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Isolated segmental,sectoral and right hepatic bile duct injuries

World Journal of Gastroenterology 2009年第12期15卷 1415-1419页

作者： radoje b Colov.c Institute of Digestive Diseases First Surgical ClinicClinical Center of Serbia6 Koste Todorovica11000 BelgradeSerbia

The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery; 3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated; 4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes; the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis; all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-γ repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-γ repair. Two others also underwent a Roux-en-γ repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-γ anastomosis should be considered.

关键词： Segmental bile duct Sectoral bile duct Right hepatic bile duct Injury Treatment

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Metastatic melanoma to the common bile duct causing obstructive jaundice:A case report

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World Journal of Gastroenterology 2007年第5期13卷 813-815页

作者： radoje b Colov.c Nikica M Grubor Miodrag D Jovanovic Marjan T Micev Natasa R Colov.c Institute for Digestive Diseases First Surgical Clinic Clinical Center of Serbia Koste Todorovica 6 Belgrade 11000 Serbia

Metastatic melanoma to the common bile duct is very rare with only 18 cases reported so far. We report a 46 year old women who, 18 mo after excision of a skin melanoma, developped a painless progressive obstructive jaundice. At operation a melanoma within the distal third of the common bile duct was found. There were no other secondaries within the abdomen. The common bile duct, including the tumor, was resected and anastomosed with Roux-en-Y jejunal limb. The patient survived 31 mo without any sign of local recurrence and was submitted to three other operations for axillar and brain secondaries, from which she finally died. Radical resection of metastatic melanoma to the common bile duct may result in lifelong relief of obstructive jaundice. It is safe and relatively easy to perform. In other cases, a less aggressive approach, stenting or bypass procedures, should be adopted.

关键词： Metastatic melanoma Common bile duct Jaundice

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Perigastric extraskeletal Ewing's sarcoma: A case report

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World Journal of Gastroenterology 2009年第2期15卷 245-247页

作者： radoje b Colov.c Nikica M Grubor Marjan T Micev Slavko V Matic Henry Dushan Edward Atkinson Stojan M Latincic Institute for Digestive Diseases Clinical Center of Serbia Koste Todorovica 6 Belgrade 11000 Serbia Imperial College School of Medicine St Mary's Hospital Praed Street London W2 1NY United Kingdom

Ewing's sarcoma (ES) is a neoplasm of undifferentiated small round cells, which occurs in the bones and deep soft tissues of children and adolescents. We present a rare case of a 44-year-old woman with gastric ES presenting with epigastric pain and weight loss. Ultrasound and computed tomography scans indicated a solid/cystic mass in the pancreatic tail. At laparotomy, the tumor was found attached to the posterior surface of the stomach, completely free from the pancreas, with no lymphadenopathy or local metastases. The polynodal, partly pseudocystic, dark-red soft tumor was excised. Histopathology revealed an anaplastic small-round-cell tumor with strong membranous CD99 immunoexpression. Additionally, there was patchy immunostaining for S-100 protein, vimentin, protein gene product (PGP) 9.5 and neuron-specifi c enolase, and weak focal CD117 cytoplasmic immunoreactivity. The patient had no adjuvant chemotherapy; her postoperative recovery was uneventful, and she remains symptom-free, and without any sign of recurrence at 20 mo. To the best of our knowledge, this is only the third ever case of gastric ES.

关键词： Stomach Extraskeletal Ewing's sarcoma

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Two synchronous somatostatinomas of the duodenum and pancreatic head in one patient

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World Journal of Gastroenterology 2009年第46期15卷 5859-5863页

作者： radoje b olov. Slavko V Mati Marjan T Micev Nikica M Grubor Henry Dushan Atkinson Stojan M Latini The First Surgical Clinic Clinical Center of Serbia Surgical Directorate Imperial College School of MedicineSt Mary's HospitalPraed St

Somatostatinomas are extremely rare neuroendocrine tumors of the gastrointestinal tract,f irst described in the pancreas in 1977 and in the duodenum in *** may be functional and cause somatostatinoma or inhibi-tory syndrome,but more frequently are non-functioning pancreatic endocrine tumors that produce somatostatin *** are usually single,malignant,large lesions,frequently associated with metastases,and generally with poor *** present the unique case of a 57-year-old woman with two synchronous non-function-ing somatostatinomas,one solid duodenal lesion and one cystic lesion within the head of the pancreas,that were successfully resected with a pylorus-preserving Whipple's *** secondaries were found in the liver,or in any of the removed regional lymph *** patient had an uneventful recovery,and remains well and symptom-free at 18 mo *** is an extremely rare case of a patient with two synchro-nous somatostatinomas of the duodenum and the *** condition is discussed with reference to the literature.

关键词： Somatostatinoma Duodenal neoplasms Pancreatic neoplasms

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Cystic lymphangioma of the pancreas

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World Journal of Gastroenterology 2008年第44期14卷 6873-6875页

作者： radoje b Colov.c Nikica M Grubor Marjan T Micev Henry Dushan E Atkinson Vitomir I Rankovic Mihajlo M Jagodic Institute for Digestive Diseases Clinical Center of SerbiaFirst Surgical ClinicKoste Todorovica 6Belgrade11000Serbia Imperial College School of Medicine St Mary's HospitalPraed StreetLondon W21NYUnited Kingdom

Lymphangioma of the pancreas is an extremely rare benign tumour of lymphatic origin, with fewer than 60 published cases. Histologically, it is polycystic, with the cysts separated by thin septa and lined with endothelial cells. Though congenital, it can affect all age groups, and occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable mass. Complete excision is curative, even though, depending on the tumour location, surgery may be simple or involve extensive pancreatic resection and anastomoses. The authors present a 49-year-old woman in whom a polycystic septated mass, 35 mm× 35 mm in size, was discovered by ultrasonography （US） in the body of the pancreas during investigations for epigastric pain and nausea. At surgery, a well circumscribed polycystic tumor was completely excised, with preservation of the pancreatic duct. The postoperative recovery was uneventful. Histology confirmed a microcystic lymphangioma of the pancreas. Immunohistochemistry showed cystic endothelial cells reactivity to factor Ⅷ -RA （＋＋）, CD31 （＋＋＋） and CD34 （-）. Postoperatively, abdominal pain disappeared and the patient remained symptomfree for 12 mo until now. Although extremely rare, lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of a pancreatic cystic lesion, especially in women.

关键词： Pancreas Cystic lymphangioma Localsurgical excision

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