Isolated Small Bowel Transplantation from a Living-Related Donor at the Catholic University of Korea: A Case Report of Rejection - Free Course -

The bowel transplantation team at the Catholic Medical Center, Korea, on April 9 2004, accomplished a case of isolated small bowel transplantation (SBT) in a 57 year-old female with short bowel syndrome. The primary surgery was a jejunocolostomy due to mesenteric vein thrombosis, while maintaining 30 cm of the jejunum and colon distal to the splenic flexure. Her renal function was partially unbalanced. During more than 2 years of home TPN, the superior vena cava (VC) and subclavian veins had become occluded, but the inferior VC line remained. SBT was planned due to the repeated life-threatening infections of the last central line. One hundred and fifty centimeter of the distal ileum of the 27 year-old living-related donor, the patient's daughter, was harvested. The graft mesenteric artery and vein were anastomosed to the recipient's inferior mesenteric vessels. A proximal end- to-end jejuno-ileostomy and a distal end-to-side ileo-colostomy of the graft were made, creating a Bishop-Koop enterostomy for graft surveillance. A tube jejunostomy, via a gastrostomy, was established for early feeding and simultaneous gastric drainage. Induction with Daclizumab and immunosuppression consisted of tacrolimus and methylprednisolone, given intravenously, and then mycophenolate mofetil (MMF), enterally from day 3. The patient was discharged on day 42. A CMV infection on day 83 was successfully treated with 3 weeks of gancyclovir therapy. She has been nutritionally independent, with complete oral feeding, and free of rejection until day 170 after the transplantation.

Intravascular Papillary Endothelial Hyperplasia (Masson's Hemangioma) of the Liver: A New Hepatic Lesion

Intravascular papillary endothelial hyperplasia (Masson's hemangioma) is a disease characterized by exuberant endothelial proliferation within the lumen of medium-sized veins. In 1923, Masson regarded this disease as a neoplasm inducing endothelial proliferation, however, now it is considered to be a reactive vascular proliferation following traumatic vascular stasis. The lesion has a propensity to occur in the head, neck, fingers, and trunk. Occurrence within the abdominal cavity is known to be very rare, and especially in the liver, there has been no reported case up to date. The authors have experienced intravascular papillary endothelial hyperplasia of the liver in a 69-yr-old woman, and report the case with a review of the literature.

A Popliteal Vein Aneurysm Causing Pulmonary Embolism

Popliteal vein aneurysm is a very uncommon and rarely reported although potentially life-threatening disease because it can be a source of pulmonary embolism. A patient with recurrent pulmonary embolism must be checked for lower extremity venous abnormalities. Recently, newer techniques including duplex scanning, computerized tomography and magnetic resonance imaging are useful in detecting popliteal fossa venous abnormalities. However, venography is also mandatory before operating on a popliteal vein aneurysm. Several methods are useful for the surgical treatment of popliteal vein aneurysms, including aneurysmectomy with lateral venorrhaphy, aneurysmectomy with vein transposition, aneurysmectomy with vein patch, etc. Following surgery, anticoagulation therapy is widely accepted. Here in, we present a case of popliteal vein aneurysm with pulmonary embolism. This patient was a 67-year-old woman exhibiting chest pain and exertional dyspnea. Lung scan and chest CT revealed multiple pulmonary embolisms and lower extremity venography revealed a right popliteal vein aneurysm with thromboembolism. This patient underwent aneurysmectomy with lateral venorrhaphy.

Small Bowel Complication Due to Magnetic Foreign Body Ingestion in Childhood

Accidental ingestion of foreign body is a common problems in pediatric emergencies. The majority of such cases occur in children between 6 months and 3 years of age. 80% of ingested foreign bodies which reach the stomach will pass uneventfully through the gastrointestinal tract, however the remainder may cause obstruction, perforation or hemorrhage. When several magnets are ingested, they can be attracted to each other through the intestinal wall, causing necrosis and intestinal perforation or fistula, so they should be removed while they are still in the stomach. The authors experienced 2 cases of unusual small bowel complication caused by the ingestion of magnets. The first case was a 10-month-old male with ileal perforation due to 2 ingested magnetic beads, and the second case was a 22-month-old male with ileo-ileal fistula due to 7 ingested magnetic beads.