1/59. Acute pancreatitis and deep vein thrombosis associated with hellp syndrome.The hellp syndrome (HS) belongs to the list of obstetric complications believed to be associated with coagulation disorders. It was formerly thought that chronic intravascular clotting (DIC) in the placental vessels was the main cause. A hypercoagulable state has been reported in cases of severe HS associated with microvascular abnormalities that may involve cerebral, placental, hepatic and renal vessels. A case of acute pancreatitis and DVT of inferior cava in a pregnant woman, presenting with HS at 29 weeks, who was found to have a R506Q mutation, is reported. Preeclampsia-associated pancreatitis and DVT have rarely been reported. It is hypothesized that APC-R and Factor V Leiden mutation may prove to be new and more important markers capable of predicting a more significant maternal morbidity associated with HS. thrombosis prophylaxis may be considered during pregnancy in order to reduce hazardous multiorgan failure (MOF) in women who are heterozygous for Factor V Leiden mutation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/59. Massive intraperitoneal bleeding from tryptic erosions of the splenic vein. Another cause of sudden deterioration during recovery from acute pancreatitis.Acute bleeding is a rare, but frequently fatal complication of pancreatitis. Bleeding into the gastrointestinal tract may occur owing to gastric or duodenal erosions, peptic ulcers, or varices in the esophagus, stomach, or colon following splenic vein thrombosis, or intraperitoneally from eroded vessels in pancreatic pseudocysts or expanding pseudoaneurysms. We report a novel case of massive intraperitoneal bleeding owing to tryptic erosions of the splenic vein in a patient recovering from acute pancreatitis. Diagnosis of the bleeding was made by ultrasound and ultrasound-guided blood aspiration. The source of the bleeding was identified intraoperatively, and a left-sided pancreatectomy and a splenectomy were performed.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/59. Laparoscopic distal pancreatectomy with preservation of the spleen.We describe a case of chronic pancreatitis treated by laparoscopic distal pancreatectomy with conservation of the spleen involving the resection of the splenic vessels. A proximal ligation of the splenic artery and vein was performed, followed by transection of the body of the pancreas. Retroperitoneum was dissected to the left by mobilizing the stump of the transected pancreas. The entire distal pancreas was freed posteriorly. The distal splenic artery and vein were ligated and divided individually adjacent to the tail of the pancreas at the hilum of the spleen. The points of this operation were to ligate the splenic artery and vein at both sides of the resected pancreas and to save the spleen with the blood supply continuing through the short gastric vessels and the splenocolic ligament. This operation with splenic preservation is more suitable for a patient who is a candidate for laparoscopic distal pancreatectomy, which will minimize the operation time, preserve the useful immunologic role of the spleen, and obtain the intact resected specimen. Furthermore, this procedure is useful in chronic pancreatitis patients because it avoids the difficult dissection of the posterior pancreas off of the splenic vessels.- - - - - - - - - - ranking = 1.5keywords = vessel (Clic here for more details about this article) |
4/59. Control of major hemorrhage from the spleno-mesenteric vein junction during pancreaticoduodenectomy: successful use of an occlusion balloon catheter.BACKGROUND/AIMS: Vascular disruption is sometimes associated with intractable hemorrhage due to either vessel fragility or increased blood flow rates in patients with chronic pancreatitis during surgical operation. This paper describes the successful use of an occlusion catheter for repairing a major laceration at the spleno-mesenteric vein junction. methods: A 14-Fr Fogarty occlusion balloon catheter was directly inserted into the splenic vein through the site of venous laceration and inflated to stop blood flow from the splenic vein. RESULTS: This procedure perfectly controlled massive hemorrhage from the spleno-mesenteric vein junction. The injured site was repaired with a continuous suture in 5 min. CONCLUSION: The direct insertion of a balloon catheter to the injured site is simple and expeditious to control major hemorrhage from the spleno-mesenteric vein junction when the situation is otherwise unmanageable.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/59. duodenal ulcer and pancreatitis associated with pancreatic arteriovenous malformation.Arteriovenous malformation (AVM) of the pancreas is a rare condition that may cause severe gastrointestinal bleeding. We describe a 54-year-old man with a 7-year history of recurrent duodenal ulcer due to AVM in the pancreatic head. We recommended pancreatoduodenectomy because of recurrent haemorrhage from the duodenal ulcer, but the patient refused surgery on several occasions. He was admitted to our hospital complaining of severe upper abdominal pain radiating to the back and was diagnosed with acute pancreatitis. He agreed at that stage to the surgical treatment. The resected specimen contained a highly vascular malformation in the pancreatic head and ulceration in the adjacent descending duodenum. Histopathological examination revealed numerous vascular structures with dilated and tortuous vessels in the pancreatic head, confirming the presence of AVM. Moreover, oedema, inflammatory cell infiltration, haemorrhage and necrosis were evident, confirming the presence of acute pancreatitis.