A Case of carcinoma of the duodenal bulb

A seventy-seven-year-old man was found to have a duodenal tumor by X-ray examination, which was identified to be malignant one by an endoscopic examination. On admission a slight anemia, increased erythrocyte sedimentation rate, positive occult blood reaction in stool were desclosed. An upper G.I. series revealed a filling defect of duodenal bulb. A duodenal endoscopic examination showed a protruding lesion on the greater curvature of the front wall of duodenal bulb. A biopsy specimen obtained at the same time was identified as a well differentiated adenocarcinoma tubulare by histological study. Local injection of MMC, 5Fu and predonin under endoscopic observation was performed weekly four times. Nevertheless the lesion have remained stationally. The patient have been well and still remaines under our medical supervision

Bile duct stone formation around a nylon suture after gastrectomy: A case report

BACKGROUND: Many cases of choledocholiths formed around sutures and clips used during cholecystectomy have been reported. We describe a case of gallstone formation around a nylon suture after non-biliary surgery. To the best of our knowledge, this is the first report of such a case. CASE PRESENTATION: A 75-year-old Japanese man, who had undergone distal gastrectomy for gastric cancer and reconstruction with the Billroth II method 8 years earlier, presented with gastric discomfort. Abdominal ultrasonography was conducted and we diagnosed cholecysto-choledocholithiasis with dilatation of the intrahepatic bile duct. He underwent cholecystectomy and cholangioduodenostomy for choledocholith removal. Gallstones, which had formed around a nylon suture used during the previous gastrectomy, were found in the bile duct. Sutures of the same material had also been placed on the duodenum. Chemical analysis revealed that the stones were composed of calcium bilirubinate. The patient was discharged on postoperative day 19, and choledocholithiasis has not recurred thus far. CONCLUSION: The findings from this case suggest that standard, non-resorbable sutures used in gastrectomy may be associated with the formation of bile duct stones; therefore, absorbable suture material may be required to avert gallstone formation even in the case of gastrectomy