Septic Embolism: A Potentially Devastating Complication of Infective Endocarditis

Infective endocarditis is associated with significant cardiac and noncardiac morbidity. Among many complications, septic embolism has the potential of causing devastating sequelae and even life-threatening clinical situations. This dreaded clinico-pathologic entity is characterized by its heterogeneous presentation and the ability to affect various body systems and organs. Septic emboli to the brain, kidneys, spleen, and the pulmonary system constitute the vast majority of metastatic infections. However, other organ systems can also be affected. This chapter provides an overview of septic embolism associated with infective endocarditis, focusing on key diagnostic and therapeutic considerations in the most commonly seen and clinically relevant scenarios

Intraductal oncocytic papillary neoplasm of the extrahepatic biliary tree: first report

Tumors with oncocytic differentiation may occur in a variety of organs, but are extremely rare in the biliary system. Intraductal oncocytic papillary neoplasms (IOPNs) were first described in the pancreas to differentiate a rare subset of pancreatic neoplasm from the intraductal papillary mucinous neoplasms (IPMNs). IOPN of the extrahepatic biliary tree has not been previously described. We describe the first case of an intraductal oncocytic papillary neoplasm at the bifurcation of the common hepatic duct in a 52-year-old white male with a two-year history of intermittent biliary obstruction

Recent Trends in the Management of Combined Pancreatoduodenal Injuries

In an effort to better characterize the natural history of pancreatoduodenal injuries, we present a review of clinical experiences in the treatment of combined traumatic pancreatoduodenal injuries, focusing on patients in extremis. Records of patients with abdominal trauma admitted to a level 1 trauma center from 1997 to 2001 were reviewed. Of 240 patients who sustained a pancreatic or duodenal injury, 33 had combined pancreatoduodenal injuries. Eighty-two per cent of the patients (27/33) in this series had penetrating injuries, 72 per cent (24) sustained gunshot wounds (GSW). Thirty-one patients were male, and the mean age was 33 years (range, 7–74). These patients presented with an average Injury Severity Score (ISS) of 22 ± 12 and an average Glasgow Coma Score of 14 ± 2. Overall length of stay was 39 ± 59 days (range, 0–351 days). These 33 patients underwent a total of 57 laparotomies with an average of 1.7 operations per patient (range, 1 to 5 operations). Eighty-four per cent of the patients had an associated gastrointestinal injury and 45 per cent had a major vascular injury. Thirteen of the 33 (39%) patients presented in extremis, all 13 underwent an abbreviated laparotomy. The complication rate was 36 per cent, including fistula, abscess, pancreatitis, and organ dysfunction. There were 6 hospital deaths for a mortality rate of 18 per cent. Pancreatoduodenal injuries are associated with a variety of other serious injuries, which add to the overall complexity of these patients. Abbreviated laparotomy may be helpful when managing combined pancreatoduodenal injuries in patients who are in extremis