BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
BACKGROUND Recurrence of common bile duct(CBD)calculi within 30 days following T-tube cholangiography is exceedingly rare.CASE SUMMARY This article details an instance of choledocholithiasis involving a 1.2 cm×0....BACKGROUND Recurrence of common bile duct(CBD)calculi within 30 days following T-tube cholangiography is exceedingly rare.CASE SUMMARY This article details an instance of choledocholithiasis involving a 1.2 cm×0.9 cm stone located in the lower and middle segments of the CBD,identified 30 days after T-tube cholangiography,accompanied by multiple microstones.Magnetic resonance cholangiopancreatography revealed dilation of both intrahepatic and extrahepatic bile ducts,with the widest segment of the CBD measuring approximately 2 cm.The patient underwent laparoscopic choledochal exploration followed by choledochojejunostomy using the Roux-en-Y technique.CONCLUSION Although recurrence of choledocholithiasis within such a short postoperative period is exceedingly uncommon,this case underscores the necessity for clinicians to remain vigilant regarding the potential for early postoperative recurrence.展开更多
BACKGROUND Common variable immunodeficiency(CVID)is a primary antibody immunodeficiency disorder characterized by diminished IgG levels.Despite ongoing research,the precise pathogenesis of CVID remains unclear.Genetic...BACKGROUND Common variable immunodeficiency(CVID)is a primary antibody immunodeficiency disorder characterized by diminished IgG levels.Despite ongoing research,the precise pathogenesis of CVID remains unclear.Genetic factors account for only 10%-20%of cases,with an estimated incidence of 1 in 10000 to 1 in 100000,affecting individuals across all age groups.CASE SUMMARY We report the case of a 32-year-old man with CVID who presented with a chief complaint of“recurrent diarrhea and significant weight loss over the past 2 years”.Laboratory tests on admission showed fat droplets in stool,while other parameters were within normal ranges.Gastroscopy revealed a smooth gastric mucosa without bile retention or signs of Helicobacter pylori infection;however,the mucosa of the descending segment of the duodenum appeared rough.Further evaluation of the small intestine using computed tomography indicated no abnormalities.Finally,the whole-small bowel double-balloon enteroscopy(DBE)was performed,which revealed various phenotypic changes in the small intestinal mucosa.The patient was diagnosed with CVID,which improved after immunoglobulin therapy,with favorable follow-up outcomes.CONCLUSION Non-infectious enteropathy in CVID is rare.Therefore,DBE is essential for diagnosing small intestinal involvement in such cases.展开更多
BACKGROUND In patients with large stones in the common bile duct(CBD),advanced treatment modalities are generally needed.Here,we present an interesting case of a huge CBD stone treated with electrohydraulic lithotrips...BACKGROUND In patients with large stones in the common bile duct(CBD),advanced treatment modalities are generally needed.Here,we present an interesting case of a huge CBD stone treated with electrohydraulic lithotripsy(EHL)by the percutaneous approach and rendezvous endoscopic retrograde cholangiography(ERC)using a nasal endoscope.CASE SUMMARY A 91-year-old woman underwent ERC for a symptomatic large CBD stone with a diameter of 50 mm.She was referred to our institution after the failure of lithotomy by ERC,and after undergoing percutaneous transhepatic biliary drainage.We attempted to fragment the stone by transhepatic cholangioscopy using EHL.However,the stones were too large and partly soft clay-like for lithotripsy.Next,we attempted lithotomy with ERC and cholangioscopy by the rendezvous technique using a nasal endoscope and achieved complete lithotomy.No complication was observed at the end of this procedure.CONCLUSION Cholangioscopy by rendezvous technique using a nasal endoscope is a feasible and safe endoscopic method for removing huge CBD stones.展开更多
BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)has been widely used for management of gallbladder and common bile duct(CBD)stones.Post-operative clip migration is a rare...BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)has been widely used for management of gallbladder and common bile duct(CBD)stones.Post-operative clip migration is a rare complication of laparoscopic biliary surgery,which can serve as a nidus for stone formation and cause recurrent cholangitis.CASE SUMMARY A 59-year-old female was admitted to hospital because of fever and acute right upper abdominal pain.She has a history of LC and had a LCBDE surgery 2 mo ago.Physical examination revealed tenderness in the upper quadrant of right abdomen.Computed tomography scan demonstrated a high-density shadow at the distal CBD,which was considered as migrated clips.The speculation was confirmed by endoscopic retrograde cholangiopancreatography examination,and two displaced Hem-o-lok clips were removed with a stone basket.No fever or abdominal pain presented after the operation.In addition to the case report,literature regarding surgical clip migration after laparoscopic biliary surgery was reviewed and discussed.CONCLUSION Incidence of postoperative clip migration may be reduced by using clips properly and correctly;however,new methods should be explored to occlude cystic duct and vessels.If a patient with a past history of LC or LCBDE presents with features of sepsis and recurrent upper quadrant pain,clip migration must be considered as one of the differential diagnosis.展开更多
BACKGROUND We report a rare case of numbness in the right hand,finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and ...BACKGROUND We report a rare case of numbness in the right hand,finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and explain the cause of these diseases.CASE SUMMARY The patient was a 65-year-old woman.She complained of dizziness,numbness and weakness of the right hand for 6 mo.She was diagnosed with bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome by ultrasound,enhanced computed tomography,computed tomography angiography and other examinations.Considering the surgical risks,the patient refused the aberrant right subclavian artery stent implantation and was discharged.We hypothesize that these two kinds of deformity and right subclavian steal syndrome may not occur by accident and result from multiple malformations.CONCLUSION Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome is rare.This case reminds interventional radiologists of the possibility of these abnormalities before surgery.展开更多
