Incidental Findings at Surgery—Part 1
Section snippets
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
References (91)
Benign liver tumors
Clin Liver Dis
(2002)- et al.
Cystadenoma and cystadenocarcinoma of the liver: a single center experience
J Am Coll Surg
(2005) - et al.
Management of hepatic hemangiomas: a 14-year experience
J Gastrointest Surg
(2005) - et al.
Diagnosis, management, and outcomes of 115 patient with hepatic hemangioma
J Am Coll Surg
(2003) Pathology of fatty liver disease
Mod Pathol
(2007)Surgical treatment for obesity and its impact on non-alcoholic steatohepatitis
Clin Liver Dis
(2007)- et al.
Obesity, inflammation, and insulin resistance
Gastroenterology
(2007) - et al.
Risk factors for mortality after surgery in patients with cirrhosis
Gastroenterology
(2007) - et al.
International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas
Pancreatology
(2006) - et al.
Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization
J Clin Epidemiol
(1989)
Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula and gallstone ileus
Am J Gastroenterol
Should cholecystectomy be performed for asymptomatic cholelithiasis in transplant patients?
J Am Coll Surg
Prophylactic cholecystectomy in transplant patients: a decision analysis
J Gastrointest Surg
Prophylactic cholecystectomy is not indicated following renal transplantation
Am J Surg
Incidental cholecystectomy during major abdominal surgery in the elderly
Am J Surg
Gallstones in chronic liver disease
J Gastrointest Surg
Long-term evolution of asymptomatic cholelithiasis diagnosed during abdominal operations for variceal bleeding in patients with cirrhosis
Am J Surg
Gallbladder disease in the morbidly obese
Am J Surg
Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study
J Surg Res
Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbid obese patients?
Surg Obes Relat Dis
Incidence of cholelithiasis in sickle cell anemia using the ultrasonic gray-scale technique
J Pediatr
Management approaches to adrenal incidentalomasA view from Rochester, Minnesota
Endocrinol Metab Clin North Am
[Laparoscopic surgery in the treatment of adrenal pathology: experience with 200 cases]
Actas Urol Esp
Laparoscopic adrenalectomy for malignancy
Surg Clin North Am
The diagnosis and management of benign hepatic tumors
J Clin Gastroenterol
Benign liver lesions
New advances in evaluation and management of patients with polycystic liver disease
Am J Gastroenterol
Giant hepatic hemangioma with Kasabach-Merritt syndrome: is the appropriate treatment enucleation or liver transplantation?
HPB Surg
Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment
World J Surg
Resolution of a contraceptive-steroid-induced hepatic adenoma with subsequent evolution into hepatocellular carcinoma
Ann Intern Med
Liver adenomatosis: reappraisal, diagnosis, and surgical management: eight new cases and review of the literature
Ann Surg
Nodular regenerative hyperplasia of the liver: an under-recognized cause of portal hypertension in hematological disorders
Am J Hematol
Bile duct hamartomas: a report of two cases
J Clin Gastroenterol
Angiomyolipoma of the liver
J Surg Oncol
A growing burden: the pathogenesis, investigation and management of non-alcoholic fatty liver disease
J Clin Pathol
Nonalcoholic fatty liver disease: a clinical review
Dig Dis Sci
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
Prognostic factors of cirrhotic patients in extra-hepatic surgery
Minerva Chir
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
Model for end-stage liver disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis
Ann Surg
Surgical risk and complications after major surgery in patients with cirrhosis
Rev Invest Clin
Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death
Hepatology
Observation of pancreatic incidentaloma
Klin Khir
Periampullary and pancreatic incidentaloma: a single institution's experience with an increasingly common diagnosis
Ann Surg
Management of diagnostic dilemmas of the pancreas by ultrasonographically guided laparoscopic biopsy
Surgery
Cited by (2)
Legal & ethical dilemmas in incidental findings during surgery: Review article
2020, International Journal of SurgeryCitation 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.
The incidental asymptomatic pancreatic lesion: Nuisance or threat?
2009, Journal of Gastrointestinal Surgery