An adenoma is a rare benign tumor arising in the extra-hepatic biliary duct. Adenocarcinomatous changes are often observed in the background of an adenoma. Double or triple cancer with an adenoma and adenocarcinoma in the biliary tract can be the crucial evidence of the adenoma-carcinoma sequence. We first performed laparoscopic surgery on a 63-year old male patient complaining of pain in the right upper quadrant of the abdomen and jaundice a week earlier, which was initially diagnosed by a radiologist as a sessile polyp of the gallbladder along with stones in the gallbladder and the common bile duct. A mass was found in the distal common bile duct and ampullary area during intraoperative choledochoscopy. The frozen sections taken during surgery indicated a cancer or dysplasia in the gallbladder and the distal common bile duct. The patient underwent a pylorus-preserving pancrea-toduodenectomy. The final diagnosis was a double primary can-cer originating in the gallbladder and the ampulla of Vater with an adnocarcinoma in an adenoma. We report this case with review of the relevant literature.
Abdomen ; Adenocarcinoma ; Adenoma ; Ampulla of Vater* ; Biliary Tract ; Common Bile Duct ; Diagnosis ; Frozen Sections ; Gallbladder ; Gallbladder Neoplasms* ; Humans ; Jaundice ; Laparoscopy ; Male ; Middle Aged ; Polyps

PURPOSE: Traditionally, the main treatment for common bile duct (CBD) stones and gallstones is ERCP combined with a laparoscopic cholecystectomy (LC). However, this procedure is generally performed in 2 stages, which makes the patients uncomfortable and unsatisfied. It also can result in the need for several procedures if it fails, and sometimes the surgery is warranted. Recently in the laparoscopic era, the laparoscopic skill has been developed quite rapidly. In the case of CBD stones, there are many reports involving laparoscopic procedures. We reviewed the safety and feasibility of removing CBD stones using a laparoscope and choledochoscope. METHOD: This retrospective study reviewed 40 cases who underwent a laparoscopic cholecystectomy and choledocholithotomy for bile duct stones between Feb. 2002 and Aug. 2004. RESULTS: Of the 40 patients who underwent the laparoscopic procedure, 25 were combined with gallstones, and 12 underwent the transcystic duct approach. The average operation time and average hospital stay was 141.2 mins and 11.3 days, respectively, and the average age was 69.4 year old. There was 1 case of a major complication, where bile leakage occurred for more than 14 days due to a shincter stenosis. This case was improved by an endoscopic sphincterotomy. Of them, 30 underwent a primary closure and 8 underwent T-tube drainage, 2 underwent a biliary stent. CONCLUSION: The laparoscopic cholecystectomy and choledocholithotomy using a choledochoscope are quite safe and feasible, can reduce the patient's anxiety, and increase their level of satisfaction.
Anxiety ; Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Choledocholithiasis* ; Common Bile Duct* ; Constriction, Pathologic ; Drainage ; Gallstones ; Humans ; Laparoscopes ; Length of Stay ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Stents

PURPOSE: We peformed endoscopic thyroidectomy and open thyroidectomy during the same period. In this study, we analyzed the result (merits and demerits) between endoscopic procedure and open procedure. METHODS: From Aug. 2003 to Aug. 2004, each procedure was performed in 92 patients. Conventional open thyroidectomy was underwent in 50 patients and endoscopic thyroidectomy was underwent in 42 patients. We performed the endoscopic thyroidectomy using breast approach. The 2 incisions, which could use 12 mm ports were placed on the areolar area of the breast as a circumferential fashion. The remaining 1 incision, which could use 5 mm port was placed on the right subclavicular area, 3~4 cm below right clavicle. We used 25 degree, a rigid laparoscope with 5 mm Hg of CO2 insufflation pressure. We also compared the results of mean ages and sex ratio, pathologic diagnosis, extent of operation, mean hospital day, mean operation time between open surgery group and endoscopic thyroidectomy group. RESULTS: We found that the mean age in the endoscopic group was younger, inversely the operation time was longer than in the open surgery group significantly (P<0.05). There was no statistically significant difference in the other results between two groups (P>0.05). The endoscopic group in the aspect of cosmetic was satisfactory. CONCLUSION: We could perform the endoscopic thyroidectomy safely and feasibly. The endoscopic surgery was cosmetically satisfactory. We expect it can increase the extent of surgery.
Breast ; Clavicle ; Diagnosis ; Humans ; Insufflation ; Laparoscopes ; Sex Ratio ; Thyroidectomy*

The concern about multiple primary cancers has been raised in recent years, but their cause has yet to be elucidated clearly. It has been speculated that many factors may contribute, such as family history, genetic factors, chemotherapy, and radiotherapy.(1) The incidence of multiple primary cancers is estimated to be 13%. However, synchronous multiple primary cancers of the stomach and duodenum are uncommon due to the rarity of duodenal cancer. Duodenal cancer poses diagnostic difficulties because of its rarity, non- specific signs and symptoms, and the fact that duodenum is usually ignored during upper gastrointestinal endoscopy. This 71-year-old female patient was diagnosed with double primary cancer of the stomach and duodenum, which was found by abdominal computed tomography preoperatively, and she underwent a Whipple procedure. The histological diagnosis revealed poorly-differentiated adenocarcinoma in the stomach and moderately-differentiated adenocarcinoma in the duodenum. Here we report a case of synchronous double primary cancer of the stomach and duodenum with a review of the literature.
Adenocarcinoma ; Aged ; Duodenal Neoplasms ; Duodenum ; Endoscopy, Gastrointestinal ; Female ; Humans ; Incidence ; Stomach ; Stomach Neoplasms