BACKGROUND Ectopic opening of the common bile duct is a condition with low incidence.Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis.Patients wi...BACKGROUND Ectopic opening of the common bile duct is a condition with low incidence.Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis.Patients with atypical symptoms and imaging findings are easily misdiagnosed;moreover,it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography,and common bile duct stones are prone to postsurgical recurrence.CASE SUMMARY A 45-year-old male patient presented with“intermittent upper abdominal pain and elevated liver enzymes for 1 wk”.Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones.Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic.Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones.Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed.After surgery,the patient recovered well and was discharged.The patient has been followed up for 2 years since the operation.He has not experienced stone recurrence,and his liver function and quality of life are good.CONCLUSION Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.展开更多
BACKGROUND Breast cancer is the most common tumor in women,and about one-third of cases develop metastatic disease.However,metastatic breast cancer rarely invades the common bile duct(CBD)directly without involving th...BACKGROUND Breast cancer is the most common tumor in women,and about one-third of cases develop metastatic disease.However,metastatic breast cancer rarely invades the common bile duct(CBD)directly without involving the liver,and involvement of the gastrointestinal tract is rare.Cases of such metastases pose a particular diagnostic challenge.CASE SUMMARY A 55-year-old female presented to the Department of Gastroenterology with complaint of a 2 mo history of right upper abdominal pain accompanied by pain in the right back,aggravated after eating greasy diet.The patient had received a diagnosis of breast cancer 3 years prior.Physical examination showed obvious superficial protuberant erythema on the left neck and chest skin,with slight tenderness and burning sensation.Endoscopic retrograde cholangiopancreatography showed an obstruction at the end of the CBD.Histopathology of the CBD and symptomatic skin biopsies showed positivity for cytokeratin 7 and trans-acting T-cell-specific transcription factor breast cancer biomarkers.A cancer embolus was also found in the skin vasculature.Accordingly,the diagnosis of breast cancer metastases to the skin and biliary ducts was made.A plastic biliary sent was placed,which relieved the right upper abdominal pain and protected against unnecessary hepatectomy surgery.CONCLUSION Although rare,biliary metastasis should be considered in patients with bile duct stenosis and a history of breast cancer.展开更多
OBJECTIVE: To investigate beneficial effects of manual acupuncture on common cold periods and its symptoms depended on the difference onset time of common cold, within 36 h or over than that. To prove effects of manua...OBJECTIVE: To investigate beneficial effects of manual acupuncture on common cold periods and its symptoms depended on the difference onset time of common cold, within 36 h or over than that. To prove effects of manual acupuncture on common cold, a retrospective chart review was conducted.METHODS: Chart data for patients with commoncold who were treated with only manual acupuncture with fulfilling Jackson scales and satisfaction at the end of each treatment were collected via multi-centers of Oriental hospitals,Oriental medicine clinics and covalent hospital in South Korea. Totally 187 patients were divided into two groups, Group Ⅰ(115 patients, within 36 h)and Group Ⅱ(72 patients, onset time of cold over than 36 h). Finally 120 patients were observed until entire resolution of cold symptoms.RESULTS: GroupⅠ showed significant decreases themediandurationsofcompletelyrecovery(3 days;95% CI 3.0-4.0) as compared with Group Ⅱ(6 days;95% CI 4.0-7.0, P < 0.001). The manual acupuncture beneficially worked for reduction rate of common cold symptoms by 50% after initial treatment,decreased cold symptoms, and reduced cold duration.CONCLUSION: Manual acupuncture beneficially affected common cold and its symptoms.Moreover it is more susceptibility on the early time of onset cold.展开更多
BACKGROUND Most major abdominal vascular injuries are caused by penetrating injuries.A common iliac artery occlusion caused by blunt force trauma is rare,and very few cases have been reported.Because of this low incid...BACKGROUND Most major abdominal vascular injuries are caused by penetrating injuries.A common iliac artery occlusion caused by blunt force trauma is rare,and very few cases have been reported.Because of this low incidence,atypical symptoms,and frequent association with other severe injuries,the proper diagnosis tends to be missed or delayed.The gold standard for diagnosis is angiography,and treatment remains a challenge.CASE SUMMARY We report here the unusual case of a common iliac artery occlusion caused by blunt abdominal compressive trauma,with transection of the small intestine.At presentation,the patient(a 56-year-old man)complained of pain and numbness in the left lower extremity and severe pain in the whole abdomen.Physical examination showed total abdominal tenderness with evidence of peritoneal irritation.The left lower limb was pulseless and cold.Abdominal computed tomography examination revealed digestive tract perforation,and abdominal computed tomography angiography showed left common iliac artery occlusion.The patient was treated successfully by anastomosis of the intestine,percutaneous transluminal angioplasty,and stenting.The patient was followed for more than 11 mo after the operation and showed a good recovery.CONCLUSION Patients with abdominal trauma should be suspected of having major vascular injury.Individualized treatment strategies are needed for this condition.展开更多
BACKGROUND Duplication of the extrahepatic bile duct(DCBD)is an extremely rare congenital anomaly of the biliary system.There are five types of DCBD according to the latest classification.Among them,Type V is characte...BACKGROUND Duplication of the extrahepatic bile duct(DCBD)is an extremely rare congenital anomaly of the biliary system.There are five types of DCBD according to the latest classification.Among them,Type V is characterized by single drainage of the extrahepatic bile ducts.Reports on DCBD Type V are scarce.CASE SUMMARY A 77-year-old woman presented with recurrent epigastric pain but without fever or chills.Computed tomography revealed a dilated common bile duct(CBD)that harboured multiple choledocholithiasis.Endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the stones were extracted using a Dormia basket.She was discharged without any complications;however,she visited the emergency department a day after she was discharged due to epigastric pain and fever.Laboratory findings were suggestive of cholestasis.After urgent ERCP for stone removal,magnetic resonance cholangiopancreatography was performed to evaluate remnant choledocholithiasis.Magnetic resonance cholangiopancreatography revealed a DCBD Type Va and remnant choledocholithiasis in the right CBD.Both CBDs were accessed,and the stones were cleared successfully during a subsequent ERCP.CONCLUSION In this article,we report an extremely rare case of DCBD manifesting as recurrent pyogenic cholangitis.This case highlights the importance of recognizing DCBD because stones in the unrecognized bile duct could make the patient’s prognosis critical.展开更多
BACKGROUND Given its size and location,the liver is the third most injured organ by abdominal trauma.Thanks to recent advances,it is unanimously accepted that the nonoperative management is the current mainstay of tre...BACKGROUND Given its size and location,the liver is the third most injured organ by abdominal trauma.Thanks to recent advances,it is unanimously accepted that the nonoperative management is the current mainstay of treatment for hemodynamically stable patients.However,those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical management.Moreover,an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability,thereby imposing therapeutic challenges in the tertiary referral hepato-biliopancreatic centers’setting.CASE SUMMARY We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion,due to a crush polytrauma.The patient was referred to the nearest emergency hospital and because of the hemorrhagic shock,damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery,and hemostatic packing.Afterwards,the patient was referred immediately to our tertiary hepato-bilio-pancreatic center.We performed depacking,a right hepatectomy and Roux-en-Y hepaticojejunostomy.On the 9th postoperative day,the patient developed a high output anastomotic bile leak that required a redo of the cholangiojejunostomy.The postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound pressure.The follow-up was optimal,with no complications at 55 mo.CONCLUSION In conclusion,the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management,conducted in a tertiary referral hepato-bilio-pancreatic center,where a stepwise and complex surgical approach is mandatory.展开更多
BACKGROUND Cholecystectomy is a common elective procedure for cholecystic diseases,including cholecystitis and cholelithiasis.Common bile duct injury is a major complication in both open and laparoscopic cholecystecto...BACKGROUND Cholecystectomy is a common elective procedure for cholecystic diseases,including cholecystitis and cholelithiasis.Common bile duct injury is a major complication in both open and laparoscopic cholecystectomy(LC).The number of cholecystectomies performed has increased due to popularization and application of the laparoscopic technique,which has led to an increase in the number of bile duct injuries.CASE SUMMARY A 65-year-old man presented to the General Surgery Department with a complaint of repeated right upper quadrant pain for 2 years that had worsened over the previous day.The patient had a history of gallstones and hypertension.A LC was performed;it was found that a biliary stricture of 53 h duration was caused by a ligature injury of the common bile duct during the LC.Another laparoscopic exploration was performed,and the stricture was released.CONCLUSION LC is a common surgical procedure,but if a complication occurs,it is important for the surgeon to consider another exploratory surgery.展开更多
BACKGROUND In most cases,it is not difficult to differentiate common bile duct(CBD)stone from Ascaris infection because they are different disease entities and have different imaging findings.The two diseases usually ...BACKGROUND In most cases,it is not difficult to differentiate common bile duct(CBD)stone from Ascaris infection because they are different disease entities and have different imaging findings.The two diseases usually demonstrate unique characteristic findings on computed tomography or magnetic resonance cholangiopancreatography.However,we report a rare case from our experience in which a CBD stone mimicked and was misdiagnosed as Ascaris.CASE SUMMARY A 72-year-old male presented with elevated serum liver enzymes.Computed tomography showed a hyper-attenuated,elongated lesion in the CBD lumen and associated biliary inflammation.Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography revealed a linear filling defect in the bile duct.Moreover,elongated echogenic material with a central hypoechogenic area was seen on endoscopic ultrasound.Although the imaging findings caused us to suspect infection with the nematode Ascaris,the lesion was revealed to be a dark-brown-colored CBD stone through endoscopic extraction.CONCLUSION We report a rare case of a CBD stone that mimicked Ascaris.We also review the literature for side-by-side comparisons of the imaging features of CBD stones and ascariasis.展开更多
BACKGROUND Carcinosarcomas of the common bile duct(CBD)are an extremely rare finding in the clinical setting.Based on a review of 12 literatures,3 cases had the imaging features of ossification.Carcinosarcomas are pro...BACKGROUND Carcinosarcomas of the common bile duct(CBD)are an extremely rare finding in the clinical setting.Based on a review of 12 literatures,3 cases had the imaging features of ossification.Carcinosarcomas are prone to distant metastasis,as they possess clinical features of both carcinoma and sarcoma,and generally have with a poor prognosis.Due to the small number of cases reported,clinical experience in the diagnosis and treatment of the disease is lacking.CASE SUMMARY The patient was a 75-year-old woman who had experienced recurrent chills with nausea and vomiting for 3 mo.Computed tomography,magnetic resonance imaging,endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography led to the diagnosis of malignant tumor of the CBD.The patient ultimately underwent cholecystectomy,CBD resection,and choledochojejunostomy.Postoperative pathological examination revealed carcinosarcoma of the CBD,and the latest follow-up showed that the patient is recovering well.Based on previous case reports,some carcinosarcoma has ossification characteristics in imaging.If it is misdiagnosed as biliary calculi,the use of laser lithotripsy in surgery may lead to tumor diffusion.Choledochoscopy and narrow band staining of mucosa are very important for diagnosis.CONCLUSION We herein present a rare case of carcinosarcomas of the CBD,we found the tumours may have imaging features of polypoid growth and ossification only when the sarcomal components are bone differentiation,while show soft tissue shadow when non bone differentiation.Confirmation of diagnosis depends greatly upon postoperative pathological examination and the adjuvant treatment has not been established,which leads to the poor prognosis.展开更多
