ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)https://www.scielo.br/journal/abcd/feed/2024-03-12T20:21:41.992000ZVol. 37 - 2024WerkzeugPARTIAL DISTAL DUODENECTOMY IN PATIENT WITH ADENOCARCINOMA10.1590/0102-672020240003e17962024-03-12T20:21:41.992000Z2020-08-09T06:48:04.361000ZLOSADA, HéctorPORTILLO, NorbertoTRONCOSO, AndrésBECKER, RenatoVERA, Rocio
<em>Losada, Héctor</em>;
<em>Portillo, Norberto</em>;
<em>Troncoso, Andrés</em>;
<em>Becker, Renato</em>;
<em>Vera, Rocio</em>;
<br/><br/>
ABSTRACT BACKGROUND: Duodenal adenocarcinoma is a small percentage of gastrointestinal neoplasms, around 0.5%, and its treatment is based on resection of the tumor, classically by pancreaticoduodenectomy. In recent years, however, segmental resections of duodenal lesions, that do not involve the second portion or the periampullary region, have gained relevance with good surgical and oncological outcomes as well as the benefit of avoiding surgeries that can result in high morbidity and mortality. AIMS: To report a case of an elderly female patient with malignant neoplastic lesion in the third and fourth duodenal portion, non-obstructive, submitted to surgical treatment. METHODS: The technical option was the resection of the distal duodenum and proximal jejunum with preservation of the pancreas and reconstruction with side-to-side duodenojejunal anastomosis. RESULTS: The evolution was satisfactory and the surgical margins were free of neoplasia. CONCLUSIONS: Segmental resections of the duodenum are feasible and safe, offering the benefit of preventing complications of pancreaticoduodenectomies.BILE DUCT INJURY REPAIR IN A PATIENT WITH <i>SITUS INVERSUS TOTALIS</i>10.1590/0102-672020240002e17952024-03-12T20:21:41.992000Z2020-08-09T06:48:04.361000ZMEIRA-JÚNIOR, José DonizetiRAMOS-ARANDA, JavierCARRILLO-VIDALES, JavierVELÁSQUEZ-CORIA, Erik RodrigoMERCADO, Miguel AngelDOMINGUEZ-ROSADO, Ismael
<em>Meira-Júnior, José Donizeti</em>;
<em>Ramos-Aranda, Javier</em>;
<em>Carrillo-Vidales, Javier</em>;
<em>Velásquez-Coria, Erik Rodrigo</em>;
<em>Mercado, Miguel Angel</em>;
<em>Dominguez-Rosado, Ismael</em>;
<br/><br/>
ABSTRACT BACKGROUND: Bile duct injury (BDI) causes significant sequelae for the patient in terms of morbidity, mortality, and long-term quality of life, and should be managed in centers with expertise. Anatomical variants may contribute to a higher risk of BDI during cholecystectomy. AIMS: To report a case of bile duct injury in a patient with situs inversus totalis. METHODS: A 42-year-old female patient with a previous history of situs inversus totalis and a BDI was initially operated on simultaneously to the lesion ten years ago by a non-specialized surgeon. She was referred to a specialized center due to recurrent episodes of cholangitis and a cholestatic laboratory pattern. Cholangioresonance revealed a severe anastomotic stricture. Due to her young age and recurrent cholangitis, she was submitted to a redo hepaticojejunostomy with the Hepp-Couinaud technique. To the best of our knowledge, this is the first report of BDI repair in a patient with situs inversus totalis. RESULTS: The previous hepaticojejunostomy was undone and remade with the Hepp-Couinaud technique high in the hilar plate with a wide opening in the hepatic confluence of the bile ducts towards the left hepatic duct. The previous Roux limb was maintained. Postoperative recovery was uneventful, the drain was removed on the seventh post-operative day, and the patient is now asymptomatic, with normal bilirubin and canalicular enzymes, and no further episodes of cholestasis or cholangitis. CONCLUSIONS: Anatomical variants may increase the difficulty of both cholecystectomy and BDI repair. BDI repair should be performed in a specialized center by formal hepato-pancreato-biliary surgeons to assure a safe perioperative management and a good long-term outcome.