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Parenchyma Preserving Pancreatic Resections

Parenchyma Preserving Pancreatic Resections. Dr. V Gandhi. 12 yr old girl H/o Pain abdomen left hypochondrium-1yr Increased since 3-4 months Episodic, last one week back. Vomiting associated with pain, bilious Wt loss from one month No other GI Symtoms. Examination. GPE-WNL P/A

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Parenchyma Preserving Pancreatic Resections

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  1. Parenchyma Preserving Pancreatic Resections Dr. V Gandhi

  2. 12 yr old girl • H/o • Pain abdomen left hypochondrium-1yr • Increased since 3-4 months • Episodic, last one week back. • Vomiting associated with pain, bilious • Wt loss from one month • No other GI Symtoms

  3. Examination • GPE-WNL • P/A • Non distended, soft • Tenderness in epigastric region • No palpable lump • BS+ • Chest/CVS/CNS-NAD

  4. Investigations HB-11.6 PCV-37.5 TLC-11800 (N-58,L-38,M-2,E-2,B-0) Plt-4.0 RBS-112 Urea-24 Cr-0.6 CA-19-9 -12(upto37u/ml) Amylase-93 ESR-16 PT- 12.8/13.0 APTT- 32.9/30.0 Tot pro - 6.9 Ser albumin-4.8 Bilirubin T - 0.6 ALP-455 (n-upto 850) SGOT-10 SGPT-10 HIV,HBsAg -ve

  5. Radiology • USG Abd : • Well defined hypoechoic mass lesion in the region of head of pancreas with increased vascularity in it.

  6. Homogenous mass lesion in the head of pancreas cect

  7. Head mass pancreas Impression

  8. Intra – op findings

  9. Hepatic artery Tumor Normal pancreas Gastro-Du artery

  10. Tumor Distal pancreas Normal pancreas SMV

  11. Reconstruction Proximal stump closed Duct to mucosa PJ to distal stump

  12. 4 X 4 cm solid tumor in the neck of the pancreas overlying the SMV Rest of pancreas normal Few nodes along the hepatic artery Liver N, Vessels free Intra – op findings

  13. Median Pancreatectomy with duct to mucosa PJ Operativeprocedure

  14. Solid pseudo – papillary tumor • Lymph nodes – reactive hyperplasia HPR

  15. It was first described by Frantz. • Solid-pseudopapillary tumor of the pancreas is a rare benign or low-grade malignant lesion. • Occurs most commonly in young women and girls.

  16. Local infiltration, distant metastasis and recurrence are very rare. • The histogenetic origin of the tumor cell remains to be elucidated. Solid-pseudopapillary tumor of the pancreas in a 9-year-old girl. Meyer S etal

  17. Although the tumor reaches a large diameter, complete tumor resection has a very good prognosis (Solid-pseudopapillary tumors in childhood.Lange S etal)

  18. Benign or low grade malignant lesions No suspicion of malignancy Preserves exocrine and endocrine function Spleen preservation Preserves the gastro duodenal continuity Complication – pancreatic fistula 0-30%

  19. 50 yrs male Fall from height No other symptoms Lab – normal Case capsule

  20. Tachycardia BP – 100/60 mm hg P/A – distended Resuscitation in ICU Case capsule

  21. CECT

  22. Grade 3 pancreatic trauma Spleen preserving distal pancreatectomy

  23. Grade of Injury (AAST Scale)

  24. Grade I detected at surgery for associated injuries Grading & Management I • Grade II • Pre op detected – Conservative Laparotomy & drainage II

  25. Grade III • Distal Pancreatectomy + Splenectomy • Spleen preserving distal pancreatectomy Grading & Management III

  26. Grade IV • Debridement + distal ductal drainage Grading & Management IV Roux en Y Pancreaticojejunostomy ( after 3 months) • Grade V ---- Whipples

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