BACKGROUND Undifferentiated pleomorphic sarcoma(UPS)is a rare malignant mesenchymal tumor with a poor prognosis.It mainly occurs in the extremities,trunk,head and neck,and retroperitoneum regions.Owing to the lack of ...BACKGROUND Undifferentiated pleomorphic sarcoma(UPS)is a rare malignant mesenchymal tumor with a poor prognosis.It mainly occurs in the extremities,trunk,head and neck,and retroperitoneum regions.Owing to the lack of specific clinical manifestations and imaging features,UPS diagnosis mainly depends on pathological and immunohistochemical examinations for exclusive diagnosis.Here we report an extremely rare case of high-grade UPS in the common bile duct(CBD).There are limited available data on such cases.CASE SUMMARY A 70-year-old woman was admitted to our department with yellow eyes and urine accompanied by upper abdominal distending pain for 2 wk.Her laboratory data suggested significantly elevated hepatorenal function levels.The imaging data revealed calculous cholecystitis,intrahepatic and extrahepatic bile duct dilation with extrahepatic bile duct calculi,and a space-occupying lesion at the distal CBD.After endoscopic biliary stenting and symptomatic support therapy,CBD exploration and biopsy were performed.The frozen section indicated malignant spindle cell tumor of the CBD mass,and further radical pancreaticoduodenectomy was performed.Finally,the neoplasm was diagnosed as a high-grade UPS combined with the light-microscopic morphology and immunohistochemical results.CONCLUSION This extremely rare case highlighted the need for increasing physicians'vigilance,reducing the odds of misdiagnosis,and providing appropriate treatment strategies.展开更多
BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as...BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as either impaired sensation from the lower lateral leg to the top of the foot or drop foot,or as a combination of both.CASE SUMMARY We report the case of a 58-year-old Asian female who presented with inversion of the right foot during the stance phase of gait without sensory complaints related to the lower leg.Electrodiagnostic testing revealed the neuropathy of the common peroneal nerve at the level of the knee,exclusively affecting the muscular branch of the superficial peroneal nerve.A neuromuscular ultrasound disclosed swelling of the right common peroneal nerve just before it crossed over a large fabella as well as atrophy and fatty infiltration of the right peroneus longus and peroneus brevis muscles.Surgical excision of the fabella and neurolysis were performed.Subsequently,the strength of the right foot evertors improved,but the unsteady gait with occasional falls persisted for nine months after the surgery.Therefore,another procedure was performed to transfer the split posterior tibialis tendon to the peroneus brevis in order to correct the gait.CONCLUSION This is the first case of neuropathy of the common peroneal nerve caused by compression by a fabella affecting exclusively the muscular branch of the superficial peroneal nerve.Clinicians should be aware of this unusual peripheral neuropathy while evaluating and treating patients with gait disturbance.展开更多
BACKGROUND Malignant small round cell tumor(MSRCT)metastasis to the common bile duct associated with recurrent biliary hemorrhage is extremely rare.Thus far,there have been no reports of metastatic small round cell tu...BACKGROUND Malignant small round cell tumor(MSRCT)metastasis to the common bile duct associated with recurrent biliary hemorrhage is extremely rare.Thus far,there have been no reports of metastatic small round cell tumors of the common bile duct.CASE SUMMARY Herein,we report the case of a 77-year-old female patient with an MSRCT in the common bile duct.The patient was admitted to hospital due to gastrointestinal hemorrhage and abdominal pain.We found a neoplasm in the common bile duct with active bleeding through a spyglass.We performed biopsy through the spyglass and placed a metal stent to stop bleeding.The pathological result suggested that it was an MSRCT metastasized from the back to the common bile duct.Later,we found using fluorescence in situ hybridization that the SS18 gene break test was negative,ruling out the diagnosis of synovial sarcoma.CONCLUSION MSRCT is a group of tumors with similar cell morphology and diffuse histological structure.Complete tumor resection results in improved survival in patients with MSRCT.Roux-en-Y cholangiojejunostomy was performed.After excision of the common bile duct tumor,the patient felt that the abdominal pain improved and hemorrhage disappeared.The patient underwent routine fecal examination one month after surgery,indicating a negative fecal occult blood test.On May 22,2023,the patient was reexamined by abdominal computed tomography,and no abdominal space occupying lesions or abdominal lymphadenopathy was found.展开更多
BACKGROUND Adenomyomatous hyperplasia of the distal common bile duct(CBD)is very rare,with only scarce case reports in the literature.Diagnosis is usually based on imaging findings,and endoscopic biopsy is very diffic...BACKGROUND Adenomyomatous hyperplasia of the distal common bile duct(CBD)is very rare,with only scarce case reports in the literature.Diagnosis is usually based on imaging findings,and endoscopic biopsy is very difficult before operation.It is believed that adenomyomatous hyperplasia has little or no risk of malignant transformation.CASE SUMMARY A 68-year-old woman with abdominal pain in the right upper quadrant was referred to our hospital.Abdominal ultrasonography in the emergency ward revealed acute cholecystitis and dilated CBD.Laboratory findings showed elevated levels of transaminases,phosphatase,andγ-glutamyltranspeptidase.Pharmaceutical treatment for 3 d did not relieve the symptoms.Magnetic resonance cholangiopancreatography(MRCP)and computed tomography(CT)showed proximal bile duct dilatation but could not identify the cause.Endoscopic ultrasonography(EUS)demonstrated a mixed echogenic mass in the distal CBD.During surgery,a firm mass was found in the distal CBD and the Whipple procedure was performed with the initial concern of malignancy.Histology showed diffuse adenomyomatous hyperplasia.CONCLUSION EUS may be a useful choice to diagnose adenomyoma of the distal CBD before operation,especially in patients with ambiguous MRCP/CT findings.展开更多
BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated ...BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated using clips.However,postoperative migration of clips to the common bile duct(CBD)or Ttube sinus tract is an overlooked complication of laparoscopic biliary surgery.Previously,most reported cases of postoperative clip migration involved metal clips,with only a few cases involving Hem-o-lok clips and review of the literature.CASE SUMMARY This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery.Case 1 is a 68-year-old female admitted due to abdominal discomfort,and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage,and were removed using a stone extraction balloon.The patient was discharged smoothly after recovery.Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction.Nine weeks postoperatively,following T-tube removal,a Hem-o-lok clip was found in the sinus tract,and was extracted from the T-tube sinus tract.The patient recovered smoothly postoperatively.This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD,T-tube sinus tract,or duodenum.CONCLUSION In patients with a history of LC and/or LCBDE,clip migration should be considered as a differential diagnosis.展开更多
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
基金Supported by the Key Research and Development Program of Shaanxi Province,China,No.2021GXLH-Z-100.
