Incidental Findings at Surgery—Part 1

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Incidentalomas of the Liver

Finding incidental liver lesions is a regular occurrence. Although many are benign, a specific diagnosis is necessary. Table 1 outlines the differential diagnosis of the commonly occurring incidentalomas of the liver.

Incidentalomas of the Pancreas

Although incidentalomas have been routinely recognized and managed in other organs, the earliest formal report of a pancreatic incidentaloma was published only as recently as 2001.27 However, any lesion of the pancreas, whether it be malignant or benign, cystic or solid, primary or metastatic, can be identified in asymptomatic patients, and there are numerous case reports in the literature to this effect. Malignancies include pancreatic adenocarcinoma, cholangiocarcinoma, ampullary or duodenal

Incidental Gallstones

According to the 1992 NIH Consensus Statement, approximately 10% to 15% of the adult population, or approximately 20 million people, have gallstones. Complications of gallstone disease account for a significant number of hospitalizations and substantial health care costs.35 Currently, the standard treatment of symptomatic gallstones is laparoscopic cholecystectomy. Before the advent of laparoscopy an open cholecystectomy was associated with significant morbidity, which precluded this as a

Incidentalomas of the Adrenal

An incidental adrenal mass or “incidentaloma” is an adrenal mass, generally 1 cm or more in diameter, that is discovered on a radiological examination performed for indications other than adrenal disease. The traditional definition of incidentaloma excludes patients undergoing imaging procedures as part of staging and evaluation for cancer, as well as those in whom the diagnosis of a symptomatic adrenal-dependent syndrome was missed because of insufficient suspicion or investigation.77, 78 The

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References (91)

  • A. Abou-Saif et al.

    Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula and gallstone ileus

    Am J Gastroenterol

    (2002)
  • L.S. Kao et al.

    Should cholecystectomy be performed for asymptomatic cholelithiasis in transplant patients?

    J Am Coll Surg

    (2003)
  • L.S. Kao et al.

    Prophylactic cholecystectomy in transplant patients: a decision analysis

    J Gastrointest Surg

    (2005)
  • W.S. Melvin et al.

    Prophylactic cholecystectomy is not indicated following renal transplantation

    Am J Surg

    (1998)
  • H. Schreiber et al.

    Incidental cholecystectomy during major abdominal surgery in the elderly

    Am J Surg

    (1978)
  • M.A. Silva et al.

    Gallstones in chronic liver disease

    J Gastrointest Surg

    (2005)
  • H. Orozco et al.

    Long-term evolution of asymptomatic cholelithiasis diagnosed during abdominal operations for variceal bleeding in patients with cirrhosis

    Am J Surg

    (1994)
  • J. Amaral et al.

    Gallbladder disease in the morbidly obese

    Am J Surg

    (1985)
  • L. Wudel et al.

    Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study

    J Surg Res

    (2002)
  • D.E. Swartz et al.

    Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbid obese patients?

    Surg Obes Relat Dis

    (2005)
  • S. Sarnaik et al.

    Incidence of cholelithiasis in sickle cell anemia using the ultrasonic gray-scale technique

    J Pediatr

    (1980)
  • W.F. Young

    Management approaches to adrenal incidentalomasA view from Rochester, Minnesota

    Endocrinol Metab Clin North Am

    (2000)
  • O. Castillo et al.

    [Laparoscopic surgery in the treatment of adrenal pathology: experience with 200 cases]

    Actas Urol Esp

    (2006)
  • C. Sturgeon et al.

    Laparoscopic adrenalectomy for malignancy

    Surg Clin North Am

    (2004)
  • B. Choi

    The diagnosis and management of benign hepatic tumors

    J Clin Gastroenterol

    (2005)
  • J. Belghiti et al.

    Benign liver lesions

  • H.L. Arnold et al.

    New advances in evaluation and management of patients with polycystic liver disease

    Am J Gastroenterol

    (2005)
  • S.N. Hochwald et al.

    Giant hepatic hemangioma with Kasabach-Merritt syndrome: is the appropriate treatment enucleation or liver transplantation?

    HPB Surg

    (2000)
  • P. Herman et al.

    Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment

    World J Surg

    (2000)
  • S.C. Gordon et al.

    Resolution of a contraceptive-steroid-induced hepatic adenoma with subsequent evolution into hepatocellular carcinoma

    Ann Intern Med

    (1986)
  • L. Chiche et al.

    Liver adenomatosis: reappraisal, diagnosis, and surgical management: eight new cases and review of the literature

    Ann Surg

    (2000)
  • K. Al-Mukhaizeem et al.

    Nodular regenerative hyperplasia of the liver: an under-recognized cause of portal hypertension in hematological disorders

    Am J Hematol

    (2004)
  • S. Wei et al.

    Bile duct hamartomas: a report of two cases

    J Clin Gastroenterol

    (1997)
  • C.N. Yeh et al.

    Angiomyolipoma of the liver

    J Surg Oncol

    (2001)
  • P. Riley et al.

    A growing burden: the pathogenesis, investigation and management of non-alcoholic fatty liver disease

    J Clin Pathol

    (2007)
  • D. Sass et al.

    Nonalcoholic fatty liver disease: a clinical review

    Dig Dis Sci

    (2005)
  • A.S. Befeler et al.

    The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome

    Arch Surg

    (2005)
  • M. Franzetta et al.

    Prognostic factors of cirrhotic patients in extra-hepatic surgery

    Minerva Chir

    (2003)
  • T.I. Huo et al.

    Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis

    Liver Transpl

    (2006)
  • P.G. Northup et al.

    Model for end-stage liver disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis

    Ann Surg

    (2005)
  • G.A. Ramírez et al.

    Surgical risk and complications after major surgery in patients with cirrhosis

    Rev Invest Clin

    (1990)
  • D.M. Heuman et al.

    Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death

    Hepatology

    (2004)
  • T.S. Kostiuk

    Observation of pancreatic incidentaloma

    Klin Khir

    (2001)
  • J.M. Winter et al.

    Periampullary and pancreatic incidentaloma: a single institution's experience with an increasingly common diagnosis

    Ann Surg

    (2006)
  • S.M. Strasberg et al.

    Management of diagnostic dilemmas of the pancreas by ultrasonographically guided laparoscopic biopsy

    Surgery

    (1999)
  • Cited by (2)

    • Legal & ethical dilemmas in incidental findings during surgery: Review article

      2020, International Journal of Surgery
      Citation Excerpt :

      As a result, the abdomen can hide a multitude of pathologies without causing symptoms. The specialty involves the surgeon to operate on the liver, pancreas, gallbladder, adrenal glands [2], thyroid, kidney, ovary [3], appendix, colon [4] and stomach [5]. For this reason, General Surgery is chosen for this article to evaluate the crucial clinical, legal and ethical decisions which need to be made by the surgeon in IF during surgery.

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