Spontaneous Rupture of the Hepatic Duct / 한국간담췌외과학회지

Spontaneous rupture of the bile duct is an exceedingly rare and usually recognized fatal cause of peritonitis and intraabdominal sepsis. Several reports of isolated cases have demonstrated its rarity in the absence of operative trauma or severe injury. Perforation of the biliary system occurs most frequently in the gall bladder, which perforation of the hepatic duct is less common, being described mainly in infants, but extremely rarely in adults. The diagnosis of the spontaneous rupture of the bile duct depends on meticulous clinical examination and imaging investigation. The basic principles of treatment are to stop the bile leakage, evacuate the extravasated bile, apply decortication of the encapsulated fluid collection and provide adequate drainage. We report on a patient with spontaneous perforation of the right hepatic duct who presented with abdominal pain, jaundice and fever. Exploratory surgery showed proximal common bile duct obstruction with right hepatic duct perforation.

Spontaneous Rupture of Spleen in a Patient with Malarial Infection

Malaria is a protozoan disease transmitted by the bite of infected mosquitoes. During acute and chronic malarial infection, altered splenic structure and function produce asymptomatic enlargement or com plications such as hematoma formation, rupture, hypersplenism, or cyst formation. Spontaneous splenic rupture occurs during acute infection, usually during the primary attack. However, rupture occurring in chronic malarial splenomegaly is seldom spontaneous; obvious trauma is almost always the precipitating event. Recently, conservative therapy has been applied in all cases of malarial splenic rupture. Surgical therapy should be reserved for patients with severe rupture or for those with continued or recurrent bleeding. We report the case of a recently treated 25-year-old male who had acute malaria complicated by fever and by severe abdominal pain, tenderness, and distension, a condition that may result in splenic rupture. At operation, the spleen was slightly enlarged and multiple tearing was found in the lateral surface of the capsule. A splenectomy was preformed.

Spontaneous Rupture of Spleen in a Patient with Malarial Infection

Malaria is a protozoan disease transmitted by the bite of infected mosquitoes. During acute and chronic malarial infection, altered splenic structure and function produce asymptomatic enlargement or com plications such as hematoma formation, rupture, hypersplenism, or cyst formation. Spontaneous splenic rupture occurs during acute infection, usually during the primary attack. However, rupture occurring in chronic malarial splenomegaly is seldom spontaneous; obvious trauma is almost always the precipitating event. Recently, conservative therapy has been applied in all cases of malarial splenic rupture. Surgical therapy should be reserved for patients with severe rupture or for those with continued or recurrent bleeding. We report the case of a recently treated 25-year-old male who had acute malaria complicated by fever and by severe abdominal pain, tenderness, and distension, a condition that may result in splenic rupture. At operation, the spleen was slightly enlarged and multiple tearing was found in the lateral surface of the capsule. A splenectomy was preformed.

Sarcomatoid Carcinoma of the Duodenum: A case report

A sarcomatoid carcinoma of the gastrointestinal tract is a very rare tumor. Only limited cases have been reported in the literature. The tumor is more malignant than the usual adenocarcinoma of the gastrointestinal tract. Typically, when discovered, a sarcomatoid carcinoma of the small intestine is already in a late stage of disease with a rapidly progressive course. The survival rate is markedly lower than for adenocarcinomas. Here, we report the case of a 63-year-old male patient who was referred from the Gastroenterology Department of Chonnam University Hospital. He had been suffering from a sudden onset of painless jaundice, and from weight loss for one month. The operation at our hospital was performed under a diagnosis of periampullary cancer. Whipple's operation was carried out on Dec. 14, 1998. Pathology confirmed the diagnosis of a sarcomatoid carcinoma of the duodenum. This article presents that case of a sarcomatoid carcinoma of the duodenum with a brief review of the literature.

Subcutaneous Metastasis at the PTBD Catheter Insertion Site in Bile-duct Carcinomas: Report of two cases

Percutaneous transhepatic biliary drainage (PTBD) is the basis for most biliary interventional pro cedures, and the application of preoperative PTBD to patients who have malignant obstructive jaundice has a significant effect on overall morbidity, mortality, and patient survival by allowing selective application of the most appropriate therapeutic modality. There are few case reports on subcutaneous metastasis of bile-duct cancer. We recently observed a subcutaneous metastasis at the catheter insertion site after PTBD in two patients with bile-duct cancer. Although tumor-cell seeding along the catheter tract is a very rare complication, we think that PTBD requires more attention when a curative resection is planned.

A Clinical Review of 123 Cases of Pancreaticoduodenectomy / 한국간담췌외과학회지

BACKGROUNDS: Pancreaticoduodenectomy has been applied to diseases of periampullary region since 1935 by Whipple and associates, but this procedure is so complexed that associated with high morbidity and mortality. In the treatment of periampullary cancer, curative surgical resection only promises the possibilities of cure, because other methods of treatment including chemotherapy and radiation therapy have been of little or no benefit to improve the survival rate. METHODS: We performed the clinical analysis on 123 cases of pancreaticoduodenectomies at the department of Surgery, Chonnam University Hospital, during the past 11 years from June 1986 to May 1997 to assess the associated factors with postoperative complications and the survival rate. RESULTS: Among 123 cases, 104 cases(84.6%) were malignant tumor of periampullary region, 16 cases were benign lesion, and 3 cases were type IV pancreatic injury. Pancreaticoduodenectomy was performed in 115 cases, pylorus-preserving pancreaticoduodenectomy in 4 cases, total pancreatectomy in 2 cases and extended pancreaticoduodenectomy in 2 cases. Postoperative complications were developed in 28 cases(22.8%) and the major cause of postoperative complication was the anastomotic leakage, especially in the pancreatico-jejunostomy site. The overall operative and hospital mortality rate was 7.3%. Preoperative percutaneous transhepatic biliary drainage(PTBD) and the serum level of albumin and bilirubin were not related to the development of postoperative complications. Factors affecting survival after resection of malignant tumor were the size of tumor, presence of lymph node metastasis and tumor infiltration to adjacent tissue, but the level of CEA, alphaFP, and CA 19-9 and tumor differentiation were not related to the survival rate statistically. CONCLUSION: Optimal preoperative preparation of the patient and a meticulous and standarized operative technique are mandatory to minimize the operative morbidity and mortality after pancreaticoduodenectomy. In the treatment of periampullary cancer, radical surgical resection is recommended for long-term survival, as well as the development of other treatment modalities to prevent the postoperative recurrence.