Intestinal obstruction in the terminal ileum caused by an anomalous congenital vascular band between the mesoappendix and the mesentery: report of a case.

We report a case of intestinal obstruction caused by a congenital abnormal vascular band in a 17-year-old boy. The patient was admitted with acute colicky abdominal pain, and an emergency laparotomy revealed that the ileum was strangulated by a fibrous band with vessels about 2 mm in diameter and 7 cm in length, extending from the antemesenterium of the terminal ileum to the mesoappendix. The affected intestine was resected with the band and the appendix. Histologically, the fibrous band was composed of loose connective tissue containing arteries, veins, and nerve fibers, suggesting that it was congenital and originated from a remnant of the ventral mesentery in the embryonic period. There have been few reports of intestinal obstruction being caused by a congenital vascular band, especially in patients beyond the pediatric age group.

Bile duct cancer developing 21 years after choledochoduodenostomy.

BACKGROUND: Cholangiocarcinoma in patients with choledochoenterostomy has been a rare condition with few cases reported in the literature written in English, and there have been few pathological descriptions of this disease. However, it has recently been documented as a late complication of choledochoenteric anastomosis, and has become a serious issue today since choledochoenterostomy and sphincteroplasty for benign biliary lesions were frequently resorted to in the 1970s and 1980s. The authors here present a case of a 67-year-old woman who developed a cholangiocarcinoma 21 years after choledochoduodenostomy. METHODS: The patient underwent a curative resection of the tumor with a hepatopancreatoduodenectomy after a detailed preoperative assessment, including cholangiography and cholangioscopy. RESULTS: Although this tumor has been reported to have a poor prognosis, a precise preoperative evaluation and aggressive surgery may contribute to better survival. Pathologically, the tumor originated in the bile duct mucosa of the choledochoduodenostomy, and was accompanied by intestinal and pyloric gland-like metaplasia. CONCLUSION: These epithelial changes presumably induced by chronic inflammation due to the reflux of intestinal contents and bile stasis may be responsible for the carcinogenesis.

Pseudoaneurysm of the cystic artery with hemobilia treated by arterial embolization and elective cholecystectomy.

Pseudoaneurysm of the cystic artery is a rare cause of hemobilia, with only 11 cases having been reported in the English literature. We report this unusual condition in a 62-year-old Japanese man whose chief complaint was repeated upper abdominal pain. A liver function test showed obstructive jaundice, and endoscopy revealed a small amount of blood coming from the papilla of Vater. We diagnosed him as having hemobilia, and immediate angiography was performed. The results demonstrated a pseudoaneurysm arising in the cystic artery. Selective embolization of the cystic artery then followed. Ten days later the patient underwent elective cholecystectomy and had a good postoperative course. Microscopically, the resected specimen revealed caliculous cholecystitis and an organized pseudoaneurysm perforating the lumen of the gallbladder. We supposed that this pseudoaneurysm was associated with the inflammatory reaction seen with the acute cholecystitis. This case emphasizes the need for a high level of awareness of hemobilia whenever bleeding is associated with signs of biliary disorders. Immediate angiography and embolization of the pseudoaneurysm followed by radical surgery may be the preferred strategy. We believe this is the first reported case of successful "two-step" treatment of such a pseudoaneurysm.