We have surgically experienced a case with primary double cancer which metachronously occurred in the gall bladder and the distal portion of common bile duct. This 61-year-old male underwent cholecystectomy with en bloc wedge resection of liver due to the malignant tumor in the gall bladder about 30 months ago. The histopathological examination revealed that the lesion was adenocarcinoma, moderately to poorly differentiated, with partly neuroendocrine differentiation, in the neck portion of the gall bladder (Figure 1). The malignant potential invaded to the subserosal layer, and the resected margin of the cystic duct was free from the malignant invasion. During the post-operative period, he has periodically or sporadically visited the out-patient Department of Surgery and Internal Medicine at Taejeon St. Mary's Hospital for follow-up studies. He was admitted again because of the insiduous onset of painless jaundice along with generalized itching sensations. The studies, using the ultrasonogram and the CAT scan, showed that the intra- and extra-hepatic biliary trees were moderately dilated due to a mass effect at the distal portion of the common bile duct (Figure 2). The ERCP revealed the lesion was malignant(Figure 3), and histologically confirmed adenocarcinima, well differentiated. He underwent Whipple's pancreaticoduodenectomy with regional lymph node dissection(Figure 4). The histopathological examination revealed that the lesion was adenocarcinoma, moderately differentiated, with lymphatic and perineural invasion, in the distal portion of the common bile duct (Figure 5). The malignancy extended toward the submucosal layer of duodenum and the pancreatic parenchyme. The resected margin of common bile duct was free from malignant invasion. He recovered uneventfully from the second surgical intervention. He periodically visits the out-patient Department of Surgery nowadays.
Adenocarcinoma ; Animals ; Biliary Tract* ; Cats ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Common Bile Duct ; Cystic Duct ; Daejeon ; Duodenum ; Follow-Up Studies ; Humans ; Internal Medicine ; Jaundice ; Liver ; Lymph Nodes ; Male ; Middle Aged ; Neck ; Outpatients ; Pancreaticoduodenectomy ; Pruritus ; Sensation ; Ultrasonography ; Urinary Bladder

Intramural duodenal hematoma (IDH) is a quite rare disese entity which results from the collection of blood and body fluid between mucosa and serosa. Various degrees of duodenal obstruction may be caused by IDH as it gradually enlarges and compresses the mucosa against the opposite side of duodenum. The most common cause of IDH is blunt abdominal trauma and the spontaneous IDHs are generally casused by coagulation disorder such as blood dyscrasia, anticoagulation treatment or pancreaticoduodenal aneurysm. The diagnosis is usually made by the typical imaging on abdominal computed tomographic scan with a previous history of blunt abdominal trauma. For spontaneous IDH without coagulation disorder, an abdominal angiogram may be considered to exclude vascular anomalies. Medical treatment is recommended unless the associated visceral injuries require immediate laparotomy. Here, we report a case of acute duodenal obstruction due to IDH which had resolved completely without an operative management.
Aneurysm ; Body Fluids ; Diagnosis ; Duodenal Obstruction* ; Duodenum ; Hematoma* ; Laparotomy ; Mucous Membrane ; Serous Membrane

Nasogastric tube insertion is a routine clinical procedure for nutritional support, gastric aspiration and decompression. Although it is generally a safe procedure, complication rates range from 0.3~8%. Submucosal esophageal dissection is a rare disorder caused by mucosal tearing and bleeding between the mucosal and muscular layers of the esophagus, leading to their separation. We report a case of submucosal esophageal dissection secondary to the accidental iatrogenic intramural insertion of a nasogastric tube.
Decompression ; Esophagus ; Hemorrhage ; Nutritional Support