UNASSIGNED: In cystic lesions of the pancreas, hydatid cyst should be considered in the differential diagnoses and its presence should be ruled out before any invasive interventions. Serological tests along with imaging studies related to hydatid cyst diagnostic indicators should be performed in people who live in Echinococcus granulosus endemic areas and suffer from cystic lesions of the gastrointestinal tract.
UNASSIGNED: Primary pancreatic hydatid cysts, caused by the tapeworm Echinococcus granulosus, represent a rare occurrence often challenging to diagnose due to their similarity to other pancreatic conditions. This case report outlines a 67-year-old male presenting with jaundice and cholestasis but lacking typical symptoms associated with pancreatic hydatid cysts. Laboratory findings revealed elevated bilirubin levels, liver enzyme abnormalities, and tumor markers, prompting imaging studies that indicated a cystic mass near the pancreatic head. Misdiagnosed initially as a mucinous cystic neoplasm, the patient underwent Whipple surgery, unveiling a large cystic lesion upon examination.

OBJECTIVE: Splanchnic hypoperfusion during abdominal surgery contributes to postoperative gut sepsis and mortality. Dobutamine is an inotrope with vasodilator properties that improve hepatosplanchnic perfusion. The aim of this study was to examine the effect of intraoperative dobutamine infusion during Whipple surgery on splanchnic perfusion, hemodynamic, and overall postoperative outcome.
METHODS: Sixty patients were randomly allocated to receive intraoperatively (3 μg/kg per minute or 5 μg/kg per minute) doses of dobutamine or saline. Baseline measurements included hemodynamic parameters, gastric tonometric parameters, and arterial and mixed venous gases. These patients had a follow-up for development for in-hospital morbidity and mortality.
RESULTS: Intraoperative use of dobutamine increased oxygen-derived parameters as evidenced by increased mixed venous oxygen saturation. Tonometered gastric mucosal pH, a surrogate for splanchnic perfusion, increased in patients who received intraoperative dobutamine. Patients in the dobutamine groups demonstrated significant higher heart rates, premature ventricular contraction arrhythmias, and electrocardiographic signs of ischemia. Mean arterial blood pressure demonstrated no significant difference among groups. The overall incidence of postoperative complications was higher in control group 70 % vs 20% to 40% in dobutamine groups.
CONCLUSIONS: Intraoperative use of dobutamine improved global oxygen delivery, splanchnic perfusion, and postoperative outcome after Whipple surgery. These findings may be of clinical importance when the therapeutic goal is to improve gut perfusion.