1/25. A case of complex hepatolithiasis successfully treated with a systematic approach.A systematic approach is required to treat complex hepatolithiasis. A 45 year-old female patient with hepatolithiasis had bilateral intrahepatic stones, biliary strictures at the right hepatic duct and segment IV duct, cholangitic abscess, and shrinkage of the right hepatic lobe. Six sessions of lithotomy were carried out under the guidance of percutaneous transhepatic choledochoscopy using a dye-laser lithotriptor through the segment III duct. Although stones were eradicated from the common bile duct and segment III duct, stones remained in other segments where cholangioscopic access was not feasible. Biliary bilirubin concentration increased and the liver abscess was resolved. Thereafter, the patient underwent right hepatectomy and choledochojejunostomy. After surgery, percutaneous transhepatic cholangio-drainage and balloon dilatation of the segment IV duct was performed. The patient underwent 11 more sessions of cholangioscopic lithotomy through 2 transhepatic routes and the bilioenteric bypass. Thereafter, the patient became almost stone-free. After discharge, biliary tracts were irrigated with saline through a subcutaneously placed reservoir. The patient is alive and well and had been without stone recurrence for 3 years. This report shows the efficacy of the vigorous combination therapy, including repeated cholangioscopic lithotomy through multiple routes using laser lithotripsy, surgery, and long-term biliary irrigation.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/25. Stromal tumor of the gallbladder with phenotype of interstitial cells of cajal: a previously unrecognized neoplasm.We report a small, well-demarcated stromal tumor of the gallbladder in a 69-year-old woman. The tumor and associated cholelithiasis led to chronic cholecystitis symptoms. The wall of the gallbladder contained a 2.4-cm hypocellular nodule composed of bland spindle-shaped cells that were immunoreactive for vimentin, CD34, and CD117. With the latter antibody, which stains interstitial cells of cajal (ICC), the neoplastic cells appear fusiform with elongated bipolar projections or dendritic-like cytoplasmic projections. The gallbladder wall adjacent to the tumor contained numerous CD117-positive cells in close contact with the normal smooth muscle cells, whereas two of 10 gallbladders with minimal chronic cholecystitis showed only a few CD117-positive cells. These findings provide evidence that this stromal tumor of the gallbladder shows ICC differentiation similar to some stromal tumors of the gut. The presence of numerous ICC in the uninvolved gallbladder wall suggests that this tumor might have evolved through hyperplasia of ICC.- - - - - - - - - - ranking = 1.277889990537keywords = neoplasm (Clic here for more details about this article) |
3/25. Implantation metastasis following external biliary drainage in biliary tract cancers--cause for concern!Three patients with periampullary cancer developed tumor seedings along the T-tube choledochostomy tract, thus precluding curative resection in two patients and an early recurrence at the choledochostomy exit site in the third patient. External biliary drainage and intraoperative bile spill should be avoided in patients with curable biliary tract neoplasms.- - - - - - - - - - ranking = 0.31947249763424keywords = neoplasm (Clic here for more details about this article) |
4/25. cholelithiasis and perforated gallbladder in an infant.An infant presented with abdominal distension and failure to thrive. This patient was a 3.5-month-old, ex-26-week premature infant at the time of presentation who required supplemental parenteral nutrition until day 9 of life. Workup found ascites and a complex cystic mass in the porta hepatis. A perforated gallbladder with gallstones was found at laparotomy. The gallstones were removed, and the bed of the gallbladder was drained. Output from the drain was minimal by postoperative day 6, and the drain subsequently was removed. The child did well postoperatively; hematologic and metabolic workups were unrevealing. Perforation of the gallbladder is an exceedingly uncommon finding in infants. Appropriate management includes laparotomy and drainage of the gallbladder bed.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
5/25. Combined small cell carcinoma and clear cell carcinoma of the gallbladder: report of a case and review of the literature.We report a case of an incidental combined carcinoma of the gallbladder in a 66-year-old woman who underwent cholecistectomy for gallstones. The neoplasm was mainly constituted by a clear cell component and a small cell, chromogranin-positive one; it also showed some areas of conventional adenocarcinoma and foci of vascular invasion. The patient died after 3 years following treatment with combination chemotherapy. The histologic and immunohistochemical profile of the lesion is described, together with a brief review of the pertinent bibliography.- - - - - - - - - - ranking = 0.31947249763424keywords = neoplasm (Clic here for more details about this article) |
