Intrahepatic Cholangiocarcinoma Associated with Intrahepatic Duct Stones
|
|
- William Wheeler
- 5 years ago
- Views:
Transcription
1 Original Article Intrahepatic Cholangiocarcinoma Associated with Intrahepatic Duct Stones Hoon Hur, Il-Young Park, Gi-Young Sung, Do-Sang Lee, Wook Kim and Jong-Man Won, Department of Surgery, Holy Family Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Korea. OBJECTIVE: It has been well established that the long-term prognosis of intrahepatic duct stones (IHDS) is complicated by the late development of biliary cirrhosis with associated intrahepatic cholangiocarcinoma (IHCC). Despite recent improvements in imaging studies, accurate preoperative diagnosis of IHCC is difficult. Therefore, we attempted to elucidate the clinical features of patients with IHDS with IHCC. METHODS: We reviewed 80 patients with IHDS and divided them into two groups. The DS group included 72 patients who had only IHDS. The second group was defined as the CC group and included eight patients who had IHDS and IHCC. For diagnosis of IHDS and confirmation of coexisting IHCC, patients underwent various radiological evaluations and additional laboratory tests, such as serum carbohydrate antigen 19-9 (CA 19-9). RESULTS: There was no significant difference in the symptoms and stone characteristics between the two groups. For the CC group, liver resection was performed in four patients. Three patients underwent curative resection, but only one of these patients was alive at 36 months without recurrence. CONCLUSION: IHCC with IHDS was difficult to diagnose in the early phase. Therefore, while performing diagnostic studies and surgery for IHDS, one should always consider the possibility of coexisting cholangiocarcinoma. [Asian J Surg 2009;32(1):7 12] Key Words: cholangiocarcinoma, IHDS Introduction Intrahepatic duct stones (IHDS) have a higher prevalence in Asian countries compared to other regions of the world. Although many physicians have made an effort to effectively manage patients diagnosed with IHDS, the possibility of the development of biliary cirrhosis or intrahepatic cholangiocarcinoma (IHCC) has led to a poor prognosis for these patients. 1 The possibility of the development of IHCC has been more extensively investigated because it has been reported that the effect of treatment for IHCC is very unsatisfactory. The first two cases of IHCC occurring together with IHDS were reported in Recent reports have documented that the rate of the development of IHCC while patients are being treated and followed for IHDS was 4 to 11%. 3 5 Because this potential for the development of IHCC is not trivial and the diagnosis is difficult, it is important that clinicians know about the various characters of IHCC associated with IHDS. The aim of this study was to describe the clinical features of IHCC that developed in patients who were diagnosed with IHDS and to provide an aid to assess presence of characteristic features for an early diagnosis of IHCC in patients with IHDS. Patients and methods Between 1993 and 2004, we treated 80 patients with IHDS at the Holy Family Hospital, Bucheon-City, Korea Address correspondence and reprint requests to Dr Il-Young Park, Department of Surgery, Holy Family Hospital, 2 Sosa-dong, Wonmi-gu, Bucheon, Gyeonggi-do, Korea. parkiy@catholic.ac.kr Date of acceptance: 1 August Elsevier. All rights reserved. ASIAN JOURNAL OF SURGERY VOL 32 NO 1 JANUARY
2 HUR et al with a mean follow-up of 35 months. We divided the 80 patients into two groups. The DS group included 72 patients who had been treated for IHDS without IHCC. The CC group included eight patients who were diagnosed with IHCC at the same time or during a follow-up period after they had been treated for IHDS. We compared the two groups with regard to clinical features such as: gender, age, previous treatment, radiologic evaluation, and symptoms. We retrospectively examined the characteristics of the stones and treatment methods in both groups. We evaluated the results of a tumour marker (CA 19-9) and other laboratory studies, radiological and surgical findings, and the outcome for both groups. A Mann-Whitney U test for continuous variables and Fisher s exact test for categorical variables were used for comparison of the study groups. A value of p < 0.05 (two-sided) was considered to be significant. Results Patient characteristics and symptoms We compared the two groups with regard to the clinical characteristics: age, gender, and previous biliary surgery. The results are summarised in Table 1. There is no difference between the two groups in any of the characteristics, and the number of female patients was three times greater than the number of male patients in both groups. In both groups, the most common previous biliary surgery was cholecystectomy. The patients presented with abdominal pain, fever and jaundice as initial symptoms. Abdominal pain was the most common symptom and was found in over 90% of patients in both groups. Jaundice occurred in only 33% of the DS group and 38% of the CC group. There was no significant difference in the symptoms between the two groups (Table 2). Diagnosis and characteristics of IHDS in the two groups The diagnosis of intrahepatic duct stones was not difficult in patients where this was highly suspected. Abdominal ultrasonography (US) and computed tomography (CT) were commonly used for the detection of the stones and to identify their location in both groups. Endoscopic retrograde cholangiopancreaticogram (ERCP) or magnetic resonance cholangiopancreaticogram (MRCP) was performed when necessary to confirm clinical suspicion or to identify causes of obstruction (Table 2). Table 1. Patient characteristics in the DS and CC groups Characteristics DS group CC group (n = 72) (n = 8) Age (yr) 56.6 (29 82) 60.0 (37 83) Male:Female 20:52 2: Previous biliary 32 (44%) 2 (25%) surgery (%) *Statistical significance was tested by the Mann-Whitney U test for continuous variables and Fisher s exact test for categorical variables; presented as median (range); the most common previous biliary operation in the DS group was cholecystectomy (25 cases; 78%); two prior biliary operations in the CC group were cholecystectomies. Table 2. Symptoms and radiologic evaluations for patients in both groups DS group CC group (n = 72) (n = 8) Symptoms Abdominal pain 66 (92%) 8 (100%) Fever 20 (28%) 3 (38%) Jaundice 24 (33%) 3 (38%) No symptoms 2 (3%) 0 (0%) Radiologic methods US 52 (72%) 7 (88%) ERCP 15 (21%) 2 (25%) MRCP 15 (21%) 0 (0%) CT 29 (40%) 5 (63%) *Statistical significance was tested by Fisher s exact test. US = abdominal ultrasonography; ERCP = endoscopic retrograde cholangiopancreaticogram; MRCP = magnetic resonance cholangiopancreaticogram; CT = computed tomography. CA 19-9 level at the diagnostic time was retrospectively evaluated in the 21 patients, and the variance was too large to analyse the difference between the two groups. In the DS group, the range of CA 19-9 levels of 17 evaluated patients was 1.33 to 10,942 U/mL. The range of four patients in the CC group was 460 U/mL to 4,438 U/mL. No difference in the results between the two groups was shown in other laboratory findings such as AST, ALT, and total bilirubin. The most common site for the stones was in the left liver (51 cases of 80 patients, 64%). There was no significant difference in the incidence of IHCC on the basis of the location of the stones (Table 3). Out of a total of 80 patients, 68 patients (85%) had pigment stones. All patients in the CC group had pigmented stones, but there p* p* 8 ASIAN JOURNAL OF SURGERY VOL 32 NO 1 JANUARY 2009
