1/50. Biliary migration of hepatocellular carcinoma fragment after transcatheter arterial chemoembolization therapy.Occasional side-effects of transcatheter arterial chemoembolization therapy in hepatocellular carcinoma are essentially related to tissue necrosis. We report the case of a patient with hepatocellular carcinoma who experienced an acute common bile duct obstruction a few weeks after such a procedure, in the absence of obvious biliary tract invasion. An endoscopic sphincterotomy relieved the obstruction. At histology, the intra-biliary material was identified as a fragment of hepatocellular carcinoma. We discuss the causes of obstructive jaundice in the setting of hepatocellular carcinoma as well as in the specific situation of transcatheter arterial chemoembolization therapy.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
2/50. Doppler sonography in hepatolithiasis: a case report.In the treatment of hepatolithiasis, it is important to not only remove all stones and eliminate bile stasis in the biliary tract, but also to remove atrophic hepatic tissue, as such tissue may cause recurrent cholangitis as well as latent cholangiocarcinoma. A 75-year-old woman was diagnosed as having hepatolithiasis with stenosis at the branching of the bile ducts in segment II and segment III by sonography, computed tomography, endoscopic retrograde cholangiography, and magnetic resonance cholangiography. Portograms did not reveal portal branches in segment III but did demonstrate the portal branches in segment II. During the operation, Doppler sonography was done. Doppler sonography did not reveal the portal blood flow in segment III, but did demonstrate a "to-and-fro" pattern in the portal branches in segment II, indicating atrophic hepatic tissue with disrupted portal blood flow. Lateral segmentectomy (resection of segments II and III and lithotomy with choledo-chotomy were done. The patient is in good health 2 years 6 months after the operation. Doppler sonography is useful in the detection of disrupted portal blood flow and the diagnosis of hepatic atrophy. This is clearly advantageous in the decision-making about whether to perform a liver resection with hepatolithiasis.- - - - - - - - - - ranking = 0.125keywords = carcinoma (Clic here for more details about this article) |
3/50. Multidisciplinary approach to palliation of obstructive jaundice caused by a central hepatocellular carcinoma.BACKGROUND/AIMS: Obstructive jaundice due to intraductal tumour growth is a rare symptom in association with hepatocellular carcinoma (HCC). methods: We report a 65-year-old white male who was admitted to our department with a 2-week history of progressive jaundice. At laparotomy, the liver showed advanced cirrhosis due to long-standing biliary obstruction. cholangiography confirmed total obstruction of the main bifurcation of the hepatic duct by intraductal tumour growth. Combination treatment with surgical segment III drainage, transcatheter arterial embolization and radioembolization with yttrium-90 resin particles and endoscopic stenting was performed. This form of treatment has never been reported before. RESULTS: With these combined procedures, relief of jaundice and a survival time of 32 months could be achieved. CONCLUSION: The combination of palliative methods may relieve jaundice, ensure a good quality of life and possibly prolong survival in patients with mechanical tumour obstruction of the biliary tree by HCC.- - - - - - - - - - ranking = 1.9423948669558keywords = ductal, carcinoma (Clic here for more details about this article) |
4/50. Benign biliary stricture associated with atherosclerosis.We report a case of benign bile duct stricture that could not be differentiated from intrahepatic bile duct carcinoma preoperatively. The patient was a 79-year-old man. Computed tomography showed dilatation of the intrahepatic bile duct in the left lobe. Direct cholangiography showed segmental stricture of the left bile duct. Angiography showed narrowing of the left hepatic artery. Although bile cytology did not show malignant cells, we suspected intrahepatic bile duct carcinoma preoperatively. We performed extended left hepatic lobectomy. Histopathologic examination of the resected duct also showed no malignant cells; fibrosis with infiltration by lymphocytes was seen at the bile duct stricture. In addition, the resected liver specimen showed sclerotic change in the intrahepatic arteries. The postoperative course was uneventful for more than 26 months, without recurrence or cholangitis. We encountered a very rare case of benign segmental bile duct stricture, which was difficult to differentiate from bile duct carcinoma. We think the biliary stricture was secondary to atherosclerosis which may have caused bile duct ischemia.- - - - - - - - - - ranking = 0.375keywords = carcinoma (Clic here for more details about this article) |
5/50. Left hepatectomy for the choledochal cyst (type IV-A) with intrahepatic stenosis: report of a case.The case of a 16-year-old male with expansion of the gallbladder and dilatation of the common bile duct is reported. ultrasonography and computed tomography imaging showed expansion of the gallbladder and eminent cystic dilatation in the common bile duct and the left intrahepatic bile duct. Endoscopic retrograde cholangiopancreatography indicated expansion-like beads of the bilateral hepatic ductus and the left intrahepatic bile duct, including anomalies of the pancreaticobiliary ductal junction. Because relative stenosis of the membranous diaphragm was revealed in the porta hepatis, we diagnosed this case as a type IV-A choledochal cyst, using Todani's classification. Intraoperative cholangiography and cholangiofiberscopy showed a pinhole stricture and re-expansion of the tip of the left intrahepatic bile duct. As the narrow segment could not be expanded though we put proper pressure there, left hepatectomy was performed as a preventive measure in addition to extended biliary tract excision and cholangiojejunostomy. hepatectomy seems to be an appropriate choice in a case of intrahepatic stenosis to help increase the patient's postoperative quality of life.- - - - - - - - - - ranking = 0.65869743347788keywords = ductal (Clic here for more details about this article) |
