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      Journal of Pain Research (submit here)

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      Abdominal Pain After Subtotal Gastrectomy: A First Report of Accessory Pancreatic Fistula

      case-report

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          Abstract

          Background

          The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo and varies greatly during development. An APD fistula is a rare and easily neglected complication. In this case report, the first symptom of the patient was postoperative abdominal pain and fever. He was eventually diagnosed with accessory pancreatic fistula combined with duodenal fistula. Such a case has not been reported in the literature.

          Case Summary

          A 66-year-old man was emergently hospitalized for abdominal pain. His preliminary diagnosis was perforation of the digestive tract. He developed fever and abdominal pain after emergency subtotal gastrectomy, followed by changes in the colour of the abdominal drainage fluid. An APD fistula and duodenal stump fistula were confirmed by drainage fluid amylase analysis, contrast fistulography and percutaneous transhepatic cholangial drainage (PTCD). After PTCD, nutritional management and drug treatment, the patient recovered well.

          Outcome

          We found and successfully cured a case of accessory pancreatic duct fistula combined with duodenal stump fistula.

          Most cited references10

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          Intestinal perforation by an ingested foreign body*

          Objective To identify the computed tomography findings suggestive of intestinal perforation by an ingested foreign body. Materials and Methods This was a retrospective study of four cases of surgically proven intestinal perforation by a foreign body, comparing the computed tomography findings with those described in the literature. Results None of the patients reported having ingested a foreign body, all were over 60 years of age, three of the four patients used a dental prosthesis, and all of the foreign bodies were elongated and sharp. In all four patients, there were findings indicative of acute abdomen. None of the foreign bodies were identified on conventional X-rays. The computed tomography findings suggestive of perforation were thickening of the intestinal walls (in all four cases), increased density of mesenteric fat (in all four cases), identification of the foreign body passing through the intestinal wall (in three cases), and gas in the peritoneal cavity (in one case). Conclusion In cases of foreign body ingestion, intestinal perforation is more common when the foreign body is elongated and sharp. Although patients typically do not report having ingested such foreign bodies, the scenario should be suspected in elderly individuals who use dental prostheses. A computed tomography scan can detect foreign bodies, locate perforations, and guide treatment. The findings that suggest perforation are thickening of the intestinal walls, increased mesenteric fat density, and, less frequently, gas in the peritoneal cavity, often restricted to the point of perforation.
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            Management of duodenal stump fistula after gastrectomy for gastric cancer: Systematic review.

            To identify the most effective treatment of duodenal stump fistula (DSF) after gastrectomy for gastric cancer.
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              Pneumoperitoneum and its association with ruptured abdominal viscus.

              Pneumoperitoneum is not invariably associated with ruptured or perforated intra-abdominal viscus. To determine the incidence of free air associated with intra-abdominal viscus perforation, the medical records of 77 consecutive patients whose discharge or autopsy diagnosis included pneumoperitoneum or perforated viscus at a community hospital were retrospectively reviewed between June 1980 and October 1985. Abdominal viscus perforation, as determined by contrast studies or at operation, was not invariably associated with free air. Sixty-nine percent (23/33) of gastroduodenal, 30% (3/10) of small-bowel, and 37% (11/30) of large-bowel perforations had free air, as determined by preoperative x-ray film. Four cases with a total of six episodes of pneumoperitoneum were identified where viscus perforation was not documented. Pneumoperitoneum thus remains a reliable sign of viscus perforation; however, lack of this finding does not rule out perforation, and unusual causes must be considered.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                19 February 2020
                2020
                : 13
                : 431-435
                Affiliations
                [1 ]Graduate School of Peking Union Medical College , Beijing 100029, People’s Republic of China
                [2 ]Department of General Surgery, China-Japan Friendship Hospital , Beijing 100029, People’s Republic of China
                Author notes
                Correspondence: Zhi-Ying Yang Department of General Surgery, China-Japan Friendship Hospital , 2 Cherry Blossom East Street, Beijing100029, People’s Republic of China Email yangzhy@aliyun.com
                Author information
                http://orcid.org/0000-0002-9120-6340
                Article
                238599
                10.2147/JPR.S238599
                7037110
                20072094-9b06-4bea-8041-32082ce9861c
                © 2020 Zhang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 14 November 2019
                : 12 February 2020
                Page count
                Figures: 2, References: 12, Pages: 5
                Categories
                Case Report

                Anesthesiology & Pain management
                gastrointestinal perforation,abdominal pain,accessory pancreatic duct fistula,duodenal stump fistula,case report

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