1/3. Gallstone ileus after endoscopic sphincterotomy.An attack of gallstone ileus observed in a 60-year-old female patient is reported. In this patient who previously had been cholecystectomized, instant extraction of giant residual gallstones was unsuccessful despite a large endoscopic sphincterotomy. Three days later, she developed colicky abdominal pain and vomiting. At laparotomy nine days after the endoscopic procedure an impacted gallstone measuring 3.5 cm in diameter was removed from the the jejunum, some 50 cm below the ligament of Treitz. This observation demonstrates an unusual complication of endoscopic sphincterotomy and clearly outlines that very large stones can, after an initial delay, pass into the duodenum despite an apparently "unsuccessful" sphincterotomy.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/3. Causes of intrahepatic shadowing on ultrasound examination.Acoustic shadowing on ultrasound examination of the liver can be caused by both normal anatomical structures (ligamentum teres, walls of bile ducts and portal veins, interpositioned colon) as well as by abnormalities which may or may not be clinically important (air in the bile ducts, biliary calculi, calcified granulomas, foreign bodies). Acoustic shadowing is more frequently seen when high frequency transducers or lower gain at scanning are used.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/3. Cavernous transformation of the portal vein coinciding with early gastric cancer and cholelithiasis.A 71-year-old man who developed jaundice with a high-grade fever was admitted to our hospital. The episode was ascribed to cholecysto-choledocholithiasis. In the preoperative evaluation, a cavernous transformation of the portal vein and an early gastric cancer were found. The patient thereafter underwent an operation for those pathologies after the endoscopic removal of a choledochal stone; cholecystectomy, and a distal gastrectomy with regional lymph node dissection for gastric cancer. The proposed procedures of gastrectomy and cholecystectomy were completed without any major difficulty because no markedly enlarged collateral veins were found in the area where the regional lymph node dissection was carried out. Thanks to advances in imaging modalities, an asymptomatic cavernous transformation of the portal vein coinciding with gastric cancer such as that seen in the present case may be increasingly encountered in the future. The greatest caution, however, needs to be exerted at operation to minimize any unexpected bleeding and to avoid any interruption of the porto-portal shunts in such cases. Further, the reestablishment of the portal blood supply to the liver might be required in advanced cases of gastric cancer, where regional lymph node dissection may necessitate skeletonization of the hepatoduodenal ligament for curative purposes.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |