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Successful surgical management of ruptured umbilical hernias in cirrhotic patients

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World Journal of Gastroenterology 2015年第10期21卷 3109-3113页

作者： Nikolaos A Chatzizacharias J Andrew Bradley Simon Harper Andrew Butler asif jah Emmanuel Huguet Raaj K Praseedom Michael Allison Paul Gibbs Department of HPB and Transplant Surgery Addenbrooke’s Hospital NIHR Cambridge Biomedical Research Centre Department of Hepatology Addenbrooke’s Hospital

Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual,but potentially lifethreatening complication,with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical *** options include primary surgical repair with or without concomitant portal venous system decompression for the control of the *** present a retrospective analysis of our centre's experience over the last 6 *** cohort consisted of 11 consecutive patients(median age:53 years,range:36-63 years) with advanced hepatic cirrhosis and refractory *** patient resuscitation and optimisation with intravenous fluids,prophylactic antibiotics and local measures was *** failed attempt for conservative management was followed by a successful primary *** all cases,with one exception,a primary repair with non-absorbable Nylon,interrupted sutures,without mesh,was *** perioperative complication rate was 25% and the recurrence rate 8.3%.No mortality was *** length of hospital stay was 14 d(range:4-31 d).Based on our experience,the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period,provided that meticulous patient optimisation is performed.

关键词： Umbilical hernia Rupture Cirrhosis Ascites Transju

Colonic and anal metastases from pancreato-biliary malignancies

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World Journal of Gastroenterology 2014年第13期20卷 3693-3697页

作者： Farshid Ejtehadi Nikolaos A Chatzizacharias Rebecca J Brais Nigel R Hall Edmund M Godfrey Emmanuel Huguet Raaj K Praseedom asif jah Department of HPB and Transplant Surgery Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridgeshire CB2 0QQUnited Kingdom Department of Histopathology Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridgeshire CB2 0QQUnited Kingdom Cambridge Colorectal Unit Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridgeshireCB2 0QQUnited Kingdom Department of Radiology Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridgeshire CB2 0QQUnited Kingdom

Pancreato-biliary malignancies often present with locally advanced or metastatic *** is the mainstay of treatment although less than 20%of tumours are suitable for resection at *** sites for metastases are liver,lungs,lymph nodes and peritoneal *** disease carries poor prognosis,with median survival of less than 3 *** report two cases where metastases from pancreato-biliary cancers were identified in the colon and anal *** both cases specific immunohistochemical staining was utilised in the *** the first case,the pre-senting complaint was obstructive jaundice due to an ampullary tumour for which a pancreato-duodenectomy was carried ***,the patient re-presented 4wk later with an atypical anal fissure which was found to be metastatic deposit from the primary ampullary *** the second case,the patient presented with obstructive jaundice due to a biliary *** imaging revealed sigmoid thickening,which was confirmed to be a metastatic *** colonic and anorectal metastases from pancreatobiliary cancers are rare and can masquerade as primary colorectal *** key to the diagnosis is the specific immunohistochemical profile of the intestinal lesion biopsies.

关键词： Pancreatobiliary cancer Rare metastatic sites Colonic metastasis Anal metastasis Immunohistochemistry

Endoscopic Ultrasound-guided drainage of an abdominal fluid collection following Whipple's resection

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World Journal of Gastroenterology 2008年第44期14卷 6867-6868页

作者： asif jah Neville Jamieson Emmanuel Huguet William Griffi ths Nicholas Carroll Raaj Praseedom Department of Hepatobiliary and Transplant Surgery Addenbrooke's HospitalCambridge University Hospitals NHS Foundation TrustCambridge CB2 2QQUnited Kingdom Department of Gastroenterology and Hepatology Addenbrooke's HospitalCambridge University Hospitals NHS Foundation TrustCambridge CB2 2QQUnited Kingdom Department of Radiology Addenbrooke's HospitalCambridge University Hospitals NHS Foundation TrustCambridge CB2 2QQUnited Kingdom

Percutaneous aspiration and drainage of post-operative abdominal fluid collections is a well established standard technique. However,some fluid collections are not amenable to percutaneous drainage either due to location or the presence of surrounding visceral structures. Endoscopic Ultrasound (EUS) has been widely used for the drainage of pancreatitis-related abdominal fluid collections. However,there are no reports on the use of this technique in the post-operative setting. We report a case where the EUS-guided technique was used to drain a percutaneously inaccessible post-operative collection which had developed after Whipple's resection.

关键词： Endoscopic ultrasound Pancreatectomy Whipple's resection

Incidental non-benign gallbladder histopathology after cholecystectomy in an United Kingdom population: Need for routine histological analysis?

