Adolfo Beguiristain

Intrahepatic biliary carcinoid.

Carcinoid tumors of the biliary tract are rare and account for 0.2% to 2% of all gastrointestinal carcinoids. Intrahepatic biliary carcinoid is exceedingly uncommon. These are usually slow growing neoplasms with low malignant potential and hence are amenable to aggressive surgical management. Preoperative diagnosis is difficult because they mimic the signs and symptoms of choledocholithiasis and/or cholangiocarcinoma. This case serves to highlight that intrahepatic biliary carcinoids constitute a rare but identifiable subset of bile duct tumors. A 60-year-old male initially presented with clinical jaundice and elevated transaminases. NMR and NMR-cholangiogram established a mass suspicious for cholangiocarcinoma (Klatskin tumor) (Fig. 1). The patient was initially managed with a percutaneous transhepatic cholangiogram tube. At the time of surgery (August 2005) successful removal of a firm nodular mass at the area of the ductal bifurcation was achieved and biliary continuity re-established with a Roux-en-Y hepaticojejunostomy with multiple hepaticenteral segmental anatomosis. Pathology revealed carcinoid tumor (Figs. 2 and 3) of the bile duct with negative lymph node positive for tumor. The patient did not receive any adjuvant radiation or chemotherapy. Patient condition currently is normal. Carcinoid tumor of the extrahepatic bile duct is a rare form of biliary obstruction, with fewer than 34 cases reported in the English literature. The most common anatomic sites were the CBD (58%), perihilar region (28%), cystic duct (11%), and common hepatic duct (3%). Unlike cholangiocarcinoma, biliary carcinoids occur more commonly in younger patients and in women. Aggressive local invasion by the primary tumor is rare, and metastases occur in less than

Fístula pancreaticopleural: pruebas diagnósticas y tratamiento

Pancreaticopleural fistula is an uncommon clinical entity that appears in patients with a history of chronic pancreatitis. Apropos of the case of a 40-year-old man in our hospital, we reviewed the literature and found 40 publications with little more than 100 patients. All of these publications highlight the atypical presentation with dyspnea as the first symptom and stress that diagnosis is based on magnetic resonance pancreatography. Endoscopic retrograde cholangiopancreatography is used in confusing cases and in planning the optimal surgical approach. Initial treatment should consist of conservative medical therapy, including total parenteral nutrition and somatostatin or its analogues. If the fistula persists or recurs, various options are available such as surgery, placement of a transpapillary pancreatic stent or nasopancreatic tube. The overall mortality rate from pancreaticopleural fistula is approximately 5%.

Torsión de vesícula biliar

Resumen La torsion de la vesicula biliar es una condicion diagnosticada de forma excepcional de forma preoperatoria. Se describe generalmente en pacientes de edad avanzada. Una demora en el diagnostico y el tratamiento puede tener consecuencias grave. Presentamos un caso de volvulo de vesicula biliar

Carcinoide biliar intrahepático

Carcinoid tumors of the biliary tract are rare and account for 0.2%-2% of all GI carcinoids (1). Intrahepatic biliary carcinoid is exceedingly uncommon. These are usually slow-growing neoplasms with a low malignant potential, and hence are amenable to aggressive surgical management. Preoperative diagnosis is difficult because they mimic the signs and symptoms of choledocholithiasis and/or cholangiocarcinoma. The present case serves to highlight that intrahepatic biliary carcinoids constitute a rare but identifiable subset of bile duct tumors.