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In order to identify and correct concomitant diseases all patients undergo a comprehensive examination before surgical treatment. Rare concomitant diseases include primary chronic adrenal insufficiency. This clinical case presents the total duodenopancreatectomy in a patient with primary chronic adrenal insufficiency. Available algorithms are not always suitable in the treatment of such patients after surgical interventions, especially long-term and extensive. It is necessary to focus on laboratory parameters and the clinical picture. An individual and multidisciplinary approach to the treatment of patients with comorbid pathologies is important.

IntroductionPancreatic necrosis is one of the most severe acute abdominal conditions, accounting for 15%–20% of all patients with acute pancreatitis and characterized by significant rates of postoperative complications and mortality. Patients with pancreatic necrosis, in which pathological changes are localized in the proximal pancreas and retroperitoneal space, deserve special attention. This form of the disease includes patients with disconnected main pancreatic duct (MPD) syndrome who have a difficult prognosis.AimThe aim of the study was an improvement of treatment results in patients with necrotizing pancreatitis and signs of the dissociation of the pancreas duct system using the endoscopic transpapillary stent placement method.Material and methodsThis study was a retrospective cohort study. There were 32 patients with acute necrotizing pancreatitis who were managed using the endoscopic transpapillary stent placement method between 2019 and 2021. Disconnected MPD syndrome was diagnosed in all 32 patients. In total, 26 patients were admitted to hospital in the first 72 h, while 6 patients were admitted after 72 h. We diagnosed the necrotizing process located in the proximal and central areas of the pancreas and peripancreatic space in all these patients (“model III”).ResultsPositive results related to transpapillary stent placement were noted in 24 (75%) patients (first cohort). A total of 20 patients from this group were admitted to hospital in the first 48 h, and 4 patients were admitted later than 72 h from the onset of disease. Moreover, 8 patients (25%; second cohort) failed to succeed in transpapillary stent placement. Complications in the first cohort occurred in 3 (12.5%) patients: dislocation of the stent into the duodenum occurred in 1 patient, and bleeding after papillosphincterotomy took place in 2 patients. Meanwhile, infected necrotized pancreatitis developed in 5 patients, and 1 patient (5%) died. Complications among the second cohort occurred in 2 (25%) patients: erosive bleeding (after debridement). Infected necrotized pancreatitis developed in 4 patients, and 2 patients (25%) died.ConclusionsEndoscopic transpapillary stent placement is an effective minimally invasive approach in the management of patients with necrotizing pancreatitis.

Adrenal gland incidentaloma (incidental – sudden, accidental) is a mass of the adrenal gland(s), accidentally detected by an instru-mental examination conducted for other reasons. The frequency of detection of this pathology based on computer tomography of the abdominal organs is 0.5%–2%. In most cases, the mass is represented by adrenocortical adenomas without hormonal secretion. It is an extremely rare case (less than 1% of all cases) when the adrenal incidentaloma is a primary adrenal lymphoma, which accounts for 1% of all non-Hodgkin lymphomas and 3% of all extranodal lymphomas with a few cases reported in the literature. In our article, we present a case of left adrenal incidentaloma of the adrenal gland, which, during further observation and examination, increased in size, which was the reason for performing laparoscopic adrenalectomy. According to the results of the histological examination, the mass turned out to be diffuse large B-cell lymphoma.

Determining the taxonomic composition of microbial consortia of the piglet intestine is of great importance for pig production. However, knowledge on the variety of the intestinal microbiome in newborn piglets is limited. Piglet diarrhea is a serious gastrointestinal disease with a high morbidity and mortality that causes great economic damage to the pig industry. In this study, we investigated the microbiome of various sections of the piglet intestine and compared the microbiome composition of healthy and diarrheal piglets using high-throughput sequencing of the 16S rRNA gene. The results showed that bacteria of the Lactobacillus genus were the most common in the ileum, while Fusobacterium and Bacteroides dominated in the rectum. Comparing the microbiome composition of healthy and diarrheal piglets revealed a reduced number of Lactobacillus bacteria as a hallmark of diarrhea, as did an increased content of representatives of the Escherichia-Shigella genus and a reduced number of Bacteroides, which indicates the contribution of these bacteria to the development of diarrhea in piglets. The relative abundance of Enterococcus bacteria was higher in the diarrhea group. Although some bacteria of this genus are commensals, a small number of species may be associated with the development of diarrhea in piglets. Therefore, our results indicate that the gut microbiome may be an important factor in the development of diarrhea in piglets.

The Russian consensus on exo - and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo - and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian Pancreatic Club using the Delphi method. Its goal was to consolidate the opinions of national experts on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is ensured by the participation of leading gastroenterologists and surgeons.