Biliary Anastomotic Stricture after Surgical Management of Mirizzi Syndrome: Treated with Long-term Percutaneous Transhepatic Biliary Drainage / 대한췌담도학회지

Mirizzi syndrome (MS) is a rare complication of cholecystolithiasis that is characterized by obstruction of the common hepatic duct due to mechanical compression by impacted stones in the neck of the gallbladder or the cystic duct. Treatment of MS is surgical, and operative procedure would vary depending on its classification type. Biliary stricture after surgical treatment of MS is an unusual complication and endoscopic approach is not possible for patients who have undergone bilioenteric anastomosis. We report a case of a 60-year-old patient with biliary anastomotic stricture after surgical management of MS who was successfully treated with long-term percutaneous transhepatic biliary drainage.

Study on the Feasibility and the Safety of Hem-o-lok Clipping for Complicated Acute Appendicitis during Laparoscopic Appendectomy

PURPOSE: The objective of this retrospective study is to evaluate the practical feasibility and safety of applying hem-o-lok clips for the closure of the appendiceal stump in complicated appendicitis. METHODS: From January 2009 to April 2010, 267 patients who underwent laparoscopic appendectomies at the Pusan National University Yangsan Hospital were included in this study. Of these patients, 161 were diagnosed by computed tomography as having complicated acute appendicitis. In 107 patients, the appendiceal stump was closed with hem-o-lok clips, whereas in the remaining 160 patients, it was closed with endoloops. These two groups were compared for clinicopathologic data and procedural cost-effectiveness. RESULTS: No significant differences were found between the two groups in terms of age, sex, hospital stay, or blood loss. Furthermore, postoperative complications were similar and highly acceptable in both groups. However, operation times were significantly shorter and hospital cost was lower for the hem-o-lok group. CONCLUSION: The hem-o-lok clips has advantages such as simplicity of application, a shorter operation time, and lower hospital cost when used as a means of securing the base of the appendix in relation to the endoloop procedure.

A Case of Acute Graft versus Host Disease after Liver Transplantation / 대한이식학회지

The mortality rate of patients with acute graft versus host disease (GVHD) after liver transplantation is very high. Autoimmune hepatitis and diabetes mellitus (DM) is the risk factors of GVHD. Human leukocyte antigen (HLA)-homozygote donor with one way donor-recipient HLA matching is on the risk of fatal GVHD following living donor liver transplantation (LDLT). If recipient has more than one risk factors of GVHD and is going to LDLT, HLA typing is needed to identify donor-dominant one-way HLA matching and helpful to diagnose and treat early and survival of patient will be improved. We report a case of GVHD after liver transplantation for hepatocellular carcinoma and DM who received an allograft from his HLA-homozygous son.

A First Experience of Rh(D) Incompatible Living Related Liver Transplantation in Korea / 대한수혈학회지

To expand the indications for living liver allograft, an increasing number of clinical trials of ABO incompatible liver transplantation have been reported in the literature. Administration of immunosuppressive drugs has resulted in decreased rates of mortality and graft loss in patients undergoing in ABO-incompatible living donor liver transplantation (LDLT). Rh incompatibility in liver transplantation has not been reported as frequently as that of ABO-incompatible LDLT. Rh-antigens are said to be located only on red blood cells, and have not been demonstrated on leukocytes or tissue cells. For this reason, the incompatibility of Rh antigen between the donor and the recipient has received significantly less consideration in organ transplantations. Here, we report on a case of Rh incompatible living related liver transplantation from a group O, Rh-positive donor to a group O, Rh-negative recipient. The recipient did not develop Rh alloimmunization after administration of immunosupressive drugs and Rh immunoglobin (RhIG).

A First Experience of Rh(D) Incompatible Living Related Liver Transplantation in Korea / 대한수혈학회지

To expand the indications for living liver allograft, an increasing number of clinical trials of ABO incompatible liver transplantation have been reported in the literature. Administration of immunosuppressive drugs has resulted in decreased rates of mortality and graft loss in patients undergoing in ABO-incompatible living donor liver transplantation (LDLT). Rh incompatibility in liver transplantation has not been reported as frequently as that of ABO-incompatible LDLT. Rh-antigens are said to be located only on red blood cells, and have not been demonstrated on leukocytes or tissue cells. For this reason, the incompatibility of Rh antigen between the donor and the recipient has received significantly less consideration in organ transplantations. Here, we report on a case of Rh incompatible living related liver transplantation from a group O, Rh-positive donor to a group O, Rh-negative recipient. The recipient did not develop Rh alloimmunization after administration of immunosupressive drugs and Rh immunoglobin (RhIG).

More than 7-year survival of a patient following repeat hepatectomy for total 20 colon cancer liver metastases / 대한외과학회지

A 54-year-old man was transferred with sigmoid colon cancer combined with multiple bilobar liver metastases. Nine metastases were in the left lobe and 5 metastases were in the right lobe. After low anterior resection, all 9 lesions in the left lobe were completely removed by wedge resections. Because the remnant liver volume after multiple wedge resection of the left lobe was not sufficient to perform a right hepatectomy simultaneously, we planned a two-stage hepatectomy. Right portal vein embolization was performed one week after the first liver operation. A right hepatectomy was safely performed 22 days after the first hepatectomy. A recurrent mass developed in the segment III 18 months after the right hepatectomy. Radiofrequency ablation (RFA) was performed to remove that lesion. Five other metastases developed 18 months after RFA whereby multiple wedge resections were performed. The patient has survived for more than 7 years after the first liver operation.

Spontaneous Hemoperitoneum

Spontaneous hemoperitoneum commonly presents as acute abdominal pain, and this malady is relatively rare and difficult to diagnose. It is defined as a presence of intraperitoneal blood that is not related to trauma. We usually consider some conditions to be associated with this event, i.e, hepatic, splenic, gynecological, vascular and coagulopathic causes. For the management of spontaneous hemoperitoneum, the decision to the treatment depends on the type of hemoperitoneum according to patient's conditions, although selected operations have been performed for it's management in the past. However there are many recent developments in diagnostic imaging modalities such as computed tomography and magnetic resonance imaging for identifying some of the causes. We recently experienced 4 cases of spontaneous hemoperitoneum that were unrelated to trauma or intraabdominal malignancies, and they all achieved satisfactory outcomes. One case was managed by surgical treatment; however, we couldn't determine it's cause. The other cases were managed by nonsurgical treatment. We report on theses cases along with including a review of the relevant literature.