A1504 SSAT ABSTRACTS

6795

OBSTRUCTION: EVALUATION WITH HELICAL COMPUTERTOMOGRAPHY.Athanasios I. Alexopoulos, Stergios Delakidis, Konstantin Dalamarinis,Garifalia Tsioga, Andreas Petroulakis, Petros Antonopoulos, SISMANO­GLION Hasp, Athens, Greece.

Aim: The aim of this study was to determine the level and cause of bowelobstruction with helical computer tomography. Material and Methods:Thirty five patients with suspected obstruction of the bowel, botb clinicallyand on plain films, underwent helical CT. Contrast material(720ml) wasadministrated orally or through nasogastric tube 2 hours before scanning.In 14 cases contrast material did not reach the level of obstruction. Sixpatients were unable to drink contrast material. Intravenous contrast ma­terial was additionally administrated in six casest4 with recurrent malig­nancies, 2 with abscess). Diagnosis was established by surgery in 28patients and clinical course in 7 patients. Results: The level and cause ofbowel obstruction was accurently diagnosed in all causes. Causes ofobstruction included adhesion(n= 16), hernia(n=6), recurrent malignancy(n=4), primary tumor(n=2), Crohn's disease (n=2), large bowel volvu­lusm =2). mesentery abscess(n=2) and colonic diverticulitis(n= I). Thelevel of obstruction was in 27 patients in the small bowel and in 8 patientsin the colon. Conclusion: Helical CT is a valuable method to determine thelevel and canse of bowel obstruction. We believe tbat helical CT is theprocedure of choice in patients with a history of abdominal malignancy orsnspected primary abdominal malignancy. Also it plays a secondary rolepostsurgical in patients .without cancer, most likely to have adhesive bowelobstruction.

6796ACUTE COLONIC DIVERTICULITIS: EVALUATION WITH UN·ENHANCED THIN-SECTION HELICAL COMPUTER TOMOG­RAPHY.Athanasios I. Alexopoulos, Stergios Delakidis, Garifalia Tsioga, AndreasPetroulakis, Maria Chatzopoulou, Konstantin Oalamarinis, Petros Antono­poulos. SISMANOGLION Hasp, Athens, Greece.

Purpose: The aim of this study was to define the diagnostic value ofthin-section helical computer tomography (CT) during the acute phase ofdiverticulitis. Material and Methods: Over a 12 month period 59 adultpatients presented to our emergency department with suspected acutediverticulitis underwent helical computer tomography as a first imagingexamination. All patients were given 500-1000ml of contrast materialbefore scanning. After the routine helical CT exam we performed athin-section technique (slice thickness 4-5mm, reconstruction interval4-5mm) in the area of interest.CT results were correlated with clinicalfollow up in all patients, by CT exames follow up in 6 patients and bysurgery in 3 patients. Results: Acute diverticulitis was diagnosed by helicalCT in 50 of the cases (50/59) . Diverticula was present in all subjects(50/50), pericolonic inflammatory infiltration in 48/50(98%), focal inflam­matory wall thickening in 45/50(90%), muscular wall hypertrophy in42/50(84%),pericolonic phlegmon in 10/50(20%), abscess in 3/50(6%) anddiffuse wall thickening in 1/50(2%). Nine patients (9/59) had CT resultsother than diverticulitis included ileitis(n=3),left tuba-ovarian ab­scess(n=2) and other diseases (n=4). Conclusion: Unenhanced thin-sec­tion helical CT is an accurate and effective technique to confirm or excludeclinically suspected diverticulitis and to suggest alternative conditions ifthey are present.

6797INTRAHEPATIC PORTAL VEIN ANEURYSM S(IHPVA) WITHPORTO·VENOUS SYSTEM SHUNT ANALYSIS OF ELEVENCASES.Shingo Asahara, Takaaki Ikari, Akira Kamei, Eiichi Sato, Kouichi Takano,Takuya Kudo, Naomi Sago, Kazuko Beppu, Hironori Kokudo, CancerInstitute Hosp, Tokyo, Japan.

OBJECTIVE: Portal vein aneurysm has been considered to be rare. Withthe advent of color doppler ultrasonography, however, reports of caseshave been discribed. The purpose of this study is to clarify clinical aspectsand ultrasonografical findings of intrahepatic portal vein aneurysm withporto-venous system shunt. Materials and Methods: In the periods fromMay 1998 to March 1999, 15,871 cases of ultrasonography were performedfor disease screening or disease follow-up. 1175 cases of computed to­mography were also undergone during the same periods. Eight cases ofIHPVA were detected with US and three with CT. All were confirmed bycolor doppler ultrasonography. Eleven patients consisted of two males andnine fimales with a mean age of 64.5. Clinical presentation, laboratory dataand imaging findings were reviewed. Results: Liver cysts were detected in3,900 patients(24.6%). Among them, eleven patients had IHPVA withporto-venous system shunt. Two patients presented with liver dysfunction,hyperammonemia and portal hypertension (related with HCV virus). Fivepatients were previously misdiagnosed as liver cyst. IHPVA were locatedin lateral or medial segment in four patients, anterior in two and posteriorin one patient. Portal vein branch dilatation around IHPVA were recog­nized in ten patients and hepatic vein dilatation in eight by ultrasonogra­phy. Cystic lesions measured from 4.4 to 23.9 mm in diameter. Thefeatures of aneurysm showed simple cyst in eight patients and multilocularcyst in three. Color doppler ultrasonography revealed IHPVA with porto­venous system shunt in all patients. Conclusions:IHPVA with porto-ve-

GASTROENTEROLOGY Vol. 118, No.4

nous system shunt was visualized as cystic lesions with dilatation ofhepatic or portal vein branch by ultrasonography. Color doppler ultra­sonography can easly confirm blood flow and communication of aneurysmand vessels. IHPVA is not always related with portal hypertension and itsclinical significance remains still unknown.

