy ; Middle Aged ; Pancreatic Ducts* ; Pancreatitis, Acute Necrotizing ; Sphincterotomy, Endoscopic ; Suppuration

Agenesis of dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas. It may be associated with diabetes mellitus, pancreatic exocrine dysfunction, or abdominal pain. Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case is herein described involving a complete agenesis of dorsal pancreas and diabetes mellitus. A 38-year-old man with a 7-months history of non-insulin dependent diabetes mellitus was admitted due to weight loss and abdominal pain. Abdominal ultrasonography and computed tomography showed a normal biliary tree and enlarged head of the pancreas without visualization of the pancreatic body and tail. Endoscopic retrograde cholangiopancreatography (ERCP) revealved the short duct of Wirsung in the uncinate process and a head without opacification of any ducts in the pancreatic body or tail. The patient underwent explo-laparotomy for evaluation of the suspected pancreatic cancer. The patient was diagnosed as having complete agenesis of the dorsal pancreas by ERCP, CT, and surgery.
Abdominal Pain ; Adult ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Diabetes Mellitus ; Endoderm ; Head ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatic Neoplasms ; Ultrasonography ; Weight Loss

Haemosuccus pancreaticus describes the syndrome of gastrointestinal bleeding into the pancreatic duct, manifested by blood loss through the ampulla of Vater. It has been confined mainly to small series or isolated case reports in patients with chronic pancreatitis with pseudocysts. Endoscopy is useful mostly to exclude other sources of hemorrhage but visualization of bleeding from the papilla is a rare event. A case in herein reported of a patient, suffering from bleeding into the pancreatic duct, who had a history of recurrent, chronic pancreatitis with pseudocysts for 6 months. During duodenoscopic examination, bleeding from the papilla of Vater was identified, however the alternative cause was not suggestive. In alcoholic pancreatitis, recurrent eipsodes of acute pancreatitis with pancreatic ductal hemorrhage is a natural history, so resection of the affected segment of the pancreas can be the treatment of choice. A distal pancreatectomy and splenectomy was performed.
Ampulla of Vater ; Endoscopy ; Hemorrhage ; Humans ; Natural History ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatitis ; Pancreatitis, Alcoholic ; Pancreatitis, Chronic ; Splenectomy

Lymphoepithelial cysts of the pancreas are extremely rare cystic lesion characterized by the presence of a mature, squamous epithelial lining surrounded by dense lymphoid tissue. They were first described in 1985 by Lchtrath and Schriefers. A 70-year-old male was admitted with a four month history of intermittent right upper quadrant abdominal pain radiating to the right subscapular area. Physical examination and laboratory studies did not show any abnormal findings. Computed tomography of the abdomen revealed a 2.7 cm well-circumscribed, uniloculated cystic lesion on the tail of the pancreas. Endoscopic retrograde pancreatography showed no abnormalities in the duct system. A distal pancreatectomy with a splenectomy was performed, with a suspected diagnosis of cystic neoplasms of the pancreas. Histopathologic diagnosis was a lymphoepithelial cyst of the pancreas. Although the histogenesis of lymphoepithelial cysts is not fully disclosed, they are benign and can be cured by local excision. This case is reported herein with a review of relevant literature.
Abdomen ; Abdominal Pain ; Aged ; Diagnosis ; Humans ; Lymphoid Tissue ; Male ; Pancreas* ; Pancreatectomy ; Physical Examination ; Splenectomy

