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Volume 13 (1999)
- Issue 4 Pages 301-
- Issue 3 Pages 139-
- Issue 2 Pages 81-
- Issue 1 Pages 21-
Volume 13, Issue 1
Displaying 1-8 of 8 articles from this issue
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Minoru HORIGUCHI, Masayuki IWABUCHI, Keisuke KAWABATA1999 Volume 13 Issue 1 Pages 21-31
Published: February 25, 1999
Released on J-STAGE: November 13, 2012
JOURNAL FREE ACCESSA 75-year-old female was admitted due to a liver function disturbance. She was diagnosed with an upper bile duct carcinoma by preoperative direct cholangiography. On June 10,1991 following en block resection of the gallbladder and the bile duct, she had an R2 lymph nodes-dissection. Post operative pathologic examination revealed a squamous cell carcinoma arising from the gallbladder and infiltrating into the bile duct.
We collected 28 cases of squamous cell carcinoma of the gallbladder in which gallbladder resection was performed, from Japanese literature since 1970 to add to our case, after which we questioned the authors, and examined their clinical features, operations and prognosis.
And compared with resected cases of other types of carcinoma of the gallblad der reported in the literature, the prognosis was significantly better in the resected case of squamous cell carcinoma.
Moreover, the study of long-term survival cases showed that surgical resection with aggressive postoperative radiation therapy would obtain better clinical results.View full abstractDownload PDF (3032K) -
Junzo SHIMIZU, Hiroaki NAGANO, Masato SAKON, Keizo DONO, Masaki OKUYAM ...1999 Volume 13 Issue 1 Pages 32-38
Published: February 25, 1999
Released on J-STAGE: November 13, 2012
JOURNAL FREE ACCESSWe examined the influence of patency of Vater's papilla to complication after expandable metallic stenting (EMS). Two groups were divided; preserved papilla cases (p-group, n=8) and unpreserved cases (u-group, n = 7). The incidence of biliary tract infection, hospital stay (days)and home stay (days) were compared between these 2 groups. Six of 7 cases had cholangitis in ugroup; no evidence was shown in p-group. Liver abscess was induced in 2 of these 6 biliary infected cases. Bacterial culture of bile was positive in just 1 case in p-group (12.5%); in all cases in ugroup (100%). Home stay in u-group became significantly shorter than in u-group due to bile duct infection; no difference about hospital stay. From these results, regurgitating cholangitis would be important in the cases of unpreserved Vater's papilla after EMS.View full abstractDownload PDF (1909K) -
Yuichi KITAGAWA, Akihiro YAMAGUCHI, Masatoshi ISOGAI, Akihiro HORI, Yu ...1999 Volume 13 Issue 1 Pages 39-44
Published: February 25, 1999
Released on J-STAGE: November 13, 2012
JOURNAL FREE ACCESSIn 1983 patients underwent cholecystectomy, total amylase concentration of the gallbladder bile was measured.158 patients total amylase value was over 1,000 IU/L. In 73 of 158 patients, gallbladder was not visualized by direct cholangiography. In another 85 patients,35 patients had common bile duct stone,8 with maljunction of the pancreatobiliary ducts,3 with duodenal diverticulum adjacent to the papilla of Vater, and in remaining 39 patients both the bile and pancreatic ducts were visualized by cholangiography. Those 85 patients were considered as the pathological common bile duct that produces high amylase concentration due to reflux of pancreatic juice into the bile.
In 103 of 158 patients the gallbladder was histologically examined. The gallbladder mucosa showed metaplasia in 92.2%, dysplasia in 14.6%, and hyperplasia in 1.9%. These findings in patients with latent maljunction suggest reflux of pancreatic juice into the gallbladder. Relation between biliary malignancies and the reflux was not defined in this study.View full abstractDownload PDF (1958K) -
Akihiro KAWABE, Syunji SAKURAMACHI, Toshihiko KOBAYASHI, Masayuki YOSH ...1999 Volume 13 Issue 1 Pages 45-50
Published: February 25, 1999
Released on J-STAGE: November 13, 2012
JOURNAL FREE ACCESSThe management of patients with CBD stones has been revolutionized by the introduction of laparoscopic surgery and endoscopic treatment (EST and EPBD). Since 1992 we started laparoscopic common bile duct exploration (CBDE). Between January,1992 and August,1998 we worked with 65 cases of choledocholithiasis. Laparoscopic CBDE was attempted in 48 patients, and was successful in 43 patients. Twenty-one patients underwent laparoscopic CBDE through a transcystic duct approach, and 22 patients through the choledochotomy. There were no morbid complications. Laparoscopic CBDE is a single-stage treatment without damage to the papilla. The results obtained suggest that laparoscopic CBDE, especially transcystic approach, is an easy and feasible procedure. However the high-risk patients with CBD stones are better candidates of other procedure (endoscopic treatment or open surgery).View full abstractDownload PDF (1353K) -
Naoto EGAWA, Yuyang TU, Terumi KAMISAWA, Kouji TSURUTA, Atsutake OKAMO ...1999 Volume 13 Issue 1 Pages 51-54