3 CHOLANGIOCARCINOMA ASSOCIATED WITH IHDS Table 3. Classification of patients with intrahepatic duct stones by location Location DS group CC group Total Incidence of cancer (%)* Right only Left only Both Total *Incidence of cancer: proportion of CC group in total number. No significant difference in incidence by stone location (p = 0.082) by Chi-square test. Table 4. Treatment methods used in the DS group (n = 72) Stone location Cases Left IHDS patients (n = 44) LLS 24 Left hepatectomy 4 Hepatotomy 1 Choledochoscopic removal 10 Percutaneous drainage 1 No operation 4 Right IHDS patients (n = 17) Right hepatectomy 1 Choledochoscopic removal 12 No operation 4 Both IHDS patients (n = 11) LLS and choledochoscopic removal 2 Choledochoscopic removal 6 Choledochojejunostomy 1 No operation 2 IHDS = intrahepatic duct stone; LLS = left lateral sectionectomy. was also no significant difference in stone type between the two groups. Treatment methods used for patients in the DS group Table 4 shows the treatment methods used for the DS group. Surgical intervention could not be provided in 10 patients, due to patient refusal or high surgical risk. The surgical methods used for the patients in the DS group differed according to the stone location and the status of the liver parenchyma. We performed hepatectomy for cases with severe atrophic liver parenchyma, possible malignancy, or main hepatic duct stricture. The most common operation for a left IHDS was left lateral sectionectomy (55%). However, in cases of a right IHDS or IHDS on both sides, choledochoscopic removal was used most commonly. Right hepatectomy was performed in only one patient, because of the high risk of operative mortality and morbidity. After treatment for IHDS, patients had a mean follow-up of 37 months without development of cholangiocarcinoma. Clinical characteristics of patients in the CC group We evaluated eight patients with IHCC associated with IHDS (Table 5). Two patients who were evaluated by US only were not preoperatively diagnosed with cholangiocarcinoma. Four patients who had CT or ERCP in addition to US were preoperatively diagnosed with cholangiocarcinoma. During surgery, the correct diagnosis and extension of carcinoma was confirmed by intraoperative examination of a frozen section. Although liver resection could be performed in five patients, three patients underwent curative resection involving safe margins and lymph node dissection around the hepatic hilum. In two of these patients, cholangiocarcinoma recurred within 4 months. One patient had a recurrence in the remnant of the right medial section; in the other patient, the cholangiocarcinoma recurred at multiple sites in the peritoneal cavity. After a recurrence was identified, the patients received conservative treatment. The mean survival was 11.1 months. Only one patient survived for 36 months without recurrence. Discussion Risk factors for IHCC include: IHDS, 6 cystic liver disease, 7 Clonorchis sinensis, 8 primary biliary cirrhosis, 9 ulcerative colitis, 10 Carolis disease, 11 and congenital liver fibrosis. 12 In Asia, IHDS is one of the factors that have been highly associated with IHCC. 13,14 Since Sanes and MacCallum 2 reported two cases of cholangiocarcinoma related to hepatolithiasis that were discovered incidentally at autopsy for the first time in 1942, the association of IHDS with IHCC has been reported to be from 4 11% in reported series over the world. 3,4,15 17 In our study, the ASIAN JOURNAL OF SURGERY VOL 32 NO 1 JANUARY
4 HUR et al Table 5. Clinical characteristics of the CC group No Age Clinical Radiologic Preoperative Postoperative CA 19-9 Surgical Sex symptoms evaluation diagnosis diagnosis (U/mL) procedure Follow-up 1 81 RUQ pain US Lt IHDS Lt IHDS Not T-tube ChT 16 months F Lt liver multiple checked and Bx died IHCC 2 37 RUQ pain US, CT, Lt IHDS Klatskin s Not Bx 20 months F Fever ERCP with CCC tumour checked died Jaundice (type IV) 3 75 RUQ pain US GB CBD Lt IHDS 4438 T-tube ChT 18 months F Jaundice stone, Both liver and Bx died Lt IHDS IHCC 4 70 RUQ pain CT Lt IHDS with Lt IHDS 2400 Palliative LH 5 months F Fever chronic Lt liver multiple died cholangitis IHCC 5 61 RUQ pain US Lt IHD stone Lt IHDS Not Curative LLS 36 months F Lt liver IHCC checked alive 6 59 RUQ pain US, CT, Lt IHDS Lt IHDS Not Palliative LH 5 months F Fever ERCP Lt liver IHCC Lt liver IHCC checked died 7 55 RUQ pain US,CT Lt IHDS Lt IHDS 5079 Curative LLS 2 months M Jaundice Lt liver IHCC Lt liver IHCC recurrence; 6 months died 8 46 RUQ pain US,CT Rt IHDS Rt IHDS 460 Curative LH 4 months M Lt liver IHCC Lt liver IHCC recurrence; 2 months died RUQ = right upper quadrant; US = abdominal ultrasonography; IHDS = intrahepatic duct stone; IHCC = intrahepatic cholangiocarcinoma; ChT = choledochostomy; Bx = biopsy; CT = computed tomography; ERCP = endoscopic retrograde cholangiopancreaticogram; LH = left hepatectomy; LLS = left lateral sectionectomy. proportion of patients who were diagnosed with IHCC during the evaluations and treatment for IHDS was relatively high at 10%. The most important factors that contribute to stone formation are bile stasis and bacterial infection in the bile duct. 18 Some investigators have described the association between IHDS and IHCC to be due to mechanical injury from intrahepatic calculi or chemical irritation to the bile duct wall by infected bile. 19 Other studies 20,21 have reported that recurrent cholangitis caused by IHDS results in the development of atypical epithelium which may give rise to cancerous lesions. In our study, we examined some livers with IHDS and those with IHCC that had atrophic features. Several reports in which the features of IHDS have been described have shown that the most common presenting symptoms were associated with acute cholangitis because a large portion of the liver with IHDS was affected by stenosis in the bile duct. 22,23 In some studies comparing patients with only IHDS and those with IHDS accompanied by IHCC, 6,24,25 there were no significant differences in clinical characteristics between these two groups, but the features and locations of stones in addition to the levels of tumour markers have been shown to be discriminating factors. In our study, there was no difference between the clinical features and characteristics of stones evaluated in the DS and the CC groups. With regard to radiologic evaluation, our results show no difference in the frequency of usage of US, ERCP, CT. Chen et al 26 reported that a hyperechoic mass found in the liver parenchyma by US should be considered to be an IHCC. However, because the use of US is insufficient for 10 ASIAN JOURNAL OF SURGERY VOL 32 NO 1 JANUARY 2009
