Successful Conservative Treatment of an Elderly Patient with Corrosive Proctocolitis.

Corrosive proctocolitis has occurred after accidental contamination of endoscopes in most patients. But accidental administration of corrosive agents for bowel cleansing can occur. The agents implicated for chemical colitis is 15% hydrochloric acid and 2% ethoxylated alcohol. We present a case of corrosive proctocolitis, present with anal pain and bloody diarrhea. Endoscopy revealed edema, erythema, and friability of the colonic mucosa. An experience of successful nonoperative treatments has been demonstrated.

Papillomatosis of the Biliary Tree and Gallbladder: Successful Treatment With Repeated Resection and Liver Transplant.

Intraductal papillary neoplasm of the bile duct is now considered to be a specific type of bile duct tumor. The progenitor cells of intraductal papillary neoplasms of the bile duct are located in the peribiliary gland, which are distributed along the intrahepatic bile duct, extrahepatic bile duct, and gallbladder; therefore, these neoplasms could arise in any area. The mainstay of treatment for patients with intraductal papillary neoplasm of the bile duct is complete surgical resection. Neoplasms involving both lobes of the liver can only be treated with liver transplant. There have been 11 reported cases of patients with biliary papillomatosis treated with liver transplant. In all of these cases, involvement was limited to the bile duct. Herein, we present the first case of papillomatosis with extensive involvement in the intrahepatic bile duct, the extrahepatic bile duct, and the gallbladder, which was successfully treated with repeated resection and liver transplant.

Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand.

AIM: To examine survival outcomes of perihilar cholangiocarcinoma (PCCA) resection including mortality, morbidity and prognostic factors. METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011. RESULTS: There were 29 (19%) cases of intrahepatic CCA that involved hilar and 124 (81%) with hilar bile-duct cancer. R0 resection was carried out on 66 (43.1%) patients of whom 50 (32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6% (95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1. CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.

Computerized tomographic findings of hepatic fascioliasis compared with melioidosis-caused liver abscesses.

OBJECTIVE: To compare the computerized tomographic (CT) findings of hepatic fascioliasis (HF) vs. melioidosis-caused liver (ML) abscesses. MATERIAL AND METHOD: CT images of 15 patients with hepatic fascioliasis (HF) and 16 patients with melioidosis-caused liver (ML) abscesses were retrospectively reviewed. The authors evaluated and compared HF and ML abscesses (by chi2 and Fisher exact tests) vis-a-vis their location of liver involvement, size, shape, number margins, enhancement patterns, subcapsular lesions, internal architecture, dilatation of intrahepatic bile duct and combination with splenic abscesses. RESULTS: Fourteen HF patients had only liver abscesses and 1 had combined liver and splenic abscesses. Four ML patients had liver abscesses alone while 12 had combined liver and splenic abscesses (p = 0.000). Eight of the 15 HF (53.3%) and 2 of the 16 ML (12.5%) patients had subcapsular lesions (p = 0.019). The liver abscesses were round or oval with linear tracts in 8 of the 15 HF (53.3%) and none of the ML patients (p = 0.001). Between the respective HF and ML patients, there was a significant difference in those with round shaped in ML (p = 0.008), multiple and conglomerately distributed in HF (p = 0.050), multiple and discretely distributed in ML (p = 0.001) no (or minimal) peripheral contrast enhancement in HF (p = 0.011) and moderate or mark peripheral enhancement in ML (p = 0.011). CONCLUSION: The CT findings of liver abscesses that helped to differentiate hepatic fascioliasis from melioidosis liver abscesses were: their number shape, enhancement pattern, presence of subcapsular lesion (s) and co-occurrence with splenic abscesses. The diagnosis of hepatic fascioliasis by CT is suggested when the following characteristics were seen: (1) multiple, small round or oval (with linear tracts) conglomerates presenting as hypodense lesions; (2) no (or minimal) peripheral contrast enhancement; (3) subcapsular lesions; or (4) less frequent co-occurrence with splenic abscesses.