6/50. Acute pancreatitis following choledochoscopic stone extraction for hepatolithiasis.BACKGROUND: Hepatolithiasis is prevalent in Southeast Asia and presents a difficult treatment problem. The main purposes of treatment are clearance of the stones and elimination of bile stasis. Acute pancreatitis due to migratory gall bladder stone is a well documented phenomenon. To the best of our knowledge, there is no previous report of acute pancreatitis due to intrahepatic stone. We report an intriguing case of acute pancreatitis subsequent to postoperative choledochoscopy for residual intrahepatic stone. CASE REPORT: The patient, a 56-year-old male, suffered from intermittent epigastralgia for about 2 years. Endoscopic retrograde cholangiopancreatography (ERCP) performed after admission showed incomplete contrast filling of the right intrahepatic duct. The patient underwent surgical intervention with the diagnosis of right intrahepatic stones. Postoperative T-tube cholangiography demonstrated impacted right intrahepatic stones behind the stricture. Postoperative matured T-tube tract ductal dilatation (2-4) was begun about 4 weeks after the operation. Choledochoscopy was performed after dilatation. After the third postoperative choledocoscopy for residual stone extraction, the patient complained of abdominal pain the next day. Abdominal CT showed distal common bile duct stone and acute pancreatitis. After medical treatment, patient recovered CONCLUSIONS: Extrahepatic ductal migration with resultant acute pancreatitis is possible in patients with hepatolithiasis. The awareness of such a possibility enables clinicians to promptly recognize and appropriately manage this kind of acute pancreatitis.- - - - - - - - - - ranking = 1.3173948669558keywords = ductal (Clic here for more details about this article) |
7/50. Endoscopic intervention for hepatolithiasis associated with sharp angulation of right intrahepatic ducts.BACKGROUND: Hepatolithiasis (intrahepatic stones) is common in Asian patients. Hepatolithiasis with intrahepatic strictures and sharp ductal angulation poses a particularly difficult management problem. methods: Cases of hepatolithiasis with sharp angulation of right intrahepatic ducts were retrospectively reviewed. OBSERVATIONS: Five patients with hepatolithiasis and right sharp intrahepatic ductal angulation were treated endoscopically via ERCP. Two patients died soon after the procedure. In the remaining 3 patients, treatment by dilation of the intrahepatic strictures and stent placement was only partially successful. Attempts to access the sharply angulated intrahepatic duct were unsuccessful. CONCLUSIONS: Endoscopic management of hepatolithiasis associated with sharp angulation of a right intrahepatic duct is difficult and is generally managed best with percutaneous treatment modalities or surgery, where possible.- - - - - - - - - - ranking = 1.3173948669558keywords = ductal (Clic here for more details about this article) |
8/50. Intermittent jaundice by tumor emboli from intrahepatic cholangiocarcinoma.Free-floating tumor debris or mucobilia as a cause of intermittent obstruction has been described infrequently. A patient with intermittent jaundice caused by tumor emboli from an intrahepatic polypoid mucinous cholangiocarcinoma is presented. Symptoms of intermittent jaundice and midepigastric pain persisted over 5 years despite an initial cholecystectomy and common bile duct exploration before definitive diagnosis and treatment of an hepatic trisegmentectomy (segments II, III, and IV). Intraductal mucin was confirmed intraoperatively and pathologically as the cause of the obstructive jaundice. The patient remains asymptomatic and without evidence of disease more than 5 years postoperatively. This report of a predominantly mucin-producing intrahepatic cholangiocarcinoma details a rare protracted clinical course of intermittent biliary obstruction from mucus emboli and highlights the possibility of long-term survival after complete resection.- - - - - - - - - - ranking = 1.4086974334779keywords = ductal, carcinoma (Clic here for more details about this article) |
9/50. Bile duct carcinoma arising in metaplastic biliary epithelium of the intestinal type: a case report.We report herein a case of distal bile duct carcinoma showing intestinal differentiation diagnosed 3 years after endoscopic sphincterotomy for choledocholithiasis. The diagnostic problem in this case was that the granular mucosa, which is a typical finding of superficial mucosal extension of bile duct carcinoma in general, was interpreted as hyperplasia accompanying metaplasia in cholangioscopic biopsy. Discrimination of superficial mucosal cancer extension from hyperplastic mucosa with metaplastic changes was impossible using cholangioscopic examination. In our case, reflux and stasis of the duodenal and pancreatic juice into the biliary tract might have occurred because of abnormal function of the papilla of Vater following endoscopic sphincterotomy. It might be suggested that endoscopic sphincterotomy contributed to the metaplastic changes in the bile duct mucosa in our case.- - - - - - - - - - ranking = 0.75keywords = carcinoma (Clic here for more details about this article) |
10/50. liver resection for intrahepatic lithiasis. Report of a case.Intrahepatic primary lithiasis is extremely rare in the western world. The development of endoscopic technique permitted a conservative treatment for this disease. Because of the high recurrence rate after conservative treatment due to the remaining biliary stricture and the risk of incidental cholangiocarcinoma, we believe that hepatic resection is the treatment of choice of unilateral liver intrahepatic primary lithiasis. Herein we present a case affected with intrahepatic primary lithiasis localized into the left biliary system that successfully underwent left hepatic lobectomy.- - - - - - - - - - ranking = 0.125keywords = carcinoma (Clic here for more details about this article) |
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