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Schistosomiasis is an infectious disease caused by parasitic flatworms of the genus Schistosoma. The species Schistosoma mansoni is associated with hepatosplenic disease. Schistosomiasis involving the gallbladder alone is highly unusual, with a few cases reported. Herein, we present the case of a woman from a region with endemic schistosomiasis who presented with a painless solid lesion and wall thickening of the gallbladder. She underwent an uneventful laparoscopic cholecystectomy. Microscopic examination of the surgical specimen revealed Schistosoma mansoni eggs associated with granulomatous reaction, leading to the diagnosis of schistosomiasis of the gallbladder, prompting subsequent treatment with praziquantel and follow-up. This case illustrates the importance of suspicion for this diagnosis in endemic areas, as it can be misdiagnosed with malignancy if not examined microscopically. Complications and treatment strategies are poorly characterized for the few cases of schistosomiasis; reporting this case can serve as a helpful reminder of a rare presentation of this disease., Competing Interests: Conflict of interest: The authors have no conflict of interest to declare., (Copyright: © 2024 The Authors.)

Background: The unresectable pancreatic head tumors develop obstructive jaundice and cholestasis during follow-up. Cholestasis is associated with complications and treatment options are endoscopic stenting (ES) and biliary bypass surgery (BBS)., Aims: The aim of the current study was to compare the safety and efficacy of biliary bypass surgery (BBS) and endoscopic stenting (ES) for cholestasis in advanced pancreas cancer., Methods: This is a retrospective cohort of patients with cholestasis and unresectable or metastatic pancreas cancer, treated with BBS or ES. Short and long-term outcomes were evaluated. We considered the need for hospital readmission due to biliary complications as treatment failure., Results: A total of 93 patients (BBS=43; ES=50) were included in the study. BBS was associated with a higher demand for postoperative intensive care (37 vs.10%; p=0.002, p<0.050), longer intensive care unit stay (1.44 standard deviation±2.47 vs. 0.66±2.24 days; p=0.004, p<0.050), and longer length of hospital stay (7.95±2.99 vs. 4.29±5.50 days; p<0.001, p<0.050). BBS had a higher risk for procedure-related complications (23 vs. 8%; p=0.049, p<0.050). There was no difference in overall survival between BBS and ES (p=0.089, p>0.050). ES was independently associated with a higher risk for treatment failure than BBS on multivariate analysis (hazard ratio 3.97; p=0.009, p<0.050)., Conclusions: BBS is associated with longer efficacy than ES for treating cholestasis in advanced pancreatic cancer. However, the BBS is associated with prolonged intensive care unit and hospital stays and higher demand for intensive care.

Bariatric patients are at risk for developing biliary stones. Choledocholithiasis poses a significant challenge in Roux-en-Y gastric bypass patients due to anatomical changes, complicating the treatment. We present a case of a 71-year-old female with recurrent choledocholithiasis post-bariatric surgery. After failed endoscopic attempts, a biliodigestive bypass with choledocoduodenal anastomosis was performed successfully using the Da Vinci robotic platform. This technique offers a single anastomosis, excluding the duodenum from transit, preventing food reflux. The patient had an uneventful recovery with no recurrence after 1 year. The choledocoduodenal anastomosis is a viable option for biliary diversion in patients with challenging endoscopic access post-gastric bypass, offering favorable outcomes., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Minimally invasive distal pancreatectomy (MIDP) is associated with less blood loss and faster functional recovery. However, the benefits of robotic assisted distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) are unknown., Aims: To compare RDP versus LDP for surgical treatment of benign lesions, pre-malignant and borderline malignant pancreatic neoplasias., Methods: This is a retrospective study comparing LDP with RDP. Main outcomes were overall morbidity and overall costs. Secondary outcomes were pancreatic fistula (PF), infectious complications, readmission, operative time (OT) and length of hospital stay (LOS)., Results: Thirty patients submitted to LDP and 29 submitted to RDP were included in the study. There was no difference regarding preoperative characteristics. There was no difference regarding overall complications (RDP - 72,4% versus LDP - 80%, p=0,49). Costs were superior for patients submitted to RDP (RDP=US$ 6,688 versus LDP=US$ 6,149, p=0,02), mostly due to higher costs of surgical materials (RDP=US$ 2,364 versus LDP=1,421, p=0,00005). Twenty-one patients submitted to RDP and 24 to LDP developed pancreatic fistula (PF), but only 4 RDP and 7 LDP experienced infectious complications associated with PF. OT (RDP=224 min. versus LDP=213 min., p=0.36) was similar, as well as conversion to open procedure (1 RDP and 2 LDP)., Conclusions: The postoperative morbidity of robotic distal pancreatectomy is comparable to laparoscopic distal pancreatectomy. However, the costs of robotic distal pancreatectomy are slightly higher.