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/59. Renal vein and inferior vena cava thrombosis associated with acute pancreatitis.Renal vein thrombosis (RVT) is a well-recognized complication of the nephrotic syndrome, but it is extremely rare in patients with acute pancreatitis. Vascular thrombosis complicating pancreatitis is thought to be due to release of proteolytic enzymes from the pancreas and direct vasculitis. Peripancreatic vessels are most commonly involved in the complications associated with pancreatitis. Renal vein and inferior vena cava (IVC) thrombosis, however, is an exceptionally rare complication of pancreatitis. awareness of this complication will help physicians in its early diagnosis and management. We report a case of renal vein and IVC thrombosis in a patient with acute pancreatitis.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/59. Minute pancreatic carcinoma with initial symptom of acute pancreatitis.We experienced a case of minute pancreatic carcinoma in a 59-year-old man who complained of upper abdominal pain after drinking alcohol. Abdominal ultrasonography (US) revealed dilatation of the main pancreatic duct (MPD). Abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed slight dilatation of the MPD and its obstruction near the portal vein. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated occlusion of the MPD, and cytology of aspirated pancreatic juice was negative for malignancy. With the diagnosis of benign localized obstruction of the MPD, the patient underwent surgery. There was a clear demarcation of hardness and color of the pancreas on the left margin of the superior mesenteric vein, and the caudal pancreas was hard and fibrotic. Intraoperative US revealed slight dilatation of the MPD, and the aspiration cytology result was class IV. First, segmental resection of the pancreas was performed, but pathological examination of frozen section showed neither malignancy nor stenotic lesion. An additional small portion of the proximal pancreas was resected. The specimen included a ductal carcinoma, 5 mm in diameter. Accordingly, a pylorus-preserving pancreatoduodenectomy was performed. Microscopically, the minute carcinoma had already penetrated the duct wall and infiltrated lymph vessels and veins. The patient has been under close observation at our outpatient clinic, and so far there have been no signs of recurrence. To improve the poor prognosis of pancreatic cancer, we should be alert to the occurrence of acute pancreatitis as an initial symptom.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/59. blue toe syndrome: a rare complication of acute pancreatitis.CONTEXT: blue toe syndrome is an unusual complication of acute pancreatitis. It is characterized by tissue ischemia secondary to cholesterol crystal or atherothrombotic embolization leading to the occlusion of small vessels. Clinical presentation can range from a cyanotic toe to a diffuse multiorgan systemic disease that can mimic other systemic illnesses. CASE REPORT: Here we describe a young male who developed this complication after acute alcoholic pancreatitis.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/59. Acute pancreatitis during sickle cell vaso-occlusive painful crisis.Sickle cell disease is characterized by chronic hemolytic anemia and vaso-occlusive painful crisis. The vascular occlusion in sickle cell disease is a complex process and accounts for the majority of the clinical manifestations of the disease. abdominal pain is an important component of vaso-occlusive painful crisis and may mimic diseases such as acute appendicitis and cholecystitis. Acute pancreatitis is rarely included as a cause of abdominal pain in patients with sickle cell disease. When it occurs it may result form biliary obstruction, but in other instances it might be a consequence of microvessel occlusion causing ischemia. In this series we describe four cases of acute pancreatitis in patients with sickle cell disease apparently due to microvascular occlusion and ischemic injury to the pancreas. All patients responded to conservative management. Acute pancreatitis should be considered in the differential diagnosis of abdominal pain in patients with sickle cell disease.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/59. Treatment of bleeding in severe hemorrhagic pancreatitis with recombinant factor VIIa.Recombinant factor viia (rFVIIa) has been used to treat bleeding complications in patients with hemophilia. It acts at the site of vessel injury, forming a complex with tissue factor to activate the clotting cascade. Recent reports have shown rFVIIa may be a useful hemostatic agent in patients after obstetrical, urologic, trauma, or transplant procedures. We report the first documented case of bleeding from hemorrhage pancreatitis treated with rFVIIa.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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