There are many causes of extrahepatic biliary obstruction. The most common causes are gallstones and malignant or benign strictures. Web of the common bile duct is a rare disease, and it may produce obstructive jaundice. On cholangiography, a common bile duct web typically appears as a shelf--like radiolucent ring. It is frequently associated with bile duct stone, and it is occasionally related to bile duct trauma or primary sclerosing cholangitis. We report here on a case of a web of the common bile duct without choledocholithiasis in a 27-year-old man. The patient was treated by Roux-en-Y choledochojejunostomy above the level of the web.
Adult ; Bile Ducts ; Cholangiography ; Cholangitis, Sclerosing ; Choledocholithiasis ; Choledochostomy ; Common Bile Duct ; Constriction, Pathologic ; Gallstones ; Humans ; Jaundice, Obstructive ; Rare Diseases

Laparoscopic cholecystectomy has been widely performed as the gold standard for patients suffering with symptomatic gallstone disease. However, conversion to open cholecystectomy is a dilemma when the surgeon encounters a variant biliary anomaly. A gallbladder lying to the left of the round ligament represents a rare congenital anomaly, which is termed as a left-sided gallbladder. The true left-sided gallbladder, situated on the inferior aspect of the left lobe of the liver, is extremely rare and this represents a truly ectopic gallbladder that may developmentally arise as a second gallbladder from the left hepatic duct. This is accompanied by the disappearance of the normal gallbladder on the right side. We report here on 2 cases of left-sided gallbladder that were successfully treated with laparoscopic cholecystectomy at Hallym Medical Center. In both cases, the true left-sided gallbladders were identified intraoperatively. The round ligament was indeed located in its normal position, and the gallbladder was located to the left of the round ligament, which is a type of malposition known as sinistroposition. The operation was carried out in the usual manner with the trocars placed their usual location. Although operations can be carried out with using the standard port sites, a better arrangement for laparoscopic cholecystectomy consists of more medial positioning of the gallbladder-retracting port and placement of the right hand operating port to the left side of the round ligament.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Deception ; Gallbladder ; Gallbladder Diseases ; Gallstones ; Hand ; Hepatic Duct, Common ; Humans ; Liver ; Round Ligament of Uterus ; Round Ligaments ; Stress, Psychological ; Surgical Instruments

Schwannoma or neurilemmoma is an uncommon neoplasm, and it is derived from the peripheral nerve sheath. These tumors most frequently occur in the head, neck and flexor surfaces of the upper and lower extremities, while the porta hepatis and retroperitoneum are rarely implicated. We report here on a case of benign schwannoma in the porta hepatis with compression of the common bile duct, and this was successfully treated by surgical excision. The patient was a 63-year-old woman who had a slow growing upper abdominal mass for 3 years. The abdominal CT scan showed a 12 cm-sized cystic mass with a solid portion, and this was accompanied with intrahepatic bile duct dilatation. Abdominal exploration revealed a yellowish, cystic, encapsulated mass attached to the inferior vena cava, portal vein, the common bile duct and the liver. There has been no evidence of recurrence during 36 months of follow-up.
Bile Ducts, Intrahepatic ; Common Bile Duct ; Dilatation ; Female ; Follow-Up Studies ; Head ; Humans ; Liver ; Lower Extremity ; Middle Aged ; Neck ; Neurilemmoma ; Peripheral Nerves ; Portal Vein ; Recurrence ; Vena Cava, Inferior

Gallbladder agenesis is a rare congenital biliary anomaly that may be associated with other biliary and extrabiliary congenital anomalies. Awareness of this condition is important because many of these patients may have vague biliary symptoms that lead to unnecessary operations. We treated a 46-year-old woman who was diagnosed with gallbladder agenesis during performance of gynecologic laparoscopic surgery. The gallbladder was not visualized by the preoperative abdominal ultrasonography, the abdominal computed tomography and the MRCP. The hepatobiliary scan revealed non-visualization of the gallbladder. Based on these imaging studies, there was a high suspicion of a sclero-atrophic gallbladder or agenesis of the gallbladder. At surgery, we carefully examined the porta hepatis and found that the gallbladder was absent. The operation involved only examination with a laparoscope. The patient has remained well and asymptomatic. It is extremely difficult to diagnose gallbladder agenesis in clinical settings; the identification of gallbladder agenesis is often an incidental finding. For cases where the gallbladder is not visualized preoperatively, a diagnostic laparoscopy can be an alternative diagnostic tool prior to performing laparotomy.
Female ; Gallbladder ; Humans ; Incidental Findings ; Laparoscopes ; Laparoscopy ; Laparotomy ; Middle Aged

Gastrointestinal stromal tumors (GISTs) are rare tumers of the alimentary tract, and these tumors arise from primitive mesenchymal cells. Duodenal GISTs comprise 4-5% of all GISTs. In this article, we report on a case of duodenal GIST in 35-year-old male who presented with a fistulo in ano and anal bleeding. Abdominal computed tomography and magnetic resonance imaging revealed a huge tumor, about 11x7 cm in size, of the duodenum. Duodenoscopy revealed a protruded mass with central deep ulceration on the third portion of the duodenum. Endoscopic biopsies showed subepithelial spindle cell proliferation of the tumor, and this was consistent with GIST. Pylorus-preserving pancreaticoduodenectomy was then performed. He subsequently underwent the sphincter-preserving modified loose Seton surgical technique. The patient did not have any problems postoperatively and he remained symptom-free at 6 months after surgery.
Adult ; Biopsy ; Cell Proliferation ; Duodenoscopy ; Duodenum ; Gastrointestinal Stromal Tumors ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Pancreaticoduodenectomy ; Ulcer