文摘BACKGROUND Recurrence of common bile duct(CBD)calculi within 30 days following T-tube cholangiography is exceedingly rare.CASE SUMMARY This article details an instance of choledocholithiasis involving a 1.2 cm×0.9 cm stone located in the lower and middle segments of the CBD,identified 30 days after T-tube cholangiography,accompanied by multiple microstones.Magnetic resonance cholangiopancreatography revealed dilation of both intrahepatic and extrahepatic bile ducts,with the widest segment of the CBD measuring approximately 2 cm.The patient underwent laparoscopic choledochal exploration followed by choledochojejunostomy using the Roux-en-Y technique.CONCLUSION Although recurrence of choledocholithiasis within such a short postoperative period is exceedingly uncommon,this case underscores the necessity for clinicians to remain vigilant regarding the potential for early postoperative recurrence.
基金Supported by National Natural Science Foundation of China,No.82360120Ten Thousand Doctor Plan in Yunnan Province,No.YNWRMY-2018-020Yunnan Provincial Key Laboratory of Clinical Virology,No.202205AG070053-07.
文摘BACKGROUND Common variable immunodeficiency(CVID)is a primary antibody immunodeficiency disorder characterized by diminished IgG levels.Despite ongoing research,the precise pathogenesis of CVID remains unclear.Genetic factors account for only 10%-20%of cases,with an estimated incidence of 1 in 10000 to 1 in 100000,affecting individuals across all age groups.CASE SUMMARY We report the case of a 32-year-old man with CVID who presented with a chief complaint of“recurrent diarrhea and significant weight loss over the past 2 years”.Laboratory tests on admission showed fat droplets in stool,while other parameters were within normal ranges.Gastroscopy revealed a smooth gastric mucosa without bile retention or signs of Helicobacter pylori infection;however,the mucosa of the descending segment of the duodenum appeared rough.Further evaluation of the small intestine using computed tomography indicated no abnormalities.Finally,the whole-small bowel double-balloon enteroscopy(DBE)was performed,which revealed various phenotypic changes in the small intestinal mucosa.The patient was diagnosed with CVID,which improved after immunoglobulin therapy,with favorable follow-up outcomes.CONCLUSION Non-infectious enteropathy in CVID is rare.Therefore,DBE is essential for diagnosing small intestinal involvement in such cases.
文摘BACKGROUND In patients with large stones in the common bile duct(CBD),advanced treatment modalities are generally needed.Here,we present an interesting case of a huge CBD stone treated with electrohydraulic lithotripsy(EHL)by the percutaneous approach and rendezvous endoscopic retrograde cholangiography(ERC)using a nasal endoscope.CASE SUMMARY A 91-year-old woman underwent ERC for a symptomatic large CBD stone with a diameter of 50 mm.She was referred to our institution after the failure of lithotomy by ERC,and after undergoing percutaneous transhepatic biliary drainage.We attempted to fragment the stone by transhepatic cholangioscopy using EHL.However,the stones were too large and partly soft clay-like for lithotripsy.Next,we attempted lithotomy with ERC and cholangioscopy by the rendezvous technique using a nasal endoscope and achieved complete lithotomy.No complication was observed at the end of this procedure.CONCLUSION Cholangioscopy by rendezvous technique using a nasal endoscope is a feasible and safe endoscopic method for removing huge CBD stones.
基金Medical and Health Technology Plan of Zhejiang Province,No.2019RC179.
文摘BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)has been widely used for management of gallbladder and common bile duct(CBD)stones.Post-operative clip migration is a rare complication of laparoscopic biliary surgery,which can serve as a nidus for stone formation and cause recurrent cholangitis.CASE SUMMARY A 59-year-old female was admitted to hospital because of fever and acute right upper abdominal pain.She has a history of LC and had a LCBDE surgery 2 mo ago.Physical examination revealed tenderness in the upper quadrant of right abdomen.Computed tomography scan demonstrated a high-density shadow at the distal CBD,which was considered as migrated clips.The speculation was confirmed by endoscopic retrograde cholangiopancreatography examination,and two displaced Hem-o-lok clips were removed with a stone basket.No fever or abdominal pain presented after the operation.In addition to the case report,literature regarding surgical clip migration after laparoscopic biliary surgery was reviewed and discussed.CONCLUSION Incidence of postoperative clip migration may be reduced by using clips properly and correctly;however,new methods should be explored to occlude cystic duct and vessels.If a patient with a past history of LC or LCBDE presents with features of sepsis and recurrent upper quadrant pain,clip migration must be considered as one of the differential diagnosis.
基金Supported by Fujian Province Medical Innovation Project,No.2016-CXB-13
文摘BACKGROUND We report a rare case of numbness in the right hand,finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and explain the cause of these diseases.CASE SUMMARY The patient was a 65-year-old woman.She complained of dizziness,numbness and weakness of the right hand for 6 mo.She was diagnosed with bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome by ultrasound,enhanced computed tomography,computed tomography angiography and other examinations.Considering the surgical risks,the patient refused the aberrant right subclavian artery stent implantation and was discharged.We hypothesize that these two kinds of deformity and right subclavian steal syndrome may not occur by accident and result from multiple malformations.CONCLUSION Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome is rare.This case reminds interventional radiologists of the possibility of these abnormalities before surgery.
基金Supported by The Key Research and Development Program of Gansu,No. 17YF1FA128Lanzhou Science and Technology Bureau Innovation and Entrepreneurship Talent Program,No. 2017-RC-37.