This article addresses the question of the Muslim umma (the universal community of Muslims) which arises within the context of the ongoing debates about the status of refugees and their rights around the world, especially in the Muslim world, where a significant majority of migrants and refugees originate and are hosted. We question the existence of the Muslim umma under contemporary circumstances and discuss the extent to which the modern nation-state has undermined the principles of Muslim unity and solidarity beyond national borders. We also examine how Islamic ethics and law ( fiqh ) identify the imperatives of providing comfort and protection for refugees (whether they are Muslim or non-Muslim) individuals, groups, and communities when required or requested. We see this in principle, but not always in practice. Are refugee policies applied by Muslim-majority countries today in accordance with the fundamental Islamic teachings and experiences of the original hijra ? Or have such principles been made redundant by the political-geographic imperatives of ethnicized nation-states? To what extent can applied policies in Muslim-majority countries be developed and enhanced in the light of umma principles that might alleviate the longstanding refugee crises in this troubled area of the world? The article consists of three main sections. The first provides a theoretical and religious analysis of the idea of the umma as an inclusive entity that encompasses all Muslims, contrasted with the modern nation-state as an exclusive geographically defined political institution. The second looks at three Muslim-majority countries that played a significant hosting role in refugee crises over the past decade, namely Jordan, Bangladesh, and Turkey. We offer some insight in understanding to what extent their policies or behavior were based upon ummatic principles, or secularist notions of national interest and humanitarian aid? The last section summarizes the recent innovation providing for Muslim refugees through a UNHCR arrangement and adaptation with the Islamic charitable obligation of Zakat . It is suggested that the UNHCR Zakat Fund is an ummatic manifestation that has already proved honorable and viable. The conclusion calls for a better understanding of the umma as it is in the Islamic consciousness towards an effective reforming of refugee policies and practices, suggesting a further enhancement of ummatic institutional collaboration between the OIC and UNHCR for refugee integration., Competing Interests: Competing interestsBoth authors declare that they have no competing interests., (© The Author(s) 2022.)

Background: The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has been increasing systematically in the last few decades. Surgical resection was once considered the treatment of choice but has been questioned in the direction of a more conservative approach for selected patients. Our aim was to analyze the outcome of surgical resection of small (≤3cm) NF-PNETs., Methods: We retrospectively evaluated 14 patients with sporadic NF-PNETs who underwent pancreatic resection. Data were collected from patients' medical records., Results: Of the 14 patients included, 35.71% were men, and the average age was 52.36 ± 20.36 years. Comorbidities were present in 92.86% of the cases. The incidence of postoperative complications was 42.86%, the 30-day mortality was zero, and the length of follow-up was 3.31 ± 3.0 years. The results of pathological evaluations revealed WHO grade I in 42.86% of cases, II in 21.43%, and neuroendocrine carcinoma in 35.71%. The median tumor size was 1.85cm (range, 0.5-3cm), and 2 cases had synchronous metastasis. The median TNM stage was IIa (range, I-IV). The disease-free and patient survival rates were 87.5% and 100% at 3 years and 43.75% and 75% at 10 years, respectively. The tumor pathological grade was significantly higher in head tumors than body-tail tumors, but there were no differences with respect to tumor size and TNM staging., Conclusion: A surgical approach to treat small sporadic NF-PNETs is safe with low mortality and high patient survival. Based on these data, small pancreatic head tumors can be more aggressive, suggesting that surgical resection is still the best option to treat small nonfunctioning PNETS. Thus, conservative treatment should be indicated very cautiously for only cases with absolute contraindications for surgery., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2021 Estela Regina Ramos Figueira et al.)

Lipomas of the gastrointestinal tract are uncommon benign tumors of mature adipocytes and may occur in any portion along the gut. Depending on location they may have a variety of clinical presentations and even simulate malignant neoplasms. We report a case of a 58-year-old woman who presented with acute pelvic pain. An emergency sonogram detected a hyperechogenic mass in the left adnexal region, with no vascularization on Doppler. A computed tomography confirmed the hypothesis of a fat containing tumor with signals of torsion. The patient underwent laparoscopy which depicted a mass over the antimesenteric side of the sigmoid with signs of ischemia and twisted vascular pedicle. The lesion was resected, and the microscopy confirmed the diagnosis of lipoma. The multidisciplinary team in the emergency room must be aware of these possible complications in order to optimize patient care.

