The Feasibility of Laparoscopic Hepatectomy for the Patients with Left Intrahepatic Stones

PURPOSE: Recently, there have been several studies on the early results of hepatectomy for various intrahepatic lesions. We report the early experience of our hospital after total laparoscopic left hepatectomy in patients with intrahepatic stones in the left hemi-liver. METHODS: We retrospectively analyzed the medical records of patients who were diagnosed with left intrahepatic stones and underwent hepatectomy between January 2007 and June 2009. The patients were grouped according to operative procedure into open hepatectomy, laparoscopy-assisted hepatectomy, and total laparoscopic hepatectomy. RESULTS: There were 31 patients who underwent Lt hemihepatectomy and Lt lateral sectionectomy during this period. Hepatectomy with open method, laparoscopy-assisted method, and total laparoscopy method were performed in 10, 14, and 7 cases. There were no significant differences between the three methods for operating time and postoperative complications. But the number of fasting times and hospital days was shorter with total laparoscopic hepatectomy than with others. CONCLUSION: Total laparoscopic liver resection is a safe and useful method for treating patients with intrahepatic stones and offers the advantage of quick patient recovery. Careful selection of appropriate patients and further development in the laparoscopic surgical technique resulting from accumulated experiences will help enable the laparoscopic hepatectomy to be performed more easily and safely in patients with intrahepatic stones.

Peutz-Jeghers Syndrome with Intussusception

Peutz-Jeghers syndrome (PJS) is a rare disease of autosomal dominant inheritance, which is characterized by multiple hamartomatous polyps and mucocutaneous pigmentations. Multiple hamartomatous polyps in the gastrointestinal tract are the hallmarks of PJS, and occur most commonly in the small intestine. Complications induced by polyps include colicky abdominal pain, bleeding, bowel obstruction; rectal prolapse of polyps, and intussusceptions. A male patient visited our emergency room with colicky abdominal pain. The patient was diagnosed small intestine intussusceptions with multiple polyps. We report this case with a review of the literature.

Clinical Experiences of Management of Bile Duct Injuries during Laparoscopic Cholecystectomy

PURPOSE: Laparoscopic cholecystectomy (LC) has become the gold standard of management of gallstone disease. LC is associated with a two-to-four times higher incidence of bile duct injury, which is a rare but more serious complication than open cholecystectomy. We reviewed our experiences with the management of bile duct injury during laparoscopic cholecystectomy. METHODS: From January 1999 to April 2009, 13 patients with bile duct injuries following LC were managed in our hospital. Patients' charts were retrospectively reviewed to analyze perioperative management. RESULTS: Among the 13 patients, 7 patients sustained their bile duct injuries at our hospital. Six patients were referred to our hospital to manage their bile duct injuries. Five patients' injuries were identified during LC. According to the Strasberg classification, there are 5 cases of type A, 2 cases of type C, 1 case of type D and 5 cases of type E injuries. Four type A bile duct injuries were treated by direct ductal ligation during LC and 1 type A bile duct injury and 1 type C bile duct injury were managed by non-surgical treatment. Type D and type E injuries were managed by Roux-en-Y hepaticojejunostomy. CONCLUSION: Bile duct injuries are a rare but serious complications that occur during laparoscopic cholecystectomy. Most minor bile duct injuries are well treatable with non-surgical management, whereas major bile duct injuries require surgical management. The combination of non-surgical management and surgical treatment results in successful outcomes in bile duct injuries.

The Characteristics and Significances of Incidental Focal Uptake by PET-CT in the Thyroid Gland / 대한내분비외과학회지

PURPOSE: The increased use of positron emission tomography-computed tomography (PET-CT) has resulted in increased detection of incidentally found thyroid lesions. The purpose of this study was to determine the clinical significance of incidental PET-CT uptake in the thyroid and the characteristics of malignant thyroid lesions. METHODS: A retrospective review was conducted on the patients who were incidentally found to have abnormal uptake of thyroid on PET-CT. The patients' records were assessed for the demographics, the PET-CT findings, the standard uptake values (SUVmax), the ultrasonography findings, the fine needle aspiration (FNA) cytology and the surgical pathologic findings. RESULTS: One hundred-ten (4.0%) individuals were identified to have focal (n=35) or diffuse (n=75) thyroid uptake. Thyroid ultrasonography was performed on 29 patients with 35 focal thyroid uptakes, and there was no correlation between the mass size on ultrasonography and the SUVmax on PET-CT. The cytologic diagnosis was available for 26 patients and in 16 (61.53%) patients, the nodule was found to be malignant. The mean and standard deviation of the SUVmax was 5.21±4.08 for the malignant nodules and 8.78±7.32 for the benign nodules. There was no significant difference in the SUVmax between the benign and malignant nodules. CONCLUSION: In our study, focal thyroid uptakes incidentally found on PET-CT had a high risk of thyroid malignancy (55.17%). There seems to be no correlation between the SUVmax of the lesion and the risk of malignancy.

Solitary Fibrous Tumor of the Liver

Solitary fibrous tumor of the liver is a rare neoplasm. Thirty-nine cases have been described in the English literature. Its immunohistochemical positivity for CD34 and vimentin is believed to be unique. It is known to be usually benign and only one case of metastasis is reported. We report an additional case. A 71-year-old woman presented with fatigue and weight loss. CT scan showed a solid mass occupying the left lobe of the liver. Left lobectomy was performed. Pathological examination showed spindle cell and fibroblast-like cells within the collagenous stroma. On immunohistochemical staining, these spindle tumor cells showed diffuse CD34 and vimentin positive reactivity. The post-operative course was uneventful. Solitary fibrous tumors of the liver, although rare, need to be considered in the differential diagnosis of mesenchymal lesions of the liver.

Adrenal Pseudocyst Mistaken as Mucinous Cystadenoma of the Pancreas: A Case Report / 대한내분비외과학회지

Adrenal cysts are a relatively uncommon disorder and most such cases are discovered at autopsy. According to the overseas cases, the reported incidence is 0.06~0.18% and the incidence is increasing due to the widespread use of ultrasonography and computed tomography scanning. Adrenal cysts are usually asymptomatic and they need to be differentiated from other cystic lesions including liver, pancreas and kidney cystic lesions. We report here on a case of a 39-year-old female with an adrenal pseudocyst that was misdiagnosed preoperatively as a pancreas mucinous cystic neoplasm.