文摘BACKGROUND Ectopic opening of the common bile duct is a condition with low incidence.Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis.Patients with atypical symptoms and imaging findings are easily misdiagnosed;moreover,it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography,and common bile duct stones are prone to postsurgical recurrence.CASE SUMMARY A 45-year-old male patient presented with“intermittent upper abdominal pain and elevated liver enzymes for 1 wk”.Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones.Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic.Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones.Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed.After surgery,the patient recovered well and was discharged.The patient has been followed up for 2 years since the operation.He has not experienced stone recurrence,and his liver function and quality of life are good.CONCLUSION Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.
基金Top-level Clinical Discipline Project of Shanghai Pudong,No.PWYgf2018-04.
文摘BACKGROUND Breast cancer is the most common tumor in women,and about one-third of cases develop metastatic disease.However,metastatic breast cancer rarely invades the common bile duct(CBD)directly without involving the liver,and involvement of the gastrointestinal tract is rare.Cases of such metastases pose a particular diagnostic challenge.CASE SUMMARY A 55-year-old female presented to the Department of Gastroenterology with complaint of a 2 mo history of right upper abdominal pain accompanied by pain in the right back,aggravated after eating greasy diet.The patient had received a diagnosis of breast cancer 3 years prior.Physical examination showed obvious superficial protuberant erythema on the left neck and chest skin,with slight tenderness and burning sensation.Endoscopic retrograde cholangiopancreatography showed an obstruction at the end of the CBD.Histopathology of the CBD and symptomatic skin biopsies showed positivity for cytokeratin 7 and trans-acting T-cell-specific transcription factor breast cancer biomarkers.A cancer embolus was also found in the skin vasculature.Accordingly,the diagnosis of breast cancer metastases to the skin and biliary ducts was made.A plastic biliary sent was placed,which relieved the right upper abdominal pain and protected against unnecessary hepatectomy surgery.CONCLUSION Although rare,biliary metastasis should be considered in patients with bile duct stenosis and a history of breast cancer.
基金Supported by Educational Research in 2014(the Project of Intramural Research Supporting Program,No.201400950001)from Daejeon UniversityStudy of Acupuncture Therapy in Traditional Korean Medicine(Theory of the Acupuncture Lecture in South Korea,No.2014-001A)
文摘OBJECTIVE: To investigate beneficial effects of manual acupuncture on common cold periods and its symptoms depended on the difference onset time of common cold, within 36 h or over than that. To prove effects of manual acupuncture on common cold, a retrospective chart review was conducted.METHODS: Chart data for patients with commoncold who were treated with only manual acupuncture with fulfilling Jackson scales and satisfaction at the end of each treatment were collected via multi-centers of Oriental hospitals,Oriental medicine clinics and covalent hospital in South Korea. Totally 187 patients were divided into two groups, Group Ⅰ(115 patients, within 36 h)and Group Ⅱ(72 patients, onset time of cold over than 36 h). Finally 120 patients were observed until entire resolution of cold symptoms.RESULTS: GroupⅠ showed significant decreases themediandurationsofcompletelyrecovery(3 days;95% CI 3.0-4.0) as compared with Group Ⅱ(6 days;95% CI 4.0-7.0, P < 0.001). The manual acupuncture beneficially worked for reduction rate of common cold symptoms by 50% after initial treatment,decreased cold symptoms, and reduced cold duration.CONCLUSION: Manual acupuncture beneficially affected common cold and its symptoms.Moreover it is more susceptibility on the early time of onset cold.
文摘BACKGROUND Most major abdominal vascular injuries are caused by penetrating injuries.A common iliac artery occlusion caused by blunt force trauma is rare,and very few cases have been reported.Because of this low incidence,atypical symptoms,and frequent association with other severe injuries,the proper diagnosis tends to be missed or delayed.The gold standard for diagnosis is angiography,and treatment remains a challenge.CASE SUMMARY We report here the unusual case of a common iliac artery occlusion caused by blunt abdominal compressive trauma,with transection of the small intestine.At presentation,the patient(a 56-year-old man)complained of pain and numbness in the left lower extremity and severe pain in the whole abdomen.Physical examination showed total abdominal tenderness with evidence of peritoneal irritation.The left lower limb was pulseless and cold.Abdominal computed tomography examination revealed digestive tract perforation,and abdominal computed tomography angiography showed left common iliac artery occlusion.The patient was treated successfully by anastomosis of the intestine,percutaneous transluminal angioplasty,and stenting.The patient was followed for more than 11 mo after the operation and showed a good recovery.CONCLUSION Patients with abdominal trauma should be suspected of having major vascular injury.Individualized treatment strategies are needed for this condition.
文摘BACKGROUND Duplication of the extrahepatic bile duct(DCBD)is an extremely rare congenital anomaly of the biliary system.There are five types of DCBD according to the latest classification.Among them,Type V is characterized by single drainage of the extrahepatic bile ducts.Reports on DCBD Type V are scarce.CASE SUMMARY A 77-year-old woman presented with recurrent epigastric pain but without fever or chills.Computed tomography revealed a dilated common bile duct(CBD)that harboured multiple choledocholithiasis.Endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the stones were extracted using a Dormia basket.She was discharged without any complications;however,she visited the emergency department a day after she was discharged due to epigastric pain and fever.Laboratory findings were suggestive of cholestasis.After urgent ERCP for stone removal,magnetic resonance cholangiopancreatography was performed to evaluate remnant choledocholithiasis.Magnetic resonance cholangiopancreatography revealed a DCBD Type Va and remnant choledocholithiasis in the right CBD.Both CBDs were accessed,and the stones were cleared successfully during a subsequent ERCP.CONCLUSION In this article,we report an extremely rare case of DCBD manifesting as recurrent pyogenic cholangitis.This case highlights the importance of recognizing DCBD because stones in the unrecognized bile duct could make the patient’s prognosis critical.
