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Management of splenic artery aneurysm associated with extrahepatic portal vein obstruction

Hepatobiliary & Pancreatic Diseases International 2012年第3期11卷 330-333页

作者： Pramod Kumar Mishra Sundeep Singh Saluja Ashok K Sharma Premanand Pattnaik department of gastrointestinal surgery surgery gb pant hospital Department of Gastrointestinal Surgery and Department of Radiology Surgery GB Pant Hospital department of gastrointestinal surgery gb pant hospital

BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS: The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome.

关键词： splenic artery aneurysm extrahepatic portal vein obstruction portal hypertension proximal splenorenal shunt

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Composite pheochromocytoma masquerading as solidpseudopapillary neoplasm of pancreas

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World Journal of Clinical Cases 2015年第5期3卷 474-478页

作者： Geetanjali Gupta Ravindra Kumar Saran Satyajit Godhi Siddharth Srivastava Sundeep Singh Saluja Pramod Kumar Mishra department of Pathology Academic Block GB Pant Hospital New Delhi 110002 India department of Gastroenterology Academic Block GB Pant Hospital New Delhi 110002 India department of gastrointestinal surgery Academic Block GB Pant Hospital New Delhi 110002 India

Pheochromocytoma and ganglioneuroma form rare composite tumours of the adrenal medulla comprising less than 3% of all sympathoadrenal tumours. We present a case of intraoperatively detected adrenal medullary tumour of composite pheochromocytoma and ganglioneuroma diagnosed on histopathology, in a normotensive patient. A 50-year-old male with a past history of chronic obstructive pulmonary disease presented with abdominal pain and significant weight loss since one month. Ultrasound and contrast-enhanced computed tomography abdomen revealed a large lobulated lesion in the distal body and tail of pancreas suggestive of solid and papillary neoplasm of body and tail of pancreas. Intra-operatively, a 15 cm × 10 cm solid lesion with cystic areas was seen arising from the left lower pole of the adrenal gland pushing the pancreas which appeared unremarkable. In our case, exploratory laparotomy with tumour excision was done. Extensive sectioning and microscopic examination of this adrenal tumour confirmed a diagnosis of composite Pheochromocytoma with Ganglioneuroma on histopathology. Immunophenotyping with S-100 further supported the diagnosis. The goal of this report is to increase the awareness of this rare disease and to further identify its variable presentation.

关键词： Ganglioneuroma Pheochromocytoma Adrenal

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Gastric conduit perforation

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World Journal of Clinical Cases 2014年第8期2卷 398-401页

作者： Nilesh Patil Arvind Kaushal Amit Jain Sundeep Singh Saluja Pramod Kumar Mishra department of gastrointestinal surgery Academic BlockGB Pant Hospital and Maulana Azad Medical CollegeNew Delhi 110002India

As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.

关键词： Gastric conduit Ulcer formation Perforation Carcinoma of the esophagus Proton pump inhibitors

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Pancreatic ductal adenocarcinoma associated with pancreatic ductal intraepithelial neoplasia:report of a case

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 553-556页

作者： Rajkumar Krishnasamy Shaleen Agarwal Shivendra Singh Sunil Puri Puja Sakhuja Anil K Agarwal department of gastrointestinal surgery Govind Ballabh Pant Hospital and Maulana Azad Medical College(Delhi University)New Delhi 110002India department of radiology Govind Ballabh Pant Hospital and Maulana Azad Medical College(Delhi University)New Delhi 110002 department of Pathology Govind Ballabh Pant Hospital and Maulana Azad Medical College(Delhi University)New Delhi 110002

BACKGROUND:The presence of pancreatic ductal intraepithelial neoplasia in patients with chronic pancreatitis is a risk factor for development of pancreatic adenocarcinoma. METHOD:A case of pancreatic ductal adenocarcinoma associated with pancreatic ductal intraepithelial neoplasia was diagnosed in the setting of chronic pancreatitis. RESULTS:Distal pancreatectomy combined with splenec- tomy was performed with a diagnosis of pancreatic body carcinoma.Histopathological examination suggested adenocarcinoma associated with pancreatic ductal intraepithelial neoplasia.The tumor was detected in the remaining head of the pancreas,for which a total pancreatectomy was done. CONCLUSIONS:When a patient with pancreatic ductal intraepithelial neoplasia associated with adenocarcinoma of the pancreas in the setting of chronic pancreatitis is at an increased risk of recurrence in the remaining pancreatic parenchyma,total pancreatectomy may be feasible.

关键词： pancreatectomy pancreatic ductal carcinoma chronic pancreatitis

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