Congenital dilatation of the common bile duct is relatively rare anomaly. Its pathogenesis has not been completely understood. Complications of the choledochal cyst are mainly suppurative cholangitis, liver cirrhosis, stone formation, malignant change, bile peritonitis due to spontaneous and traumatic rupture. We experienced one case of choledochal cyst associated with hemorrhagic tendency and a cerebral hematoma, which is extremely rare complication. The 3 months old male patient reported here was treated with complete excision of cyst and Roux-en-Y choledochojejunostomy after correction of bleeding tendency and removal of cerebral hematoma. Postoperative course was relatively uneventful. 11 days after operation, the patient was discharged with full improvement.
Bile ; Cholangitis ; Choledochal Cyst* ; Choledochostomy ; Common Bile Duct ; Dilatation ; Hematoma* ; Hemorrhage ; Humans ; Liver Cirrhosis ; Male ; Peritonitis ; Rupture

PURPOSE: Currently, the role of liver transplantation in the treatment of hepatocellular carcinomas with cirrhosis is controversial due to the shortage of donors and to the high recurrence rate after transplantation. What remain to be determined are the best treatment protocol and who are likely to have a good outcome after liver transplantation. METHODS: Eight patients (all male, range 30 to 67 years) with a hepatocellular carcinoma underwent liver transplantation between 1993 and 1999 in Catholic University, Medical College. The criteria for exclusion of transplantation were extrahepatic tumor metastasis, positive regional lymph nodes, and tumor thrombus on the main portal trunk. All except one were treated with preoperative arterial chemoembolization alone or combined with chemotherapy or ethanol injection. The follow-up period was from 5 months to 27 months. The pathologic findings, the recurrence, and the survival rate were analyzed. RESULTS: One patient had a tumor, larger than 5 cm in diameter (5.9 cm) and another patient had 6 nodules in number. Vascular invasion was present in 3 patients. Among the 8 patients, postsurgical TNM staging was stage III in 3 patients and stage IVA in 2 patients. During the follow-up, 7 of the 8 patients (87.5%) survived, and the number of disease-free survivals was 6 among the 8 patients (75%). One patient died with recurrent hepatitis C 6 months after transplantation without tumor recurrence. The patient who had the largest tumor in size had recurrent cancer on the abdominal wall at 9 months after transplantation, and subsequent pulmonary recurrences at 15 and 19 months which were treated by resection. CONCLUSION: Hepatocellular carcinoma could be a good indication for liver transplantation in selected patient, but the best protocol remains to be determined, especially in large tumors.
Abdominal Wall ; Carcinoma, Hepatocellular* ; Clinical Protocols ; Disease-Free Survival ; Drug Therapy ; Ethanol ; Fibrosis ; Follow-Up Studies ; Hepatitis C ; Humans ; Liver Transplantation* ; Liver* ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Neoplasm Staging ; Recurrence ; Survival Rate ; Thrombosis ; Tissue Donors

The authors investigated the distribution of Hepatitis C virus (HCV) genotype in blood donors with positive for anti-HCV (n=34), health check-up examiness with positive for anti-HCV (n=29), and in patients with various chronic liver disases positive for anti-HCV (n=63) in Pusan, Korea. HCV genotype was determined by using the molecular typing method through the reverse transcription - polymerase chain reaction (RT - PCR) with four type specific primers. Among 116 anti-HCV positive study subjects, 66.4% were positive HCV RNA by RT-PCR. The major HCV genotype was type II (31.9%) and it was followed by type III (27.6%). Two cases were type IV (1.7%). Double infection with two different HCV genotypes (mixed type) was found in three cases (2.6%). Three cases (2.6%) were not determined by the four type specific primers, it may have different subtype. Type II was more prevalent than type III in the blood donors and health check-up examinees, but the reverse was true in the chronic liver disease patients including hepatocellular carcinoma patients. Type II was more prevalent than type III among the anti-HCV positive subjects with risk factors such as acupuncture history, surgical operation history, and trans-fusion history. In contrast type III was more prevalent than type II among the subjects without the above risk factors. It is supposed that the pathogenicity of different kind of HCV genotype might be different. The results of this study suggest that the type II and type III may be the major CV genotype in Korea. The differences of HCV genotype distribution between the study groups support that the clinical significance according to the HCV genotype may be different.
Acupuncture ; Blood Donors ; Busan* ; Carcinoma, Hepatocellular ; Genotype ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Korea* ; Liver ; Liver Diseases ; Molecular Typing ; Polymerase Chain Reaction ; Prevalence* ; Reverse Transcription ; Risk Factors ; RNA ; Virulence