6798

"BEGER" VS. "FREY": A COMPARISON OF LIMITED PANCRE·ATIC HEAD RESECTIONS FOR BENIGN DISEASE.Gudrun Aspelund, Mark D. Topazian, Dana K. Andersen, Yale Univ Schof Medicine, New Haven, CT.

Introduction: The Duodenum-Preserving Pancreatic Head Resection (DP­PHR) by Beger et al, and the Extended Lateral Pancreatico-Jejunostomy(ELPJ) by Frey, have expanded the surgical treatment of benign pancreaticdisease. Improved outcomes and lower morbidity compared to the Whipple(WHIP) procedure have been reported, but direct comparisons of DPPHRand ELPJ have been limited. We reviewed our single-surgeon experiencewith these resections, compared to standard and pylorus-sparing WHIPresection, distal pancreatic resections (DPR) and pancreatic duct sphinc­teroplasties (PDS) performed contemporaneously. Methods: From 3/97 to11/99, a total of 42 pancreatic procedures were performed, including 8DPPHR,7 ELPJ, II WHIP, 6 DPR, and 5 PDS. We evaluated indications,including chronic pancreatitis, proximal duct stenosis, benign tumors, andmalignancies; morbidity, including operative time, blood loss, length ofnasogastric intubation, length of post-op stay, and major complications;and outcomes, including new diabetes mellitus, persistent analgesic use,and complete functional recovery. Results: No deaths occurred. All DP­PHR, ELPJ and PDS patients had preop ERCP, and most had EUS.Operative time, including intraoperative ultrasound etc, was I hour shorterfor ELPJ vs. OPPHR. Both were shorter than for WHIP. Results show lowmorbidity and similar outcomes with DPPHR and ELPJ. Blood loss wasless and length of stay shorter for OPPHR and ELPJ than for WHIP. Majorcomplications (including I pancreatic duct leak in OPPHR, WHIP andOPR) were absent in ELP1. Persistent analgesic use and failures to achievefull functional recovery were similar in DPPHR (14%), ELPJ (14%) andWHIP (9%) groups. New diabetes occurred after I WHIP operation but notafter OPPHR or ELP1. Conclusions: Our initial experience suggests lowmorbidity and good outcomes witb both DPPHR and ELPJ. The earlyfunctional recovery and freedom from analgesics are similar, althoughOPPHR may be superior to ELPJ when ductal stenosis exists. Selection ofOPPHR VS. ELPJ is therefore dictated by preop evaluation of ductalanatomy. The morbidity of DPPHR is similar to the WHIP procedure,although length of stay is comparable to lesser procedures. Long termfollow up will be required to determine whether patients with benigndisease benefit preferentially from DPPHR vs. ELPJ, but both appear tooffer better outcomes than WHIP procedures.

6799SURGICAL MANAGEMENT OF PANCREATIC NEUROENDO­CRINE TUMORS.Mark F. Berry, Noel N. Williams, Jason H. Lee, Richard Whittington,Robert J. Canter, Ernest F. Rosato, Univ of Pennsylvania, Philadelphia,PA; Univ of Pennsylvania, Philedelphia, PA.

Background: The clinical presentation of pancreatic neuroendocrine tu­mors is dependent on whether the tumor produces functional hormones.Objective: The aim of this study was to examine the clinical presentation,diagnosis, surgical management, pathology, and outcome in patients withpancreatic neuroendocrine tumors. Methods: A retrospective review wasperformed to evaluate the clinical course of 28 patients treated surgically atthe Hospital of tbe University of Pennsylvania between 1989 and 1997 forneuroendocrine tumors of the pancreas. Results: The age of the 28 patients(14 male, 14 female) ranged from 25 to 80 with a mean of 54 ::':: 2.5 years.Ten (36%) patients had functional tumors (8 insulinomas, 2 gastrinomas),with clinical presentations consistent with syndromes of hormone excess.Eighteen (64%) patients had non-functional tumors, with the most commonpresenting symptoms being abdominal pain (72%) and weight loss (39%).Non-functional tumors were identified on 100% of CT scans, MRIs, andangiograms. Functional tumors were identified on only 57% of MRls, 0%of CT scans, and 0% of angiograms. Endoscopic ultrasound (80%), venoussampling (75%), and ERCP (67%) were more successful at localizingfunctional tumors. Tumor location within the pancreas were tail (43%),body (29%), and head (21%). Surgery included distal pancreatectomy(n= 18), Whipple procedure (n= 5), and tumor enucleation (n= 5). Pathol­ogy revealed malignancy in 17 patients and benign disease in II patients.Non-functional tumors had an average size of7.1 ::':: 1.0 ern, and functionaltumors averaged 2.3 ::':: 0.4 ern (p < 0.05). Benign tumors were on average2.8 ::':: 0.6 ern and malignant tumors 7.0 ::':: l.l cm in size (p < 0.05). Themost common post-operative complications were fever (57%), atelectasis(54%), pleural effusion (29%), and infection (25%). Follow-up rangedfrom 2 to 115 months (mean 47 ::':: 5.6). Three of these patients have died,and 4 others have suffered distant disease failure. The overall 2, 3, and 5year survival rates were 92.3%, 84.2%, and 72.7%. The 2, 3, and 5 yearsurvival rates were 100% for benign disease, as compared to 87.5%, 75%,and 66.7% for malignant disease. Conclusions: Surgical resection of pan­creatic neuroendocrine tumors has a low mortality and depends on locationwithin the pancreas. Presentation and successful techniques for localizationdiffer between functional and non-functional tumors. Malignant tumors are