Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.
Chyle ; Chylous Ascites ; Humans ; Pancreatic Neoplasms ; Pancreatitis ; Parenteral Nutrition, Total ; Peritoneum ; Portal Vein ; Rare Diseases ; Rupture ; Thrombosis

No abstract available.
Anemia, Iron-Deficiency* ; Ferritins* ; Iron*

BACKGROUND/AIMS: The use of diagnostic laparoscopy has been changed because of the development of lesser invasive radiologic tools, which is more useful in the diagnosis of diffuse liver diseases recently. The aim of this study was to evaluate the clinical value of laparoscopy in diagnosis of diffuse liver diseases during laparoscopic surgery and to find the relationship between laparoscopic gross finding and liver biopsy. METHOD: Sixty-five patients were performed laparoscopic cholecystectomy from March 1. 2001 to July 30 . 2001. We prospectively compared the result of liver biopsy with preoperative serum liver function test, ultrasonographic finding and liver surface characteristics as observed during laparoscopic surgery. RESULTS: The results of liver biopsy obtained in 59 cases were normal liver; 57.6%, mild steatosis; 15.4%, moderate to severe steatosis; 16.9%, chronic liver disease; 1.5%, cholangitis; 3.1% and cirrhosis; 1.5%. There was no correlation between preoperative liver function test and liver biopsy. However, the ultrasonographic finding was more correlated with liver diseases. The sensitivity of laparoscopic liver surface characteristics was 76.0%. The liver surface characteristics was well correlated with liver biopsy finding, especially in color of liver surface and contuor of liver margin. Importantly, when one more abnormal findings in liver surface characteristics were found, the positive predictability of liver disease was 56%. CONCLUSIONS: Diagnostic laparoscopy is a safe and accurate method for evaluating the diffuse liver diseases. If the abnormal findings of liver surface characteristics is found during laparoscopic surgery, one shoud confirm liver disease by liver biopsy.
Biopsy ; Cholangitis ; Cholecystectomy, Laparoscopic ; Diagnosis* ; Fibrosis ; Humans ; Laparoscopy* ; Liver Diseases* ; Liver Function Tests ; Liver* ; Prospective Studies

Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. The tumor was characterized by high serum alpha-fetoprotein (AFP) levels. A 73-year-old male patient was admitted to the hospital with abdominal pain. Gastrofiberscopy revealed a gastric tumor occupying the antrum and pylorus. Radical subtotal gastrectomy was done and the result of biopsy was poorly differentiated adenocarcima of stomach and stage 3B. At postoperation 8 month, AFP was elevated and liver mass was detected on CT. Right extended hepatectomy was done under the impression of primary liver tumor. But, the biopsy revealed metastatic hepatoid adenocarcinoma of the stomach. Re-examination of the resected stomach was done and the result was hepatoid adenocarcinoma of the stomach. Two months later, after the hepatic resection, multiple metastases developed. This type of tumor has frequent early liver metastasis and poor prognosis. Therefore, early diagnosis and more careful investigation for liver metastasis are recommended.
Abdominal Pain ; Adenocarcinoma ; Aged ; alpha-Fetoproteins ; Biopsy ; Early Diagnosis ; Gastrectomy ; Hepatectomy ; Humans ; Liver ; Male ; Neoplasm Metastasis ; Prognosis ; Pylorus ; Stomach

PURPOSE: Although duodenal perforation following ERCP is very rare compared to other complications, it can result in a fatal outcome. To find the most effective treatment strategy, the cases experienced at our hospital were reviewed and analyzed. METHODS: A retrospective chart review, conducted at our hospital between December 1994 and April 2006, identified 15 periduodenal perforation cases related to ERCP; a rate of 0.53%. The following parameters were reviewed: clinical presentation of perforation, diagnostic methods, time to diagnosis and operation, method of management, length of stay and outcome. RESULTS: Fourteen patients were managed by surgery and one conservatively. Eleven patients were cured without complications, but four suffered from severe complications, and required several re-operations. Two patients (50%) of the re-operated group died. The mean time to surgery was longer in the re-operated than non-re-operated group (34.3+/-12.4 hours vs. 17.2+/-21.7 hours). The causes for the reoperation were an anastomosis blowout in the duodenotomy for transduodenal sphincteroplasty in 3 and duodenal perforation at the site of transduodenal sphincteroplasty in the remaining patient. All re-operated cases had large retroperitoneal fluid collection, as seen on CT scanning, and had been operated on by inexperienced surgeons. CONCLUSION: The early detection is important for the treatment of a duodenal perforation following ERCP. If surgical treatment is needed, it must be performed within 24 hours. Although the type of surgical procedure will depend on the surgeon's preference, a less invasive procedure, such as simple closure & drainage, will be adequate in cases with a delayed diagnosis, a septic condition or an inexperienced surgeon.
Cholangiopancreatography, Endoscopic Retrograde* ; Delayed Diagnosis ; Diagnosis ; Drainage ; Fatal Outcome ; Humans ; Length of Stay ; Reoperation ; Retrospective Studies ; Sphincterotomy, Transhepatic ; Tomography, X-Ray Computed

Cavernous angiomas of the cranial nerves are rarely reported. We report a case of a 33-year-old man affected by a cavernous angioma originated in the oculomotor nerve with it's palsy. Preoperative radiological findings are difficult to differentiate it from meningioma or neurinoma. Postopertive pathological report discloses it as cavernous angioma. We discuss radiological, pathological features and management of this vascular lesion of the cranial nerve.
Adult ; Cranial Nerves ; Hemangioma ; Hemangioma, Cavernous* ; Humans ; Meningioma ; Neurilemmoma ; Oculomotor Nerve* ; Paralysis ; Vascular Malformations

