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Kemoun G, Weiss E, El Houari L, Bonny V, Goury A, Caliez O, Picard B, Rudler M, Rhaiem R, Rebours V, Mayaux J, Bachet JB, Belin L, Demoule A, Decavèle M. Clinical features and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission: A retrospective multicenter study. Dig Liver Dis 2024; 56:514-521. [PMID: 37718226 DOI: 10.1016/j.dld.2023.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND We sought to describe the reasons for intensive care unit (ICU) admission and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission. PATIENTS AND METHODS Retrospective cohort study in five ICUs from 2009 to 2020. All patients with pancreatic cancer admitted to the ICU were included. Patients having undergone recent surgery were excluded (< 4 weeks). RESULTS 269 patients were included. Tumors were mainly adenocarcinoma (90%). Main reason for admission was sepsis/septic shock (32%) with a biliary tract infection in 44 (51%) patients. Second reason for admission was gastrointestinal bleeding (28%). ICU and 3-month mortality rates were 26% and 59% respectively. Performance status 3-4 (odds ratio OR 3.58), disease status (responsive/stable -ref-, newly diagnosed OR 3.25, progressive OR 5.99), mechanical ventilation (OR 8.03), vasopressors (OR 4.19), SAPS 2 (OR 1.69) and pH (OR 0.02) were independently associated with ICU mortality. Performance status 3-4 (Hazard ratio HR 1.96) and disease status (responsive/stable -ref-, newly diagnosed HR 2.67, progressive HR 4.14) were associated with 3-month mortality. CONCLUSION Reasons for ICU admissions of pancreatic cancer patients differ from those observed in other solid cancer. Short- and medium-term mortality are strongly influenced by performance status and disease status at ICU admission.
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Affiliation(s)
- G Kemoun
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France.
| | - E Weiss
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Département d'anesthésie-réanimation, Clichy, France; Université de Paris, UMRS1149, Centre de recherche sur l'inflammation, Liver Intensive Care Group of Europe (LICAGE), France
| | - L El Houari
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - V Bonny
- AP-HP Sorbonne Université, site Saint-Antoine, Service de Médecine Intensive - Réanimation, Paris, France
| | - A Goury
- Unité de médecine intensive et réanimation polyvalente, Hôpital Robert Debré, CHU de Reims, France
| | - O Caliez
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - B Picard
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - M Rudler
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - R Rhaiem
- Service de chirurgie hépatobiliaire, pancréatique et oncologique digestive, Hôpital Robert Debré, CHU de Reims, France
| | - V Rebours
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Service de Pancréatologie, Clichy, France; Université de Paris, INSERM, UMR 1149, pancreatic rare diseases (PaRaDis), centre de référence de maladies rares, Clichy, France
| | - J Mayaux
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - J B Bachet
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - L Belin
- Sorbonne-Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - A Demoule
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - M Decavèle
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Brugel M, Bouché O, Kianmanesh R, Teuma L, Tashkandi A, Regimbeau JM, Pessaux P, Royer B, Rhaiem R, Perrenot C, Neuzillet C, Piardi T, Deguelte S. Time from first seen in specialist care to surgery does not influence survival outcome in patients with upfront resected pancreatic adenocarcinoma. BMC Surg 2021; 21:413. [PMID: 34876080 PMCID: PMC8649990 DOI: 10.1186/s12893-021-01409-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study evaluated the impact of time to surgery (TTS) on overall survival (OS), disease free survival (DFS) and postoperative complication rate in patients with upfront resected pancreatic adenocarcinoma (PA). METHODS We retrospectively included patients who underwent upfront surgery for PA between January 1, 2004 and December 31, 2014 from four French centers. TTS was defined as the number of days between the date of the first consultation in specialist care and the date of surgery. DFS for a 14-day TTS was the primary endpoint. We also analyzed survival depending on different delay cut-offs (7, 14, 28, 60 and 75 days). RESULTS A total of 168 patients were included. 59 patients (35%) underwent an upfront surgery within 14 days. Patients in the higher delay group (> 14 days) had significantly more vein resections and endoscopic biliary drainage. Adjusted OS (p = 0.44), DFS (p = 0.99), fistulas (p = 0.41), hemorrhage (p = 0.59) and severe post-operative complications (p = 0.82) were not different according to TTS (> 14 days). Other delay cut-offs had no impact on OS or DFS. DISCUSSION TTS seems to have no impact on OS, DFS and 90-day postoperative morbidity.