The most frequent tumor arising from retroperitoneum is sarcoma. Most sarcomas of retroperitoneal origin have no symptoms and comprise 15% of all sarcomas. However, they can grow so great as to cause pain, which implies the possibility of invasion to adjacent organs. Moreover, if its location is between right adrenal gland and inferior vena cava (IVC) ambiguity of its origin can arise. Leiomyosarcoma of IVC is so rare that it can be seen to mimic right adrenal tumor. This 56-year-old female patient with back pain since approximately 4 months prior was transferred to our hospital via local clinic. We performed radical resection of tumor including segmental resection of IVC. Final diagnosis was leiomyosarcoma of IVC. We report this case with a review of literature.
Adrenal Glands ; Back Pain ; Female ; Humans ; Hydrazines ; Leiomyosarcoma ; Middle Aged ; Sarcoma ; Vena Cava, Inferior

The most causes of an icteric hepatoma are a late stage hepatocellular carcinoma or intrahepatic cholangiocarcinoma. A hepatocellular carcinoma, causing an obstrucution of the bile duct, rarely results in jaundice. With a late stage hepatocellular carcinoma, the accurate diagnosis and treatment may be difficult. Herein, we report a case of a hepatocellular carcinoma and obstructive jaundice, due to hilar tumor emboli, with a review of the literature.
Bile Ducts ; Carcinoma, Hepatocellular* ; Cholangiocarcinoma ; Diagnosis ; Jaundice* ; Jaundice, Obstructive

In the case of using surgical clips for division of the cystic duct during laparoscopiccholecystectomy, surgical clip migration into the common bile duct is known to be an extremely rare complication. However, its mechanism is currently unclear. The incidence of performing laparoscopic hepatectomy has significantly increased in the laparoscopic center of hospitals. Accordingly, the complications associated with using clips in laparoscopic cholecystectomy have increase as well. A 49 year-old female patient underwent laparoscopic left hepatectomy due to left intrahepatic duct stones with cholangitis. We report here on a case of a clip that migrated into the common bile duct and the duct had bile stones. We also review the relevant literature.
Bile ; Bile Ducts, Extrahepatic ; Cholangitis ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Cystic Duct ; Female ; Hepatectomy ; Humans ; Incidence ; Surgical Instruments

Tuberculosis is a systemic disease that can occur anywhere in body. Its incidence is various according to the organ or location, and TB in an organ where the general incidence is rare causes so many unexpected symptoms and complications that physicians can sometimes be baffled when attempting to make a diagnosis. If this rare occurrence of TB in an unusual location results in non-specific symptoms, then it is important not to overlook the possibility of tuberculosis. Hepatic tuberculosis is mainly a secondary type of disease that has disseminated from the lungs or other organs. Because a primary TB focus in the liver is rare, in the case in which the lung or other organs have no tuberculosis, it is extremely difficult to arrive at the proper diagnosis of primary hepatic tuberculosis. The authers experienced a case of primary tuberculous granuloma that was associated with intrahepatic duct stones and abscess. This patient was first diagnosed as suffering with intrahepatic duct stones and abscess only. We discovered the associated tuberculous granuloma of the liver by histologic examination after hepatectomy. We report on this case with a review of the relevant literature.
Abscess* ; Diagnosis ; Granuloma ; Hepatectomy ; Humans ; Incidence ; Liver ; Lung ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Hepatic

Situs inversus totalis is a rare congenital disorder, which is total transposition of thoracic and abdominal organs. Its incidence is 1 in 10,000~50,000 live births. This might be associated with multiple abnormalities such as accessory spleen, asplenia, intestinal malrotation and so on. For this reason, in cases of operation in patients with situs inversus totalis, we need to scrutinize the presence of accompanied anomalies. Moreover, if Dieulafoy gastric bleeding has occurred, vascular anomalies can be accompanied. This 31-year-old male patient with situs inverses totalis was admitted to our hospital for management of UGI (upper gastrointestinal) bleeding. Gastroendoscopy revealed Dieulafoy disease in the upper body of the stomach as the cause of UGI bleeding. Several attempts with endovascular embolization and hemoclips were applied but failed. We performed a suture & ligation of the Dieulafoy lesion as well as total resection of accessory spleen with devascularization of prominently developed vessels around the upper stomach. We report this case with a review of the literature.
Abnormalities, Multiple ; Adult ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Hemorrhage ; Humans ; Incidence ; Ligation ; Live Birth ; Male ; Situs Inversus ; Spleen ; Stomach ; Sutures

Four cases of mucinous ductal ectasia of the pancreas are presented, along with a review of the literature. Mucinous ductal ectasia is a clinicopathologic entity characterized by dilation and filling of the main pancreatic duct or its side branches with thick, viscid mucus, leading to recurrent acute pancreatitis or symptoms that mimic chronic pancreatitis. Three of the patients were male (M:F=3:1) and the patients were 54~74 years old. The symptoms of two patients were abdominal pain and they had a frequent admission history due to pancreatitis. One patient had jaundice, and one patient presented no symptoms. In all of the patients, the tumor was located in the read of the pancrease and the size of tumor was about 3 cm. A total pancreatectomy was performed, and three pancreatico-duodenectomy were performed. The pathologic report revealed that two cases were malignant and two cases were borderline malignant. The tumor marker did not correlate with the presence of malignancy. Because mucinous ductal ectasia is recognized as a premalignant disease, the treatment of choice is pancreatic resection.
Abdominal Pain ; Dilatation, Pathologic* ; Humans ; Jaundice ; Male ; Mucins* ; Mucus ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Pancreatitis ; Pancreatitis, Chronic ; Pancrelipase