6/25. Percutaneous hepaticojejunostomy with use of a metal stent for injury of the right hepatic duct after laparoscopic cholecystectomy.Bile-duct injuries related to laparoscopic cholecystectomy may be complex and require a multidisciplinary approach. The authors report a case of a high hepatic duct injury treated surgically by a left hepaticojejunostomy and an ischemic right hepatic duct that could not be identified during the operation. The right hepatic lobe was subsequently drained radiologically by the percutaneous creation of a right hepaticojejunostomy, through and into a jejunal access loop, followed by deployment of a metallic stent. The patient remained well at 3-year follow-up.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
7/25. Endobiliary endoprosthesis without sphincterotomy for the treatment of biliary leakage.Endoscopic retrograde cholangiopancreatography with biliary drainage is an effective therapeutic tool in the management of bile duct injuries associated with laparoscopic cholecystectomy. Placement of a stent or a nasobiliary drain in the common bile duct, or biliary sphincterotomy, is an effective treatment for bile leaks and obviates the need for otherwise complex biliary tract surgery. Although there are no controlled comparative trials, placement of a 7-, 8.5-, or 10-Fr biliary stent without sphincterotomy may cause the least morbidity and be the most comfortable nonoperative management option. We report a child who presented with a bile leak that occurred after laparoscopic cholecystectomy and was successfully treated with the placement of a biliary stent without sphincterotomy. To our knowledge, this is the second pediatric case of a bile leak successfully treated by endoprosthesis placement without sphincterotomy.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
8/25. Staphylococcal liver abscess and acute cholecystitis in a patient with Crohn's disease receiving infliximab.We present an unusual case of empyema of the gallbladder associated with a pyogenic liver abscess in a patient with Crohn's disease on Infliximab. It manifested by weakness, weight loss, and vague abdominal pain, which eventually localized to the right upper quadrant 4 days prior to admission. Diagnostic evaluation, which included ultrasonography and computed tomography, revealed cholelithiasis, gallbladder wall thickening, and a low-attenuation, complex mass in the left hepatic lobe. cholecystectomy and open drainage of the liver abscess were successfully performed. There are few reports of intrahepatic abscess associated with Crohn's disease. The relationship between acute cholecystitis and Crohn's disease has also been documented. However, this report documents the unusual complication of pyogenic liver abscess secondary to acute cholecystitis in the unique population of Crohn's disease patients on Infliximab.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
9/25. Malignant angioendotheliomatosis (Angiotropic lymphoma) of the gallbladder.We present a case of malignant angioendotheliomatosis of the gallbladder, the first reported. Diagnostic problems connected with this rare malignancy are underlined. Immunohistochemical studies were useful in providing further evidence of the lymphoid nature of the neoplasm and avoiding possible misdiagnosis. We suggest that the term "angiotropic lymphoma" might be more appropriate to define this malignancy.- - - - - - - - - - ranking = 0.31947249763424keywords = neoplasm (Clic here for more details about this article) |
10/25. Postoperative jaundice as a clue to unrecognized biliary tract obstruction.Postoperative jaundice is often a complex clinical problem of multifactorial origin. If underlying liver disease is present preoperatively, there is a greater likelihood of jaundice after surgery. We describe two patients: one with intrabiliary hepatocellular carcinoma and the other with primary sclerosing cholangitis. The underlying processes were unmasked after the development of jaundice in the postoperative period. These cases point out the importance of considering previously undiagnosed biliary tract obstruction in the differential diagnosis of postoperative jaundice.- - - - - - - - - - ranking = 0.2keywords = complex (Clic here for more details about this article) |
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