Isolated Resection of Segment I (Caudate Lobe): Is it Justified?

Background: Isolated caudate lobectomy is a challenging surgical procedure for which safe and reliable techniques have yet to be developed

Mucobilia in Association With a Biliary Cystadenocarcinoma of the Caudate Duct: A Rare Cause of Malignant Biliary Obstruction

Mucobilia is a rare condition characterized by the accumulation of abundant mucus within the intra- or extrahepatic biliary tree. A variety of hepatobiliary and pancreatic neoplasms are mucin producing and have been associated with the development of mucobilia including biliary mucinosis, biliary papillomatosis, mucin-producing cholangiocarcinoma (MPCC), or cystic neoplasms of the pancreas or biliary tree (cystadenoma or cystadenocarcinoma). We report the case of 46 year-old male with a biliary cystadenocarcinoma of the caudate lobe which resulted in chronic biliary obstruction and relapsing cholangitis. A review of the literature for both mucobilia and biliary cystadenocarcinoma is provided along with a discussion addressing the clinical presentation, diagnosis, treatment, and prognosis for this rare entity

Giant Hepatic Hemangioma With Kasabach–Merritt Syndrome: Is the Appropriate Treatment Enucleation or Liver Transplantation?

We present a case of giant cavernous hemangioma of the liver with disseminated intravascular coagulopathy (Kasabach–Merritt syndrome) which was cured by enucleation. The 51 year old woman presented with increased abdominal girth and easy bruisability. Workup elsewhere revealed a massive hepatic hemangioma and she was started on radiation therapy to the lesion and offered an orthotopic liver transplant. After careful preoperative preparation, we felt that resection was possible and she underwent a successful enucleation. The operation and postoperative course were complicated by bleeding but she recovered and remains well in followup after 6 months. All coagulation parameters have returned to normal. Enucleation should be considered the treatment of choice for hepatic hemangiomas, including those presenting with Kasabach–Merritt syndrome. The benefits of enucleation as compared to liver transplantation for these lesions are discussed

Isolated Hepatic Splenosis: First Reported Case

Splenosis is the autotransplantation of splenic tissue, most commonly seen after traumatic splenic rupture and splenectomy. Post-traumatic splenosis is often considered a rare entity, but is probably underreported because of its asymptomatic nature. We describe the first reported case of splenosis presenting as a liver mass, indistinguishable from a liver tumor by standard preoperative evaluation. The pathophysiology, evaluation and management of splenosis is discussed as well as the decision to resect a benign appearing liver mass

Hepatic Surgery Facilitated by a New Jet Dissector

Increasing experience with major hepatic resections has stimulated the development of improved resectional techniques and tools. A new high velocity water jet dissector is reported which offers significant advances over previously developed ultrasonic and low pressure water jet machines. It has been successfully used in 8 major hepatic resections with minimal blood loss, excellent visibility and without complications. The dissector is also of value in the exposure of intrahepatic bile ducts for biliaryenteric anastomosis

Long Term Survival in a Patient Following Resection for Carcinoma of the Gallbladder and Rectum

We describe a 66-year-old man who presented initially with acute cholecystitis. He was treated by cholecystostomy and biopsy of the gallbladder mucosa which revealed carcinoma of the gallbladder. Four weeks later a cholecystectomy was performed followed by resection of the common bile duct, common hepatic duct and segments IV and V of the liver and a hepaticojejunostomy. Sixteen months later an abdomino-perineal resection was performed for a moderately differentiated Dukes′ stage C carcinoma of the rectum. He is alive and without evidence of recurrence seven years later. Few patients survive for this length of time following resection of either carcinoma of the gallbladder or rectum. This case report demonstrates the value of aggressive surgical treatment in patients with early carcinoma of the gallbladder

Solitary Metastasis From Cutaneous Melanoma to the Liver: Resection by Extended Left Hepatectomy (Trisegmentectomy) With Clearance of Tumor From the Portal Vein

A 61-year-old woman presented with low grade fever and an epigastric mass eight years following resection of a stage Clark IV infraclavicular cutaneous melanoma followed by axillary node dissection. Investigations revealed a tumor in segment II, III, IV and V of the liver and a thrombus involving the main portal vein. Liver resection with extended left hepatectomy (left trisegmentectomy) and portal vein thrombectomy is reported

Rectal Bleeding Associated With Chronic Pancreatitis

Pseudocyst formation, with its attendant complications of compression, rupture, bleeding and fistula formation, is a well known complication of chronic pancreatitis. In 1966 Berne and Edmondson drew attention to the often fatal outcome of pancreatico-colonic fistula complicated by hemorrhage. We present two cases of this rare complication of chronic pancreatitis as defined by the Marseille classification

Clinical Observation: Congenital Absence of the Left Portal Vein in a Patient Undergoing Hepatic Resection

Congenital absence of the left portal vein is a rare vascular anomaly with a reported prevalence varying from one in 62 to one in 507 cases. A patient admitted for recurrent cholangitis secondary to extensive dilation of the left biliary ductal system associated with Caroli's Disease was determined by preoperative dynamic CT to have an excessively large right portal vein and no left portal vein. The surgeon must be aware of any variations in portal vascular anatomy in patients undergoing hepatic resection in order to prevent potentially fatal postoperative complications