1/10. Unusual manifestation of an ampullary tumor presenting with severe upper gastrointestinal bleeding.Ampullary tumors can occasionally ulcerate and present as frank gastrointestinal bleeding. The most common clinical presentation is jaundice like in other tumors of the biliary tree. We report on a 68-year-old man who presented with severe upper gastrointestinal hemorrhage secondary to an asymptomatic mass of the ampulla of vater. An endoscopic biopsy specimen revealed a villous adenoma with moderate dysplasia. A curative resection was performed, and pathological work-up revealed the presence of an infiltrating, moderately differentiated ampullary adenocarcinoma.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/10. portal vein aneurysm.While there have been a few references to portal vein aneurysm in the world literature, this is the first report in united states radiologic literature. During a routine evaluation for fever in one patient, an ultrasound examination suggested this unusual entity at the junction of the splenic and superior mesenteric vein. It was later confirmed by angiography. Two other patients were being investigated angiographically for gastrointestinal bleeding when portal vein aneurysms were discovered. In contrast to the central location of the first patient's aneurysm, the latter two were more distal in the portal tree. The literature is reviewed and different etiologic hypothesis discussed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/10. common bile duct obstruction associated with a dacron H-graft portacaval shunt.An unusual patient had ascending cholangitis secondary to common bile duct obstruction by stones and a Dacron graft previously utilized in the performance of an H-graft portacaval shunt. Erosion of this foreign body into the common bile duct appeared to be secondary to bacterial contamination of the graft and direct contact of the foreign material with the biliary tree.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
4/10. Successful pregnancy outcome in a patient with congenital biliary atresia.Congenital biliary atresia is one of the most common congenital anomalies of the biliary tree. Without surgical correction, two-thirds of all cases of extrahepatic biliary atresia are fatal within 18 months. Historically, the preferred surgical procedure to correct this anomaly has been the Kasai procedure. Surgical treatment of congenital biliary atresia is associated with substantial perioperative morbidity and mortality, as well as long-term sequelae. Portal hypertension and hypersplenism can complicate the course of up to 50% of patients who survive for more than 2 years. Not surprisingly, few of these patients reach adulthood. We report the case of a woman with congenital biliary atresia surgically corrected with the Kasai operation who subsequently reached adulthood and became pregnant. Despite a prenatal course complicated by portal hypertension, bleeding esophageal varices, and hypersplenism, the woman delivered a healthy infant at 36.5 weeks' gestation.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/10. hemobilia from ruptured hepatic artery aneurysm. Report of a case and review of the literature.hepatic artery aneurysm is a rare vascular disease associated with high mortality caused by massive hemorrhage or by complications following surgical treatment. Over the past twenty-five years it has been managed surgically with increasing success. Eighty reported cases of hepatic artery aneurysms ruptured into the biliary tree were reviewed and the etiology, clinical signs, diagnosis, and treatment of such an aneurysm are discussed. A personal case with an aneurysm of the right hepatic artery ruptured into the common hepatic duct is reported. The diagnosis was made before surgery by arteriography and the aneurysm was successfully managed by ligation of the right hepatic artery both proximal and distal to the aneurysm, closure of the communication between the common hepatic duct and the aneurysm, and choledochal drainage. hemobilia secondary to hepatic artery aneurysm must be considered in thedifferential diagnosis of unexplained gastrointestinal hemorrhage.