Endocrine cells distribution in human proximal small intestine: an immunohistochemical and morphometrical study

Atrophy of the pancreatic remnant after pancreaticoduodenectomy might be consequent to deregulation of pancreatic endocrine stimuli after duodenal removal. Relative technical surgical solution could be the anastomosis of the 1st jejunal loop to the stomach and the 2nd to the pancreatic stump. Data on the distribution of endocrine cells within the proximal intestine might represent the lacking tile of the problem. Our aims were to investigate the distribution pattern of serotonin, cholecystokinin and secretin cells in the duodenum, the 1st and 2nd jejunal loops of humans. Bowel specimens of ten patients submitted to pancreaticoduodenectomy were collected; immunohistochemical reactions and morphometric analyses were performed. A general ab-oral decrease of enteroendocrine cells was found. The rate of serotonin cells showed a significant 30.67±8.13% reduction starting from the 1st jejunal loop versus duodenum. The rate of both cholecystokinin and secretin cells in the duodenum was superimposable to that in the 1st jejunal loop, with a significant 62.88±4.80% loss of cholecystokinin and 39.5±9.31% of secretin cells in the 2nd loop. After removal of duodenum, preservation of the 1st jejunal loop could impact the function of pancreatic remnant maintaining the physiological enteroendocrine stimulus for pancreatic secretion that can compensate, at least in part for the abolished duodenal hormonal release

Endocrine cells distribution pattern in the proximal small intestine of patients submitted to pancreaticoduodenectomy

The best surgical technique for pancreatic anastomosis after pancraticoduodenectomy (PD) is still debate. It is estimated that the atrophy of the pancreatic remnant is the common evolution after one year after surgical PD [1]. This may also be a consequence of deregulation of pancreatic neurohumoral stimulatory factors after duodenal removal. After PD, in order to maintain the pancreatic exocrine function, has been proposed the recostruction with two jejunal loops [2]: the first jejunal loop to the stomach, and the second jejunal loop to the pancreatic stump (end-to-end pancreatic jejunostomy), and following a hepatic jejunostomy. At the end, the intestinal continuity is restored by an entero-entero anastomosis [3]. Gastric preservation might favour an adequate weight gain after surgery due to higher caloric intake and normal acid secretion acts as a physiologic stimulus to promote the secretion of secretin and cholecystokinin (CCK). Our aims were to investigate the distribution pattern of serotonin-, secretin- and CCK cells in proximal small intestine. Specimens from duodenal, first and second jejunal loop taking from seven male patients submitted to PD were collected and immunohistochemical reaction and morphometrical analysis were performed. We found a general decrease of enteroendocrine cells in the second jejunal loop with a significant reduction of CCK-cells. So after removal of the duodenal source of secretin and CCK, preservation of the first jejunal loop that comes anastomized to the stomach, restores the alimentary circuit and maintain the physiological jejunal secretion of secretin and CCK subsequent to alimentary transit and can compensate (at least in part) for the abolished duodenal hormonal release. This operative procedure may preserve the exocrine and endocrine pancreatic secretion through the maintenance of physiological stimuli

Metastatic renal cell carcinoma invading liver, duodenum and ivc, surgical treatment and literature review. A case report

Renal Cell Carcinoma has a biologic predisposition for direct vascular invasion: intravascular tumor thrombus is found in 5% to 20% of the cases inside the renal vein or the inferior vena cava. Despite new and effective conservative therapy such as targeted therapy and immunotherapy, cytoreductive nephrectomy and palliative nephrectomy continues to have an important role in T4 patient. The patient selection for cytoreductive nephrectomy should be done carefully. This report present an unique case of metastatic RCC with invasion of the duodenum, liver and retrohepatic IVC, the adopted surgical approach and a review of the literature. Complete surgical extirpation is possible in cases of RCC invading other organs such as pancreas, duodenum, liver, retroperitoneum and IVC. In this scenario, to narrow the possible intraoperative complication, a multidisciplinary approach and equipe is recommended