Objective: To improve the method of pancreaticoduodenal transplantation and to establish a more physiological rat model. Methods: SD rats served as donors and recipients. The vein was reconstructed by end-to-side anas...Objective: To improve the method of pancreaticoduodenal transplantation and to establish a more physiological rat model. Methods: SD rats served as donors and recipients. The vein was reconstructed by end-to-side anastomosis between the donor portal vein and the recipient superior mesenteric vein, and arterial reconstruction was carried out by end-to-side anastomosis of the donor to the recipient abdominal aorta. Enteric drainage was performed by side-to-side anastomosis between the duodenum of donors and that of recipients. Results: Fifty experiments were performed. The successful rate of transplantation which restored the recipients euglycemia were 78%. Conclusion: This model of pancreaticoduodenal transplantation in rats was stable and reliable, which was in accordance with the trend of clinical pancreas transplantation and could be applied for further scientific research.展开更多
Pancreaticoduodenal artery aneurysms are a rare type of visceral artery aneurysm, whose rupture is associated with high mortality. These aneurysms are of particular interest because local haemodynamic change caused by...Pancreaticoduodenal artery aneurysms are a rare type of visceral artery aneurysm, whose rupture is associated with high mortality. These aneurysms are of particular interest because local haemodynamic change caused by coeliac artery obstruction plays an important role in their development. However, the pathophysiological mechanism of coeliac artery obstruction is not completely understood. Pressure from the median arcuate ligament is most frequently reported cause. Although it is well-known that stenosis or occlusion of the visceral vessels may be caused by aortic syndrome, reports of pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion due to aortic syndrome are extremely rare. Our case indicates a new aetiology for a pancreaticoduodenal artery aneurysm and demonstrates the rapid deterioration of the patient affected.展开更多
BACKGROUND Pancreaticoduodenal artery (PDA) aneurysms are extremely rare. The complicated clinical presentations and high incidence of rupture make it difficult to diagnose and treat. PDA pseudoaneurysms often rupture...BACKGROUND Pancreaticoduodenal artery (PDA) aneurysms are extremely rare. The complicated clinical presentations and high incidence of rupture make it difficult to diagnose and treat. PDA pseudoaneurysms often rupture into the gastrointestinal tract and result in life-threatening gastrointestinal hemorrhage. CASE SUMMARY A 69-year-old man was admitted to our hospital due to right upward abdominal pain. A computed tomography (CT) scan demonstrated acute cholecystitis and cholecystolithiasis. Percutaneous gallbladder drainage was performed subsequently. He was discharged after 3 d and readmitted to hospital for cholecystectomy as arranged 1 mo later. A repeat CT scan revealed an emerging enhancing mass between the pancreatic head and the descending duodenum. Then, he suffered hematochezia and hemorrhagic shock suddenly. Emergency percutaneous angiogram was performed and selective catheterization of the superior mesenteric artery demonstrated a pseudoaneurysm in the inferior PDA. Coil embolization was performed and his clinical condition improved quickly after embolization and blood transfusion. He underwent laparoscopic cholecystectomy and was discharged from hospital after surgery under satisfactory conditions. CONCLUSION PDA pseudoaneurysms are uncommon. Acute haemorrhage is a severe complication of pseudoaneurysm with high mortality which clinicians should pay attention to.展开更多
INTRODUCTIONThe use of combined pancreatic and renaltransplantation in patients with diabetes and end-stage renal failure has gained widespreadrecognition as an acceptable treatment option.Theprevailing method used fo...INTRODUCTIONThe use of combined pancreatic and renaltransplantation in patients with diabetes and end-stage renal failure has gained widespreadrecognition as an acceptable treatment option.Theprevailing method used for transplantation of thepancreas involves anastomosis of the graft’s portalvein and the rccipient’s iliac vein to provide展开更多
Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery(SMA) stenosis were previously described and both were treated surgically.However,for interventional treatment,securing...Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery(SMA) stenosis were previously described and both were treated surgically.However,for interventional treatment,securing a sufficient blood supply to the SMA should be a priority of treatment.We present the case of a 71-year-old male with a 20 mm diameter pancreaticoduodenal arterial aneurysm accompanied by SMA stenosis at its origin.The guidewire traverse from SMA to the aneurysm was difficult because of the tight SMA stenosis;however,the guidewire traverse from the celiac artery was finally successful and was followed by balloon angioplasty using a pull-through technique,leading to stent placement.Thereafter,coil packing through the SMA achieved eradication of the aneurysm without bowel ischemia.At the last follow-up computed tomography 8 mo later,no recurrence of the aneurysm was confirmed.The pull-through technique was useful for angioplasty for tight SMA stenosis in this case.展开更多
Background: While the safety of pancreaticoduodenectomy (PD) has improved, the high level of difficulty associated with this operation means that the procedure carries a high mortality rate compared to other gastroint...Background: While the safety of pancreaticoduodenectomy (PD) has improved, the high level of difficulty associated with this operation means that the procedure carries a high mortality rate compared to other gastrointestinal operations. Various trials have been implemented in efforts to reduce the incidence of complications after PD. In particular, a large amount of intraoperative bleeding and the use of red blood cell transfusions are reportedly risk factors for postoperative complications after PD. Aim: In an attempt to reduce the amount of intraoperative bleeding during PD, consideration was given to the anatomical characteristics of the region of the pancreatic head, and the gastroduodenal artery (GDA) and inferior pancreaticoduodenal artery (IPDA) were ligated in advance of separating the head from the portal vein. We herein report the use of ultrasonography during PD to facilitate the early identification and ligation of the IPDA. Case Presentation: A 72-year-old female was diagnosed with pancreatic cancer and underwent pylorus-preserving pancreatoduodenectomy. We used ultrasonography during the operation to initially identify the IPDA and then ligate it in advance, after which the GDA was ligated before separating the pancreatic head from the superior mesenteric artery and portal vein. Identification of the IPDA was performed with the SMA as a guide using ultrasonography in Doppler mode. The amount of intraoperative bleeding was 235 ml. The patient left the hospital without any postoperative complications and has since demonstrated a good postoperative course, with no evidence of recurrent disease. Conclusions: Early ligation of the IPDA using intraoperative US is non-invasive and makes it simple to identify the IPDA. This method may be a useful technique for reducing intraoperative bleeding during the normal course of PD procedures.展开更多
Pancreaticoduodenal artery pseudoaneurysm is one kind of rare splanchnic artery aneurysm. Hemorrhage from the lesion could be life-threatening. We present a case which color Doppler ultrasound and computed tomography ...Pancreaticoduodenal artery pseudoaneurysm is one kind of rare splanchnic artery aneurysm. Hemorrhage from the lesion could be life-threatening. We present a case which color Doppler ultrasound and computed tomography angiography （CTA） only showed pancreatic pseudocyst on the background of chronic pancreatitis at first, but contrast-enhanced ultrasound detected blood flow in the pseudocyst and a pancreaticoduodenal artery pseudoaneurysm was worked up several days after. Finally, the pancreaticoduodenal artery pseudoaneurysm was confirmed by digital subtracted angiography. It might suggest the potential advantage of contrast-enhanced ultrasound in evaluating this kind of disease in comparison of CTA.展开更多
BACKGROUND Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis(CP)or necrotizing pancreatitis with an incidence of 4%to 17%,but it is potentially life-threatening.It is well known that mo...BACKGROUND Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis(CP)or necrotizing pancreatitis with an incidence of 4%to 17%,but it is potentially life-threatening.It is well known that most pancreatic pseudoaneurysms are clinically associated with pancreatic pseudocysts and are usually in the peripancreatic body-tail.A minority of intrapancreatic pseudoaneurysms occur in the absence of pseudocyst formation.Noninvasive computed tomography(CT)and magnetic resonance imaging(MRI)are most commonly used examinations for screening pancreatic pseudoaneurysms.Notably,the rare intrapancreatic pseudoaneurysm in the pancreatic head can mimic a hypervascular solid mass and be misdiagnosed as a pancreatic tumor.CASE SUMMARY We report the case of a 67-year-old man who had been admitted to our hospital due to recurrent abdominal pain for 1 mo that was aggravated for 5 d.CT and MRI revealed a mass in the pancreatic head with