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Affiliation(s)
- M. Brugel
- Department of Ambulatory Oncology Care Unit, Centre Hospitalier Universitaire de Reims, Rue du general Koenig, Reims, France
| | - O. Bouché
- Department of Ambulatory Oncology Care Unit, Centre Hospitalier Universitaire de Reims, Rue du general Koenig, Reims, France
- University Reims Champagne-Ardenne (URCA), Reims, France
| | - R. Kianmanesh
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - L. Teuma
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - A. Tashkandi
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - J. M. Regimbeau
- Digestive Surgery Department, CHU Amiens Picardie, 1 rond-point du Professeur Christian Cabrol, Amiens, France
- University of Picardie Jules-Vernes, 51 boulevard de Chateaudun, Amiens, France
| | - P. Pessaux
- General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, 1 quai Louis Pasteur, Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - B. Royer
- General Surgeon, Clinique de Courlancy, 38bis rue de Courlancy, Bezannes, France
| | - R. Rhaiem
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - C. Perrenot
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - C. Neuzillet
- Medical Oncology Department, Institut Curie, 35 rue Dailly, Saint-Cloud, France
- Versailles Saint-Quentin University, Paris Saclay University, Saint-Cloud, France
| | - T. Piardi
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - S. Deguelte
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
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Dagorno C, Sommacale D, Laurent A, Attias A, Mongardon N, Levesque E, Langeron O, Rhaiem R, Leroy V, Amaddeo G, Brustia R. Prehabilitation in hepato-pancreato-biliary surgery: A systematic review and meta-analysis. A necessary step forward evidence-based sample size calculation for future trials. J Visc Surg 2021; 159:362-372. [PMID: 34489200 DOI: 10.1016/j.jviscsurg.2021.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Prehabilitation is defined as preoperative conditioning of patients in order to improve post-operative outcomes. Some studies showed an increase in functional recovery following colorectal surgery, but its effect in hepato-pancreato-biliary (HPB) surgery is unclear. The aim of this study was to realize a systematic literature review and meta-analysis on the current available evidence on prehabilitation in HPB surgery. MATERIALS AND METHODS A systematic review and a metanalysis were carried out on prehabilitation (physical, nutritional and psychological interventions) in HPB surgery (2009-2019). Assessed outcomes were postoperative complications, length of stay (LOS), 30-day readmission, and mortality. MAIN RESULTS Four studies among the 191 screened were included in this systematic review (3 randomized controlled trials, 1 case-control propensity score study), involving 419 patients (prehabilitation group, n=139; control group, n=280). After pooling, no difference was observed on LOS ((-4.37 days [95% CI: -8.86; 0.13]) or postoperative complications (RR 0.83 [95%CI: 0.62; 1.10]), reported by all the included studies. Two trials reported on readmission rate, but given the high heterogeneity, a meta-analysis was not realized. No deaths were reported among the included studies. CONCLUSION No effect of prehabilitation programs in HPB surgery was observed on LOS or postoperative complications rate. Future trials with standardized outcomes of measure, and adequately powered samples calculations are thus required. PROSPERO REGISTRATION CRD42020165218.
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Affiliation(s)
- C Dagorno
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - D Sommacale
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; Inserm U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", France-Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - A Laurent
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - A Attias
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - N Mongardon
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; U955-IMRB, Equipe 03 "Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)", Inserm, University Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), 94700 Maisons-Alfort, France
| | - E Levesque
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - O Langeron
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - R Rhaiem
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, Reims, France
| | - V Leroy
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Inserm U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", France-Assistance Publique-Hôpitaux de Paris, Créteil, France; Department of Hepatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - G Amaddeo
- Université Paris Est Creteil, Faculté de Santé, 94010 Créteil, France; Inserm U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", France-Assistance Publique-Hôpitaux de Paris, Créteil, France; Department of Hepatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - R Brustia
- Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
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Rhaiem R, Piardi T, Renard Y, Deguelte S, Kianmanesh R. Laparoscopic thermal ablation of liver tumours. J Visc Surg 2021; 158:173-179. [PMID: 33483291 DOI: 10.1016/j.jviscsurg.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Rhaiem
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France; Anatomy Laboratory of the Reims-Champagne-Ardenne, Faculty of Medicine, Reims, France.
