Bernard Stark

Adenocarcinoma of the Pancreas Producing Pancreatitis and Pancreatic Abscess

Pancreatic abscess is a severe complication of pancreatitis usually caused by alcohol, gallstones, abdominal trauma, or prior operative procedures. Pancreatic cancer is a rare cause of acute pancreatitis and an extremely rare cause of pancreatic abscess. We report three patients with pancreatic abscess caused by cancer who experienced a prolonged, complicated course with delay in diagnosis and substantial morbidity.

LONG-TERM FOLLOW-UP OF TWENTY PATIENTS WITH ADENOCARCINOMA OF THE PANCREAS : Resection Following Combined Modality Therapy

Long-term follow-up of 5 or more years in 20 patients with initially unresectable cancer of the pancreas that responded to chemoradiation therapy is detailed in this article. All patients underwent resection. Seven or 18 surgical survivors are alive 50 or more months.

Pancreatic calcification in an 18-yr-old patient following gallstone pancreatitis and recurrent pseudocysts

SummaryMost authors believe that biliary pancreatitis rarely progresses to chronic pancreatitis. Here, we present a case of an 18-yr-old white male with a history of gallstone pancreatitis and pancreatic pseudocyst resulting in radiographic and pathologic evidence of pancreatic calcification over a 16-mo period.

7101 Choledocho-duodenostomy rendezvous : an approach to solo biliary rendezvous for performance of biliary sphincterotomy in a case of sump syndrome.

Introduction Sump syndrome is an infrequent complication of side-to-side choledocho-duodenostomy (CDD). Endoscopic sphincterotomy with removal of the debris has been shown to be an effective means of treating sump syndrome. However, cases arise in which standard sphincterotomy is not possible because of distal CBD impaction, ampullary stenosis or stricture.We describe a technique of solo biliary rendezvous for performance of biliary sphincterotomy in patients with side-to-side CDD. Case A 63 year old female was referred to our institution for ERCP for treatment of probable sump syndrome that developed following CDD. An ERCP was performed. Endoscopy revealed a patent double-barrel CDD but the ampulla appeared small with no clearly visible papilla. Cannulation of the ampulla with a cannulotome or wire was unsuccessful. Pre-cut was not performed due to a very short intramural segment. Cholangiography of the lower limb of the CDD revealed distal CBD blockage and no flow into the duodenum. Given the lack of easy access to the distal duct for standard sphincterotomy, we proceeded with antegrade wire and cannula access through the CDD. Under fluroscopic guidance, a Zebra wire was passed via the lower limb into the distal CBD through the ampulla and into the duodenum. The endoscope was carefully withdrawn to the ampulla while maintaining the postion of Zebra wire in its location in the duodenum. At this point, a regular snare was passed alongside the Zebra wire through the therapeutic channel of the endoscope. The soft tip of the Zebra wire was snared. Under fluroscopic guidance, the endoscope was carefully withdrawn, while feeding the Zebra wire and maintaining a large loop of wire through the lower limb of the CDD, ampulla and duodenum. After removal of the endoscope from the patient, the soft tip of this wire was then threaded through the distal end of the therapeutic channel of the ERCP endoscope. The endoscope was then re-inserted and passed to the ampulla. At this point the endoscopists visualized the wire exiting the ampulla. Thereafter, standard wire-guided sphincterotomy was easily performed. Adequate biliary drainage of the distal sump segment was achieved and the patient remains asymptomatic. Discussion The preceding case illustrates a technique for solo biliary rendezvous for performance of biliary sphincterotomy in patients with side-to-side choledocho-duodenostomy and tough access to the distal CBD.