‘Latent’ Portal Hypertension in Benign Biliary Obstruction

A prospective study was undertaken to evaluate the changes in portal venous pressure in patients with benign biliary obstruction (BBO) but without overt clinical, endoscopic or radiological evidence of portal hypertension. Portal venous pressure was measured at laparotomy in 20 patients (10 each with either benign biliary stricture or choledocholithiasis) before and after biliary decompression. Pressure was found to be on the high side in seven patients (>25 cm of saline in three patients and > 30 cm of saline in four). The mean fall of pressure was 3.4 cm of saline after biliary decompression. No correlation could, however, be found between portal venous pressure and duration of biliary obstruction, serum bilirubin or bile duct pressure. Liver histology showed mild to moderate cholestatic changes but maintained portal architecture in all. Benign biliary obstruction may therefore, lead to elevation of portal pressure, even though the patient may not necessarily have any clinical, endoscopic or radiological manifestations of portal hypertension. The pathogenesis of this ‘latent’ portal hypertension is probably multifactorial. If biliary obstruction is left untreated the development of overt portal hypertension may become a possibility in the future

Amebic Liver Abscess With Intra-Biliary Rupture

The case of a large amebic liver abscess with an atypical presentation is reported. High output bile drainage persisted after ultrasound guided percutaneous catheter drainage because of a preexisting communication of the abscess with the right hepatic ductal system. The abscess was managed successfully by surgical evacuation and internal drainage into a defunctioned jejunal loop

Partial Cholecystectomy Safe and Effective

Patients undergoing surgical treatment for calculous disease were considered to have had a partial cholecystectomy performed when a part of the gall bladder wall was retained for technical reasons. Forty patients underwent partial cholecystectomy: for chronic cholecystitis (20), acute cholecystitis (4), Mirizzi's syndrome (14), portal hypertension or partially accesible gall bladder (one patient each). Four patients (10%) developed infective complications and two patients had retained common bile duct stones. In a mean follow up period of 13 months (range 1–36 mths), only 3 patients have ongoing mild dyspeptic symptoms while the rest have remained asymptomatic. Partial cholecystectomy has been found to be a safe and effective procedure in difficult cholecystectomy situations, since it combines the merits of cholecystectomy and cholecystostomy

Imaging Findings in Agenesis of the Dorsal Pancreas. Report of Three Cases

Context Agenesis of the dorsal pancreas is rare. The dorsal pancreatic agenesis is described in two forms, the partial and the complete form. Patients with this anomaly may be asymptomatic or may present with diabetes mellitus, epigastric pain, acute or chronic pancreatitis. Case report We report the computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) findings in three cases with dorsal pancreatic agenesis, one with partial and the other two with complete form. Speckled calcification at pancreatic head was observed in one patient. Lateral contour lobulation of pancreatic head which is seen in one third of normal population is believed to be due to variation in fusion between ventral and dorsal pancreas. In contrast, we observed lateral contour lobulation of pancreatic head in a case of complete agenesis of the dorsal pancreas where structures derived from dorsal pancreas are undeveloped. The ventral and dorsal pancreatic duct lengths were measured on MRCP images and we observed that in partial agenesis, the duct of Wirsung was shorter in length, compared to the duct of Santorini. The duct of Wirsung was relatively longer in cases of complete agenesis of the dorsal pancreas. Conclusion The CT, MRI and MRCP findings in dorsal pancreatic agenesis and the relationship between the length of ventral duct with the type of dorsal pancreatic agenesis will provide a new insight into this particular anomaly