| | - T Piardi
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France
| | - Y Renard
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France; Anatomy Laboratory of the Reims-Champagne-Ardenne, Faculty of Medicine, Reims, France
| | - S Deguelte
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France
| | - R Kianmanesh
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France
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5
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Affiliation(s)
- R Rhaiem
- Department of hepatobiliary, digestive and endocrine surgery, Robert-Debré hospital, university hospital of Reims, Reims, France; University of Champagne Ardenne, Reims faculty of medicine, Reims, France.
| | - T Piardi
- Department of hepatobiliary, digestive and endocrine surgery, Robert-Debré hospital, university hospital of Reims, Reims, France; University of Champagne Ardenne, Reims faculty of medicine, Reims, France
| | - R Kianmanesh
- Department of hepatobiliary, digestive and endocrine surgery, Robert-Debré hospital, university hospital of Reims, Reims, France; University of Champagne Ardenne, Reims faculty of medicine, Reims, France
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Brustia R, Fleres F, Tamby E, Rhaiem R, Piardi T, Kianmanesh R, Sommacale D. Postoperative collections after liver surgery: Risk factors and impact on long-term outcomes. J Visc Surg 2019; 157:199-209. [PMID: 31575482 DOI: 10.1016/j.jviscsurg.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Postoperative collection (PC) can occur after liver surgery, but little is known on their impact on short and long-term outcomes. The aim of this study was to analyse factors predicting the occurrence of PC, the need of drainage and their impact on oncologic outcomes. METHODS This single-center, cohort-study included adult patients undergoing liver surgery between 2008 and 2017. The primary objective was to determine variables associated with PC occurrence defined by fluid collection on postoperative day-7 CT scan. Secondary objectives were factors predicting drainage requirement, and predictors of overall survival. RESULTS During the study period 395 patients were included: 53.6% of them (n=210) developed a PC with 12% (n=49) requiring drainage. Variables associated to the occurrence of PC were body mass index>35kg/m2 (OR 8.09, 95%CI (1.50,43.60) P=0.015) and extension of liver surgery (major vs. minor, OR 1.96, 95% CI (1.05,3.64) P<0.034) while laparoscopic approach was associated to a protective role (OR 0.35, 95%CI (0.18,0.67) P=0.001) in the multivariate analysis. The presence of a PC requiring treatment was associated to long-term mortality (OR:1.85, 95% CI (1.15, 2.97) P<0.01) in patients with malignant disease. CONCLUSIONS Patients undergoing to major open liver surgery with BMI>35kg/m2 have an increased risk to develop a PC: this target population need a systematic imaging in the postoperative period, even if the indication for drainage should be guided by clinical symptoms. Last, the presence of PC requiring treatment has a negative impact on overall survival among patients treated for malignant disease.
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Affiliation(s)
- R Brustia
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, Henri-Mondor University Hospital, AP-HP, Université Paris Est, 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Research Unit BQR SSPC, Université de Picardie Jules-Verne, 32 rue des Minimes 80000 ,Amiens, France
| | - F Fleres
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - E Tamby
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - R Rhaiem
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - T Piardi
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - R Kianmanesh
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - D Sommacale
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, Henri-Mondor University Hospital, AP-HP, Université Paris Est, 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Tashkandi A, Rhaiem R, Adlani I, Fossaert V, Sommacale D, Kianmanesh R, Piardi T. Sequential treatment of rupture of pseudoaneurysm of hepatic artery with peritoneal patch and radiological embolization. J Surg Case Rep 2019; 2019:rjz103. [PMID: 30967936 PMCID: PMC6451181 DOI: 10.1093/jscr/rjz103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/19/2019] [Indexed: 01/23/2023] Open
Abstract
Bleeding after pancreatico-duodenectomy (PD) is a serious complication with high rates of morbidity and mortality. Interventional radiology techniques’ using embolization and/or stenting is the optimal management. In case of hemodynamic instability, surgical treatment is mandatory, but its mortality rate is considerable. Herein, we report the management of massive bleeding in a 52-year-old-male patient, 3 weeks after PD. The patient suffered severe hemorrhage with two cardiac arrests and surgical treatment was performed immediately after resuscitation. A defect in the distal part of the hepatic artery was repaired using a peritoneal patch. A postoperative CT scan confirmed bleeding control and the presence of a pseudoaneurysm within the patch area. The second step of the treatment was to perform selective embolization. The course was uneventful, and the patient was discharged 6 weeks later.
