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  • Author: Arkadiusz Fabiszewski x
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Arkadiusz Fabiszewski and Marek Jackowski

Bleding From the Splenic Artery into a Pancreatic Pseudocyst with a Coexisting Microfistula to the Transverse Colon as Atypical Recurent Masive Gastrointestinal Bleding

Here we present a case of a 49-year old male patient who was hospitalized at our Clinic from 2 to 16 December 2008 due to recurrent massive gastrointestinal bleeding. It was a patient with a history of recurrent pancreatitis. He had a history of surgical treatment for postinflamamtory pancreatic cyst (Jurasz cystogastrostomy). From 28.01.2007 to 16.12.2008 he was hospitalized five times. During the last hospitalization he received a total of 12 units of packed red blood cells. Neither gastroscopy nor colonoscopy did demonstrate the site of bleeding. AngioCT of the abdominal cavity demonstrated clearly enlarged spleen and a well delineated region, 30×35 mm, reaching spleen hilum, filled with dense fluid suggesting a vascular fistula, in the projection of the body and tail of the pancreas. The patient was qualified for laparotomy. Intraoperatively, bleeding from the splenic artery into the pancreatic pseudocyst with coexisting microperforation to the transverse colon was detected. The pancreatic cyst was opened and drained, the bleeding blood vessel as well as the splenic artery were underpinned. Splenectomy was performed and wall of the transverse colon was repaired. The patient underwent reoperation due to adhesion related small bowel obstruction on day 30 after the procedure. Currently the patient is in good general condition, without complaints, undergoes periodic follow up in the outpatient setting.

Open access

Arkadiusz Fabiszewski, Łukasz Brycht and Marek Jackowski

Primary Small Intestine Tumour as the Cause of Gastrointestinal Tract Occlusion

The following paper presents the case of a 40-year-old patient staying in our Clinic between 2 March 2010 and 12 March 2010 due to the symptoms of permeable occlusion of gastrointestinal tract. This is a patient with a several weeks' history of non-specific abdominal pain, vomiting and significant weight loss (ca 20 kg). Until recently he has not suffered from any serious illnesses. In the performed abdominal ultrasound, gastroscopy and colonoscopy no pathology was affirmed. CT scan with intravenous and oral contrast showed significantly widened intestinal loops with residual liquid matter in the stomach, duodenum and a part of the jejunum without any distinguishing pathological mass, and also single mesenteric lymph nodes and para-aortic nodes enlarged to the size of 12 mm. The patient was qualified for laparatomy. During the surgery, a 4-cm tumour of the jejunum, concentrically narrowing intestinal lumen was found. Segmental resection of the small intestine was performed with side to side anastomosis with the use of a linear stapler. Currently the general condition of the patient is good, without any ailments, and the patient is undergoing systemic treatment.