ABSTRACT
Portomesenteric vein thrombosis is an uncommon but potentially life-threatening complication associated with laparoscopic sleeve gastrectomy. We present the case of a 26-year-old male who underwent an uneventful laparoscopic sleeve gastrectomy and presented on postoperative day 14 with portomesenteric vein thrombosis. The patient was treated conservatively with IV heparinization, followed by an oral anticoagulant agent. He was discharged in stable condition without further problems. A high index of suspicion for the disease is required not to miss or delay the diagnosis of portomesenteric vein thrombosis which could lead to a fatal outcome. All patients should be screened beforehand for underlying hypercoagulability before surgery.
ABSTRACT
Spontaneous intrahepatic bleeding is a rare condition. In the absence of trauma, intrahepatic hematoma may be due to underlying liver disease. We report a case of hepatocellular carcinoma in the patient who had huge intrahepatic hematoma without definite intrahepatic tumor at the time of initial presentation. A 54-year-old man was admitted to our hospital with a sudden onset of upper abdominal pain. Initial abdominal CT scan showed huge hematoma measuring more than 13 cm in diameter in the right lobe of the liver. However, there was no enhancing lesion in the liver. Laboratory data showed high alanine aminotransferase, alpha-fetoprotein and positive HBsAg. The MRI and angiography could not also depict any mass in the liver. The patient was treated with percutaneous drainage on the intrahepatic hematoma. The cytology from drainaged blood revealed no malignant cell. After hematoma decreased, follow-up CT scan depicted an enhancing tumor in the liver. He underwent right hepatic lobectomy and histopathological examination showed hepatocellular carcinoma.
Subject(s)
Humans , Male , Middle Aged , Carcinoma, Hepatocellular/diagnosis , Hematoma/diagnosis , Liver Diseases/diagnosis , Liver Neoplasms/diagnosis , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
BACKGROUND/AIMS: The aim of this study was to investigate the epidemiological characteristics and changing patterns of gallstone disease over the last 20 years. METHODS: Four thousands and twenty gallstone patients who had received surgery at Seoul National University Hospital (1981~2000) were analyzed according to time of treatment; period I: 1981~1985 (831 cases), period II: 1986~1990 (888 cases), period III: 1991~1995 (1,040 cases) and period IV: 1996~ 2000 (1,261 cases). Data from 13 institutes in Korea reporting 13,101 gallstone cases were also reviewed with literature to elucidate the nation-wide trends. RESULTS: The number of gallstone cases has gradually increased. A female- predominance was not observed (F/M=1.17-1.37). The CBD stone patients were older than the GB and the IHD stone patients. Over the study period, the relative portion of the GB stone group increased. The portion of CBD stone group decreased, while that of the IHD stone group was unchanged. The rural pattern of gallstone disease (low GB stone, high CBD and IHD stone) has become similar to the urban pattern. Such patterns are well agreed with the other literature reported in Korea. CONCLUSIONS: The pattern of gallstone disease in Korea has become similar to that in Western countries except a high prevalence of hepatolithiasis.