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Competing Interests: L. Rebibo, R. Delcenserie et J.-M. Regimbeau déclarent n’avoir aucun lien d’intérêts.

Background/aims: Liver cirrhosis is considered to be a contraindication for pancreaticoduodenectomy (PD). The aim of this study was to present 4 cases of successful PD in cirrhotic patients., Methodology: Among the charts of 90 patients who underwent PD between 2004 and 2008, 4 patients with liver cirrhosis were retrospectively reviewed., Results: There were 3 males and 1 female, aged from 53 to 66 years, who underwent PD for pancreatic head adenocarcinoma (n=3) or ampullary carcinoma (n=1). The median tumor size was 21mm (18-26) and 2 patients had preoperative biliary drainage. All patients had biopsy showing cancer prior to the operation. Cirrhosis was preoperatively suspected due to chronic alcoholism or liver dismorphy on CTscan and confirmed histologically in all patients. All patients were Child Pugh A without portal hypertension. The median operating time was 575 minutes (480-600) and 2 patients received an intraoperative blood transfusion. No patient died postoperatively. All patients had postoperative complications: ascites (n=2), pancreatic fistula (soft pancreas) (n=2) and pulmonary infection (n=1). There was neither liver failure nor postoperative bleeding. Two patients required re-operation for suspected mesenteric ischemia (n=1) and pancreatic fistula (n=1). The median length of hospitalization was 50 days (41-74). The median survival was 12.5 months (3 patients are alive and disease free)., Conclusions: Our data shows that PD in patients with Child A liver cirrhosis should not be systematically considered as a contraindication.

Surgical indications for chronic pancreatitis can be schematically separated into five main groups: pain, effects of fibrosis on adjacent organs, the consequences of main pancreatic duct rupture above an obstruction, and suspected cancer. Finally surgery is also indicated in patients who cannot undergo endoscopic procedures (no accessible papilla) or who have too recently undergone this procedure. Surgical procedures include derivation (pancreatic, cystic, biliary) or mixed procedures combining derivation/resection or pancreatic resection. Finally splanchnicectomy can be discussed. Whatever the indication, surgical treatment must meet several goals: the approach to surgery must be multidisciplinary, surgery must be associated with low morbidity and mortality, preserve as much endocrine function as possible, improve quality of life, and be evaluated in the long term, as well as prospectively if possible. We clarify some important points about the management of patients with chronic pancreatitis before discussing the various treatments in detail.

Obstructive jaundice is uncommon in patients with hepatocellular carcinoma. It can be due to compression of the common bile duct by the liver tumor or by enlarged lymph node metastases in the porta hepatis. Obstructive jaundice can also be due to direct extension of hepatocellular carcinoma into the bile ducts with or without a detectable primary hepatic tumor. These particular hepatocellular carcinoma have been termed "icteric type hepatoma" by Lin et al. in 1975, who emphasized their poor prognosis. We report a similar case of endobiliary hepatoma without a detectable intraparenchymal hepatic tumor in a seventy year-old man. This case is unusual because of its positive evolution and late recurrence.

Numerous infectious agents may induce acute pancreatitis. We report 6 cases of Salmonella-associated acute pancreatitis. Pathogenesis of this type of pancreatitis is related to multiple factors that may coexist in the same patient. The typical clinical picture consists in epigastric pain, nausea, vomiting, diarrhoea and fever. Imaging techniques often disclose minimal changes such as moderate swelling of a part or of the totality of pancreas. As outcome is usually good, conservative treatment and antibiotics may be sufficient to ensure recovery.