Usefulness of multi-3-dimensional computed tomograms fused with multiplanar reconstruction images and peroral cholangioscopy findings in hilar cholangiocarcinoma.

Multiplanar reconstruction (MPR) images are used for assessing horizontal and vertical extent of hilar cholangiocarcinoma, while peroral cholangioscopy (POCS) is used for diagnosing ductal spread and mapping biopsy. We fused conventional 3-dimensional computed tomography (3DCT) with MPR images and POCS findings for preoperative assessment of cholangiocarcinoma. The extent of cancer was assessed using MPR images, which were plotted and fused onto 3DCT cholangiography. In addition, the results of mapping biopsy performed under POCS were marked on virtual endoscopic imaging and transferred onto a 3DCT image. Once an angiographic CT image was fused, a multi-3DCT image was created. The incision line was determined based on these images. Multi-3DCT images were created for 13 patients with hilar cholangiocarcinoma. Of 10 patients who underwent POCS, superficial spread was observed in two. Resection was performed in 12 patients. In two cases, the cut end of the intrahepatic bile duct was positive, resulting in 83.3% diagnostic accuracy for horizontal spread. In all patients, the estimated number of bile ducts was the same as the number of the actual resections. R0 resection was achieved in 10 patients (83.3%). Multi-3DCT imaging proved useful in diagnosing longitudinal ductal spread of hilar cholangiocarcinoma.

Bacterial contamination in ascitic fluid is associated with the development of clinically relevant pancreatic fistula after pancreatoduodenectomy.

OBJECTIVES: Clinically relevant postoperative pancreatic fistula (POPF) after pancreatoduodenectomy is often accompanied by bacterial infection. To elucidate the mechanism of bacterial infection associated with POPF, we investigated the relationship between POPF and bacteria isolated from ascitic fluid and removed drains. METHODS: Subjects were 101 patients who had undergone pancreatoduodenectomy. Microbial culture was performed using ascitic fluid obtained from drains. We also compared the isolated bacteria from removed drains on postoperative day (POD) 4 and after POD 7. RESULTS: In 23 patients (22.8%), microbial cultures were already positive on POD 1, although purulent discharge was not observed. Among patients with grade B/C POPF, bacteria were detected on POD 1 in 53.8%; these isolated bacteria were the same as those isolated after POPF formation. In contrast, only 7.7% of patients with grade A POPF were positive on POD 1. The number of bacteria isolated from drains removed after POD 7 significantly increased compared with those isolated from drains removed on POD 4. CONCLUSIONS: Bacterial contamination in ascitic fluid may be an initiating event that leads to the development of clinically relevant POPF. Therefore, it is important to perform both the administration of the appropriate antibiotics and early drain removal.