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World Journal of Gastrointestinal Surgery 2016年第10期8卷 685-692页

作者： Krashna Patel Khaled Dajani Satheesh Iype Nikolaos A Chatzizacharias Saranya Vickramarajah Susan Davies Rebecca Brais Siong S Liau Simon Harper asif jah Raaj K Praseedom Emmanuel L Huguet Department of Surgery Hepato-Pancreato-Biliary Unit Addenbrooke’s Hospital Cambridge CB20XZ United Kingdom Department of Upper Gastrointestinal Surgery Addenbrooke’s Hospital Cambridge CB20XZ United Kingdom Department of Histopathology Addenbrooke’s Hospital Cambridge CB20XZ United Kingdom

AIM To analyse the range of histopathology detected in the largest published United Kingdom series of cholecystectomy specimens and to evaluate the rational for selective histopathological *** Incidental gallbladder malignancy is rare in the United Kingdom with recent literature supporting selective histological assessment of gallbladders after routine *** cholecystectomy gallbladder specimens examined by the histopathology department at our hospital during a five year period between March 2008 and March 2013 were retrospectively *** data was collected on all specimens demonstrating carcinoma,dysplasia and polypoid *** The study included 4027 *** majority(97%) of specimens exhibited gallstone or cholecystitis related *** were demonstrated in 44(1.09%),the majority of which were cholesterol based(41/44).Dysplasia,ranging from low to multifocal high-grade was demonstrated in 55(1.37%).Incidental primary gallbladder adenocarcinoma was detected in 6 specimens(0.15%,5 female and 1 male),and a single gallbladder revealed carcinoma in situ(0.02%).This large single centre study demonstrated a full range of gallbladder disease from cholecystectomy specimens,including more than 1% neoplastic histology and two cases of macroscopically occult gallbladder *** Routine histological evaluation of all elective and emergency cholecystectomies is justified in a United Kingdom population as selective analysis has potential to miss potentially curable life threatening pathology.

关键词： Gallbladder Incidental Cholecystectomy Histopathology Carcinoma

Colorectal liver metastases: Current management and future perspectives

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World Journal of Clinical Oncology 2020年第10期11卷 761-808页

作者： Jack Martin Angelica Petrillo Elizabeth C Smyth Nadeem Shaida Samir Khwaja HK Cheow Adam Duckworth Paula Heister Raaj Praseedom asif jah Anita Balakrishnan Simon Harper Siong Liau Vasilis Kosmoliaptsis Emmanuel Huguet Department of Surgery Addenbrookes HospitalNIHR Comprehensive Biomedical Research and Academic Health Sciences CentreCambridge University Hospitals NHS Foundation TrustCambridge CB20QQUnited Kingdom Department of Precision Medicine Division of Medical OncologyUniversity of Campania"L.Vanvitelli"Napoli 80131Italy&Medical Oncology UnitOspedale del Mare80147 Napoli Italy Department of Oncology Addenbrookes HospitalNIHR Comprehensive Biomedical Research and Academic Health Sciences CentreCambridge University Hospitals NHS Foundation TrustCambridge CB20QQUnited Kingdom Department of Radiology Addenbrookes HospitalNIHR Comprehensive Biomedical Research and Academic Health Sciences CentreCambridge University Hospitals NHS Foundation TrustCambridge CB220QQUnited Kingdom Department of Nuclear Medicine Addenbrookes HospitalNIHR Comprehensive Biomedical Research and Academic Health Sciences CentreCambridge University Hospitals NHS Foundation TrustCambridge CB20QQUnited Kingdom Department of Pathology Addenbrookes HospitalNIHR Comprehensive Biomedical Research and Academic Health Sciences CentreCambridge University Hospitals NHS Foundation TrustCambridge CB20QQUnited Kingdom

The liver is the commonest site of metastatic disease for patients with colorectal cancer,with at least 25%developing colorectal liver metastases(CRLM)during the course of their *** management of CRLM has evolved into a complex field requiring input from experienced members of a multi-disciplinary team involving radiology(cross sectional,nuclear medicine and interventional),Oncology,Liver surgery,Colorectal surgery,and *** management is based on assessment of sophisticated clinical,radiological and biomarker *** incomplete evidence in this very heterogeneous patient group,maximising resection of CRLM using all available techniques remains a key objective and provides the best chance of long-term survival and *** this end,liver resection is maximised by the use of downsizing chemotherapy,optimisation of liver remnant by portal vein embolization,associating liver partition and portal vein ligation for staged hepatectomy,and combining resection with ablation,in the context of improvements in the functional assessment of the future remnant *** resection may safely be carried out laparoscopically or open,and synchronously with,or before,colorectal surgery in selected *** unresectable patients,treatment options including systemic chemotherapy,targeted biological agents,intraarterial infusion or bead delivered chemotherapy,tumour ablation,stereotactic radiotherapy,and selective internal radiotherapy contribute to improve survival and may convert initially unresectable patients to *** evolving areas include biomarker characterisation of tumours,the development of novel systemic agents targeting specific oncogenic pathways,and the potential reemergence of radical surgical options such as liver transplantation.

关键词： Colorectal Cancer Liver Metastases Management Review