5 CHOLANGIOCARCINOMA ASSOCIATED WITH IHDS the diagnosis of cholangiocarcinoma, percutaneous transhepatic cholangiogram or endoscopic retrograde cholangiography should be considered for early diagnosis. Kubo et al 24 reported that portography can be used as an effective technique for the diagnosis of hepatic atrophy and cholangiocarcinoma. Obstruction of the portal vein represents the deterioration of hepatic tissue and suggests the presence of cholangiocarcinoma. Recent report presented the helical CT scans was useful for diagnosis of cholangiocarcinoma in patients with hepatolithiasis using specific CT criteria including the periductal soft tissue density, bile wall thickening, duct enhancement on portal venous phase and lymph node enlargement. 27 Therefore, periodic CT scans after treatment of hepatolithiasis should be performed in order to detect early the occurrence of cholangiocarcinoma. No specific tumour markers are available for the diagnosis of cholangiocarcinoma. However, an increase in the level of CA 19-9 is more frequently encountered than other tumour marker like carcinoembryonic antigen (CEA). 28 Su et al 29 reported that CA 19-9 levels were increased in seven of nine patients with cholangiocarcinoma and intrahepatic duct stones. We found a high level of CA 19-9 in four patients in the CC group. However, because some patients in the DS group had a level that was as high as that of the patients who had the malignancy, and other laboratory findings were not different between the two groups, it is difficult to predict whether an accompanying malignancy exists in patients having IHDS. As a result, surgeons who treat patients with IHDS using operative methods should examine carefully for cancerous lesions. In the past, most surgeons who operated on patients diagnosed with IHDS would not consider hepatic resection, since there was little knowledge between IHCC and IHDS and hepatic resection was regarded as a very risky procedure. Because of advancements in hepatic surgery, liver resection has become an option for the removal of IHDS to treat bile duct strictures and hidden malignancy. Otani et al 30 reported that the recurrence rates of IHDS and cholangitis were significantly reduced by hepatic resection, and another study showed that hepatic resection for hepatolithiasis could be performed safely with meticulous management of biliary tract abnormalities. 31,32 We performed a liver resection in 31 cases (43%) in the IHDS group; the most common operation type was the left lateral sectionectomy. Based on previously published reports, 33,34 the indications for hepatic resection included atrophy and fibrosis of a liver segment, the possibility of concomitant IHCC, or localised IHDS with biliary stricture. We performed liver resections according to the above indications. Hepatic resection, in our study, was performed in patients with left IHDS more frequently than in patients with right IHDS. Right liver resection was performed in only one patient who had severe atrophic changes in the right lobe of the liver; this was because of the high surgical risk of this procedure. 35 Recently, however, the use of right hepatectomy has been increasing for the treatment of selected patients with isolated right-sided IHDS. 36 In conclusion, our series showed there were no positive clinicopathologic or laboratory factors to predict concomitant IHCC in IHDS patients. However, in several patients, we could achieve curative resection of malignant liver lesions. Therefore, surgeons performing operations for IHDS patients should examine them thoroughly for hidden malignancies. In addition, due to the possibility of hidden malignant lesions, aggressive resection should be performed in suspicious portions of the liver. Acknowledgements The authors especially thank Dr. Sung-A Kim for helping us collect data for this paper. References 1. Chijiiwa K, Yamashita H, Yoshida J, et al. Current management and long-term prognosis of hepatolithiasis. Arch Surg 1995;130: Sanes S, MacCallum J. Primary carcinoma of the liver: cholangiocarcinoma in hepatolithiasis. Am J Pathol 1942;18: Chijiiwa K, Ichimiya H, Kuroki S, Koga A, et al. Late development of cholangiocarcinoma after the treatment of hepatolithiasis. Surg Gynecol Obstet 1993;177: Sheen-Chen SM, Chou FF, Eng HL. Intrahepatic cholangiocarcinoma in hepatolithiasis: a frequently overlooked disease. J Surg Oncol 1991;47: Tsunoda T, Furui J, Yamada M, et al. Caroli s disease associated with hepatolithiasis: a case report and review of the Japanese literature. Gastroenterol Jpn 1991;26: Kim YT, Byun JS, Kim J, et al. Factors predicting concurrent cholangiocarcinomas associated with hepatolithiasis. Hepatogastroenterology 2003;50: Vauthey JN, Maddern GJ, Blumgart LH. Adult polycystic disease of the liver. Br J Surg 1991;78: ASIAN JOURNAL OF SURGERY VOL 32 NO 1 JANUARY
6 HUR et al 8. Choi BI, Han JK, Hong ST, et al. Clonorchiasis and cholangiocarcinoma: etiologic relationship and imaging diagnosis. Clin Microbiol Rev 2004;17: Akisawa N, Maeda T, Tsuda K, et al. Primary biliary cirrhosis associated with cholangiocarcinoma. Dig Dis Sci 1998;43: Wee A, Ludwig J, Coffey RJ Jr, et al. Hepatobiliary carcinoma associated with primary sclerosing cholangitis and chronic ulcerative colitis. Hum Pathol 1985;16: Abdalla EK, Forsmark CE, Lauwers GY, et al. Monolobar Caroli s disease and cholangiocarcinoma. HPB Surg 1999;11:271 6; discussion Yamato T, Sasaki M, Hoso M, et al. Intrahepatic cholangiocarcinoma arising in congenital hepatic fibrosis: report of an autopsy case. J Hepatol 1998;28: Suh KS, Roh HR, Koh YT, et al. Clinicopathologic features of the intraductal growth type of peripheral cholangiocarcinoma. Hepatology 2000;31: Kim HJ, Yun SS, Jung KH, et al. Intrahepatic cholangiocarcinoma in Korea. J Hepatobiliary Pancreat Surg 1999;6: Koga A, Ichimiya H, Yamaguchi K, et al. Hepatolithiasis associated with cholangiocarcinoma. Possible etiologic significance. Cancer 1985;55: Nishihara K, Koga A, Sumiyoshi K, et al. Intrahepatic calculi associated with cholangiocarcinoma. Jpn J Surg 1986;16: Radin DR, Ray MJ, Ralls PW, et al. Hepatolithiasis complicated by cholangiocarcinoma. J Comput Tomogr 1987;11: Tabata M and Nakayama F. Bacteria and