Necrosis of the duodenal wall with retroperitoneal perforation as a complication of perirenal abcess. Case report and management

Duodenal perforation is a rare and severe acute surgical condition which commonly follows the complications of endoscopic and laparoscopic procedures. Small degree of damage in this mechanism and an early diagnosis allow for an effective primary management. The most difficult surgical challenge is an effective management of retroperitoneal duodenal perforation together with coexisting pathological changes of its wall. In this work we present a case of duodenal necrosis with excessive necrosis of a fragment of its wall due to perinephric abscess, with an effective method of management of a defect in an isolated free small intestinal loop in association with gastroduodenal passage exclusion

Martwica ściany dwunastnicy z perforacją do przestrzeni zaotrzewnowej w przebiegu ropnia okołonerkowego. Opis przypadku i sposób zaopatrzenia

Perforacja dwunastnicy jest rzadkim i groźnym ostrym stanem chirurgicznym, do którego dochodzi zazwyczaj w wyniku powikłania zabiegów endoskopowych oraz laparoskopowych. Niewielki rozmiar uszkodzeń powstałych w tym mechanizmie i wczesne rozpoznanie pozwala na ich skuteczne pierwotne zaopatrzenie. Najtrudniejszym wyzwaniem chirurgicznym jest skuteczne zaopatrzenie perforacji części zaotrzewnowej dwunastnicy ze współistniejącymi zmianami patologicznymi jej ściany. W niniejszej pracy przedstawiono przypadek perforacji dwunastnicy z rozległą martwicą fragmentu jej ściany, powstałej w przebiegu ropnia okołonerkowego, oraz skuteczną metodę zaopatrzenia ubytku na wyizolowanej wolnej pętli jelita cienkiego w skojarzeniu z wyłączeniem pasażu żołądkowo-dwunastniczego

Comparison of Early Results of Surgical Treatment in Patients with Pancreatic Cancer

Pancreatic tumours are a serious medical and social issue. Patients come to the doctor too late, when the disease is well advanced. The most frequently applied method of surgical treatment is pancreatoduodenectomy (Whipple procedure). The most frequently used technique of pancreatoduodenectomy is the Child-Waugh method. The procedure can be performed in a classic way or as modified by Traverso (with preservation of the pylorus).Material and methods. Between August 2008 and June 2011, in the Department of Thoracic, General and Oncologic Surgery of Medical University in Łódź, a total of 79 patients with pancreatic tumours were hospitalized. In 61, pancreatoduodenectomy was performed. The patients were divided into two groups, depending on the diagnosis and the procedures performed: group 1 comprised patients in whom the pylorus was resected (n = 43); group 2 comprised patients in whom the pylorus was preserved (Traverso-Longmire procedure; n = 18).Results. Mean duration of surgery was about 3 hours and 50 minutes in both groups. Mean duration of hospitalization after the procedure was 15.6 days in group 1 and 12.2 days in group 2 (p 0.05).Conclusions. There are specific indications for each method of surgical treatment, however, it seems that both techniques of pancreatic resection can be recommended as standard surgical treatment, and the number of complications after both procedures is similar

Assessment of quality of life in patients with non-operated pancreatic cancer after videothoracoscopic splanchnicectomy

Introduction: Pancreatic tumours are a crucial medical issue. The majority of patients report sick in the late stage ofcarcinoma clinical advancement, which considerably limits the possibility of surgical treatment. Pancreatic cancerpatients with no other alternative but palliative treatment constitute a large group.Aim: To assess pain intensity levels and quality of life of pancreatic cancer patients after videothoracoscopic splanchnicectomy.Material and methods: Between 2001 January and 2010 November in the Department of Thorax, General Surgery andOncology of the Medical University of Lodz 262 patients with pancreatic tumours were hospitalized. In 121 casesgrade 3 and grade 4 tumours were observed. Hundred and twenty-one videothoracoscopic procedures of sympathetictrunk and ganglion excision were performed in 89 patients.Results: Before the procedure the pain intensity level according to VAS was 5.66 (3.9-7.2; SD 1.24) in the trial groupand 5.46 (4.1-7.1; SD 1.15) in the control group. The quality of life average assessment in both groups did not differ statistically(p = 1.07) and was 46.3 (32-66; SD 0.92) in patients before the operation and in the control group 50.3(41-63; SD 0.75). On the 7th postoperative day the pain intensity on average was 2.33 (1.2-3.9; SD 0.78) and 4.57(3.6-5.5; SD 0.69) respectively. One week after the procedure the quality of patients’ life was estimated at 64.1(39-83; SD 1.38) and in the control group at 52.2 (42-65; SD 0.71); the differences are significant (p < 0.05). Thirty daysafter the procedure 12 patients did not t ake any painkillers (13.5%), and in the others a considerable decrease of thetaken drugs was observed. On average, the pain intensity was estimated at 1.78 (0.6-3.6; SD 0.68). The quality of life,on the other hand, improved considerably in relation to the state prior to the procedure, but increased insignificantlyin relation to the state on the 7th postoperative day to 70.9 (52-88; SD 1.14).Conclusions: Splanchnicectomy is a safe method of cancer pain treatment in patients with advanced pancreatictumours. Videothoracoscopic excision of visceral nerve thoracic section contributes to the statistically significantdecrease of cancer pain intensity and considerably improves the quality of patients’ lives