Background: Due to rising life expectancy of population, very complex surgical procedures such as pancreaticoduodenectomy (PD), are more commonly being performed in elderly patients. The objective of this study was to evaluate the safety of PD in patients older than 75 years old and the risk factors associated with severe complications., Methods: Patients who underwent PD for periampullary tumors were retrospectively reviewed and divided into two groups, A (<75 years) and B (>75 years). The primary endpoint was severe postoperative complications (Clavien 3 or greater). Secondary endpoints were mortality and any complications., Results: Ninety consecutive patients underwent PD for periampullary tumors in the studied period, 70 in group A and 20 in group B. Clinical and pathological characteristics of both groups were equivalents except for age. There were no difference regarding the incidence of severe complications (17% vs. 10%, P=0.72) or all complications (50% vs. 50%, P>0.999). Although mortality was greater in group A (8.6% vs. 0%), it was not statistically significant (P=0.333). On multivariate analyses, only male sex, obesity and American Society of Anesthesiology Score of 3 or 4 were associated with severe postoperative complications., Conclusions: Poor clinical status, obesity and male gender are associated with severe complications in PD, but not age greater than 75 years, therefore PD can be considered safe in elderly patients and age itself should not be a contraindication for PD., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Objective: To evaluate the prognostic significance of microvessel density and p53 expression in pancreatic cancer., Methods: Between 2008 and 2012, 49 patients with pancreatic adenocarcinoma underwent resection with curative intention. The resected specimens were immunohistochemically stained with anti-p53 and anti-CD34 antibodies. Microvessel density was assessed by counting vessels within ten areas of each tumoral section a highpower microscope., Results: The microvessel density ranged from 21.2 to 54.2 vessels/mm2. Positive nuclear staining for p53 was found in 20 patients (40.6%). The overall median survival rate after resection was 24.1 months and there were no differences in survival rates related to microvessel density or p53 positivity. Microvessel density was associated with tumor diameter greater than 3.0 cm and with R0 resection failure., Conclusions: Microvessel density was associated with R1 resection and with larger tumors. p53 expression was not correlated with intratumoral microvessel density in pancreatic adenocarcinoma.

Background: Solid pseudopapillary pancreatic neoplasia is usually a large well-circumscribed pancreatic mass, with cystic and solid areas more frequently found in young women. It is a benign pancreatic neoplasia in most cases, therefore minimally invasive surgery could be an interesting approach., Aim: Evaluate the results of minimally invasive surgery for this neoplasia., Methods: Patients with this tumor who underwent minimally invasive pancreatectomies between 2009 and 2015 in a single institution, were analyzed regarding demographic, clinical-pathological futures, post-operative morbidity and disease-free survival., Results: All were women, and their median age was 39 (18-54) years. Two patients with tumor in the head of the pancreas underwent laparoscopic pancreaticoduodenectomy, and another one underwent laparoscopic enucleation. Two patients with tumor in the neck underwent central pancreatectomy. Distal pancreatectomies were performed in the other five, one with splenic preservation. None required blood transfusion or conversion to open surgery. Two (20%) developed clinical relevant pancreatic fistulas, requiring readmission. Median length of postoperative hospital stay was five days (2-8). All resection margins were negative. Patients were followed for a median of 38 months (14-71), and there was no recurrence., Conclusions: Minimally invasive surgery for solid pseudopapillary pancreatic neoplasia is feasible for tumors in different locations in the pancreas. It was associated with acceptable morbidity and respected the oncologic principles for treatment.

Context: Data are scarce on the penetrance of multiple endocrine neoplasia type 1 (MEN1)-related nonfunctioning pancreatic neuroendocrine tumors (NF-PETs) and insulinomas in young MEN1 patients. A potential positive correlation between tumor size and malignancy (2-3 cm, 18%; >3 cm, 43%) has greatly influenced the management of MEN1 adults with NF-PETs., Objective: The aim of the study was to estimate the penetrance of NF-PETs, insulinomas, and gastrinomas in young MEN1 carriers., Design: The data were obtained from a screening program (1996-2012) involving 113 MEN1 patients in a tertiary academic reference center., Patients: Nineteen MEN1 patients (aged 12-20 y; 16 patients aged 15-20 y and 3 patients aged 12-14 y) were screened for NF-PETs, insulinomas, and gastrinomas., Methods: Magnetic resonance imaging/computed tomography and endoscopic ultrasound (EUS) were performed on 10 MEN1 carriers, magnetic resonance imaging/computed tomography was performed on five patients, and four other patients underwent an EUS., Results: The overall penetrance of PETs during the second decade of life was 42% (8 of 19). All eight PET patients had NF-PETs, and half of those tumors were multicentric. One-fifth of the screened patients (21%; 4 of 19) harbored at least one large tumor (>2.0 cm). Insulinoma was detected in two NF-PET patients (11%) at the initial screening; gastrinoma was not present in any cases. Six of the 11 (54%) screened patients aged 15-20 years who underwent an EUS had NF-PETs. Potential false-positive EUS results were excluded based on EUS-guided biopsy results, the reproducibility of the NF-PET findings, or the observation of increased tumor size during follow-up. Distal pancreatectomy and the nodule enucleation of pancreatic head tumors were conducted on three patients with large tumors (>2.0 cm; T2N0M0) that were classified as grade 1 neuroendocrine tumors (Ki-67<2%)., Conclusions: Our data demonstrated high penetrance of NF-PETs in 15- to 20-year-old MEN1 patients. The high percentage of the patients presenting consensus criteria for surgery for NF-PET alone or NF-PET/insulinoma suggests a potential benefit for the periodic surveillance of these tumors in this age group.