gallstones. Etiological significance. Dig Dis Sci 1981;26: Falchuk KR, Lesser PB, Galdabini JJ, et al. Cholangiocarcinoma as related to chronic intrahepatic cholangitis and hepatolithiasis. Case report and review of the literature. Am J Gastroenterol 1976; 66: Nakanuma Y, Terada T, Tanaka Y, et al. Are hepatolithiasis and cholangiocarcinoma aetiologically related? A morphological study of 12 cases of hepatolithiasis associated with cholangiocarcinoma. Virchows Arch A Pathol Anat Histopathol 1985;406: Ohta T, Nagakawa T, Konishi I, et al. Clinical experience of intrahepatic cholangiocarcinoma associated with hepatolithiasis. Jpn J Surg 1988;18: Chang TM, Passaro E Jr. Intrahepatic stones: the Taiwan experience. Am J Surg 1983;146: Sato T, Suzuki N, Takahashi W, et al. Surgical management of intrahepatic gallstones. Ann Surg 1980;192: Kubo S, Kinoshita H, Hirohashi K, et al. Hepatolithiasis associated with cholangiocarcinoma. World J Surg 1995;19: Chijiiwa K, Ohtani K, Noshiro H, et al. Cholangiocellular carcinoma depending on the kind of intrahepatic calculi in patients with hepatolithiasis. Hepatogastroenterology 2002;49: Chen MF, Jan YY, Wang CS, et al. Intrahepatic stones associated with cholangiocarcinoma. Am J Gastroenterol 1989;84: Park HS, Lee JM, Kim SH, et al. CT Differentiation of cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis. Am J Roentgenol 2006;187: Qin XL, Wang ZR, Shi JS, et al. Utility of serum CA19-9 in diagnosis of cholangiocarcinoma: in comparison with CEA. World J Gastroenteol 2004;10: Su CH, Shyr YM, Lui WY. Hepatolithiasis associated with cholangiocarcinoma. Br J Surg 1997;84: Otani K, Shimizu S, Chijiiwa K, et al. Comparison of treatments for hepatolithiasis: hepatic resection versus cholangioscopic lithotomy. J Am Coll Surg 1999;189: Ramia JM, Palomeque A, Muffak K, et al. Indications and therapeutical options in hepatolithiasis. Rev Esp Enferm Dig 2006;98: Sato M, Watanabe Y, Horiuchi S, et al. Long-term results of hepatic resection for hepatolithiasis. HPB Surg 1995;9: Chen MF, Jan YY, Wang CS, et al. Role of hepatic resection in surgery for bilateral intrahepatic stones. Br J Surg 1997;84: Fan ST, Lai EC, Wong J. Hepatic resection for hepatolithiasis. Arch Surg 1993;128: Jeng KS, Ohta I, Yang FS, et al. Coexisting sharp ductal angulation with intrahepatic biliary strictures in right hepatolithiasis. Arch Surg 1994;129: Hung CJ, Lin PW. Role of right hepatic lobectomy in the treatment of isolated right-sided hepatolithiasis. Surgery 1997;121: ASIAN JOURNAL OF SURGERY VOL 32 NO 1 JANUARY 2009
Hepatobiliary Imaging Clinical Observations
CT of Cholangiocarcinoma with Pyogenic Cholangitis Hepatobiliary Imaging Clinical Observations C D E M N E U T R Y L I M C I G O F I N G Jung Hoon Kim 1 Tae Kyoung Kim 2 Hyo Won Eun 3 Jae Young yun 4 Moon-Gyu
More informationIntraductal papillary neoplasms in the bile ducts
Intraductal papillary neoplasms in the bile ducts Seok Hwa Youn Myunghee Yoon Dong Hoon Shin Kosin University Gospel Hospital Department of general surgery Hepato-biliary-pancreatic division Introduction
More informationCase Reports. Intraductal Papillary Cholangiocarcinoma: Case Report and Review of the Literature INTRODUCTION CASE REPORT
Case Reports Kongkam K, Rerknimitr R 45 Case Report and Review of the Literature Pradermchai Kongkam, M.D. Rungsun Rerknimitr, M.D. ABSTRACT A case of papillary cholangiocarcinoma is presented. A 64-year-old
More informationPersonal Profile. Name: 劉 XX Gender: Female Age: 53-y/o Past history. Hepatitis B carrier
Personal Profile Name: 劉 XX Gender: Female Age: 53-y/o Past history Hepatitis B carrier Chief complaint Fever on and off for 2 days Present illness 94.10.14 Sudden onset of epigastric pain 94.10.15 Fever
More informationManagement of Cholangiocarcinoma. Roseanna Lee, MD PGY-5 Kings County Hospital
Management of Cholangiocarcinoma Roseanna Lee, MD PGY-5 Kings County Hospital Case Presentation 37 year old male from Yemen presented with 2 week history of epigastric pain, anorexia, jaundice and puritis.
More informationCongenital dilatation of the common bile duct and pancreaticobiliary maljunction clinical implications
Langenbecks Arch Surg (2009) 394:209 213 DOI 10.1007/s00423-008-0330-6 CURRENT CONCEPT IN CLINICAL SURGERY Congenital dilatation of the common bile duct and pancreaticobiliary maljunction clinical implications
More informationBiliary tree dilation - and now what?
Biliary tree dilation - and now what? Poster No.: C-1767 Congress: ECR 2012 Type: Educational Exhibit Authors: I. Ferreira, A. B. Ramos, S. Magalhães, M. Certo; Porto/PT Keywords: Pathology, Diagnostic
More informationImaging of liver and pancreas
Imaging of liver and pancreas.. Disease of the liver Focal liver disease Diffusion liver disease Focal liver disease Benign Cyst Abscess Hemangioma FNH Hepatic adenoma HCC Malignant Fibrolamellar carcinoma
More informationComparison Between Primary Closure of Common Bile Duct and T- Tube Drainage After Open Choledocholithiasis: A Hospital Based Study
Original article: Comparison Between Primary Closure of Common Bile Duct and T- Tube Drainage After Open Choledocholithiasis: A Hospital Based Study Kali CharanBansal Principal Specialist (General surgery)
More informationMultiple Primary Quiz
Multiple Primary Quiz Case 1 A 72 year old man was found to have a 12 mm solid lesion in the pancreatic tail by computed tomography carried out during a routine follow up study of this patient with adult
More informationpitfall Table 1 4 disorientation pitfall pitfall Table 1 Tel:
11 687 692 2002 pitfall 1078 29 17 9 1 2 3 dislocation outflow block 11 1 2 3 9 1 2 3 4 disorientation pitfall 11 687 692 2002 Tel: 075-751-3606 606-8507 54 2001 8 27 2002 10 31 29 4 pitfall 16 1078 Table
More informationCholangiocellular carcinoma. Dr. med. Henrik Csaba Horváth PhD
Cholangiocellular carcinoma Dr. med. Henrik Csaba Horváth PhD Acalculous biliary diseases April 12, 2017 2 Cholangiocarcinoma A slow growing malignancy of the biliary tract which tend - to infiltrate locally
More informationCholangiocarcinoma (Bile Duct Cancer)
Cholangiocarcinoma (Bile Duct Cancer) The Bile Duct System (Biliary Tract) A network of bile ducts (tubes) connects the liver and the gallbladder to the small intestine. This network begins in the liver
More informationIntrahepatic Sarcomatoid Cholangiocarcinoma with Portal Vein Thrombosis: A Case Report 1
Intrahepatic Sarcomatoid Cholangiocarcinoma with Portal Vein Thrombosis: A Case Report 1 Jae-Hoon Lim, M.D., Jin Woong Kim, M.D., Suk Hee Heo, M.D., Yong Yeon Jeong, M.D., Heoung Keun Kang, M.D. A 53-year-old
More informationOriginal article: new surgical approaches to the Klatskin tumour
Alimentary Pharmacology & Therapeutics Original article: new surgical approaches to the Klatskin tumour T. M. VAN GULIK*, S. DINANT*, O. R. C. BUSCH*, E. A. J. RAUWS, H. OBERTOP* & D. J. GOUMA Departments