Carbamazepine-induced liver injury is less common, but the consequences of the side effects can be very serious leading to death or a need for liver transplantation. We report a case of a 60-year-old female transverse myelitis patient with fulminant hepatic failure and Stevens-Johnson syndrome induced by carbamazepine who successfully underwent deceased donor liver transplantation. The patient, a 60-year-old female, was admitted to our service due to acute liver insufficiency and a drowsy mental state attributable to carbamazepine. She had been treated with carbamazepine to control transverse myelitis. Fifty days after the use of carbamazepine, she developed jaundice, erythematous papules and bullae, and decreased consciousness. The diagnosis of Stevens-Johnson syndrome was considered. She underwent deceased donor liver transplantation. She was discharged with normal graft functions 5 months after transplantation. Thus, liver transplantation can be a feasible therapy for patients with carbamazepine-induced hepatic failure associated with Stevens-Johnson syndrome.
Blister ; Carbamazepine ; Consciousness ; Female ; Hepatic Insufficiency ; Humans ; Jaundice ; Liver ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Middle Aged ; Myelitis, Transverse ; Stevens-Johnson Syndrome ; Tissue Donors ; Transplants

Purpose: Polydeoxyribonucleotide (PDRN) is a substance known to suppress inflammation and accelerate wound healing. In this experiment, the effect of PDRN treatment on carbon tetrachloride (CCl4)-evoked acute liver injury (ALI) was investigated using mice. Methods: We analyzed the levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and conducted hematoxylin and eosin staining in accompany with terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling staining. Western blot analysis was also conducted to assess the expressions of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, adenosine A2A receptor, Bcl-2-associated X protein (Bax), and B-cell lymphoma 2 (Bcl-2). The mice were received intraperitoneal injection of 10-mL/kg CCl4, 4 times, once every 2 days. The mice in the PDRN treatment groups received intraperitoneal injection of 200-μL distilled water comprising each concentration of PDRN for 7 days starting 1 day after first CCl4 injection. Results: ALT and AST concentrations in the serum were reduced and TNF-α, IL-1β, and IL-6 expressions were decreased by PDRN injection in CCl4-evoked ALI mice. PDRN injection suppressed Bax versus Bcl-2 ratio and reduced the percentage of TUNE-positive cells in CCl4-evoked ALI mice. PDRN injection overexpressed adenosine A2A receptor in CCl4-evoked ALI mice. Conclusions The therapeutic efficacy of PDRN also can be expected for CCl4-evoked acute urogenital injury in addition to ALI. The current research suggests that PDRN may be used for the therapeutic agent of CCl4-evoked ALI.

Hepatoblastoma is the most common primary malignant liver tumor encountered during childhood. Complete surgical resection is the most important factor in predicting which children would achieve cure. Some chemotherapy regimens are effective in reducing tumor size, often rendering initially unresectable lesions amenable to complete surgical resection, and dramatically improving disease-free survival. Liver transplantation provides an additional treatment option for patients whose tumor remains unresectable even after preoperative chemotherapy. We report a case of unresectable hepatoblastoma in a child who underwent living related liver transplantation with pre and post-operative chemotherapy.
Child* ; Disease-Free Survival ; Drug Therapy ; Hepatoblastoma* ; Humans ; Liver Transplantation* ; Liver* ; Living Donors*

Perihepatic abscess is a serious complication of bile duct or hollow viscus injury, with significant morbidity and mortality rates. Perihepatic abscess due to non-traumatic rupture of the biliary tree usually occurs in the presence of biliary stones. In contrast, perihepatic abscess as a result of spontaneous rupture of cholangiocarcinoma is very rare; cholangiocarcinoma generally forms a hard tumor with abundant fibrous stroma, making them difficult to rupture. Here, we describe a case of perihepatic abscess associated with intrahepatic bile duct stones and ipsilateral cholangiocarcinoma. Although it is unclear whether the etiology of perihepatic abscess was rupture of the biliary tree or cholangiocarcinoma, this association is very rare and has never before been reported in the literature.
Abscess ; Bile Ducts ; Bile Ducts, Intrahepatic ; Biliary Tract ; Carcinoma, Adenosquamous ; Cholangiocarcinoma ; Gallstones ; Rupture ; Rupture, Spontaneous

PURPOSE: A bile duct stone impacted at the duodenal papilla is an urgent condition that can rapidly lead to either suppurative cholangitis or acute pancreatitis due to almost complete obstruction of the bilio-pancreatic outflow. This study evaluated the clinical characteristics and results of endoscopic treatment for a bile duct stone impacted at the duodenal papilla. MATERIALS AND METHODS: Forty-six patients who had been diagnosed with an impacted papillary stone were retrospectively reviewed. RESULTS: The typical features of acute cholangitis (Charcot's triad) and pancreatitis were only observed only in 10 patients (21.7%) and 17 patients (37.0%), respectively. After the endoscopic retrograde cholangiopancreatography, 30 patients (65.2%) were found to have a solitary stone impacting the duodenal papilla and 16 patients had one or more stones in the bile duct. On the radiological studies, the former patients were associated more commonly with no visible stone or no bile duct dilatation (p < 0.05). All impacted papillary stones were successfully removed by endoscopic sphincterotomy: 23 by a needle knife and 23 by a pull type papillotome. The procedure-related complications (n = 7, 4 bleeding, 3 pancreatitis) were not serious and did not differ, based on endoscopic findings and the procedure used. CONCLUSION: A bile duct stone impacted at the duodenal papilla requires both clinical and radiographic evidence to support the diagnosis. Endoscopic sphincterotomy, either with a needle knife or a pull type papillotome, was safe and effective for removing the impacted papillary stone.