Hepaticocystic duct and a rare extra-hepatic "cruciate" arterial anastomosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>The variations in the morphological characteristics of the extra-hepatic biliary system are interesting.</p> <p>Case presentation</p> <p>During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically. Further drainage of the bile away from the gallbladder and into the duodenum was provided by the cystic duct. Formation of the common bile duct by the union of the common hepatic duct and cystic duct was absent. Further more the right hepatic artery was found to be communicating with the left hepatic artery by a "bridging artery" after giving rise to the cystic artery. An accessory hepatic artery originated from the "bridging artery" forming a "cruciate" hepatic arterial anastomosis.</p> <p>Conclusion</p> <p>Combination of a Hepaticocystic duct and an aberrant variation in the extra-hepatic arterial system is extremely rare.</p

Synchronous liver metastasis in colorectal cancer in Sri Lanka

Abstract Objective To assess the incidence of synchronous colorectal liver metastasis in patients referred to a tertiary referral center in Sri Lanka and to evaluate the differences in the clinicopathological features of patients with and without synchronous metastasis. Methods Records of 438 patients were retrospectively analyzed. Patients were classified into metastatic group (n=34, 8%) and non metastastatic group (n=404, 92%). In the two groups macroscopic features compared were: tumor size (2 cm, 2-5 cm, and &gt;5 cm), site of primary tumor and side of liver involved. Carcinoembryonic antigen (CEA) levels were recorded. At microscopy, tumor differentiation, invasion and nodal status were evaluated. Results The rectum was the primary site of the tumor in a majority (60%) of patients. There was no difference in the distribution of the primary site and size of the tumor, pathological stage, lymphatic infiltration and the degree of tumor differentiation in two groups (p&gt;0.05). Patients with metastasis had higher levels of CEA, higher frequency of vascular infiltration and N3 nodes involved (p&lt;0.05). Conclusion The incidence of synchronous colorectal liver metastasis seems to be lower in our patients. Association of higher CEA level, advanced nodal stage and presence of vascular invasion needs to be further assessed with risk of developing metachronous liver metastasis. Keywords Colonic neoplasms . Liver neoplasms/surgery Carcinoma of the large bowel is the fourth commonest cancer worldwide Methods Data on 438 patients, who were registered in the University of Kelaniya colorectal cancer database from 1999 to 2009, were analyzed retrospectively. A synchronous metastatic deposit was defined as a liver lesion detected during preoperative work-up (abdominal ultrasound scan and computed tomogram) or at the time of surgery. Patients were classified into two groups based on presence or absence of synchronous liver metastasis. Macroscopic features assessed were: tumor size (2 cm, 2-5 cm, and &gt;5 cm), site of primary tumor and side of liver involved. Carcinoembryonic antigen (CEA) levels were recorded. At microscopy, tumor type, invasion and nodal status were evaluated Statistical analysis was done by comparison of proportions using Chi square list. A p value &lt;0.05 was considered significant. Results The 438 patients (51.8%, n=227) had a mean age of 58 (SD 14.5) years. Of these, 405 patients underwent colonic resection, and 23 underwent colostomy for decompression