More informationPercutaneous Removal of Biliary Stone from Anomalous Right Hepatic Duct
Percutaneous Removal of Biliary Stone from Anomalous Right Hepatic Duct Pages with reference to book, From 94 To 96 Tanveer ul Haq, Mohammed Younus Sheikh, Changes Khan Jadun, M.N. Ahmad, Yousuf H. Husen
More informationLaparoscopic left hepatectomy in patients with intrahepatic duct stones and recurrent pyogenic cholangitis
Korean J Hepatobiliary Pancreat Surg 212;16:15-19 Original Article Laparoscopic left hepatectomy in patients with intrahepatic duct stones and recurrent pyogenic cholangitis Sunjong Han, Insang Song, and
More informationCHOLANGIOCARCINOMA (CCA)
CHOLANGIOCARCINOMA (CCA) Deepak Hariharan MD (Research), FRCS, Locum Consultant HPB Surgeon AIM Outline essential facts & principles Present 4 cases Discuss Challenges /Controversies INTRODUCTION Most
More informationHilar cholangiocarcinoma. Frank Wessels, Maarten van Leeuwen, UMCU utrecht
Hilar cholangiocarcinoma Frank Wessels, Maarten van Leeuwen, UMCU utrecht Content Anatomy Biliary strictures (Hilar) Cholangiocarcinoom Staging Biliary tract 1 st order Ductus hepatica dextra Ductus hepaticus
More informationClinical features of hepatolithiasis: analyses of multicenter-based surveys in Japan
Tazuma and Nakanuma Lipids in Health and Disease (2015) 14:129 DOI 10.1186/s12944-015-0130-2 SHORT REPORT Open Access Clinical features of hepatolithiasis: analyses of multicenter-based surveys in Japan
More informationCitation Acta medica Nagasakiensia. 1993, 38
NAOSITE: Nagasaki University's Ac Title Author(s) Clinical Aspect of Peripheral Chola Hepatectomy Cases Shimoyama, Takatoshi; Shimizu, Teru Kiyoomi; Azuma, Kohji; Shinkai, Kiy Terada, Ryusuke; Sasaki,
More informationPrimary Sclerosing Cholangitis and Cholestatic liver diseases. Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants
Primary Sclerosing Cholangitis and Cholestatic liver diseases Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants I have nothing to disclose Educational Objectives What is PSC? Understand the cholestatic
More informationState of the Art Imaging for Hepatic Malignancy: My Assignment
State of the Art Imaging for Hepatic Malignancy: My Assignment CT vs MR vs MRCP Which one to choose for HCC vs Cholangiocarcinoma What special protocols to use for liver tumors Role of PET and Duplex US
More informationPictorial review of Benign Biliary tract abnormality on MRCP/MRI Liver with Endoscopic (including splyglass) and Endoscopic Ultrasound correlation
Pictorial review of Benign Biliary tract abnormality on MRCP/MRI Liver with Endoscopic (including splyglass) and Endoscopic Ultrasound correlation Poster No.: C-2617 Congress: ECR 2015 Type: Educational
More informationAnalysis of gallbladder polypoid lesion size as an indication of the risk of gallbladder cancer
Korean J Hepatobiliary Pancreat Surg 24;8:9-3 http://dx.doi.org/.47/kjhbps.24.8..9 Original Article Analysis of gallbladder polypoid lesion size as an indication of the risk of gallbladder cancer Ji Eun
More informationIs Hepatic Resection Needed in the Patients with Peritoneal Side T2 Gallbladder Cancer?
Is Hepatic Resection Needed in the Patients with Peritoneal Side T2 Gallbladder Cancer? Lee H, Park JY, Youn S, Kwon W, Heo JS, Choi SH, Choi DW Department of Surgery, Samsung Medical Center Sungkyunkwan
More informationIncidence of underlying biliary neoplasm in patients after major hepatectomy for preoperative benign hepatolithiasis
Ann Hepatobiliary Pancreat Surg 2016;20:173-179 https://doi.org/10.14701/ahbps.2016.20.4.173 Original Article Incidence of underlying biliary neoplasm in patients after major hepatectomy for preoperative
More informationEn-liang Li 1,2, Rong-fa Yuan 1, Wen-jun Liao 1, Qian Feng 1, Jun Lei 1, Xiang-bao Yin 1, Lin-quan Wu 1* and Jiang-hua Shao 1
Li et al. BMC Surgery (2019) 19:16 https://doi.org/10.1186/s12893-019-0480-1 RESEARCH ARTICLE Open Access Intrahepatic bile exploration lithotomy is a useful adjunctive hepatectomy method for bilateral
More informationEndoscopic stenting in bile duct cancer increases liver volume
Endoscopic stenting in bile duct cancer increases liver volume Chang Hun Lee 1,3, Seung Young Seo 1,3, Seong Hun Kim 1,3, In Hee Kim 1,3, Sang Wook Kim 1,3, Soo Teik Lee 1,3, Dae Ghon Kim 1,3, Jae Do Yang
More informationMR imaging of primary sclerosing cholangitis (PSC) using the hepatobiliary specific contrast agent Gd-EOB-DTPA
MR imaging of primary sclerosing cholangitis (PSC) using the hepatobiliary specific contrast agent Gd-EOB-DTPA Poster No.: C-0019 Congress: ECR 2010 Type: Educational Exhibit Topic: Abdominal Viscera (Solid
More informationCase Report Intrabiliary Hepatic Metastasis of Colorectal Carcinoma Mimicking Primary Cholangiocarcinoma: A Case Report and Review of the Literature
Case Reports in Pathology Volume 2016, Article ID 4704781, 5 pages http://dx.doi.org/10.1155/2016/4704781 Case Report Intrabiliary Hepatic Metastasis of Colorectal Carcinoma Mimicking Primary Cholangiocarcinoma:
More informationGALLBLADDER CANCER. Lidie M. Lajoie MD Downstate Surgery M&M July 21, 2011
GALLBLADDER CANCER Lidie M. Lajoie MD Downstate Surgery M&M July 21, 2011 Agenda Case Presentation Epidemiology Pathogenesis & Pathology Staging Presentation & Diagnosis Stage-wise Management Outcomes/Prognosis
More informationThe detection rate of early gastric cancer has been increasing owing to advances in
Focused Issue of This Month Sung Hoon Noh, MD, ph.d Department of Surgery, Yonsei University College of Medicine E - mail : sunghoonn@yuhs.ac J Korean Med Assoc 2010; 53(4): 306-310 Abstract The detection
More informationCurrent status of hepatic surgery in Korea
Korean J Hepatol. 2009 Dec; 15(Suppl 6):S60 - S64. DOI: 10.3350/kjhep.2009.15.S6.S60 Current status of hepatic surgery in Korea Kyung Sik Kim Department of Surgery, Severance Hospital, Yonsei University
More informationACUTE CHOLANGITIS AS a result of an occluded
Digestive Endoscopy 2017; 29 (Suppl. 2): 88 93 doi: 10.1111/den.12836 Current status of biliary drainage strategy for acute cholangitis Endoscopic treatment for acute cholangitis with common bile duct
More informationNavigating the Biliary Tract with CT & MR: An Imaging Approach to Bile Duct Obstruction
Navigating the Biliary Tract with CT & MR: An Imaging Approach to Bile Duct Obstruction Ann S. Fulcher, MD Medical College of Virginia Virginia Commonwealth University Richmond, Virginia Objectives To
More informationBiliary Papillomatosis: case report
Chin J Radiol 2003; 28: 407-412 407 Biliary Papillomatosis: case report CHUN-LIN HUANG WEN-PIN CHEN YU-BUN NG JOSEPH HANG LEUNG Department of Medical Imaging, Chiayi Christian Hospital Biliary papillomatosis
More informationEDUCATION PRACTICE. Primary Sclerosing Cholangitis: Patients With a Rising Alkaline Phosphatase at Annual Follow-up.
