ABSTRACT
INTRODUCTION: Acquired inhibition of coagulation factors is a rare disease, and the diagnosis is often difficult and delayed. We experienced a deficiency in all coagulation factors after hepatobiliary surgery. CASE PRESENTATION: Extended left liver resection was undertaken and hepaticojejunostomy was performed in a 70-year-old man. He had suffered from a high fever caused by cholangitis for 35 days. The major cause was a narrowing of the hepaticojejunostomy, and reconstruction was carried out. Twenty-four days later, there was a sudden massive bleed from his nose and the surgical site. Steroid pulse therapy was used as a treatment because cross mixing and some blood tests revealed the patient was experiencing an inhibition of all coagulation factors, and consequently the levels of coagulation factors dramatically recovered. DISCUSSION: We considered malignancy and surgical damages to be the underlying cause. The reported treatment and examination will help clinicians explore additional reasons for massive bleeding after a severe physical injury. CONCLUSION: We have described the first case of acquired inhibition of all coagulation factors associated with extended left lobectomy.
ABSTRACT
INTRODUCTION: Cystic duct carcinoma is a rare disease, and only 33 cases reported worldwide have completely fulfilled the criteria first established by Farrar in 1951. Here we describe an extremely rare case of early cystic duct carcinoma that fulfilled the Farrar criteria, the papillary tumour protruding into the common bile duct, leading to obstructive jaundice. CASE PRESENTATION: A 76-year-old man visited a clinic with icteric conjunctivae, and was referred to our hospital for investigation of suspected obstructive jaundice. He was initially diagnosed as having a distal bile duct carcinoma on the basis of ultrasonography (US), endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiography (MRC), and underwent pancreatoduodenectomy with regional lymphadenectomy. Macroscopic examination showed that the stalk of the papillary tumour originated from the cystic duct, and that the protruding lesion was 50 mm in size. Histopathological examination revealed the tumour to be a papillary adenocarcinoma confined within the fibromuscular layer, with no evidence of lymph node metastasis. Therefore, the final diagnosis was early cystic duct carcinoma. CONCLUSION: To our knowledge, this is the first case report of obstructive jaundice due to early carcinoma of the cystic duct protruding into the bile duct, with characteristics fulfilling the Farrar criteria.
ABSTRACT
INTRODUCTION: Hepatic angiomyolipoma is a rare tumour and is difficult to obtain the accurate diagnosis preoperatively because the imaging features are similar to hepatocellular carcinoma. PRESENTATION OF CASE: We present a case study of an 80-year old woman with a liver tumour measuring 6.2 cm × 6.0 cm. We were able to diagnose the tumour preoperatively as a rare hepatic myomatous angiomyolipoma based on the presence of early venous return evident on angiography and small low-intensity areas corresponding to fat within the tumour revealed by out-of-phase EOB-MRI. The tumour was removed by minimally invasive surgery and our preoperative diagnosis was confirmed by positive immunoreactivity for both angiomyolipoma-specific human melanoma black 45 and smooth muscle cell positivity for melanin. DISCUSSION: We consider that the information obtained in this case will be useful for preoperative diagnosis of other hepatic angiomyolipomas, thus facilitating more appropriate and less invasive surgery and improving the overall outcome. CONCLUSION: Hepatic myomatous angiomyolipoma is a rare tumour. We illustrated the two specific imaging features to diagnose it preoperatively.
