The effect of fenestration procedure on liver regeneration in a case of polycystic liver disease.

We encountered a case of polycystic liver disease for which unroofing and fenestration procedures were performed. The patient was a 55-year-old Japanese female with epigastralgia and abdominal fullness. On computed tomography, millions of low-density areas were seen, particularly in S6, 7, where huge cysts 15 cm in diameter were observed. Magnetic resonance imaging showed a T1 low T2 high-intensity lesion, which was compatible with simple cysts. Unroofing for the cysts in S6, 7 and fenestration of other cysts were performed. Histological examination revealed cuboidal and flat monolayer epithelia with no dysplasia in the wall of the cysts. The postoperative course was uneventful, and the patient's abdominal symptoms remarkably improved. The percentage of the liver volume which was increased in relation to standard liver volume was reduced from 241% (3386 mL: liver parenchyma 750 mL, cysts 2636 mL) to 180% (2525 mL, 1566 mL, 959 mL, respectively) after surgery. The potent mitogen, hepatocyte growth factor, was rapidly increased after the operation and stayed high during the observation period. In this patient, since no liver resection was performed, liver regenerative stimulus was considered to be the loss of space. This phenomenon represents a model of liver regeneration in response to loss of occupied space in an absence of shear stress.

[Findings of MR and MR cholangiopancreatography in acute cholecystitis].

We retrospectively reviewed magnetic resonance cholangiopancreatography (MRCP) of 25 patients with acute cholecystitis based on clinical, sonographic and surgical findings. Intramural high signal intensity on MRCP was demonstrated in 22 of the 25 patients (88%), and pericholedochal high signal intensity was observed in 6 of the 25 patients (24%). Pericholecystic or perihepatic fluid was demonstrated in 6 of the 25 patients (24%). Gallbladder stones were identified in all 21 patients (100%) by sonography, in 19 of the 21 (90%) by MRCP and in 11 of 18 patients by CT (CT was not performed in other 3 patients). Common bile duct calculi were detected in all 6 patients (100%) by MRCP, in 2 of the 6 (33%) by sonography, and in 5 of the 6 (50%) by CT with confirmation of surgical finding or endoscopic retrograde cholangiography (ERC). MRCP had a high accuracy in diagnosing acute cholecystitis with the finding of intramural high signal intensity. MRCP is an excellent method to evaluate acute biliary disease and may replace CT and ERC in the preoperative evaluation of acute cholecystitis.