Distal pancreatectomy: M. C. Aldridge and I?.C. N. Williamson
13. 14. 15.
16. 17.
Longmire WP, Jordan PH, Briggs JD. Experience with resection of the pancreas in the treatment of chronic relapsing pancreatitis. Ann Sury 1956; 144: 681-95. Leger L. Technique de la pancreato-jejunostomie apres pancreatectomie gauche pour pancreatite chronique. J Chir (Paris) 1958; 76: 4J-115. Patcher HL, Pennington R. Chassin J, Spencer FC. Simplified distal pancreatectomy with the Auto Suture stapler: preliminary clinical observations. Surgery 1979; 85: 16670. Anderson DK, Bolman RM 111, Moylan JA Jr. Management of penetrating pancreatic injuries; subtotal pancreatectomy using the Auto Suture stapler. J Trauma 1980; 20: 347-9. Fitzgibbons TJ, Yellin AE, Maruyama MM, Donovan AJ.
18. 19. 20.
Management of the transected pancreas following distal pancreatectomy. Surg Gvnecol Obstet 1982; 154: 225-31. Lansing PB, Browder IW. Harkness SO, Kitahama A. Staple closure of the pancreas. Am Surg 1983; 49: 214-17. Scott-Conner CEH, Dawson DL. Technical considerations in distal pancreatectomy with splenic preservation. Sury Gynecol Obstet 1989; 168: 451-3. Sadek S, Holdsworth R, Cuschieri A. Experience with pancreatic banding: results of a simple techniqde for dealing with the pancreatic remnant after distal partial pancreatectomy. Br J Surg 1988; 75: 486-7.
Paper accepted 18 March 1991
Case report Br. J. Surg. 1991, Vol. 78, August. 979-980
Tumours of the liver, bile ducts, pancreas and duodenum in a single patient with familial adenomatous polyposis A. D. Spigelman, K. C. R. Farmer, M. James, P. I. Richman and R . K. S. Phillips St. Mark's Hospital, City Road, London and St. Bartholomew's Hospital, West Smithfield, London, UK Correspondence to: Mr R. K. S. Phillips, St. Mark's Hospital, City Road, London E C I V 2PS, UK
The distribution of tumours in the upper gastrointestinal tract in patients with familial adenomatous polyposis parallels mucosal exposure to bile'. The presence of duodenal, pancreatic, bile duct, gallbladder and liver tumours in a patient with polyposis is reported here.
Case report A 78-year-old male with familial adenomatous polyposis presented with
a 12-month history of weight loss and a 2-month history of epigastric abdominal pain. The patient had undergone colectomy and ileorectal anastomosis at 41 years of age. Upper gastrointestinal endoscopy revealed Stage IV duodenal polyposis'. The largest adenoma was 15 mm in diameter and was next to the papilla of Vater. Abdominal ultrasonography revealed a 2-cm mass in the head of the pancreas and multiple hypoechoic lesions in the liver. Computed tomographic-guided biopsy of the liver showed the presence of adenocarcinoma. The patient developed obstructive jaundice and died 7 weeks later. Post mortem jindings The liver was studded with numerous nodules. The common bile duct contained two tumours. The first, just below the junction of the right and left hepatic ducts, caused obstruction. The second tumour was 3 cm above the ampulla. Underlying the latter lesion was a hard, 3-cm
0007-1323/91~080979-02 7 1991 Butterworth-Heinemann Ltd
mass within the head of the pancreas with proximal pancreatic duct dilatation. The gallbladder was thickened and had an irregular mucosal surface. Lymphadenopathy was present in the porta hepatis. above the pancreas and around the aorta. The adrenal glands contained nodules. The oesophagus contained numerous sessile oesophageal polyps ( ~ 0 . cm 7 in diameter). The second and third parts of' the duodenum contained five polyps ( < 1.5 cm in diameter), and the rectal stump contained two polyps (
13. 14. 15.
16. 17.
Longmire WP, Jordan PH, Briggs JD. Experience with resection of the pancreas in the treatment of chronic relapsing pancreatitis. Ann Sury 1956; 144: 681-95. Leger L. Technique de la pancreato-jejunostomie apres pancreatectomie gauche pour pancreatite chronique. J Chir (Paris) 1958; 76: 4J-115. Patcher HL, Pennington R. Chassin J, Spencer FC. Simplified distal pancreatectomy with the Auto Suture stapler: preliminary clinical observations. Surgery 1979; 85: 16670. Anderson DK, Bolman RM 111, Moylan JA Jr. Management of penetrating pancreatic injuries; subtotal pancreatectomy using the Auto Suture stapler. J Trauma 1980; 20: 347-9. Fitzgibbons TJ, Yellin AE, Maruyama MM, Donovan AJ.
18. 19. 20.
Management of the transected pancreas following distal pancreatectomy. Surg Gvnecol Obstet 1982; 154: 225-31. Lansing PB, Browder IW. Harkness SO, Kitahama A. Staple closure of the pancreas. Am Surg 1983; 49: 214-17. Scott-Conner CEH, Dawson DL. Technical considerations in distal pancreatectomy with splenic preservation. Sury Gynecol Obstet 1989; 168: 451-3. Sadek S, Holdsworth R, Cuschieri A. Experience with pancreatic banding: results of a simple techniqde for dealing with the pancreatic remnant after distal partial pancreatectomy. Br J Surg 1988; 75: 486-7.
Paper accepted 18 March 1991
Case report Br. J. Surg. 1991, Vol. 78, August. 979-980
Tumours of the liver, bile ducts, pancreas and duodenum in a single patient with familial adenomatous polyposis A. D. Spigelman, K. C. R. Farmer, M. James, P. I. Richman and R . K. S. Phillips St. Mark's Hospital, City Road, London and St. Bartholomew's Hospital, West Smithfield, London, UK Correspondence to: Mr R. K. S. Phillips, St. Mark's Hospital, City Road, London E C I V 2PS, UK
The distribution of tumours in the upper gastrointestinal tract in patients with familial adenomatous polyposis parallels mucosal exposure to bile'. The presence of duodenal, pancreatic, bile duct, gallbladder and liver tumours in a patient with polyposis is reported here.
Case report A 78-year-old male with familial adenomatous polyposis presented with
a 12-month history of weight loss and a 2-month history of epigastric abdominal pain. The patient had undergone colectomy and ileorectal anastomosis at 41 years of age. Upper gastrointestinal endoscopy revealed Stage IV duodenal polyposis'. The largest adenoma was 15 mm in diameter and was next to the papilla of Vater. Abdominal ultrasonography revealed a 2-cm mass in the head of the pancreas and multiple hypoechoic lesions in the liver. Computed tomographic-guided biopsy of the liver showed the presence of adenocarcinoma. The patient developed obstructive jaundice and died 7 weeks later. Post mortem jindings The liver was studded with numerous nodules. The common bile duct contained two tumours. The first, just below the junction of the right and left hepatic ducts, caused obstruction. The second tumour was 3 cm above the ampulla. Underlying the latter lesion was a hard, 3-cm
0007-1323/91~080979-02 7 1991 Butterworth-Heinemann Ltd
mass within the head of the pancreas with proximal pancreatic duct dilatation. The gallbladder was thickened and had an irregular mucosal surface. Lymphadenopathy was present in the porta hepatis. above the pancreas and around the aorta. The adrenal glands contained nodules. The oesophagus contained numerous sessile oesophageal polyps ( ~ 0 . cm 7 in diameter). The second and third parts of' the duodenum contained five polyps ( < 1.5 cm in diameter), and the rectal stump contained two polyps (
