Drain Tube-Induced Jejunal Penetration Masquerading as Bile Leak following Whipple's Operation

A 70-year-old man had undergone pancreaticoduodenectomy due to a distal common bile duct malignancy. After the operation, serous fluid discharge decreased from two drain tubes in the retroperitoneum. Over four weeks, the appearance of the serous fluid changed to a greenish bile color and the patient persistently drained over 300 ml/day. Viewed as bile leak at the choledochojejunostomy, treatment called for endoscopic diagnosis and therapy. Cap-fitted forward-viewing endoscopy demonstrated that the distal tip of a pancreatic drain catheter inserted at the pancreaticojejunostomy site had penetrated the opposite jejunum wall. One of the drain tubes primarily placed in the retroperitoneum had also penetrated the jejunum wall, with the distal tip positioned near the choledochojejunostomy site. No leak of contrast appeared beyond the jejunum or anastomosis site. Following repositioning of a penetrating catheter of the pancreaticojejunostomy, four days later, the patient underwent removal of two drain tubes without additional complications. In conclusion, the distal tip of the catheter, placed to drain pancreatic juice, penetrated the jejunum wall and may have caused localized perijejunal inflammation. The other drain tube, placed in the retroperitoneal space, might then have penetrated the inflamed wall of the jejunum, allowing persistent bile drainage via the drain tube. The results masqueraded as bile leakage following pancreaticoduodenectomy

Efekti korišćenja astaksantina u ishrani na rast, pigmentaciju mišića i antioksidantne aktivnosti mlađi kalifornijske pastrmke (oncorhynchus mykiss)

This study was designed to test the effects of dietary astaxanthin on growth, muscle pigmentation, antioxidant activity and biochemical composition of juvenile rainbow trout (Oncorhynchus mykiss). Experimental diets were formulated to contain 50, 75 and 100 ppm astaxanthin (designed as AS50, AS75 and AS100). The diet without supplementation of astaxanthin was considered as the control diet. Each experimental diet was fed to three replicate groups of fish (18.5 g/fish) to visual satiation two times a day for 10 weeks. Growth performance and proximate composition of muscle of fish were not affected by dietary AS levels (P> 0.05). Total carotenoid concentration in the muscle of fish fed the AS50 diet was higher than that of fish fed the control diet, but no different to that of fish fed the AS75 and AS100 diets. The astaxanthin concentration in the muscle of fish fed AS50, AS75 and AS100 diets were higher than that of control diet. The redness (a*) of the muscle of fish fed AS50, AS75 and AS100 diets were higher than that of fish fed the control diet (P 0.05) nije uticao na performansu rasta i hemijski sastav mišića ribe. Ukupna koncentracija karotenoida u mišiću ribe koja je hranjena AS50 hranom bila je viša nego kod riba hranjenih kontrolnom hranom, ali nije bila drugačija od riba hranjenih AS75 i AS100 hranom. Koncentracija astaksantina u mišiću riba hranjenih AS50, AS75 i AS100 hranom bila je viša nego kod riba hranjenih kontrolnom hranom. Crvena boja (a*) mišića ribe koja je hranjena AS50, AS75 i AS100 hranom bila je jača nego kod ribe hranjene kontrolnom hranom (P< 0.05). Antioksidantna aktivnost DPPH, radikala hidroksila i alkila u plazmi i jetri riba nisu zavisili od nivoa astaksantina osim kod plazme koja je imala antioksidantnu aktivnost alkilnih radikala. Rezultati ove studije nagoveštavaju da se hrana koja sadrži 50 ppm astaksantina može koristiti da bi se poboljšala crvena boja mišične pigmentacije kod mlađi kalifornijske pastrmke

Electrical Characterization of Proposed Transpositional Acupoints on the Urinary Bladder Meridian in a Rat Model

Specific electrical characteristicsof acupointswere investigated on the urinary bladder (BL) meridian in 14 rats. BL acupointsand non-acupoints on the back were selected and their electrical voltages were measured by using aSPACsystem.The mean voltages of each point or each line were statistically analyzed by using the ANOVA test.The BL meridian showed voltages higher than those of the reference line (P < .05). Bilateral 1st BL lines presented higher voltages than bilateral 2nd BL lines (P < .05). Most BL acupoints had voltageshigher than those for the corresponding reference points (P < .05). In particular, theright BL16 exhibited the biggest difference from the reference point, followed by the left extra BL point-2, the right BL27, the left BL17, and theleft BL45. Additionally, the distributions of neurofilamentsfor several points were investigated by using immunohistochemistry. There was a trend for the BL acupoints to have larger numbers of neurofilaments than the reference points, and that trend seemed to be directly proportional to the difference in voltage between the points.In conclusion, BL acupoints on the back in ratsexhibited specific electric and histologic characteristics. Therefore, those acupointsmay be utilized to investigate the efficacy of acupuncturewith laboratory animals