文摘BACKGROUND Given its size and location,the liver is the third most injured organ by abdominal trauma.Thanks to recent advances,it is unanimously accepted that the nonoperative management is the current mainstay of treatment for hemodynamically stable patients.However,those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical management.Moreover,an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability,thereby imposing therapeutic challenges in the tertiary referral hepato-biliopancreatic centers’setting.CASE SUMMARY We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion,due to a crush polytrauma.The patient was referred to the nearest emergency hospital and because of the hemorrhagic shock,damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery,and hemostatic packing.Afterwards,the patient was referred immediately to our tertiary hepato-bilio-pancreatic center.We performed depacking,a right hepatectomy and Roux-en-Y hepaticojejunostomy.On the 9th postoperative day,the patient developed a high output anastomotic bile leak that required a redo of the cholangiojejunostomy.The postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound pressure.The follow-up was optimal,with no complications at 55 mo.CONCLUSION In conclusion,the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management,conducted in a tertiary referral hepato-bilio-pancreatic center,where a stepwise and complex surgical approach is mandatory.
基金Supported by National Natural Science Foundation of China,No.81701965。
文摘BACKGROUND Cholecystectomy is a common elective procedure for cholecystic diseases,including cholecystitis and cholelithiasis.Common bile duct injury is a major complication in both open and laparoscopic cholecystectomy(LC).The number of cholecystectomies performed has increased due to popularization and application of the laparoscopic technique,which has led to an increase in the number of bile duct injuries.CASE SUMMARY A 65-year-old man presented to the General Surgery Department with a complaint of repeated right upper quadrant pain for 2 years that had worsened over the previous day.The patient had a history of gallstones and hypertension.A LC was performed;it was found that a biliary stricture of 53 h duration was caused by a ligature injury of the common bile duct during the LC.Another laparoscopic exploration was performed,and the stricture was released.CONCLUSION LC is a common surgical procedure,but if a complication occurs,it is important for the surgeon to consider another exploratory surgery.
基金Soonchunhyang University Research Fund,No.20200019.
文摘BACKGROUND In most cases,it is not difficult to differentiate common bile duct(CBD)stone from Ascaris infection because they are different disease entities and have different imaging findings.The two diseases usually demonstrate unique characteristic findings on computed tomography or magnetic resonance cholangiopancreatography.However,we report a rare case from our experience in which a CBD stone mimicked and was misdiagnosed as Ascaris.CASE SUMMARY A 72-year-old male presented with elevated serum liver enzymes.Computed tomography showed a hyper-attenuated,elongated lesion in the CBD lumen and associated biliary inflammation.Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography revealed a linear filling defect in the bile duct.Moreover,elongated echogenic material with a central hypoechogenic area was seen on endoscopic ultrasound.Although the imaging findings caused us to suspect infection with the nematode Ascaris,the lesion was revealed to be a dark-brown-colored CBD stone through endoscopic extraction.CONCLUSION We report a rare case of a CBD stone that mimicked Ascaris.We also review the literature for side-by-side comparisons of the imaging features of CBD stones and ascariasis.
文摘BACKGROUND Carcinosarcomas of the common bile duct(CBD)are an extremely rare finding in the clinical setting.Based on a review of 12 literatures,3 cases had the imaging features of ossification.Carcinosarcomas are prone to distant metastasis,as they possess clinical features of both carcinoma and sarcoma,and generally have with a poor prognosis.Due to the small number of cases reported,clinical experience in the diagnosis and treatment of the disease is lacking.CASE SUMMARY The patient was a 75-year-old woman who had experienced recurrent chills with nausea and vomiting for 3 mo.Computed tomography,magnetic resonance imaging,endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography led to the diagnosis of malignant tumor of the CBD.The patient ultimately underwent cholecystectomy,CBD resection,and choledochojejunostomy.Postoperative pathological examination revealed carcinosarcoma of the CBD,and the latest follow-up showed that the patient is recovering well.Based on previous case reports,some carcinosarcoma has ossification characteristics in imaging.If it is misdiagnosed as biliary calculi,the use of laser lithotripsy in surgery may lead to tumor diffusion.Choledochoscopy and narrow band staining of mucosa are very important for diagnosis.CONCLUSION We herein present a rare case of carcinosarcomas of the CBD,we found the tumours may have imaging features of polypoid growth and ossification only when the sarcomal components are bone differentiation,while show soft tissue shadow when non bone differentiation.Confirmation of diagnosis depends greatly upon postoperative pathological examination and the adjuvant treatment has not been established,which leads to the poor prognosis.
基金Supported by the People’s Livelihood Science and Technology Innovation Project of the Bureau of Science and Technology of Jiaxing City,No.2021AD30091.
文摘BACKGROUND Undifferentiated pleomorphic sarcoma(UPS)is a rare malignant mesenchymal tumor with a poor prognosis.It mainly occurs in the extremities,trunk,head and neck,and retroperitoneum regions.Owing to the lack of specific clinical manifestations and imaging features,UPS diagnosis mainly depends on pathological and immunohistochemical examinations for exclusive diagnosis.Here we report an extremely rare case of high-grade UPS in the common bile duct(CBD).There are limited available data on such cases.CASE SUMMARY A 70-year-old woman was admitted to our department with yellow eyes and urine accompanied by upper abdominal distending pain for 2 wk.Her laboratory data suggested significantly elevated hepatorenal function levels.The imaging data revealed calculous cholecystitis,intrahepatic and extrahepatic bile duct dilation with extrahepatic bile duct calculi,and a space-occupying lesion at the distal CBD.After endoscopic biliary stenting and symptomatic support therapy,CBD exploration and biopsy were performed.The frozen section indicated malignant spindle cell tumor of the CBD mass,and further radical pancreaticoduodenectomy was performed.Finally,the neoplasm was diagnosed as a high-grade UPS combined with the light-microscopic morphology and immunohistochemical results.CONCLUSION This extremely rare case highlighted the need for increasing physicians'vigilance,reducing the odds of misdiagnosis,and providing appropriate treatment strategies.