Sclerosing mesenteritis is a rare condition; it's an idiopathic nonspecific inflammatory process in the adipose tissue of the small bowel mesentery. It often develops into huge masses that contain necrotic fat, and these masses mimick malignancy. It has two pathologically different variants: mesenteric panniculitis (acute or subacute) and retractile-mesenteritis (chronic). Although infection, trauma, local ischemia, surgery and malignancy have been implicated in the etiology of this disease, the exact causes are unknown. The disease usually has a favorable prognosis. The diagnosis is confirmed by biopsy. A 59 year-old man visited in our hospital with vague abdominal pain and diarrhea that he had suffered with during the previous three months. A computed tomography (CT) scan showed a dilated small intestine and also masses in the small bowel mesentery. On the operative findings, fibrous masses were noted in the mesentery. The pathologic report revealed sclerosing mesenteritis. We report here on a case of sclerosing mesenteritis along with a review of the literatures.
Abdominal Pain ; Adipose Tissue ; Biopsy ; Diagnosis ; Diarrhea ; Humans ; Intestine, Small ; Ischemia ; Mesentery ; Middle Aged ; Panniculitis, Peritoneal* ; Prognosis

Neuroendocrine pancreatic tumors (NPTs) arise from the pancreatic islet cells and belong to the amine and precursor uptake and decarboxylation (APUD) system. These tumors are rare and account for only 1% to 5% of pancreatic tumor. The pancreas is an extremely uncommon site of neoplasia in children and adolescents. For this reason, our understanding of these tumors is still quite limited. Although the complete surgical resection is the key to successful management of all malignant adolescence pancreatic tumors, the information on the possible role of chemotherapy and radiation in recurrent, unresectable, or metastatic cases is purely anecdotal. The 17-year-old man transferred to our hospital with abnormal ultrasonographic findings. Result of abdominal ultrasonographic examination showed a mass in the upper abdomen. He presented with 6months history of intermittent abdominal pain and vomiting and diarrhea. A computed tomography (CT) scan and magnetic resonance showed a 4.5 x 6 cm mass in the head of the pancreas. An ultrasound-guided core biopsy confirmed an pancreatoblastoma or pancreas islet cell tumor. On operative findings, there was locally advanced, unresectable tumor within the pancreatic head. We report a 17-years-old man patient with non-functional panceratic islet cell carcinoma.
Abdomen ; Abdominal Pain ; Adenoma, Islet Cell ; Adolescent* ; Biopsy ; Carcinoma, Islet Cell ; Child ; Decarboxylation ; Diarrhea ; Drug Therapy ; Head ; Humans ; Islets of Langerhans* ; Pancreas ; Vomiting

The laparoscopic cholecystectomy has been clearly established as the gold standard for the surgical treatment of calculous biliary diseases. The currently used most popular technique is the four-trocar technique. This prospective study was designed to examine whether or not three-trocar technique could be chosen as an alternative to the standard four-trocar technique. Prospective data were collected on 98 patients undergoing a laparoscopic cholecystectomy at Wonkwang University Hospital from December 1995 to July 1996. We excluded 40 cases of acute cholecystitis which under went an operative cholangiogram with conversion to the four-trocar method as unfit for this study. We evaluated all associated clinical factors for the three-trocar technique (28 cases); and the four-trocar technique (30 cases), and we analysed the operating time, the intraoperative gallbladder perforation, postoperative complications, the postoperative hospital stay, and the duration for compliants of pain. Between the two techniques, there were no significant differences in the operating times, the postoperative complications, the postopeative hospital stays, and the durations for complaint of pain. However, intraoperative gallbladder perforation more frequently developed in the three-trocar technique than in the four-trocar technique (4 cases versus 1 case, P=0.02). However, gallbladder perforation didn't cause a prolonged operating time; or any other postoperative complication. In our series, the three-trocar technique had results similar to those of the four trocar technique. Morever, the three trocar technique was more economical and had cosmetic advantages. We conclud that a qualified laparoscopic surgeon can choose the three-trocar technique as an alternative to the four-trocar technique.
Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Gallbladder ; Humans ; Length of Stay ; Postoperative Complications ; Prospective Studies ; Surgical Instruments

PURPOSE: There were many studies for adverse effects of carbon dioxide insufflation for laparoscopic cholecystectectomy, mainly focused on cardiovascular and respiratory system. The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects. However, its effect on tissue trauma & postoperative pain remains controversial. The aim of this study was to compare postoperative pain intensity between different insufflation pressures in laparoscopic cholecystecetomy. METHODS: We randomly allocated fifty four patients to 7 mmHg (LC7), 9 mmHg (LC9) and 12 mmHg (LC12) pneumoperitoneum group and examined operation time, postoperative pain intensity using visual analogue scale, amount of administered analgesics and complications prospectively. RESULTS: The characteristics of the patients were similar among groups. The procedure was successfully completed in all patients in the LC12 gruop, but in five patients of LC7 group and one patient of LC9 group the insufflation pressure was increased to 12 mmHg to complete the operation. There were no significant difference in postoperative pain scores, analgesic comsumptions among groups. There were difficulties to get a safe hemostasis and to create a adequate working space at acute cholecystitis in LC7 group. CONCLUSION: In our study, there was no superior advantage for postoperative pain when low pressure pneumoperitoneum was applied.
Analgesics ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Hemodynamics ; Hemostasis ; Humans ; Insufflation* ; Pain, Postoperative* ; Pneumoperitoneum ; Prospective Studies ; Respiratory System