Aneurysm of the portal venous system is extremely rare and its etiology is controversial. In the following study, a case congenital aneurysm of the portal vein is reported. A 47-year-old male had a one-year history of generalized weakness. During routine evaluation, an ultrasound examination showed a masslike dilatation of the portal vein near the porta hepatis and its distal portion was communicating with the normal-sized superior mesenteric vein. The diagnosis was confirmed by dynamic computed tomography and portal venography as portal vein aneurysm and an unusually tortuous portal vein. The patient had no history or clinical evidence of underlying liver disease, pancreatitis, or other disease states that would predispose development of an aneurysm. It was speculated that this portal vein aneurysm may have been congenital and that the associated tortuous portal vein may have been secondary to hemodynamic changes in the portal vein system.
Aneurysm* ; Diagnosis ; Dilatation ; Hemodynamics ; Humans ; Liver Diseases ; Male ; Mesenteric Veins ; Middle Aged ; Pancreatitis ; Phlebography ; Portal Vein* ; Ultrasonography

Biliary-cutaneous fistula is frequently associated with biliary surgery, hepatic trauma, liver biopsy, and percutaneous interventional procedures, etc. Bile entering the vascular system is a rare clinical situation that has been reported in association with biliary obstruction from common bile duct stones and normal blood vessels. However, we experienced a 62-year-old woman who developed a biliary-cutaneous fistula combined with biliary-hepatic venous connection and who was not associated with distal biliary obstruction. On fistulography, we detected contrast dye entering the hepatic vein from the biliary-cutaneous fistula cavity. Segmentectomy of Couinaud segment 7 was performed. Histopathologic findings showed chronic granulomatous inflammation with caseous necrosis. It was diagnosed as a primary hepatic tuberculosis.
Bile ; Biopsy ; Blood Vessels ; Common Bile Duct ; Female ; Fistula* ; Hepatic Veins ; Humans ; Inflammation ; Liver ; Mastectomy, Segmental ; Middle Aged ; Necrosis ; Tuberculosis, Hepatic

A web arising in the bile duct is a rare disease. Most cases are found at operation or autopsy becasue of the rare incidence and absence of specific clinical manifestations. However, early diagnosis has been feasible with the development of radiologic studies. We report a case of choledochal web with a review of the literature.
Autopsy ; Bile Ducts ; Early Diagnosis ; Incidence ; Rare Diseases

The frequency of anatomical variation of the bile duct system is relatively common. The constitution of a normal biliary confluence by union of the right and left hepatic ducts is reported in only 57% (Couinaud 1957) to 72% (Healy & Schroy 1953) of cases. While many of these variations have little or no clinical importance, some cases cause symptoms and signs, or may lead to incorrect diagnosis and inappropriate management of biliary disorder. We report a case of rare extrahepatic bile duct anomaly in a 60-year-old man. His chief complaint was intermittent right upper quadrant pain for six months.There was a low union of both extrahepatic ducts and the cystic duct. The left extrahepatic duct fused with the right extrahepatic duct anteriorly and the long cystic duct ran alongside and parallel with the right and left extrahepatic duct before joining them. Distal CBD cancer was also combined.
Bile Ducts ; Bile Ducts, Extrahepatic* ; Constitution and Bylaws ; Cystic Duct ; Diagnosis ; Hepatic Duct, Common ; Humans ; Middle Aged

Gallbladder agenesis is a rare condition of hepatobiliary congenital anomaly. It is caused by failure of development of the caudal division of the primitive hepatic diverticulum or failure of vacuolization after the solid phase of embryonic development. It is divided into 2 groups: (1) those whose conditions are discovered clinically because of persistent symptoms and proven by abdominal exploration with operative cholangiography; and (2) those who are asymptomatic during life and whose conditions are discovered only at necropsy. If symptoms are present, they are unlikely to be related to gallbladder disease. It is impossible, at present, to make a preoperative diagnosis of gallbladder agenesis. Operative cholangiography is absolutely necessary to rule out an intrahepatic gall bladder. Confirmation at surgery and autopsy requires thorough dissection of the biliary tract and liver bed. Therefore, we presented this case with a brief review of the related literature.
Autopsy ; Biliary Tract ; Cholangiography ; Diagnosis ; Diverticulum ; Embryonic Development ; Female ; Gallbladder Diseases ; Gallbladder* ; Liver ; Pregnancy ; Urinary Bladder