significant expansion of the main pancreatic duct and mild atrophy of the pancreatic body-tail.He was admitted to the department of hepatobiliary and pancreatic surgery due to the possibility of a pancreatic tumor.The patient was then referred for endoscopic ultrasonography(EUS)with possible EUS-FNA.However,EUS showed a cystic lesion in the pancreatic head with wall thickness and enhancing nodules,which was doubtful because it was inconsistent with the imaging findings.Subsequently,color doppler flow imaging demonstrated turbulent arterial blood flow in the cystic lesion and connection with the surrounding vessel.Therefore,we highly suspected the possibility of CP complicated with intrapancreatic pseudoaneurysm,combined with the patient's long-term drinking history and the sonographic features of CP.Indeed,angiography revealed an oval area of contrast medium extravasation(size:1.0 cm×1.5 cm)at the far-end branch of the superior pancreaticoduodenal artery,and angiographic embolization was given immediately at the same time.CONCLUSION EUS is an important differential diagnostic tool when pancreatic pseudoaneurysm mimics the imaging appearance of a hypervascular pancreatic tumor.展开更多
BACKGROUND Median arcuate ligament syndrome(MALS)is relatively rare and is due to extraluminal compression of the coeliac artery by the median arcuate ligament of the diaphragm.Here,we report a case of MALS found in a...BACKGROUND Median arcuate ligament syndrome(MALS)is relatively rare and is due to extraluminal compression of the coeliac artery by the median arcuate ligament of the diaphragm.Here,we report a case of MALS found in a patient with abdominal pain and retroperitoneal haemorrhage for education and dissemination.CASE SUMMARY This article describes a 46-year-old female patient who was admitted to our hospital with abdominal pain as her chief complaint.She had experienced no obvious symptoms but had retroperitoneal bleeding during the course of the disease.Contrast-enhanced computed tomography(CT)and noninvasive CT angiography(CTA)led to an initial misdiagnosis of pancreaticoduodenal artery aneurysm(PDAA)causing retroperitoneal hemorrhage.After intraoperative exploration and detailed analysis of enhanced CT and CTA images,a final diagnosis of MALS was made.The cause of the haemorrhage was bleeding from a branch of the gastroduodenal artery,not rupture of a PDAA.The prognosis of MALS combined with PDAA treated by laparoscopy and interventional therapy is still acceptable.The patient was temporarily treated by gastroduodenal suture haemostasis and was referred for further treatment.CONCLUSION MALS is very rare and usually has postprandial abdominal pain,upper abdominal murmur,and weight loss.It is diagnosed by imaging or due to complications.When a patient has abdominal bleeding or PDAA,we should consider whether the patient has celiac trunk stenosis(MALS or other etiology).When abdominal bleeding is combined with an aneurysm,we generally think of aneurysm rupture and hemorrhage first,but it may also be collateral artery rupture and hemorrhage.展开更多
文摘Objective: To improve the method of pancreaticoduodenal transplantation and to establish a more physiological rat model. Methods: SD rats served as donors and recipients. The vein was reconstructed by end-to-side anastomosis between the donor portal vein and the recipient superior mesenteric vein, and arterial reconstruction was carried out by end-to-side anastomosis of the donor to the recipient abdominal aorta. Enteric drainage was performed by side-to-side anastomosis between the duodenum of donors and that of recipients. Results: Fifty experiments were performed. The successful rate of transplantation which restored the recipients euglycemia were 78%. Conclusion: This model of pancreaticoduodenal transplantation in rats was stable and reliable, which was in accordance with the trend of clinical pancreas transplantation and could be applied for further scientific research.
文摘Pancreaticoduodenal artery aneurysms are a rare type of visceral artery aneurysm, whose rupture is associated with high mortality. These aneurysms are of particular interest because local haemodynamic change caused by coeliac artery obstruction plays an important role in their development. However, the pathophysiological mechanism of coeliac artery obstruction is not completely understood. Pressure from the median arcuate ligament is most frequently reported cause. Although it is well-known that stenosis or occlusion of the visceral vessels may be caused by aortic syndrome, reports of pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion due to aortic syndrome are extremely rare. Our case indicates a new aetiology for a pancreaticoduodenal artery aneurysm and demonstrates the rapid deterioration of the patient affected.