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/10. Massive gastrointestinal hemorrhage caused by rupture of a jejunal branch artery aneurysm.Aneurysms located in the arterial tree that directly supplies the alimentary tract account for a small percentage of all aneurysms. Jejunal branch artery aneurysms are an uncommon component of this group, and gastrointestinal hemorrhage from such an aneurysm has rarely been described. We report a case of a jejunal branch artery aneurysm appearing as sudden and massive gastrointestinal bleeding in a 28-year-old man. diagnosis was made by selective superior mesenteric artery angiography, and the patient underwent successful segmental resection of the involved area of jejunum. The pertinent literature is reviewed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/10. An unusual complication of chronic pancreatitis: a recanalized portal tree communicating with a pancreatic pseudocyst.A patient with chronic pancreatitis was admitted for digestive bleeding from esophageal varices. Portal thrombosis and cavernomatous periportal collateral circulation were found at laparotomy. The partially recanalized portal tree was excluded from the portal circulation and filled with pancreatic juice due to a communication with a pancreatic pseudocyst. splenectomy, partial left pancreatectomy, Roux en Y pancreatico-cysto-jejunostomy, and external drainage of the portal tree were performed. The postoperative course was uneventful and the patient is symptom-free and doing well 2 yr after surgery.- - - - - - - - - - ranking = 6keywords = tree (Clic here for more details about this article) |
8/10. Upper gastrointestinal hemorrhage from a Mallory-Weiss tear associated with an occult Richter's hernia and small bowel obstruction: to see the forest as well as the trees in the emergency department.Mallory-Weiss tears are a common cause of upper gastrointestinal bleeding and are often associated with vomiting from heavy alcohol ingestion. Other causes of severe emesis can induce a Mallory-Weiss tear, and it may be important to diagnose these conditions so that appropriate therapy can be instituted. We report an unusual condition presenting with a Mallory-Weiss tear, a small bowel obstruction resulting from an occult Richter's hernia, which was not suspected or diagnosed at initial presentation.- - - - - - - - - - ranking = 4keywords = tree (Clic here for more details about this article) |
9/10. pancreatitis secondary to percutaneous liver biopsy-associated hemobilia.hemobilia refers to hemorrhage in the biliary tree and is most commonly associated with accidental and iatrogenic trauma. Rarely has pancreatitis been reported in association with hemobilia and never as a consequence of percutaneous liver biopsy-induced hemobilia. We report the case of a 64-yr-old man who presented with pancreatitis 6 days after a percutaneous liver biopsy. Within 24 h of admission, he developed hematochezia. Emergency endoscopy was performed, and with a side-viewing duodenoscope, blood and clot were clearly seen oozing from the papilla. The origin of bleeding was identified angiographically as a pseudoaneurysm of the right hepatic artery. Bleeding stopped and pancreatitis resolved after angiographic embolization of the hepatic artery pseudoaneurysm. A review of the English language literature reveals eight well-documented cases of pancreatitis associated with hemobilia, including the current report. Seven cases were associated with ruptured hepatic artery aneurysms and one case with hemorrhagic acalculous cholecystitis. Six of the patients received appropriate therapy to stop bleeding and recovered uneventfully. pancreatitis should be recognized as a potential important complication of hemobilia. In addition, hemobilia should be considered in the differential diagnosis for those patients with apparent biliary or idiopathic acute pancreatitis and no stones seen on ultrasonography. When bleeding is stopped via surgical or radiological methods, the clinical course of hemobilia-associated pancreatitis appears to be benign.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/10. Major upper gastrointestinal haemorrhage associated with hepatic arterial chemoperfusion.BACKGROUND: The present study reviews the nature of upper gastrointestinal complications of hepatic arterial chemoperfusion at a tertiary referral centre for the treatment of hepatic malignancy. methods: The patients involved in the present study all had major upper gastrointestinal (GI) haemorrhage and were undergoing hepatic arterial chemoperfusion. RESULTS: Eight patients had major upper GI haemorrhage. Three of these patients were not referred for surgical management, and all three patients died. The five patients who were admitted or transferred to our unit and who underwent surgery all survived. CONCLUSIONS: These complications are probably caused by extravasation of 5-fluorouracil (5-FU) following thrombosis of the gastroduodenal artery. The resulting cavity may perforate into the hepatic artery, portal vein, duodenum or biliary tree. Surgeons and oncologists should be aware of these complications. If upper abdominal pain occurs, chemoperfusion should cease immediately and an urgent investigation, which may include catheter angiography, gastroscopy and computed tomography (CT) scanning, should be carried out to exclude an hepatic artery pseudo-aneurysm.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
| | Next -> |