Georgios Filippou

Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate

BACKGROUND Periampullary diverticula (PAD) are found in 9% to 32% of patients who undergo an ERCP. Published studies confer conflicting results regarding the true impact of PAD on the technical success and complications of ERCP. OBJECTIVE The aim of the study was to investigate and compare success rate, difficulty at cannulation, and complications between patients with and without PAD, as well as to identify independent factors that influence the difficulty at cannulation. DESIGN A prospective study. SETTING Tzaneio General Hospital. PATIENTS A total of 601 consecutive patients who underwent an ERCP were divided into 2 groups according to the presence (group A, 117 patients) or absence (group B, 484 patients) of PAD. Patients with undetectable papilla were excluded from the study cohort. The incidence of undetectable papilla was 8.3% in patients with duodenal diverticula and 0.9% in patients without duodenal diverticula (P = .000). RESULTS Successful cannulation was achieved in up to 94.9% and 94.8% in groups A and B, respectively. The effort and difficulty at attempting this goal was different between the groups (43.5% vs 59.1%, P = .003), because patients without PAD were subjected to more vigorous attempts or even the pre-cut technique to attain a cholangiogram. There was no significant difference between the groups in the complication rate either in total or in any particular patient. Multivariate logistic regression analysis showed 3 of the variables, namely choledocholithiasis, abnormal papilla, and the presence of diverticula, remained significant, and all of them presented with odds ratios indicating an easier cannulation attempt. LIMITATION A nonrandomized study. CONCLUSIONS The finding of a periampullary diverticulum during an ERCP should not be considered an obstacle to a successful cannulation and, furthermore, may be an indicator of an easier cannulation attempt, provided that the papilla can be found with confidence. Concerns about increased complications are not substantiated in this study.

Rupture of totally implantable central venous access devices (Intraports) in patients with cancer: report of four cases

BackgroundTotally implantable central venous access devices (intraports) are commonly used in cancer patients to administer chemotherapy or parenteral nutrition. Rupture of intraport is a rare complication.Patients and methodsDuring 3 years period, a total of 245 intraports were placed in cancer patients for chemotherapy. Four of these cases (two colon cancer and one each of pancreas and breast cancer) had rupture of the intraport catheter, these forms the basis of present report.ResultsMean time insitu for intraports was 164∀35 days. Median follow-up time was 290 days and total port time in situ was 40180 days. The incidence of port rupture was 1 per 10,000 port days.Three of the 4 cases were managed by successful removal of catheters. In two of these the catheter was removed under fluoroscopic control using femoral route, while in the third patient the catheter (partial rupture) was removed surgically. One of the catheters could not be removed and migrated to right ventricle on manipulations.ConclusionPort catheter rupture is a rare but dreaded complication associated with subcutaneous port catheter device placement for chemotherapy. In case of such an event the patient should be managed by an experienced vascular surgeon and interventional radiologist, as in most cases the ruptured catheter can be retrieved by non operative interventional measures.

Desmoid tumor in Gardner's Syndrome presented as acute abdomen

BackgroundGardners syndrome can occasionally be complicated with intra-abdominal desmoid tumor. These tumors usually remain asymptomatic but can exhibit symptoms due to intestinal, vascular and ureteral compression and obstruction.Case presentationA rare case of a 41-year-old male patient with Gardners syndrome complicated with intra-abdominal desmoid tumor, which first presented as acute abdomen, is presented.ConclusionExtra-abdominal manifestations of Gardners syndrome along with a palpable abdominal mass would raise suspicion for the presence of a desmoid tumor in the majority of cases. In life-threatening cases, surgical treatment should be considered as a palliative approach, though the extent of excision remains debatable

Low Spigelian hernia in a 6-year-old boy presenting as an incarcerated inguinal hernia: a case report

IntroductionLower Spigelian hernia is a very rare entity. The clinical findings are similar to those of inguinal hernias and in many cases may be misdiagnosed. In the literature, only a few references to this entity have been reported in children. To the best of our knowledge, this is the first case report of a lower Spigelian hernia in a child who presented with an acute painful scrotum.Case presentationWe discuss the case of a 6-year-old Greek boy who presented to our emergency department complaining of severe pain in the left inguinal area and scrotum. The acute painful swelling started suddenly, without any obvious cause. The initial diagnosis was incarcerated inguinal hernia which was reduced with difficulty. Five days later, the patient still experienced mild pain during palpation and he was operated on. During the operation, a large lower Spigelian hernia was revealed and reconstructed.ConclusionAlthough Spigelian hernias are rare in children and difficult to diagnose, physicians should be aware of them and include them in the differential diagnosis.

Carcinoid tumour of the appendix in children: a case report

Carcinoids are the most common tumours of the appendix. These tumours show prevalence in white children. The clinical presentation of the appendiceal carcinoids is similar to that of acute appendicitis, although in many cases the tumour is diagnosed incidentally during an operation. The diagnosis should be confirmed histologically. The prognosis in patients with local disease is excellent. In small lesions isolated appendicectomy is considered as the most appropriate treatment, while in larger lesions right colectomy should be performed. We report a case of a carcinoid tumour in the tip of the appendix of a thirteen year old girl which was diagnosed intraoperatively. The patient received isolated appendicectomy due to the small size of the lesion. Ten years after the operation there is no evidence of recurrence or metastases, and the patient is considered free of disease.

Adenosquamous carcinoma of the pancreas: a rare tumor entity: a case report

IntroductionAdenosquamous carcinoma of the pancreas is a rare variant of exocrine pancreatic tumor. This type of tumor is extremely rare as only few similar cases have been described in the literature.Case presentationWe present a case of a 72 years old male patient who was admitted to the hospital complaining of epigastric pain and jaundice. Pancreatic carcinoma of the head was diagnosed and a pylorus preserving pancreaticoduodenectomy was performed.ConclusionThis type of cancer is a very aggressive tumor followed by a dismisal prognosis. Multimodality therapy seems to be a reasonable approach but more studies are needed, to propose the most effective treatment.

Cecal epiploica appendix torsion in a female child mimicking acute appendicitis: a case report

Acute appendicitis is the most common cause of the right lower quadrant acute abdominal pain in children. Some other conditions including cecal epiploica appendix torsion, can simulate acute abdomen. Epiploica appendix torsion usually occurs in the sigmoid colon and rarely in the cecum of adult males. In children, this entity is extremely rare and may represent a diagnostic and therapeutic dilemma. We report a case of an 8-year-old Greek girl, presented with signs and symptoms mimicking acute abdomen. Our patient is the younger one among the other four with cecal epiploica appendix torsion that had been reported in the literature.

Pelvic plastron secondary to acute appendicitis in a child presented as appendiceal intussusception. A case report

We report an unusual case of an 11-year-old Greek girl with complicated acute appendicitis. The pelvic plastron that had been formatted secondary to appendix perforation was mimicking appendiceal intussusception in the preoperative ultrasound and computed tomography images. Although acute complicated appendicitis and appendiceal intussusception may represent possible causes of acute abdomen no similar cases have reported in the literature.

Torsion of an intrahydrocelic sac in a child: A case report

We report the case of a 3-yr-old boy who presented an acute right hydrocele. A rapid scrotal swelling under tension developed the first hours and the child complained for discomfort especially during palpation of the scrotum. Three days later, surgical exploration revealed an incomplete torsion of a communicated and pedunculated peritoneal sac arising from the tunica vaginalis testis.The present case report represents the eleventh report of torsion of processus vaginalis saccular protrusion in the literature, being unique due to painless hematocele.