The authors experienced three cases of cholangiocarcinoma associated with profuse mucin production. We intended to review and summarize the clinical features of these patients to emphasize the clinical importance of mucin-producing cholangiocarcinoma. All patients were female. Symptoms were mainly right upper quadrant pain and jaundice. Diagnosis was made by characteristic endoscopic retrograde cholangiographic findings and computed tomography. Bile ducts were dilatated and obstructive jaundice had developed as a result of the accumulation of mucin realeased by the tumor. Treatments were hepatic lobectomies for two intrahepatic cholangiocarcinoma patients and extrahepatic bile duct resection and hepaticojejunostomy for one patient. There was no postoperative complication. Pathologies were well differentiated papillary adenocarcinoma in two cases. Two patients are still living without recurrence for over three and four years respectively. One patient who had T4 lesion died of recurrence 38 months after operation. Conclusively, aggressive surgical treatment may be justified in the treatment of mucin hypersecreting cholangiocarcinoma even in advanced stage in view of the favorable outcome after radical operation. Further study is needed to clarify its biological behavior.
Adenocarcinoma, Papillary ; Bile Ducts ; Bile Ducts, Extrahepatic ; Cholangiocarcinoma* ; Diagnosis ; Female ; Humans ; Jaundice ; Jaundice, Obstructive* ; Mucins ; Pathology ; Postoperative Complications ; Recurrence

Confirmation of patency of the portal vein by either ultrasound or angiography is important for evaluating patients considered for living-related liver transplant(LRLT) and liver resection(LR). Portal vein thrombosis(PVT) in LRLT necessitates planning for a technically difficult operation because consideration must be given to obtaining an alternative for splanchnic inflow. When performing LR for hepatocellular carcinoma(HCC), portal vein tumor thrombus was usually thought of as a poor prognositic factor for tumor recurrence. Recently, we experienced two cases of pseudo-obstruction of the portal vein, one in LRLT and the other in LR. In the case of LRLT, a 16-month-old female patient was diagnosed as congenital biliary atresia. PVT had been preoperatively suggested, but the vein was actually open. The patient was successfully transplanted using the left lateral segment of the donor with ordinary portal vein anastomosis and the postoperative course was uneventful except for mild acute rejection episodes. In the case of LR, a 60-year-old male patient presented with incidental symptoms. Preoperative ultrasonography, computed tomography, and angiography showed a 9x8cm-sized mass in the right lobe of the liver with obstruction of the right portal vein, which suggested tumor thrombus. However, the operation disclosed the patency of the portal vein and a right lobectomy was subsequently done. Because of the scanty blood flow of the portal vein due to arterio-portal shunt, PVT was preoperatively suggested. Our experience indicates that more sophisticated image studies are needed for evaluating portal vein patency in the patient who needs hepatic transplant as well as liver resection, and that the surgeon should not hesitate to procede to operative procedures even though conventional studies suggest PVT.
Angiography ; Biliary Atresia ; Female ; Humans ; Infant ; Liver Transplantation* ; Liver* ; Male ; Middle Aged ; Portal Vein* ; Recurrence ; Surgical Procedures, Operative ; Thrombosis ; Tissue Donors ; Ultrasonography ; Veins

BACKGROUND/AIMS: To introduce and review the results of the different treatment modalities of infected pancreatic necrosis and abscess that have been used during a 1-year period. As well, to assess the technique and indications of retroperitoneal drainage that is selectively performed for the management of peripancreatic necrosis because of the problem of intraperitoneal drainage. METHODS: Five patients with infected pancreatic necrosis or abscess were operated on from July 1997 to June 1998. Two undrewent surgical necrosectomy and retroperitoneal drainage and 3 had a classical procedure of multiple intraperitoneal drainage after necrosectomy. RESULTS: Two of 5 patients that had retroperitoneal drainage performed were successful of wide ranging necrosectomy of retroperitoneal necrosis or abscess through one drainage site and the left flank, resulting in a decreased rate of intraperitoneal contamination, discomfort and disability. CONCLUSION: The advantages of retroperitoneal drainage for wide ranging retroperitoneal pancreatic necrosis are made possible by draining the retroperitoneal route from the retroperitoneal cavity to the same retroperitoneal external opening. The use of retroperitoneal drainage seemed to be a significant factor for improvement by providing a reliable drainage of retropancreatic areas and by avoiding the opening of the peritoneal cavity
Abscess ; Drainage* ; Humans ; Necrosis* ; Peritoneal Cavity

