11 research outputs found
Insulinoma Identified in Puerperium: Association with Pregnancy and Literature Review
Postpartum hypoglycemia in non-diabetic women is a rare condition. We report the case of a 34-year-old woman who experienced neuroglycopenia 2 days after delivery. Corresponding to severe hypoglycemia, we found inappropriately elevated insulin and C-peptide levels. Following magnetic resonance imaging a lesion of 10×8 mm was detected in the head of the pancreas. An ultrasound-guided fine needle aspiration of the mass confirmed the diagnostic suspicion of a pancreatic neuroendocrine tumor. Complete surgical enucleation of the insulinoma resulted in immediate and permanent resolution of the hypoglycemia. The postoperative course was uneventful. Histopathological and immunohistochemical analyses were consistent with insulinoma. The diagnostic approach to postpartum hypoglycemia represents a challenge for multidisciplinary teamwork
Pancreatic transection from blunt trauma associated with vascular and biliary lesions: A case report
Major injuries of the pancreas may result in considerable morbidity and mortality when associated with vascular and visceral injuries. In such cases, a right diagnosis and a prompt surgical intervention are necessary to give a chance to the patient. We herein describe a case of blunt abdominal trauma in a 29-year-old man whose pancreatic rupture was associated with hepatic artery, splenic vein and extrahepatic bile duct damage. Immediate surgery was performed after computer tomography (CT), the haemorrhagic lesions dictate the emergency transfer to the operating room. Spleno-pancreatic resection was done with reconstruction of the hepatic artery, ligation of the splenic vein and a Roux-en-Y bilio-jejunal diversion. The early post-operative course was complicated by stenosis of the arterial reconstruction, which was treated by endovascular angioplasty followed by percutaneous drainage of symptomatic pseudocyst, rest and antibiotics. Finally, the patient was discharged and was alive without clinical problems at the time when we wrote this case report. The present case underlines the clinical relevance of vascular and visceral injuries associated with pancreatic trauma and the problems arising in the diagnostic evaluation and the surgical strategy of complex multiple visceral and vascular lesions in blunt abdominal trauma
Factors influencing outcomes in laparoscopic adrenal surgery.
This study aims to recognize factors affecting operative and postoperative outcomes in patients undergoing unilateral laparoscopic adrenalectomy performed by using the transabdominal approach.
From a prospectively collected adrenal database, we performed a retrospective analysis of all patients undergoing unilateral adrenalectomy from July 2002 to December 2011. The outcome measures considered were the following: conversion rate, intra- and postoperative complications, duration of surgery, length of hospital stay, and return-to-work time. Demographic data, American Society of Anesthesiologists score, characteristics of adrenal tumor, and operative and postoperative variables were analyzed to assess their influence on the outcome variables.
A total of 163 laparoscopic adrenalectomies were included. Intraoperative complications, conversion to laparotomy, and postoperative complications were observed in 6.7, 6.1, and 1.8 % of cases, respectively. Conversion to open surgery, intraoperative complications, metastasis, and pheochromocytoma were found to be predictive factors for operative time of > 140 min. An operative duration of > 140 min was associated with intraoperative complications. Tumor size, intraoperative complications, and adrenalectomy for metastasis significantly increased conversion rate. Hospital stay was extended by operative time of > 140 min, conversion to laparotomy, and postoperative complications.
Our study highlights that simple clinical variables, long procedures, and operative complications have a negative impact on procedural outcomes. Based on this, it may be possible to predict cases requiring collaboration with experienced surgeons in order to minimize perioperative morbidity