Duplication of the Extrahepatic Bile Duct in Association with Choledocholithiasis as Depicted by MDCT

We report here on an extremely rare case of duplicated extrahepatic bile ducts that was associated with choledocholithiasis, and this malady was visualized by employing the minimum intensity projection images with using multi-detector row CT. The presence of duplicated extrahepatic bile ducts with a proximal communication, and the ducts were joined distally and they subsequently formed a single common bile duct, has not been previously reported

A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction

Background/AimsThe placement of self expandable metal stent (SEMS) is one of the palliative therapeutic options for patients with unresectable malignant biliary obstruction. The aim of this study was to compare the effectiveness of a covered SEMS versus the conventional plastic stent.MethodsWe retrospectively evaluated 44 patients with unresectable malignant biliary obstruction who were treated with a covered SEMS (21 patients) or a plastic stent (10 Fr, 23 patients). We analyzed the technical success rate, functional success rate, early complications, late complications, stent patency and survival rate.ResultsThere was one case in the covered SEMS group that had failed technically, but was corrected successfully using lasso. Functional success rates were 90.5% in the covered SEMS group and 91.3% in the plastic stent group. There was no difference in early complications between the two groups. Median patency of the stent was significantly prolonged in patients who had a covered SEMS (233.6 days) compared with those who had a plastic stent (94.6 days) (p=0.006). During the follow-up period, stent occlusion occurred in 11 patients of the covered SEMS group. Mean survival showed no significant difference between the two groups (covered SEMS group, 236.9 days; plastic stent group, 222.3 days; p=0.182).ConclusionsThe patency of the covered SEMS was longer than that of the plastic stent and the lasso of the covered SEMS was available for repositioning of the stent

Gallbladder Pseudodiverticulosis Mimicking a Multiseptate Gallbladder with Stones

Gallbladder diverticula have the appearance of hernia-like protrusions of the gallbladder wall. This disorder may not be diagnosed until surgically resected because it has no clinical significance unless there are associated diseases. Gallbladder pseudodiverticula have an acquired cause, multiple fundal lesions, an association with gallstones, internal saccular lesions without external hernia-like protrusions, and little to no smooth muscle in the gallbladder wall. We report a unique anomaly of multiple pseudodiverticula presenting with calculous cholecystitis, which was pathologically different from true diverticula and had a unique shape similar to a bunch of grapes and a septation infilling pattern on endoscopic retrograde cholangiography

Spontaneous Choledochoduodenal Fistula after Metallic Biliary Stent Placement in a Patient with Ampulla of Vater Carcinoma

Biliary stent-related enteric perforations are very rare complications that are caused by the sharp end of a metallic stent, stent migration, or tumor invasion. Moreover, the choledochoduodenal fistula resulting from metallic biliary stent-induced perforation is extremely rare. Here, we report a case in which a spontaneous choledochoduodenal fistula occurred after biliary metallic stent placement in a patient with an Ampulla of Vater carcinoma but was successfully managed by supportive treatments, including nasobiliary drainage. This case might have occurred as the result of a rupture of the bile duct following pressure necrosis and inflammation caused by impacted calculi and food materials over the tumor ingrowth in the uncovered biliary stent

Early Bile Duct Cancer Detected by Direct Peroral Cholangioscopy with Narrow-Band Imaging after Bile Duct Stone Removal

Cholangioscopy not only enables the direct visualization of the biliary tree, but also allows for forceps biopsy to diagnosis early cholangiocarcinoma. Recently, some reports have suggested the clinical usefulness of direct peroral cholangioscopy (POC) using an ultra-slim endoscope with a standard endoscopic unit by a single operator. Enhanced endoscopy, such as narrow band imaging (NBI), can be helpful for detecting early neoplasia in the gastrointestinal tract and is easily applicable during direct POC. A 63-year-old woman with acute cholangitis had persistent bile duct dilation on the left hepatic duct after common bile duct stone removal and clinical improvement. We performed direct POC with NBI using an ultra-slim upper endoscope to examine the strictured segment. NBI examination showed an irregular surface and polypoid structure with tumor vessels. Target biopsy under direct endoscopic visualization was performed, and adenocarcinoma was documented. The patient underwent an extended left hepatectomy, and the resected specimen showed early bile duct cancer confined to the ductal mucosa