Post-op GI bleed after Frey procedure for chronic pancreatitis. 

“Chronic pancreatitis (CP) is a progressive fibro-inflammatory disease of the pancreas leading to irreversible parenchymal damage with gradual loss of exocrine and endocrine functions. The most common and debilitating manifestation of this disease is intractable pain which may lead to loss of work, unemployment, narcotic dependence, and impairment of the quality of life (QOL). About 30–50% of patients with CP will require surgery during their life time.2,3 Several surgical procedures have been described in the literature, and these are broadly classified as drainage, resectional or a combination of the two. Each respective
procedure is chosen based on the degree of pancreatic ductal dilatation, glandular morphology, local complications, and to some extent on the experience and preference of the surgeon. The Frey procedure (FP) has emerged over the past 30 years as one of the most commonly performed operations for painful CP associated with enlarged pancreatic head. The procedure results in substantial and sustained pain relief in the majority of patients. Like other major operations, FP also is associated with several post operative complications.”

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Splenectomy and gastric devascularization in patient with chronic pancreatitis sequelae leading to splenic vein thrombosis

“Patients with extrahepatic portal vein thrombosis may present from infancy through adulthood with variceal bleeding. Physiologically, such patients differ from patient s with cirrhosis and variceal bleeding in that they have a normal liver and maintain good portal perfusion through hepatopedal collaterals.”
“Therapeutic options range from noninterventive, through ablative procedures, to shunt operations. The goal should be definitive control of bleeding and return to a normal lifestyle. Distal splenorenal shunt offers the best option if technically feasible, but if no shuntable veins are patent, ablative procedures and sclerotherapy may be required. A noninterventive, noninvestigational approach is inappropriate in patients who can be offered definitive
therapy. Splenectomy for hypersplenism should not be done in these patients.” (Galloway)

Galloway
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Emergency transarterial embolization for mesenteric bleeding – Safety and efficacy

“Mesenteric bleeding (MB) occurs rarely and its frequency is not well known. It corresponds to bleeding from mesenteric vessels in the abdominal cavity, without intra-luminal digestive bleeding. Although relatively rare, this pathology can be life-threatening if left undiagnosed and untreated. Clinically, MB are characterized by non-systematised abdominal pain and sudden blood loss. MB has many causes such as a post operative complication (especially after pancreaticoduodenectomy), traumatism, tumour, or may be idiopathic with no cause found. CT-scan is the gold standard of diagnostic imaging to identify the cause of MB. While the management of upper and lower gastrointestinal bleeding has been well established, the management of active mesenteric bleeding is less defined in the medical literature.”

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Pancreas-sparing duodenectomy for duodenal polyposis

“Pancreas-sparing duodenectomy, although technically demanding, eliminates the need for pancreatic resection. Pancreas-sparing duodenectomy is associated with good absorptive capacity, weight gain, and quality of life. Furthermore, it may reduce the risk of subsequent malignancy. Long-term surveillance, however, is still required. Pancreas-sparing duodenectomy is contraindicated in the setting of malignancy.”

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Effects of delay of emergent transfer of patients requiring surgery.

“Emergency general surgery (EGS) patients require greater resources and have increased rates of morbidity and mortality. Previous work has shown mortality differences in colectomy patients between direct admissions and transfers patients based on source, including emergency department, inpatient, and nursing home transfers. We hypothesize that patient transfer status negatively effects morbidity, mortality, and resource utilization in a mixed population of EGS patients.
This study demonstrates significant increases in mortality, morbidity, and resource utilization in EGS transfer patients who were not attributable to case mix, demographics, and comorbid status alone. These data point to potential financial and quality assessment challenges for tertiary referral centers.”

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Challenges of Endoscopic Vacuum Therapy of Upper Gastrointestinal Anastomotic Leaks

Anastomotic leaks after digestive surgery have an important impact on surgical outcome. They represent a real therapeutic challenge because of the high morbidity and mortality rates. Multiple treatment options exist, often combining interventional radiology and endoscopy and even redo surgery. To improve patient outcomes, it is of the utmost importance to provide an individualized patient-tailored treatment plan after multidisciplinary discussion. EVT is nowadays recognized as an effective and useful endoscopic approach to treat leaks or perforations in both the upper and lower gastrointestinal tract. Moreover, it has become one of the most effective treatment options overall with a very good safety profile. However, it is a time-consuming endeavour requiring engagement from the endoscopist and understanding from the patient.

Supplementary Materials: The following supporting information can be downloaded at: https:
//www.mdpi.com/article/10.3390/life13061412/s1
, Video S1: Procedure of EVT in a patient with anastomotic leak after oesophagectomy.

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