Management of symptomatic liver cysts.

Non-parasitic liver cysts are seen in up to 5% of the population. They become symptomatic when they are large and can cause pain, nausea, vomiting, early satiety and obstructive jaundice. Treatment modalities include percutaneous drainage, open deroofing, hepatic resection and lately, laparoscopic deroofing. We assessed our management of eleven symptomatic patients over the last five years between May 1996 and August 2001. Two of these had mild symptoms and were kept under review. The remaining nine were treated surgically. Of these, eight were treated by laparotomy and open deroofing with argon laser coagulation of the cut edges while one was treated with left hepatic resection. Three of these had been previously treated with laparoscopic deroofing at other hospitals and had been referred after having developed recurrent symptomatic cysts. Two patients developed post-operative complications--bile leakage that resolved with conservative management. The patients were followed up for a median period of twelve months ranging from 3-62 months. One patient died of liver failure 12 months after surgery. There was no symptomatic recurrence. We conclude that open cyst deroofing gives marked symptomatic relief with a very low complication rate. In today's era of laparoscopic surgery, it has a definite role in the management of symptomatic liver cysts, more so in recurrent cysts following laparoscopic treatment.

Transduodenal excision of ampullary tumours.

The commonly recommended treatment for ampullary tumours--pancreaticoduodenectomy results in significant morbidity and mortality. This study is a retrospective evaluation of the procedure of transduodenal local excision of ampullary tumours. Demographics, symptoms, histological findings and outcomes were retrospectively analysed in 15 patients. Survival analysis was done by the method of Kaplan-Meier and log-rank test. The median age was 68 years (range 54-78). Endoscopic biopsy was accurate in only 41% of cases. CT scan demonstrated a mass in 50% cases. Definitive histology reported 4 adenomas, 2 carcinomas-in-situ and 9 adenocarcinomas. Median hospital stay was 13 days. There was no operative mortality. Mean duration of follow-up was 31 months (range 7-70 months). The procedure appears curative for adenomas and in-situ carcinoma. Overall 3 year actuarial survival for ampullary tumours is 65% while that for moderately differentiated carcinomas is 50%. Pre-operative investigations provide inadequate histological information. Wide local excision is a safe operation with low morbidity and good survival in carefully selected cases. However, the role of local excision for carcinoma appears to be palliative rather than curative.

Endometrioma of the liver.

Hepatic endometriosis is extremely rare. The diagnosis is often missed and treatment is delayed. A 37-year-old woman was referred to the gynaecology department with vague abdominal pains. She had a past history of pelvic endometriosis and hysterectomy with bilateral salpingo-oophorectomy. Further investigations in due course confirmed it to be endometriosis of the liver. She was eventually referred to the hepatobiliary unit, almost three years after her first presentation, where she was operated on with good results.

True aneurysm of a femoropopliteal vein graft.

Aneurysmal dilatation of saphenous vein grafts mostly represent thin-walled pseudoaneurysms at anastomotic sites. True aneurysmal dilatation of femoropopliteal bypass vein grafts is rare. We report this unusual case, which was repaired with a prosthetic graft.