Context: Endosonography-guided biliary drainage has been used over the last few years as a salvage procedure when endoscopic retrograde cholangiopancreatography fails. Malignant gastric outlet obstruction may also be present in these patients. We report the results of both procedures during the same session in patients with duodenal and biliary obstruction due to malignant disease., Methods: A retrospective review from a prospective collected database., Results: Technical success was achieved in all five patients; however, only three patients experienced relief of jaundice and gastric outlet obstruction., Conclusions: Endosonography-guided biliary drainage and duodenal stenting in the same session is feasible. However, severe complications may limit the procedure. This is a challenging procedure and should be done by experts with special attention to patient's selection.

The paper addresses a number of issues regarding the extent to which trafficking may be applied to migrant domestic workers who enter under the kafala system of sponsorship in the Middle East. Migrant domestic workers are the most numerous of those mentioned in reports on trafficking for labour exploitation in the region. The discussion seeks to determine whether "trafficking" can be ex post facto, rather than ex ante? In other words, can the label of trafficking be attributed only after the worker has arrived in the receiving country and is victimized according to the principles of trafficking protocols? In addition, must there be a proven intent to traffic by agents, or can employers who harm and/or exploit them be considered as traffickers alone? Should the harm done to workers on arrival at their place of work be classified (and assisted) as victims of trafficking, or as exploited workers?

Annular pancreas (AP) is a rare congenital anomaly, usually present in childhood, with symptoms due to duodenal obstruction; however, this condition can manifest in adulthood with abdominal pain, pancreatitis and pancreatic head mass. The authors present a case of AP observed in a 22-year-old patient that presented an unusual dual-phase clinical manifestation of duodenal obstruction in infancy that was treated by a duodenojejunostomy, and abdominal pain due to chronic pancreatitis in the adult age. MRI with cholangiopancreatography played a decisive role in achieving the correct diagnosis. The patient was treated by a pylorus-preserving Whipple procedure, with resection of the previous duodenojejunostomy. Pancreatic changes characteristic of chronic pancreatitis were demonstrated both in the AP and in the resected pancreatic segment. A marked biliopancreatic ductal anomaly not previously described in the literature was demonstrated by radiologic examination of the surgical specimen. The pathogenesis of AP, the importance of its association with benign and malignant pancreatic disease and the treatment alternatives are discussed by the authors., (Copyright 2005 S. Karger AG, Basel and IAP)

Unlabelled: The Peutz-Jeghers syndrome is a hereditary disease that requires frequent endoscopic and surgical intervention, leading to secondary complications such as short bowel syndrome., Case Report: This paper reports on a 15-year-old male patient with a family history of the disease, who underwent surgery for treatment of an intestinal occlusion due to a small intestine intussusception., Discussion: An intra-operative fiberscopic procedure was included for the detection and treatment of numerous polyps distributed along the small intestine. Enterotomy was performed to treat only the larger polyps, therefore limiting the intestinal resection to smaller segments. The postoperative follow-up was uneventful., Conclusion: We point out the importance of conservative treatment for patients with this syndrome, especially those who will undergo repeated surgical interventions because of clinical manifestation while they are still young.

Laparoscopic procedures are rapidly advancing. Laparoendoscopic colectomy appears to be an option the treatment of colonic disease and is increasingly being performed in selected patients. The purpose of this study is to review our initial experience with the method which initiated in 1992. Thirty-three patients underwent laparoscopic resection of colorectal segment. All the patient, charts were assessed and data were obtained about the diagnosis, operation performed, complications, conversion and postoperative course. Diverticular disease was the most frequent (54.5%) indication of laparoscopic colorectal procedure in our series followed by adenocarcinoma (27.3%). Left colectomy was performed in 19 (57.6%) patients. Anastomosis followed double-stapling technique in most of them. Conversion to open procedure occurred in six (18.2%) cases. There were 4 complications associated to the method resulting in an specifíc morbidity of 12.1% in this series. There were no complications related to the anastomosis and no death occurred. Postoperative course was favorable for the patients and all could take oral liquids in the day after the procedure. Colorectal surgery performed by video-laparoscopic access is feasible, safe and benefits all patients. Conversion and morbidity in our series are similar to those shown in literature. It must, however, be indicated in a selected basis and in centers of reference for treatment of colorectal disease.