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2007;5:32 36 EDUCATION PRACTICE Primary Sclerosing Cholangitis: Patients With a Rising Alkaline Phosphatase at Annual Follow-up PHUNCHAI CHARATCHAROENWITTHAYA and
More informationLutheran Medical Center. Daniel H. Hunt, M.D. June 10 th, 2005
Lutheran Medical Center Daniel H. Hunt, M.D. June 10 th, 2005 History xx y.o. pt with primary CBD stones s/p ERCP xx months earlier for attempted stone extraction resulting in post ERCP pancreatitis. Patient
More informationClassification of choledochal cyst with MR cholangiopancreatography in children and infants: special reference to type Ic and type IVa cyst
Classification of choledochal cyst with MR cholangiopancreatography in children and infants: special reference to type Ic and type IVa cyst Poster No.: C-1333 Congress: ECR 2011 Type: Educational Exhibit
More informationAn Intraductal Papillary Neoplasm of the Bile Duct at the Duodenal Papilla
Published online: July 2, 2014 1662 6575/14/0072 0417$39.50/0 This is an Open Access article licensed under the terms of the Creative Commons Attribution- NonCommercial 3.0 Unported license (CC BY-NC)
More informationCholangiocarcinoma: Radiologic evaluation and interventions
November 2014 Cholangiocarcinoma: Radiologic evaluation and interventions Colin Nevins, Harvard Medical School Year III Agenda Initial course and work-up Endoscopic retrograde cholangiopancreatography
More informationManagement of Rare Liver Tumours
Gian Luca Grazi Hepato-Biliary-Pancreatic Surgery National Cancer Institute Regina Elena Rome Fibrolamellar Carcinoma Mixed Hepato Cholangiocellular Carcinoma Hepatoblastoma Carcinosarcoma Primary Hepatic
More informationRESEARCH ARTICLE. Morphological Classification of Intraductal Papillary Neoplasm of the Bile Duct with Survival Correlation
DOI:10.22034/APJCP.2017.18.1.207 RESEARCH ARTICLE Morphological Classification of Intraductal Papillary Neoplasm of the Bile Duct with Survival Correlation Vor Luvira 1 *, Kulyada Somsap 2, Ake Pugkhem
More informationRECURRENT PYOGENIC CHOLANGITIS
RECURRENT PYOGENIC CHOLANGITIS Resident(s): Evan Raff, MD MHA Attending(s): Narasimham Dasika, MD Program/Dept(s): University of Michigan Health System, Department of Radiology CHIEF COMPLAINT & HPI Chief
More informationThe authors have declared no conflicts of interest.
Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography Versus Endoscopic Retrograde Cholangiopancreatography Findings in the Postorthotopic Liver Transplant Population Authors: *Ashok Shiani,
More informationGeneral Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons
General Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons MODULE TITLE: UPPER GI & HPB - HEPATIC, PANCREATIC & BILIARY
More informationROLE OF RADIOLOGY IN INVESTIGATION OF JAUNDICE
ROLE OF RADIOLOGY IN INVESTIGATION OF JAUNDICE Dr. Sohan kumar sah *, Dr. Liu Sibin, Dr. sumendra raj pandey, Dr. Prakashmaan shah, Dr. Gaurishankar pandit, Dr. Suraj kurmi and Dr. Sanjay kumar jaiswal
More informationProximal Bile Duct Cancer: Contemporary Management. William R. Jarnagin, MD, FACS
Proximal Bile Duct Cancer: Contemporary Management William R. Jarnagin, MD, FACS Biliary Tract Adenocarcinoma Spectrum of disease Intrahepatic (IHC) Hilar EH Gallbladder GB CBD Distal D PD Biliary Tract
More informationOptimal Bile Duct Division Using Real- Time Indocyanine Green Near-Infrared Fluorescence Cholangiography During Laparoscopic Donor Hepatectomy
LETTERS FROM THE FRONTLINE Optimal Bile Duct Division Using Real- Time Indocyanine Green Near-Infrared Fluorescence Cholangiography During Laparoscopic Donor Hepatectomy TO THE EDITOR: Despite advances
More informationCase Scenario 1. Discharge Summary
Case Scenario 1 Discharge Summary A 69-year-old woman was on vacation and noted that she was becoming jaundiced. Two months prior to leaving on that trip, she had had a workup that included an abdominal
More informationEffectiveness of additional resection of the invasive cancer-positive proximal bile duct margin in cases of hilar cholangiocarcinoma
Original Article Effectiveness of additional resection of the invasive cancer-positive proximal bile duct margin in cases of hilar cholangiocarcinoma Wen-Jie Ma 1#, Zhen-Ru Wu 2#, Anuj Shrestha 1,3, Qin
More informationHepatic Inflammatory Pseudotumor With Elevated Serum CA19-9 Level Mimicking Liver Metastasis From Rectal Cancer: Report of a Case
Int Surg 2013;98:324 329 DOI: 10.9738/INTSURG-D-13-00091.1 Case Report Hepatic Inflammatory Pseudotumor With Elevated Serum CA19-9 Level Mimicking Liver Metastasis From Rectal Cancer: Report of a Case
More informationVesalius SCALpel : Biliary (see also: biliary/pancreatic folios) Physiology
Vesalius SCALpel : Biliary (see also: biliary/pancreatic folios) Physiology 95% of bile acids reabsorbed; colic and chenodeoxycolic primary bile acids cholecystokinin (CCK) major stimulus of gallbladder
More informationLate Development of Bile Duct Cancer in Patients Who Had Biliary-Enteric Drainage for Benign Disease: A Follow-Up Study of More Than 1,000 Patients
ANNALS OF SURGERY Vol. 234, No. 2, 210 214 2001 Lippincott Williams & Wilkins, Inc. Late Development of Bile Duct Cancer in Patients Who Had Biliary-Enteric Drainage for Benign Disease: A Follow-Up Study
More informationHepatobiliary Malignancies Retrospective Study at Truman Medical Center
Hepatobiliary Malignancies 206-207 Retrospective Study at Truman Medical Center Brandon Weckbaugh MD, Prarthana Patel & Sheshadri Madhusudhana MD Introduction: Hepatobiliary malignancies are cancers which
More informationIntroduction of GB polyp
Management of Gallbladder Polyp as Physician's View Sang Hyub Lee, MD, PhD Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Internal Medicine Division
