14.03.11 Placement notes

Angelchick prosthesis

• Large silastic 'C'-shaped ring that can secured around the oesophago-gastric junction

• Previously used for GORD

• Not used any more due to risk of stenosis + obstruction

Pancreatic pseudocyst

• • Circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue

  • Lined with granulation tissue (not epithelium)

  • Typically located in the lesser sac of the abdomen

  • Causes: Pancreatitis, Abdominal trauma]

  • Sequalae of acute pancreatic collection

  • => More organized over several weeks => Walled-off within thick wall of granulation tissue and fibrosis

  • Investigations:

    • USS (but may be obscured by gas-filled stomach)

    • CT (gold standard)

    • MRCP (to establish relationship of the pseudocyst to the pancreatic ducts)

  • Management:

  • Connection is created between the cyst and an adjacent intestinal organ

  • e.g. Cystogastrostomy/Cystjejunostomy (body or tail of pancreas), Cystduodenostomy (head of pancreas)

  • Complications

  • Infection, haemorrhage, obstruction, rupture

Whipples

• AKA Pancreaticoduodenectomy, Pancreatoduodenectomy

• Paliative procedure (occasionally curative)

  • For Ca head of the pancreas, CBD, duodenal papilla, duodenum near the pancreas, and/or pancreatitis with or without definitive cause

  • Removal of the distal half of the stomach, gall bladder and its cystic duct, CBD, head of pancreas, duodenum, proximal jejunum, and regional lymph nodes

  • Reconstruction: Pancreaticojejunostomy and hepaticojejunostomy

Notes

• • Picolax

    • = Sodium picosulphate (stimulant laxative, activated by bacteria in colon) with magnesium citrate (osmotic laxative)

    • Bowel-prep, NOT for constipation

    • Take 2 sachets on the day before procedure

  • Laxido

    • = Macrogol (PEG)

    • For long-standing constipation / faecal impaction