Giancarlo Flati

Wirsung and Santorini: The Men Behind the Ducts

During the 16th and 17th centuries, several important discoveries were accomplished by anatomists whose contribution has enlightened the most important anatomic structures of the pancreas. Following the earliest discoveries, researchers of several medical specialities further investigated the ductal pancreatic system. The accessory pancreatic duct with its minor papilla, the main pancreatic duct and the papilla major along with the confluence of the main pancreatic duct with the bile duct and pancreas divisum, have been the objects of interest of several personalities of the medical history. Eponyms in pancreatic anatomy were given to remember some of them, although anatomical misattributions are frequent and controversial. The aim of the authors was to dedicate a small tribute to the researchers who have written, during the last 500 years, important chapters of the medical history and who dedicated their lives to study the pancreatic ducts and their duodenal endings. Furthermore, a brief outlook was dedicated to the impact of anatomic variations and of embryologic anomalies of the pancreatic ducts in our clinical practice and in our actual understanding of duct-related diseases. The authors are confident that the genial curiosity of few extraordinary personalities of the past and the opportunities provided by modern technology continue to play a major role that may finally add wisdom to decision-making in dealing with duct-related biliopancreatic diseases and safety to diagnostic and therapeutic procedures employed.

Microsurgical treatment of varicocele: selecting most appropriate shunt.

Microsurgical drainage of spermatic veins tailored to the hemodynamic type of varicocele was performed in 20 patients. In 14 cases the procedure was indicated as prophylaxis and in 6 cases as treatment of infertility. Complete regression of varicosities was observed in 75 percent as early as six days postoperatively, in 85 percent at two weeks, and in 90 percent at twelve months. In the remaining 10 percent, a consistent reduction of varicocele was found. No patient experienced progression of the disease. Eighty-three percent of the patients with altered seminal parameters showed an improvement of them at a mean follow-up of 9.1 months.

Massive Fulminant Hemorrhage due to Splenic Vein Rupture in Pancreatitis

A fatal case of acute fulminant bleeding in pancreatitis associated with portal hypertension and caused by rupture of the splenic vein is reported, and the pathological and clinical features of this u

Hemorrhagic Complications of Pancreatitis

Bleeding in pancreatitis may be due either to gastroduodenal causes (e.g., acute gastric erosions, mucosal congestions, peptic ulceration, Mallory-Weiss syndrome, and alcoholic gastritis), which are usually managed with conservative treatment [1], or to direct involvement of vascular structures by pancreatitic local sequelae. The latter, although uncommon, is usually characterized by massive hemorrhage, which is considered the most severe and rapidly lethal complication of pancreatitis [2, 3]. It may be associated with either acute or chronic pancreatitis and is caused by major vessels’ erosion, followed in most cases by vessel disruption or pseudoaneurysm formation. Pseudocysts, severe inflammation, regional necrosis, and infection are the most important pathogenetic factors [4, 5]. Although the incidence of major bleeding in pancreatitis is relatively low (1.7%–2.5%), it is associated with a prohibitively high mortality rate reaching 40%–80% [6, 7, 8].

Pancreatic Abscess and Massive Intraoperative Bleeding due to Erosion of the Splenic Artery

The authors report a case of massive intraoperative bleeding complicating a post-pancreatic abscess. Hemorrhage was due to erosion of the splenic artery, which eventually ruptured within the abscess c