BACKGROUND: Hepatolithiasis is found predominantly in Southeast Asia and although it is a pathophysiologically benign disease, it frequently causes serious problems such as recurrent cholangitis, liver abscess, obstructive jaundice and sepsis. As a result it is said to be a clinically malignant disease. In order to select the best surgical treatment according to location of biliary stenosis, we analyzed the clinical manifestation of hepatolithiasis and follow-up results. METHODS: We retrospectively reviewed 42 cases of hepatolithiasis treated by various surgical treatments from Jan. 1987 to Jun. 1998 at the Department of Surgery of Kangnam General Hospital. RESULTS: In cases where the site of biliary stenosis was limited to the left intrahepatic duct, the relative incidence of good results was higher in the hepatectomy group(88.2%) than in the drainage group(0%). And in cases of biliary stenosis in both intrahepatic ducts, the relative incidence of good results was higher in the hepatectomy group(33.3%) than in the drainage group(0%). And in cases of no biliary stenosis, the relative incidence of good results was high(66.7%) even in the drainage group. CONCLUSION: Hepatic resection is a satisfactory treatment option for patients with hepatolithiasis, especially in the cases of biliary stenosis.
Asia, Southeastern ; Cholangitis ; Constriction, Pathologic* ; Drainage ; Follow-Up Studies ; Hepatectomy ; Hospitals, General ; Humans ; Incidence ; Jaundice, Obstructive ; Liver Abscess ; Retrospective Studies ; Sepsis

BACKGROUND: Self-expandable metallic stent is an effective method in palliative treatment of malignant biliary stricture. However, it is controvesial in benign biliary stricture due to recurrent jaundice, cholangtitis, and finally, obstruction of stent. The purpose of this study was to determine the long-term effectiveness of Gianturco expandable metallic stents in benign biliary strictures. METHODS: We inserted Gianturco self-expandable metallic stent in 13 patients (42~69 years old, 6 men and 7 women) with benign biliary stricture between November 1991 and September 1994 in Wonkwang University Hospital. All patients had a previous history of biliary surgery and underwent balloon dilatation procedure for management of strictures. Insertion routes were percutaneous transhepatic biliary drainage tracks in 8 cases and T-tube tracks in 5 cases. The insertion site was the right intrahepatic duct in 5 cases, the left intrahepatic duct in 2 cases, both intrahepatic ducts in 1 case, common hepatic duct in 1 case, and distal common bile ducts in 4 cases. The stents used were 2~6cm in length and 8~12mm in diameter. The follow-up period was 46months to 81months(mean, 67months). RESULTS: The initial technical success rate was 100% with good immediate patency in all patients. Nine patients(69.2%) had no recurrence of the initial strictures during the follow-up period and 4 patients(30.7%) had further symptoms of biliary obstruction caused by recurrent cholangitis or intrahepatic duct stone formation. These 4 recurrent biliary strictures were treated by surgical methods. The recurrent stricture sites were distal common bile duct(1case), left intrahepatic duct(1case), both intrahepatic ducts(1case), and Roux-en-Y hepaticojejunostomy site(1case). CONCLUSIONS: According to the results of long-term follow-up, expandable metallic stent is a useful method in recurrent biliary strictures, especially in the case where operation is not feasible; poor risk patients, patients refusing operation, multiple biliary operation.
Bile ; Cholangitis ; Common Bile Duct ; Constriction, Pathologic* ; Dilatation ; Drainage ; Follow-Up Studies* ; Hepatic Duct, Common ; Humans ; Jaundice ; Male ; Palliative Care ; Recurrence ; Stents*