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Pancreas- and Pylorus-Preserving Duodenectomy for Advanced Familial Duodenal Polyposis
- Source :
- GE: Portuguese Journal of Gastroenterology, Pp 1-7 (2019), CIÊNCIAVITAE, GE Port J Gastroenterol
- Publication Year :
- 2019
- Publisher :
- Karger Publishers, 2019.
-
Abstract
- Most patients with familial adenomatous polyposis (FAP) will develop duodenal polyps and 5% progress to cancer. Those with Spigelman stage IV have a 36% risk of cancer at 10 years. Endoscopic surveillance is necessary with local ablation for early disease. Unresectable duodenal disease and severe dysplasia are an indication for prophylactic radical surgery by pancreaticoduodenectomy or pancreas-sparing duodenectomy. Some preliminary results have shown better outcomes with duodenectomy. A 45-year-old female with FAP had restorative proctocolectomy at 24 years, desmoid of the mesentery with regression after sulindac, two pregnancies, and at the age of 37 years had duodenal polyposis stage III carpeting the periampullary region. Endoscopic papillectomy and extensive piecemeal mucosectomy was performed but was unsuccessful due to recurrence. After 7 years of regular endoscopic surveillance, focal high-grade dysplasia was diagnosed at the last evaluation. Some diminutive polyps were seen in the small-bowel capsule endoscopy. MRCP showed a normal biliary and pancreatic duct without visualization of the Santorini duct. A pancreas and pylorus-preserving duodenectomy was performed with 3 main steps: (1) duodenectomy with preservation of the pancreas and the pylorus; (2) reconstruction with an advanced jejunal limb and duodenojejunostomy; (3) reimplantation of the biliary and pancreatic duct in the jejunal loop. The patient was discharged on the 11th postoperative day without complications. In conclusion, pancreas- and pylorus-preserving duodenectomy is a promising alternative to pancreaticoduodenectomy for advanced duodenal polyposis that allows complete endoscopic surveillance.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
pancreas-sparing duodenectomy
law.invention
Familial adenomatous polyposis
Duodenectomy
Capsule endoscopy
law
familial adenomatous polyposis
Medicine
lcsh:RC799-869
General Environmental Science
Pancreatic duct
business.industry
Proctocolectomy
Gastroenterology
medicine.disease
Pancreaticoduodenectomy
Clinical Case Study
digestive system diseases
Surgery
medicine.anatomical_structure
Dysplasia
duodenal polyposis
General Earth and Planetary Sciences
lcsh:Diseases of the digestive system. Gastroenterology
pancreaticoduodenectomy
business
Pancreas
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- GE: Portuguese Journal of Gastroenterology, Pp 1-7 (2019), CIÊNCIAVITAE, GE Port J Gastroenterol
- Accession number :
- edsair.doi.dedup.....ab3a2541fbe87ba92beb168e0cfb28e4