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Humberto CRISTINO

Centro Hospitalar Universitário São João
Porto, Portugal
MD
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Spleen-preserving total laparoscopic pancreatoduodenectomy
A 68-year-old woman was referred to us for multiple pancreatic cysts incidentally discovered on a routine ultrasound. An MRI was performed showing multiple cystic tumors throughout the pancreas, the largest of which was 15mm. This led to a suspicion of multifocal, side-branch intraductal papillary mucinous neoplasm (IPMN), with minimal dilatation of the main pancreatic duct. An echo-endoscopy was subsequently performed indicating the presence of a multifocal IPMN. A fine-needle aspiration (FNA) was performed during this procedure, with aspiration of cystic content which was sent for CEA analysis and cytology. Cytology was compatible with a mucinous neoplasm with mild atypia and CEA at 98 IU/mL.
A spleen-preserving total laparoscopic pancreatoduodenectomy was proposed. The procedure was uneventful and the patient was discharged on postoperative day 5. Pathology revealed a 19mm IPMN, with severe dysplasia and 3 foci of micro-invasive ductal adenocarcinoma of 1mm - pT1N0R0.
Surgical intervention
19 days ago
342 views
3 likes
1 comment
07:41
Spleen-preserving total laparoscopic pancreatoduodenectomy
A 68-year-old woman was referred to us for multiple pancreatic cysts incidentally discovered on a routine ultrasound. An MRI was performed showing multiple cystic tumors throughout the pancreas, the largest of which was 15mm. This led to a suspicion of multifocal, side-branch intraductal papillary mucinous neoplasm (IPMN), with minimal dilatation of the main pancreatic duct. An echo-endoscopy was subsequently performed indicating the presence of a multifocal IPMN. A fine-needle aspiration (FNA) was performed during this procedure, with aspiration of cystic content which was sent for CEA analysis and cytology. Cytology was compatible with a mucinous neoplasm with mild atypia and CEA at 98 IU/mL.
A spleen-preserving total laparoscopic pancreatoduodenectomy was proposed. The procedure was uneventful and the patient was discharged on postoperative day 5. Pathology revealed a 19mm IPMN, with severe dysplasia and 3 foci of micro-invasive ductal adenocarcinoma of 1mm - pT1N0R0.
Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
Surgical intervention
2 years ago
1391 views
95 likes
0 comments
04:09
Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
Laparoscopic excision of a gastric duplication cyst
Duplication cysts are rare benign congenital anomalies, located predominantly at the proximal small intestine, emerging in the stomach in about 2 to 4% of all cases. Usually diagnosed in the pediatric age, they are commonly asymptomatic in adulthood and found incidentally on endoscopic or radiological exams. The therapeutic management of asymptomatic cysts is usually expectant. However, a surgical resection is recommended based on the potential risk of complications, such as malignant transformation.
Clinical case: This is the case of a 44-year-old woman, who had an incidental diagnosis of an intra-abdominal cyst on ultrasound examination. CT-scan and MRI revealed the presence of a 6x4cm cystic mass located between the posterior wall of the stomach and the anterior wall of the pancreas, assuming the differential diagnosis of enteric duplication cyst or pancreatic cystic lesion. A laparoscopic exploration is decided upon. She underwent a laparoscopic excision of cystic lesion of the gastric wall, without complications. The patient was discharged home on the third postoperative day. The pathological examination confirmed the diagnosis of enteric duplication cyst. Histology showed a cystic lesion composed of smooth muscle tissue and partially covered by gastric antral-type mucosa.
Surgical intervention
3 years ago
868 views
32 likes
0 comments
06:07
Laparoscopic excision of a gastric duplication cyst
Duplication cysts are rare benign congenital anomalies, located predominantly at the proximal small intestine, emerging in the stomach in about 2 to 4% of all cases. Usually diagnosed in the pediatric age, they are commonly asymptomatic in adulthood and found incidentally on endoscopic or radiological exams. The therapeutic management of asymptomatic cysts is usually expectant. However, a surgical resection is recommended based on the potential risk of complications, such as malignant transformation.
Clinical case: This is the case of a 44-year-old woman, who had an incidental diagnosis of an intra-abdominal cyst on ultrasound examination. CT-scan and MRI revealed the presence of a 6x4cm cystic mass located between the posterior wall of the stomach and the anterior wall of the pancreas, assuming the differential diagnosis of enteric duplication cyst or pancreatic cystic lesion. A laparoscopic exploration is decided upon. She underwent a laparoscopic excision of cystic lesion of the gastric wall, without complications. The patient was discharged home on the third postoperative day. The pathological examination confirmed the diagnosis of enteric duplication cyst. Histology showed a cystic lesion composed of smooth muscle tissue and partially covered by gastric antral-type mucosa.