Ulcerative colitis is a chronic inflammatory bowel disease manifested by diffuse continuous mucosal and submucosal inflammation. Adenocarcinoma of the colon may be complicated in the long-standing, extensive ulcerative colitis. But the case of an atypical carcinoid tumor arising in the chronic ulcerative colitis has been very rarely reported. A case was experienced involving a 54-year-old woman with chronic ulcerative pancolitis that was complicated by an atypical carcinoid tumor of the sigmoid colon. A small, flat, elevated lesion was found at the sigmoid colon, 8 years after the initial diagnosis of ulcerative colitis had been made. The microscopic finding of the lesion showed the nest of moderately differentiated, medium sized cells with large nuclei. The immunohistochemical stains for cytokeratin, NSE, chromogranin A, and synaptophysin were positive.The patient was treated with a total colectomy accompanied with an ileostomy, and is now in a very favor able state of recovery.
Adenocarcinoma ; Carcinoid Tumor* ; Chromogranin A ; Colectomy ; Colitis, Ulcerative* ; Colon ; Colon, Sigmoid ; Coloring Agents ; Diagnosis ; Female ; Humans ; Ileostomy ; Inflammation ; Inflammatory Bowel Diseases ; Keratins ; Middle Aged ; Synaptophysin ; Ulcer*

Peutz-Jeghers syndrome is a rare disease manifested by a combination of mucocutaneous pigmentation and gastrointestinal polyposis. The major morbidity results from intussusception, obstruction, and bleeding. Standard surgical management has been to perform enterotomies at the site of palpable polyps. A method of treating Peutz-Jeghers syndrome surgically with combined intraoperative enteroscopic polypectomy, is herein presented. The patient had multiple small bowel polyps, one of which was very large and required surgical resection. Segmental resection and multiple enterotomies were performed to remove the polyps. During the course of the operation, endoscope (CF-200I, 130 cm) was inserted per enterotomy site and multiple small bowel polyps were removed endoscopically using a snare. The combined surgical and endoscopic approach for the Peutz- Jeghers syndrome was successful. The procedure removes more accurately, the cause of the major morbidity associated with the disease, and may allow the patient a longer interval between laparotomies.
Endoscopes ; Hemorrhage ; Humans ; Ileum* ; Intussusception ; Laparotomy ; Peutz-Jeghers Syndrome* ; Pigmentation ; Polyps ; Rare Diseases ; SNARE Proteins

Duodenal divertula are relatively frequent findings in the adult gastrointestinal tract. The majority of them are asymptomatic, but vague gastrointestinal complaints have often been attributed to these lesions. These diverticula occasionally result in the obstruction of the biliary and pancreatic ducts, which leads to jaundice and pancreatitis. Other complications such as hemorrhage, perforation, sepsis, and death can occur. With the advent of therapeutic endoscopy, the diagnosis and primary treatment of duodenal diverticula associated with bleeding has changed dramatically since its first reported occurrence. Effectiveness of therapeutic endoscopy is very high in patients with diverticular bleeding in the medial aspect of sencond portion of the duodenum because of its high operative mortality. A cases of a patient suffering from gastrointestinal bleeding in the duodenal diverticulum who was diagnosed and managed by endoscopy alone is herein reported with review of relevant literature.
Adult ; Diagnosis ; Diverticulum* ; Duodenum ; Endoscopy ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Jaundice ; Mortality ; Pancreatic Ducts ; Pancreatitis ; Sepsis

Boerhaave's syndrome is a spontaneous tear through all the layers of the left lateral wall of the esophagus just above the diaphragm, produced by a sudden increase in esophageal pressure. Boerhaave's syndrome is a rare but grave syndrome, with a mortality rate around 40%. Most affected patients are middle-aged men who experience violent vomiting after heavy eating or alcohol intake or both. Vomiting followed by the abrupt onset of pain, dyspnea, and/or shock are the major symptoms. The most important diagnostic tool may be an upright chest X-ray. However, esophagograms and/or a chest CT may be required to locate the lesion. The management of esophagopleural fistula must be individualized, and both the patient's condition and the specific characteristics of the fistula must be considered. Successful management of patients must include adequate nutritional support and effective therapy of the associated empyema. A case of esophagopleural fistula complicated by Boerhaave's syndrome, which was successfully treated by endoscopic injection of Histoacryl , in herein reported.
Diaphragm ; Dyspnea ; Eating ; Empyema ; Enbucrilate* ; Esophagus ; Fistula* ; Humans ; Male ; Mortality ; Nutritional Support ; Shock ; Thorax ; Tomography, X-Ray Computed ; Vomiting