基金Supported by the National Cheng Kung University Hospital,Taiwan,No.NCKUH-11210036.
文摘BACKGROUND Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy.Involving both the superficial and deep peroneal nerves,it usually manifests as either impaired sensation from the lower lateral leg to the top of the foot or drop foot,or as a combination of both.CASE SUMMARY We report the case of a 58-year-old Asian female who presented with inversion of the right foot during the stance phase of gait without sensory complaints related to the lower leg.Electrodiagnostic testing revealed the neuropathy of the common peroneal nerve at the level of the knee,exclusively affecting the muscular branch of the superficial peroneal nerve.A neuromuscular ultrasound disclosed swelling of the right common peroneal nerve just before it crossed over a large fabella as well as atrophy and fatty infiltration of the right peroneus longus and peroneus brevis muscles.Surgical excision of the fabella and neurolysis were performed.Subsequently,the strength of the right foot evertors improved,but the unsteady gait with occasional falls persisted for nine months after the surgery.Therefore,another procedure was performed to transfer the split posterior tibialis tendon to the peroneus brevis in order to correct the gait.CONCLUSION This is the first case of neuropathy of the common peroneal nerve caused by compression by a fabella affecting exclusively the muscular branch of the superficial peroneal nerve.Clinicians should be aware of this unusual peripheral neuropathy while evaluating and treating patients with gait disturbance.
文摘BACKGROUND Malignant small round cell tumor(MSRCT)metastasis to the common bile duct associated with recurrent biliary hemorrhage is extremely rare.Thus far,there have been no reports of metastatic small round cell tumors of the common bile duct.CASE SUMMARY Herein,we report the case of a 77-year-old female patient with an MSRCT in the common bile duct.The patient was admitted to hospital due to gastrointestinal hemorrhage and abdominal pain.We found a neoplasm in the common bile duct with active bleeding through a spyglass.We performed biopsy through the spyglass and placed a metal stent to stop bleeding.The pathological result suggested that it was an MSRCT metastasized from the back to the common bile duct.Later,we found using fluorescence in situ hybridization that the SS18 gene break test was negative,ruling out the diagnosis of synovial sarcoma.CONCLUSION MSRCT is a group of tumors with similar cell morphology and diffuse histological structure.Complete tumor resection results in improved survival in patients with MSRCT.Roux-en-Y cholangiojejunostomy was performed.After excision of the common bile duct tumor,the patient felt that the abdominal pain improved and hemorrhage disappeared.The patient underwent routine fecal examination one month after surgery,indicating a negative fecal occult blood test.On May 22,2023,the patient was reexamined by abdominal computed tomography,and no abdominal space occupying lesions or abdominal lymphadenopathy was found.
基金Supported by The Program for Diagnostic and Therapeutic Technique of Clinically Important Disease in Suzhou,No.LCZX201707Program for GUSU Medicine Talents,No.GSWS2019012
文摘BACKGROUND Adenomyomatous hyperplasia of the distal common bile duct(CBD)is very rare,with only scarce case reports in the literature.Diagnosis is usually based on imaging findings,and endoscopic biopsy is very difficult before operation.It is believed that adenomyomatous hyperplasia has little or no risk of malignant transformation.CASE SUMMARY A 68-year-old woman with abdominal pain in the right upper quadrant was referred to our hospital.Abdominal ultrasonography in the emergency ward revealed acute cholecystitis and dilated CBD.Laboratory findings showed elevated levels of transaminases,phosphatase,andγ-glutamyltranspeptidase.Pharmaceutical treatment for 3 d did not relieve the symptoms.Magnetic resonance cholangiopancreatography(MRCP)and computed tomography(CT)showed proximal bile duct dilatation but could not identify the cause.Endoscopic ultrasonography(EUS)demonstrated a mixed echogenic mass in the distal CBD.During surgery,a firm mass was found in the distal CBD and the Whipple procedure was performed with the initial concern of malignancy.Histology showed diffuse adenomyomatous hyperplasia.CONCLUSION EUS may be a useful choice to diagnose adenomyoma of the distal CBD before operation,especially in patients with ambiguous MRCP/CT findings.
基金Supported by Shenzhen Science and Technology Program Project,No.JCYJ20220530145006013.
文摘BACKGROUND Laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)are widely used in gallbladder and biliary tract diseases.During these procedures,vessels or tissues are commonly ligated using clips.However,postoperative migration of clips to the common bile duct(CBD)or Ttube sinus tract is an overlooked complication of laparoscopic biliary surgery.Previously,most reported cases of postoperative clip migration involved metal clips,with only a few cases involving Hem-o-lok clips and review of the literature.CASE SUMMARY This report describes two cases in which Hem-o-lok clips migrated into the CBD and the T-tube sinus tract following laparoscopic surgery.Case 1 is a 68-year-old female admitted due to abdominal discomfort,and two Hem-o-lok clips were found to have migrated into the CBD 17 months after LC and LCBDE with T-tube drainage,and were removed using a stone extraction balloon.The patient was discharged smoothly after recovery.Case 2 is a 74-year-old male who underwent LC and LCBDE with T-tube drainage and laparoscopic biliary tract basket stone extraction.Nine weeks postoperatively,following T-tube removal,a Hem-o-lok clip was found in the sinus tract,and was extracted from the T-tube sinus tract.The patient recovered smoothly postoperatively.This study also reviews the literature from 2013 to July 2024 on using Hem-o-lok clips in LC and/or LCBDE treatment of gallbladder and biliary diseases and the postoperative migration of these clips into the CBD,T-tube sinus tract,or duodenum.CONCLUSION In patients with a history of LC and/or LCBDE,clip migration should be considered as a differential diagnosis.