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Affiliation(s)
- A Tashkandi
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France.,Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - R Rhaiem
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - I Adlani
- Department of Radiology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - V Fossaert
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - D Sommacale
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - R Kianmanesh
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - T Piardi
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
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Abstract
Mucinous cystadenomas are the most frequent cystic benign tumors of the pancreas. They are characterized by a malignant potential. Acute pancreatitis is their most common complication. This manuscript reports a unique complication of mucinous cystadenomas of the pancreas: retroperitoneal rupture associated to acute pancreatitis. After resuscitation, the patient underwent surgery. A cystic mass of the pancreas tail with retroperitoneal rupture was found. Splenopancreatectomy was performed. Outcomes were straightforward. After 3 years of follow-up, no signs of recurrence are highlighted.
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Affiliation(s)
- A Haddad
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
| | - A Sebai
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
| | - R Rhaiem
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
| | - A Ghedira
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
| | - A Makni
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007 Tunis, Tunisia.
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Haddad A, Sebai A, Rhaiem R, Ghedira A, Daghfous A. A strangled hernia through the Winslow's hiatus: about a rare situation. Ann R Coll Surg Engl 2018; 100:e123-e124. [PMID: 29607725 PMCID: PMC5956603 DOI: 10.1308/rcsann.2018.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 11/22/2022] Open
Abstract
Winslow's hiatus hernia is the rarest of the internal hernias. Its diagnosis is difficult and requires an urgent laparotomy to avoid necrosis of the incarcerated loop or even the death of the patient. We report the case of a patient operated urgently for acute intestinal obstruction caused by a strangled hernia through the Winslow's hiatus. A reduction by traction of the hernia was undertaken. Rapid management of this pathology is important using clinical and radiographical elements.
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Affiliation(s)
- A Haddad
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
| | - A Sebai
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
| | - R Rhaiem
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
| | - A Ghedira
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
| | - A Daghfous
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, Tunis, Tunisia
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Maghrebi H, Makni A, Rhaiem R, Atri S, Ayadi M, Jrad M, Jouini M, Kacem M, Bensafta Z. Adult intussusceptions: Clinical presentation, diagnosis and therapeutic management. Int J Surg Case Rep 2017; 33:163-166. [PMID: 28327421 PMCID: PMC5358816 DOI: 10.1016/j.ijscr.2017.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 12/31/2022] Open
Abstract
This is a rare entity. Its treatment still difficult because of controversy regarding the diagnosis and the optimal management. We tried to present our experience with 8 adult intussusceptions cases followed by a review of the literature in order to analyze the cause, clinical features, diagnosis, and management of this rare pathology. It was a retrospective study, But it is very interesting with clear results and excellent figures which may guide surgeons who encounter this problem. I am hoping that you have received everything as required and that the reviewing process finds the manuscript acceptable for publication in the journal. Please accept again dear professor our most humble greetings.
Background Adult intussusception is a rare clinical entity. It is an uncommon cause of intestinal obstruction in adult. It often presents with nonspecific symptoms and preoperative diagnosis remains difficult. The purpose of this study was to determine the clinical entity and surgical approach of adult intussusception. Methods We have conducted a retrospective descriptive study starting from 2006 until 2014. We reviewed data for all patients that had been admitted to our department for intestinal intussusception. Results Eight consecutive patients were admitted to our department. The mean age was 48 years old (20–71). The sex ratio was 0,6. The clinical presentation was acute in 5 cases. A computed tomography was performed in 6 cases. The diagnosis of gastrointestinal intussusception was made preoperatively in 100% of patients. All patients underwent surgery. An organic lesion was identified in 100% of the cases. In all cases, resection of the intussuscepted intestinal loop was done without intestinal reduction. All patients were well followed up and recurrences have been documented. Conclusion In adults, intussusception is usually secondary to an organic cause. In the absence of signs of severity, etiologic diagnosis based on CT allows the diagnosis of the intussusception and sometimes can detect the causal lesion. Therapeutic sanction of intussusception is surgery and there is more emphasis towards resection without reduction.
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Affiliation(s)
- H Maghrebi
- Surgery Department La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - A Makni
- Surgery Department La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - R Rhaiem
- Surgery Department La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - S Atri
- Surgery Department La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - M Ayadi
- Oncology Unit, Institut Salah Azaiez, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - M Jrad
- Radiology Department La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - M Jouini
- Surgery Department La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - M Kacem
- Surgery Department La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - Z Bensafta
- Surgery Department La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
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