More informationA Local Experience in the Management of Recurrent Pyogenic Cholangitis (Oriental Cholangitis)
Bahrain Medical Bulletin, Vol.24, No.1, March 2002 A Local Experience in the Management of Recurrent Pyogenic Cholangitis (Oriental Cholangitis) Suhair Khalifa Al-Saad, CABS, FRCSI* Mohammed Khurshid Alam,
More informationCitation American Journal of Surgery, 196(5)
NAOSITE: Nagasaki University's Ac Title Author(s) Multifocal branch-duct pancreatic i neoplasms Tajima, Yoshitsugu; Kuroki, Tamotsu Amane; Adachi, Tomohiko; Mishima, T Kanematsu, Takashi Citation American
More informationAfternoon Session Cases
Afternoon Session Cases Case 1 19 year old woman Presented with abdominal pain to community hospital Mild incr WBC a14, 000, Hg normal, lipase 100 (normal to 75) US 5.2 x 3.7 x 4 cm mass in porta hepatis
More informationPortal Vein in a Patient Undergoing Hepatic Resection
HPB Surgery, 1997, Vol. 10, pp. 323-327 Reprints available directly from the publisher Photocopying permitted by license only (C) 1997 OPA (Overseas Publishers Association) Amsterdam B.V. Published in
More informationCASE 01 LA Path Slide Seminar 13 March, 08. Deepti Dhall, MD Department of Pathology and Laboratory Medicine Cedars-Sinai Medical Center
CASE 01 LA Path Slide Seminar 13 March, 08 Deepti Dhall, MD Department of Pathology and Laboratory Medicine Cedars-Sinai Medical Center Clinical History 60 year old male presented with obstructive jaundice
More informationTreatment outcomes and prognostic factors of gallbladder cancer patients after postoperative radiation therapy
Korean J Hepatobiliary Pancreat Surg 2011;15:152-156 Original Article Treatment outcomes and prognostic factors of gallbladder cancer patients after postoperative radiation therapy Suzy Kim 1,#, Kyubo
More informationCME Article Clinics in diagnostic imaging (115) Wai C T, Seto K Y, Sutedja D S
Medical Education Singapore Med.1 2007, 48 (4) : 361 CME Article Clinics in diagnostic imaging (115) Wai C T, Seto K Y, Sutedja D S fit. B CD - -0 o -5 r t -10 Fig. I US images of the upper right abdomen
More informationDiagnosis of tumor extension in biliary carcinoma has. Differential Diagnosis and Treatment of Biliary Strictures
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:S79 S83 Differential Diagnosis and Treatment of Biliary Strictures KAZUO INUI, JUNJI YOSHINO, and HIRONAO MIYOSHI Department of Internal Medicine, Second
More informationHepatobiliary Imaging Original Research
CT Diagnosis of Cholangiocarcinoma Versus Periductal Fibrosis Hepatobiliary Imaging Original Research C D E M N E U T R Y L I M C I G O F I N G CT Differentiation of Cholangiocarcinoma from Periductal
More informationBILIARY TRACT & PANCREAS, PART II
CME Pretest BILIARY TRACT & PANCREAS, PART II VOLUME 41 1 2015 A pretest is mandatory to earn CME credit on the posttest. The pretest should be completed BEFORE reading the overview. Both tests must be
More informationDouble Intrahepatic and Extrahepatic Cholangiocarcinomas Arising from Biliary Papillomatosis: A Case Report
Korean Journal of HBP Surgery 증 례 Vol. 14, No. 1, March 2010 Double Intrahepatic and Extrahepatic Cholangiocarcinomas Arising from Biliary Papillomatosis: A Case Report Biliary papillomatosis is a rare
More informationGeneral Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons
General Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons MODULE TITLE: UPPER GI & HPB - HEPATIC, PANCREATIC & BILIARY
More informationOccult mucin-producing cholangiocarcinoma in situ: a rare clinical case with difficult tumour staging
Kiriyama et al. Surgical Case Reports (2017) 3:6 DOI 10.1186/s40792-016-0283-x CASE REPORT Open Access Occult mucin-producing cholangiocarcinoma in situ: a rare clinical case with difficult tumour staging
More informationEndoscopic Retrograde Pancreatography and Laparoscopic Cholecystectomy. TEAM 1 Janix M. De Guzman, MD Presentor
Endoscopic Retrograde Pancreatography and Laparoscopic Cholecystectomy TEAM 1 Janix M. De Guzman, MD Presentor Premise 40F Jaundice Abdominal pain US finding of gallstones with apparently normal common
More informationIntraductal papillary mucinous neoplasm (IPMN)
Int Surg 2014;99:590 594 DOI: 10.9738/INTSURG-D-13-00134.1 Case Report Ruptured Intrahepatic Biliary Intraductal Papillary Mucinous Neoplasm in a Jehovah s Witness Patient Sangchul Yun 1, Dongho Choi 2
More informationLIVER SURGERY 2. Case 1. Med 5 Refresher Course (Surgery) 2013/14. Dr Sunny Cheung
LIVER SURGERY 2 Med 5 Refresher Course (Surgery) 2013/14 24 Jun 2013 Dr Sunny Cheung Case 1 50/M Sudden onset of epigastric pain Abdominal distension Confused HR 120 BP 80/50 Haemocue = 8 What should you
More informationTrans-abdominal ultrasound features of the newly named intraductal papillary neoplasm of the bile duct
Original Article on Translational Imaging in Cancer Patient Care Trans-abdominal ultrasound features of the newly named intraductal papillary neoplasm of the bile duct Xian-Shui Fu 1 *, Meng-Na He 2 *,
More informationNewcastle HPB MDM updated radiology imaging protocol recommendations. Author Dr John Scott. Consultant Radiologist Freeman Hospital
Newcastle HPB MDM updated radiology imaging protocol recommendations Author Dr John Scott. Consultant Radiologist Freeman Hospital This document is intended as a guide to aid radiologists and clinicians
More informationTitle: Painless jaundice as an initial presentation of lung adenocarcinoma
Title: Painless jaundice as an initial presentation of lung adenocarcinoma Authors: Irene Andaluz García, Irene González Partida, Javier Lucas Ramos, Jorge Yebra Carmona DOI: 10.17235/reed.2018.5587/2018
More informationTratamiento endoscópico de la CEP. En quien como y cuando?