文摘BACKGROUND Pancreaticoduodenal artery (PDA) aneurysms are extremely rare. The complicated clinical presentations and high incidence of rupture make it difficult to diagnose and treat. PDA pseudoaneurysms often rupture into the gastrointestinal tract and result in life-threatening gastrointestinal hemorrhage. CASE SUMMARY A 69-year-old man was admitted to our hospital due to right upward abdominal pain. A computed tomography (CT) scan demonstrated acute cholecystitis and cholecystolithiasis. Percutaneous gallbladder drainage was performed subsequently. He was discharged after 3 d and readmitted to hospital for cholecystectomy as arranged 1 mo later. A repeat CT scan revealed an emerging enhancing mass between the pancreatic head and the descending duodenum. Then, he suffered hematochezia and hemorrhagic shock suddenly. Emergency percutaneous angiogram was performed and selective catheterization of the superior mesenteric artery demonstrated a pseudoaneurysm in the inferior PDA. Coil embolization was performed and his clinical condition improved quickly after embolization and blood transfusion. He underwent laparoscopic cholecystectomy and was discharged from hospital after surgery under satisfactory conditions. CONCLUSION PDA pseudoaneurysms are uncommon. Acute haemorrhage is a severe complication of pseudoaneurysm with high mortality which clinicians should pay attention to.
基金a grant from the Army Medical Science and Technology Research,No.96Z002
文摘INTRODUCTIONThe use of combined pancreatic and renaltransplantation in patients with diabetes and end-stage renal failure has gained widespreadrecognition as an acceptable treatment option.Theprevailing method used for transplantation of thepancreas involves anastomosis of the graft’s portalvein and the rccipient’s iliac vein to provide
文摘Two cases with a pancreaticoduodenal arterial aneurysm accompanied with superior mesenteric artery(SMA) stenosis were previously described and both were treated surgically.However,for interventional treatment,securing a sufficient blood supply to the SMA should be a priority of treatment.We present the case of a 71-year-old male with a 20 mm diameter pancreaticoduodenal arterial aneurysm accompanied by SMA stenosis at its origin.The guidewire traverse from SMA to the aneurysm was difficult because of the tight SMA stenosis;however,the guidewire traverse from the celiac artery was finally successful and was followed by balloon angioplasty using a pull-through technique,leading to stent placement.Thereafter,coil packing through the SMA achieved eradication of the aneurysm without bowel ischemia.At the last follow-up computed tomography 8 mo later,no recurrence of the aneurysm was confirmed.The pull-through technique was useful for angioplasty for tight SMA stenosis in this case.
文摘Background: While the safety of pancreaticoduodenectomy (PD) has improved, the high level of difficulty associated with this operation means that the procedure carries a high mortality rate compared to other gastrointestinal operations. Various trials have been implemented in efforts to reduce the incidence of complications after PD. In particular, a large amount of intraoperative bleeding and the use of red blood cell transfusions are reportedly risk factors for postoperative complications after PD. Aim: In an attempt to reduce the amount of intraoperative bleeding during PD, consideration was given to the anatomical characteristics of the region of the pancreatic head, and the gastroduodenal artery (GDA) and inferior pancreaticoduodenal artery (IPDA) were ligated in advance of separating the head from the portal vein. We herein report the use of ultrasonography during PD to facilitate the early identification and ligation of the IPDA. Case Presentation: A 72-year-old female was diagnosed with pancreatic cancer and underwent pylorus-preserving pancreatoduodenectomy. We used ultrasonography during the operation to initially identify the IPDA and then ligate it in advance, after which the GDA was ligated before separating the pancreatic head from the superior mesenteric artery and portal vein. Identification of the IPDA was performed with the SMA as a guide using ultrasonography in Doppler mode. The amount of intraoperative bleeding was 235 ml. The patient left the hospital without any postoperative complications and has since demonstrated a good postoperative course, with no evidence of recurrent disease. Conclusions: Early ligation of the IPDA using intraoperative US is non-invasive and makes it simple to identify the IPDA. This method may be a useful technique for reducing intraoperative bleeding during the normal course of PD procedures.
