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

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

Biliary Stricture Following Hepatic Resection

Anatomic distortion and displacement of hilar structures due to liver lobe atrophy and hypertrophy occasionally complicates the surgical approach for biliary stricture repair. Benign biliary stricture following hepatic resection deserves special consideration in this regard because the inevitable hypertrophy of the residual liver causes marked rotation and displacement of the hepatic hilum that if not anticipated may render exposure for repair difficult and dangerous. Three patients with biliary stricture after hepatectomy illustrate the influence of hepatic regeneration on attempts at subsequent stricture repair. Following left hepatectomy, hypertrophy of the right and caudate lobes causes an anteromedial rotation and displacement of the portal structures. After right hepatectomy, the rotation is posterolateral, and a thoracoabdominal approach may be necessary for adequate exposure. Radiographs obtained in the standard anteroposterior projection may be deceptive, and lateral views are recommended to aid in operative planning

Unresectable Malignant Biliary Obstruction: Treatment by Self-Expandable Biliary Endoprostheses

The primary goal in the treatment of malignant obstruction is the relief of jaundice. Although operative biliary bypass is a reliable method of palliation, nonoperative palliation may be desirable in selected patients

The critically ill patient after hepatobiliary surgery

BACKGROUND: We analyzed the causes and results of utilization of critical care services in the special care unit in patients after surgical procedures performed by the hepatobiliary surgical service during a 23-month period. RESULTS: Thirty-two of 537 patients (6.0%) required postoperative admission to the special care unit. Twenty-one patients were admitted directly from operating room or from recovery room because of inability to wean from ventilator (n = 10), hypovolemic shock (n = 4), myocardial ischemia or infarction (n = 2), sepsis (n = 2), upper gastrointestinal bleeding (n = 2), and acute renal failure (n =1). Eleven postoperative patients were admitted from floor care for respiratory failure (n = 4), cardiac dysrhythmia or infarction (n = 4), sepsis (n = 2), and upper gastrointestinal bleeding (n = 1). Thirty-eight per cent of patients (n = 12) admitted to the special care unit after surgery died. By multivariate analysis, total postoperative stay in the special care unit that was greater than median total duration of stay of 4.5 days was the only independent predictor of mortality (P = 0.041). CONCLUSIONS: Respiratory failure was the predominant component of all complications after hepatobiliary surgery. No clinically useful predictors of eventual outcome could be identified