Conservative treatment of bronchobiliary fistula evaluated with magnetic resonance imaging.

INTRODUCTION: Bronchobiliary fistula (BBF) is a pathological communication between the bronchial system and the biliary tree that presents with bilioptysis. Many conditions can cause its development. There is still no optimal therapy for BBF. Conservative treatment is rarely indicated, as was published before in a few cases. CASE REPORT: We presented a 71-year-old Caucasian Serbin woman with BBF secondary to previous laparotomy due to multiple echinococcus liver cysts. The diagnosis was established by the presence of bilirubin and bile acids in sputum and magnetic resonance cholangiopancreatography (MRCP). A repeat MRCP performed after conservative procedure, did not reveal fistulous communication. CONCLUSION: We suggest that in small and less severe fistulas between the biliary and the bronchial tract, conservative treatment may be used successfully, and invasive treatment methods are not needed in all patients.

Assessment of depression and anxiety in patients with chronic liver disease.

BACKGROUND/AIM: In recent years mental health of patients including those with chronic liver disease (CLD), has become interesting because its disturbance leads to reduced quality of life, that is associated with worsening of clinical outcome, reduced compliance and increased mortality. The aim of the study was to determinate the frequency and severity of depression and frequency of anxiety in patients with CLD and to assess the contribution of selected socio-demographic, clinical and laboratory risk factors for depression and anxiety. METHODS: In this cross-sectional study, we used the Hamilton depression rating scale (HDRS) and Hamilton anxiety rating scale (HARS) in patients with CLD. RESULTS: The study included 54 male and 43 female patients. Depression was present in 62.9%, and anxiety in 13.4% of the patients. A higher HDRS was noted in the patients older than 50 years (p = 0.022) and unemployed patients (p = 0.043). The patients with at least one episode of gastrointestinal bleeding had a significantly higher frequency of anxiety than those without bleeding (p = 0.018). A higher HARS score was present in the women (p = 0.011), unemployed patients (p = 0.008) and those with non-alcoholic liver disease (p = 0.007). There was a significant correlation between the mean corpuscular volume (MCV) and the value of the HDRS score, and between serum potassium and sodium levels and HDRS score. CONCLUSION: Age and the mean corpuscular volume have significant influence on the HDRS score while unemployment, gastrointestinal bleeding, serum potassium and serum sodium have predictive value for HARS score.

Hepatic abscess secondary to a rosemary twig migrating from the stomach into the liver.

The ingestion of a foreign body that penetrates the gastric wall and migrates to the liver, where it causes an abscess is uncommon. A case of an ingested rosemary twig perforating the gastric antrum, then migrating to the liver, complicated by hepatic abscess and Staphylococcus aureus sepsis is reported. A 59-year-old man without a history of foreign body ingestion was admitted to our hospital because of sepsis and epigastralgia, which had progressively worsened. No foreign body was identified at preoperative imaging, but a rosemary twig was discovered during laparotomy. The liver abscess and sepsis were controlled successfully with surgery and antibiotics. This unusual condition should be kept in mind when dealing with cases of hepatic abscess, or even sepsis of unknown origin. Despite the improvement of non-surgical techniques such as percutaneous drainage and interventional endoscopy, surgery still remains important in the treatment of hepatic abscess caused by an ingested foreign body.

Double common bile duct: a case report.

Double common bile duct (DCBD) is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct (ACBD) opens in different parts of upper gastrointestinal tract (stomach, duodenum, ductus pancreaticus or septum). This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction (APBJ) and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APBJ with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APBJ and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.

Mucinous cystadenoma of the appendix associated with adenocarcinoma of the sigmoid colon and hepatocellular carcinoma of the liver: report of a case.

Mucinous cystadenoma of the appendix is a rare condition and represents one of the three entities with the common name mucocele of the appendix. It is characterized by a cystic dilatation of the lumen with stasis of mucus inside it. Histopathologically mucocele is divided into three groups: focal or diffuse mucosal hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. This condition is often associated with other neoplasia, especially adenocarcinoma of the colon and ovaries. We here describe a 57 year old male patient who presented with abdominal discomfort, constipation, fresh blood in stool and frequent urination. He had a big cystadenoma of the appendix associated with adenocarcinoma of the colon and hepatocellular carcinoma of the liver. The patient underwent right haemicolectomy, sigmoid colon resection and segmental resection of the liver. Now 3 years later he has no evidence of disease relapse. According to this, we stress the need of accurate preoperative diagnosis and intraoperative exploration of the whole abdomen in these patients.