Published: February 25, 1999
Released on J-STAGE: November 13, 2012
JOURNAL FREE ACCESSWe describe a extremely rare example of high-grade anomaly of biliary tract with pancreaticobiliary maljunction in a 41-yr-old man. His upper abdominal pain led to endoscopic retrograde cholangiopancreatography, which revealed the anomalies. The common bile duct bifurcated before branching hepatic bile ducts and from the bigger duct at this bifurcation, the cystic duct extended and a tubular structure ran shortly. In addition, pancreatico-biliary maljunction was detected. At laparotomy this short tube was an immature left accessory bile duct. This type of anomalous left accessory bile duct has not been reported so far, and is thought to be a symmetry of 0 type of Hisatsugu's classification regarding accessory bile duct. Considering the fact in embryogenesis that formation of the accessory bile duct and the pancreatico-biliary maljunction are independent events, the combination of these two anomalies in this case is a fortuitous outcome.View full abstractDownload PDF (1413K) -
Tadashi BANDO, Mitsuyoshi SHIMODA, Takuya NAGATA, Kazuhiro TSUKADA1999 Volume 13 Issue 1 Pages 55-59
Published: February 25, 1999
Released on J-STAGE: November 13, 2012
JOURNAL FREE ACCESSA 33-years-old female was admitted to our hospital because of upper abdominal pain. Abdominal ultrasonography of the abdomen revealed polypi of the gallbladder. And endoscopic retrograde pancreatocholangiography revealed anomalous arrangement of the pancreatobiliary duct without dilatation of the common bile duct.
At operation, the gallbladder was shown to have diffuse multiple polypoid lesions on the mucosal surface and histologically many foamy cells in the lamina propria. From these findings, a diagnosis of diffuse papillomatous cholesterosis with non-dilatation of the bile duct associated with anomalous arrangement of the pancreatobiliary duct was made.
The case is of particular interest in investigating the relation between mucosal change of the gallbladder and anomalous arrangement of the pancreatobiliary duct.View full abstractDownload PDF (2395K) -
Tadashi BANDO, Mitsuyoshi SHIMODA, Takuya NAGATA, Kazuhiro TSUKADA, Fu ...1999 Volume 13 Issue 1 Pages 60-64
Published: February 25, 1999
Released on J-STAGE: November 13, 2012
JOURNAL FREE ACCESSA case of anastomotic stricture after reconstruction for intraoperative bile duct injury during laparoscopic cholecystectomy is reported. A 65-year-old female underwent laparotomical hepaticojejunostomy for the bile duct injury during laparoscopic cholecystectomy diagnosed cholecystolithiasis. She admitted to our hospital because of post operative cholangitis. Percutaneous transhepatic cholangiography revealed the stricture of anastomosis. Internal fistulation and dilatation of the anastomosis were performed during 4 months but not effective. Abdominal angiography revealed the transected right hepatic artery due to intra laparoscopic operative injury.
At operation, the wall of hepatic duct was hardly thickened caused fo r cholangitis. Excision of the thickened hepatic duct and reconstruction were performed. Post operative course about 18months was good.
This case s uggests that the reconstruction with hepaticojejunostomy requires widely anastomosis and short remnant hepatic duct to treat the injuries of the bile duct and right hepatic artery caused by laparoscopic cholecystectomy.View full abstractDownload PDF (2010K) -
Kaori KUBOTA, Itaru ENDO, Atsushi TAKIMOTO, Yoshihiro MORIWAKI, Yoshir ...1999 Volume 13 Issue 1 Pages 65-70
Published: February 25, 1999
Released on J-STAGE: November 13, 2012
JOURNAL FREE ACCESSA 66 year-old-woman visited a nearby hospital complaining of brown urine and jaundice (T-bil 5.3 mg/dl). She was admitted to our hospital on Nov.5, to examine a tumor at the porta hepatis. Endoscopic retrograde cholangio-pancreatography (ERCP) demonstrated the compressed common bile duct, with 1.5 cm in length, and regular walls. Abdominal CT showed a tumor with 4 cm in diameter at the porta hepatis. Endoscopic ultrasonogram (EUS) revealed a tumor adherent to the common bile duct,1.5 cm in the major axis. On the basis of these findings, she was diagnosed as lymphadenopathy of No.12c lymph node of malignancy or malignant lymphoma. Because the tumor caused obstructive jaundice and a rise of tumor markers (CEA, CA 19-9, KMO-1, DUPAN2), a laparotomy was performed on Nov.25. The tumor with 1.5 cm in diameter, was situated between cystic duct and common bile duct, so it was resected with gallbladder. Histologically, the tumor was composed of inflammatory cells, mainly lymphocytes, and revealed a diagnosis of inflammatory pseudotumor. Only 6 cases of inflammatory pseudotumor caused jaundice have been reported in the world literature since first documentation in 1964. This is the first case of an inflammatory pseudotumor at the porta hepatis caused jaundice.View full abstractDownload PDF (2850K)
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