ABSTRACT
Lymphangioma of the large bowel is a rare benign tumor which is composed of numerous small or large thin-walled lymphatie spaces contained fibrous tissue, smooth muscle and aggregates of lymphoid tissue. Lymphangioma never demonstrated any potential for malignant degeneration. There are three types; l. simple capillary lymphangioma, 2 cavernous lymphangioma and 3 cystic lymphangioma. Endoscopically, lymphangioma appears as a compressible smooth, round, or oval submucosal tumor covered with pale intact mucosa. The surfaces is smooth and the superficial color is the same as the surrouding mucosa or slightly more yellowish. There are change of dimension and shape during propagation of the peristaltic wave and on compression. Recently, authors experienced 4 cases of lymphangioma of large intestine which has been revealed by typical colonoscopic findings and/or endoscopic ultrasound, and confirmed by surgical resection and colonscopic snare polypectomy. 3 of 4 cases show cystic lymphangioma and one case shows carvenous lymphangio~rna. We report these cases with review of literatures.
Subject(s)
Capillaries , Colon , Intestine, Large , Lymphangioma , Lymphangioma, Cystic , Lymphoid Tissue , Mucous Membrane , Muscle, Smooth , SNARE Proteins , UltrasonographyABSTRACT
Mirizzi syndrome is a so-called functional hepatic syndrome with obstruction of the common hepatic duct secondary to pressure from an impacted stone, either in the cystic duct or the neck of the gallbladder. Mirizzi syndrome is classified into two types based on endoscopic retrograde cholangio-pancreatographic findings. Type I involves external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch. In type II, a chole-cystocholedochal fistul is present, caused by a calculus which has eroded partly or completely into the common bile duct. Gallstone obstruction of the cystic duct with resulting repeated attacks of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas. We experienced a 70-year-old female patient with Mirizzi syndrome type II, who complained of abdominal discomfort. ERCP revealed multiple filling defects in contracted gallbladder, which compressed lateral wall of common hepatic duct. Peroral cholangioscopy revealed an impacted stone at the neck of the gallbladder with neighboring mucosal erosions. She was treated under the diagnosis of Mirzzi syndrome type II by endoscopic biliary drainage and surgical operation.
Subject(s)
Aged , Female , Humans , Calculi , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct , Cystic Duct , Cytochrome P-450 CYP1A1 , Diagnosis , Drainage , Fistula , Gallbladder , Gallstones , Hepatic Duct, Common , Inflammation , Mirizzi Syndrome , Neck , NecrosisABSTRACT
Mirizzi syndrome is a so-called functional hepatic syndrome with obstruction of the common hepatic duct secondary to pressure from an impacted stone, either in the cystic duct or the neck of the gallbladder. Mirizzi syndrome is classified into two types based on endoscopic retrograde cholangio-pancreatographic findings. Type I involves external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch. In type II, a chole-cystocholedochal fistul is present, caused by a calculus which has eroded partly or completely into the common bile duct. Gallstone obstruction of the cystic duct with resulting repeated attacks of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas. We experienced a 70-year-old female patient with Mirizzi syndrome type II, who complained of abdominal discomfort. ERCP revealed multiple filling defects in contracted gallbladder, which compressed lateral wall of common hepatic duct. Peroral cholangioscopy revealed an impacted stone at the neck of the gallbladder with neighboring mucosal erosions. She was treated under the diagnosis of Mirzzi syndrome type II by endoscopic biliary drainage and surgical operation.