Tratamiento endoscópico de la CEP. En quien como y cuando? Andrés Cárdenas, MD, MMSc, PhD, AGAF, FAASLD GI / Liver Unit, Hospital Clinic Institut de Malalties Digestives i Metaboliques University of Barcelona
More informationOverview of PSC Making the Diagnosis
Overview of PSC Making the Diagnosis Tamar Taddei, MD Assistant Professor of Medicine Yale University School of Medicine Overview Definition Epidemiology Diagnosis Modes of presentation Associated diseases
More informationSECONDARIES: A PRELIMINARY REPORT
HPB Surgery, 1990, Vol. 2, pp. 69-72 Reprints available directly from the publisher Photocopying permitted by license only 1990 Harwood Academic Publishers GmbH Printed in the United Kingdom CASE REPORTS
More informationJaundice. Agnieszka Dobrowolska- Zachwieja, MD, PhD
Jaundice Agnieszka Dobrowolska- Zachwieja, MD, PhD Jaundice definition Jaundice, as in the French jaune, refers to the yellow discoloration of the skin. It arises from the abnormal accumulation of bilirubin
More informationColangitis Esclerosante Primaria: Manejo Clínico y Endoscópico
Colangitis Esclerosante Primaria: Manejo Clínico y Endoscópico Andrés Cárdenas, MD, MMSc, PhD, AGAF, FAASLD GI / Liver Unit, Hospital Clinic Institut de Malalties Digestives i Metaboliques Associate Professor
More informationCase Report Overlap of Acute Cholecystitis with Gallstones and Squamous Cell Carcinoma of the Gallbladder in an Elderly Patient
Case Reports in Surgery Volume 2015, Article ID 767196, 4 pages http://dx.doi.org/10.1155/2015/767196 Case Report Overlap of Acute Cholecystitis with Gallstones and Squamous Cell Carcinoma of the Gallbladder
More informationTakuya SAKODA* ), Yoshiaki MURAKAMI, Naru KONDO, Kenichiro UEMURA, Yasushi HASHIMOTO, Naoya NAKAGAWA and Taijiro SUEDA ABSTRACT
Hiroshima J. Med. Sci. Vol. 64, No. 3, 45~49, September, 2015 HIJM 64 8 45 Takuya SAKODA* ), Yoshiaki MURAKAMI, Naru KONDO, Kenichiro UEMURA, Yasushi HASHIMOTO, Naoya NAKAGAWA and Taijiro SUEDA Department
More informationBilirubin levels predict malignancy in patients with obstructive jaundice
DOI:1.1111/j.1477-2574.211.312.x HPB ORIGINAL ARTICLE Bilirubin levels predict malignancy in patients with obstructive jaundice Giuseppe Garcea, Wee Ngu, Christopher P. Neal, Ashley R. Dennison & David
More informationERCP / PTC Surgical Laparoscopic vs open Timing and order of approach
Choledocholithiasis Which Approach and When? Lygia Stewart, MD University of California, San Francisco 2010 Naffziger Post-Graduate Course Clinical Manifestations of Choledocholithiasis Asymptomatic (no
More informationR.Sotoudehmanesh, MD Professor of Gastroenterology Digestive Disease Research Institute Tehran University of Medical Sciences Pancreatobiliary
R.Sotoudehmanesh, MD Professor of Gastroenterology Digestive Disease Research Institute Tehran University of Medical Sciences Pancreatobiliary /Advanced Endoscopy group Most common biliary malignancy and
More informationGall bladder cancer. Information for patients Hepatobiliary
Gall bladder cancer Information for patients Hepatobiliary page 2 of 12 Who will provide my care? You will be cared for by a number of professionals who work together. These professionals will be specialist
More informationIntrahepatic Cholangiocarcinoma (ICC) Detected by Sonography
661245JDMXXX10.1177/8756479316661245Journal of Diagnostic Medical SonographyHamer research-article2016 Case Study Intrahepatic Cholangiocarcinoma (ICC) Detected by Sonography Journal of Diagnostic Medical
More informationSpectrum of Cholangiocarcinoma
Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2013; 1(6):695-699 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)
More informationIntraductal papillary mucinous neoplasm of the bile ducts: a rare form of premalignant lesion of invasive cholangiocarcinoma
Intraductal papillary mucinous neoplasm of the bile ducts: a rare form of premalignant lesion of invasive cholangiocarcinoma Authors: R. Revert Espí, Y. Fernandez Nuñez, I. Carbonell, D. P. Gómez valencia,
More informationMonosegmental Hepatobiliary Fibropolycystic Disease Mimicking a Mass: Report of Three Cases
Case Report Gastrointestinal Imaging http://dx.doi.org/10.3348/kjr.2014.15.1.54 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2014;15(1):54-60 Monosegmental Hepatobiliary Fibropolycystic Disease Mimicking
More informationManagement of the Mucin Filled Bile Duct. A Complication of Intraductal Papillary Mucinous Tumor of the Pancreas
CASE REPORT Management of the Mucin Filled Bile Duct. A Complication of Intraductal Papillary Mucinous Tumor of the Pancreas Anand Patel, Louis Lambiase, Antonio Decarli, Ali Fazel Division of Gastroenterology
More informationSurgical. Gastroenterology. Evaluating the efficacy of tumor markers CA 19-9 and CEA to predict operability and survival in pancreatic malignancies
Tropical Gastroenterology 2010;31(3):190 194 Surgical Gastroenterology Evaluating the efficacy of tumor markers and CEA to predict operability and survival in pancreatic malignancies Jay Mehta, Ramkrishna
More informationImaging Findings of Liver Clonorchiasis
J Radiol Sci 2011; 36: 145-151 Imaging Findings of Liver Clonorchiasis I-Hao Su Sung-Yu Chu Chien-Ming Chen Kuang-Tse Pan Ming-Yi Hsu Ren-Fu Shi Jeng-Hwei Tseng Kee-Min Yeow Chien-Fu Hung Department of
More informationCitation Hepato-Gastroenterology, 55(86-87),
NAOSITE: Nagasaki University's Ac Title Author(s) Combined pancreatic resection and p multiple lesions of the pancreas: i of the pancreas concomitant with du Kuroki, Tamotsu; Tajima, Yoshitsugu Tomohiko;
More informationSurgical Management of CBD Injury Jin Seok Heo
Surgical Management of CBD Injury Jin Seok Heo Department of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Bile duct injury (BDI) Introduction Incidence
More informationCase Report Heterotopic Pancreas within the Proximal Hepatic Duct, Containing Intraductal Papillary Mucinous Neoplasm
Case Reports in Surgery Volume 2015, Article ID 816960, 4 pages http://dx.doi.org/10.1155/2015/816960 Case Report Heterotopic Pancreas within the Proximal Hepatic Duct, Containing Intraductal Papillary
More informationof bile leakage after liver resecti
NAOSITE: Nagasaki University's Ac Title Author(s) Citation Percutaneous embolization with n-bu of bile leakage after liver resecti Kuroki, Tamotsu; Kitasato, Amane; T Hiroaki; Taniguchi, Ken; Maeda, Shi
More informationMirizzi syndrome with an unusual type of biliobiliary fistula a case report
Kawaguchi et al. Surgical Case Reports (2015) 1:51 DOI 10.1186/s40792-015-0052-2 CASE REPORT Mirizzi syndrome with an unusual type of biliobiliary fistula a case report Tsutomu Kawaguchi 1,2*, Tadao Itoh
More information(Received for Publication: March 24, 2015) Key words portal venous pressure, major hepatectomy, liver
55 Original Article J. St. Marianna Univ. Vol. 6, pp. 55 61, 2015 Usefulness of Intraoperative Measurement of Portal Venous Pressure for Confirming the Most Appropriate Hepatectomy in Patients with Borderline
More information