文摘Pancreaticoduodenal artery pseudoaneurysm is one kind of rare splanchnic artery aneurysm. Hemorrhage from the lesion could be life-threatening. We present a case which color Doppler ultrasound and computed tomography angiography （CTA） only showed pancreatic pseudocyst on the background of chronic pancreatitis at first, but contrast-enhanced ultrasound detected blood flow in the pseudocyst and a pancreaticoduodenal artery pseudoaneurysm was worked up several days after. Finally, the pancreaticoduodenal artery pseudoaneurysm was confirmed by digital subtracted angiography. It might suggest the potential advantage of contrast-enhanced ultrasound in evaluating this kind of disease in comparison of CTA.
基金Supported by Guizhou Provincial Basic Research Program(Natural Science),No.QIAN KE HE JI CHU-ZK(2023)YI BAN 558Collaborative Innovation Center of Chinese Ministry of Education,No.2020-39.
文摘BACKGROUND Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis(CP)or necrotizing pancreatitis with an incidence of 4%to 17%,but it is potentially life-threatening.It is well known that most pancreatic pseudoaneurysms are clinically associated with pancreatic pseudocysts and are usually in the peripancreatic body-tail.A minority of intrapancreatic pseudoaneurysms occur in the absence of pseudocyst formation.Noninvasive computed tomography(CT)and magnetic resonance imaging(MRI)are most commonly used examinations for screening pancreatic pseudoaneurysms.Notably,the rare intrapancreatic pseudoaneurysm in the pancreatic head can mimic a hypervascular solid mass and be misdiagnosed as a pancreatic tumor.CASE SUMMARY We report the case of a 67-year-old man who had been admitted to our hospital due to recurrent abdominal pain for 1 mo that was aggravated for 5 d.CT and MRI revealed a mass in the pancreatic head with significant expansion of the main pancreatic duct and mild atrophy of the pancreatic body-tail.He was admitted to the department of hepatobiliary and pancreatic surgery due to the possibility of a pancreatic tumor.The patient was then referred for endoscopic ultrasonography(EUS)with possible EUS-FNA.However,EUS showed a cystic lesion in the pancreatic head with wall thickness and enhancing nodules,which was doubtful because it was inconsistent with the imaging findings.Subsequently,color doppler flow imaging demonstrated turbulent arterial blood flow in the cystic lesion and connection with the surrounding vessel.Therefore,we highly suspected the possibility of CP complicated with intrapancreatic pseudoaneurysm,combined with the patient's long-term drinking history and the sonographic features of CP.Indeed,angiography revealed an oval area of contrast medium extravasation(size:1.0 cm×1.5 cm)at the far-end branch of the superior pancreaticoduodenal artery,and angiographic embolization was given immediately at the same time.CONCLUSION EUS is an important differential diagnostic tool when pancreatic pseudoaneurysm mimics the imaging appearance of a hypervascular pancreatic tumor.
文摘BACKGROUND Median arcuate ligament syndrome(MALS)is relatively rare and is due to extraluminal compression of the coeliac artery by the median arcuate ligament of the diaphragm.Here,we report a case of MALS found in a patient with abdominal pain and retroperitoneal haemorrhage for education and dissemination.CASE SUMMARY This article describes a 46-year-old female patient who was admitted to our hospital with abdominal pain as her chief complaint.She had experienced no obvious symptoms but had retroperitoneal bleeding during the course of the disease.Contrast-enhanced computed tomography(CT)and noninvasive CT angiography(CTA)led to an initial misdiagnosis of pancreaticoduodenal artery aneurysm(PDAA)causing retroperitoneal hemorrhage.After intraoperative exploration and detailed analysis of enhanced CT and CTA images,a final diagnosis of MALS was made.The cause of the haemorrhage was bleeding from a branch of the gastroduodenal artery,not rupture of a PDAA.The prognosis of MALS combined with PDAA treated by laparoscopy and interventional therapy is still acceptable.The patient was temporarily treated by gastroduodenal suture haemostasis and was referred for further treatment.CONCLUSION MALS is very rare and usually has postprandial abdominal pain,upper abdominal murmur,and weight loss.It is diagnosed by imaging or due to complications.When a patient has abdominal bleeding or PDAA,we should consider whether the patient has celiac trunk stenosis(MALS or other etiology).When abdominal bleeding is combined with an aneurysm,we generally think of aneurysm rupture and hemorrhage first,but it may also be collateral artery rupture and hemorrhage.
