Excision Of Gallbladder Research Articles

Laparoscopic Excision of Remnant Gallbladder after Subtotal Cholecystectomy

Laparoscopic Excision of Remnant Gallbladder after Subtotal Cholecystectomy

Heterotopic pancreatic tissue associated with type 1 choledochal cyst, cystolithiasis and gall bladder stones: a rare entity with review of literature

Choledochal cyst is a rare congenital malformation, particularly when associated with stones in cyst (cystolithiasis), gallstones and heterotopic pancreatic tissue within the cyst wall. The current case represents a 5-year-old...

Retroperitoneal Schwannoma: A Case Report and Review of the Literature

A 45 years old woman admitted to our Hospital with pain in the right flank and right hypochondrium. Her abdominal USG and CT scan showed a large complex cystic mass present in the deep soft tissue compressing the right kidney. Multiple gall bladder stones were also found in imaging. Both the adrenal glands and left kidney had a normal appearance. The mass was completely resected with extended right subcostal incision along with excision of Gall bladder. Histopathological examination of the specimen revealed a degenerated schwannoma. Patient was discharged on 8th day after operation without any complications.J Bangladesh Coll Phys Surg 2015; 33(4): 225-228

Invasive cholangiocarcinoma identified in congenital biliary dilatation in a 3-year-old boy

We herein report a 3-year-old male demonstrating invasive cholangiocarcinoma (CC) associated with congenital biliary dilatation (CBD). A 3-year-old Japanese boy was admitted to our hospital with abdominal pain and vomiting. Computed tomography and magnetic resonance imaging demonstrated a dilated extrahepatic bile duct. A diagnosis of Todani's type 1a CBD was made. Intraoperative cholangiography demonstrated the presence of pancreaticobiliary maljunction but could not reveal any tumor lesion in the bile duct. The excision of extrahepatic bile duct and gallbladder and Roux-en-Y hepaticojejunostomy were performed. On gross inspection, we could not find any tumor lesion in the resected specimen. However, the postoperative histopathologic examinations confirmed the presence of well-differentiated tubular adenocarcinoma with lymphovascular invasion. Most of the carcinoma remained within the mucosal layer, and the carcinoma was identified at both the distal and proximal surgical margins of the bile duct. We scheduled additional surgery to eradicate the residual carcinoma, but informed consent for the extra surgery could not be obtained. A close follow-up with abdominal computed tomography has been going on without either additional surgery or adjuvant chemotherapy about for 1 year. The patient has so far been clinically doing well without any obvious symptoms of recurrent disease. To our knowledge, this report is the youngest case of CC associated with CBD.

Biliary Carcinoma Risk in Patients with Pancreaticobiliary Maljunction and the Degree of Extrahepatic Bile Duct Dilatation

Background and Aim: In patients with pancreaticobiliary maljunction (PBM), pancreatic juice frequently refluxes into the bile duct. This results in a high risk of biliary carcinoma. No consensus has been reached on whether preventive resection of the extrahepatic bile duct is necessary in PBM cases without dilatation of the extrahepatic duct. The aim of this study is to examine the biliary complications of patients with PBM in relation to the degree of extrahepatic bile duct dilatation and thus to determine appropriate management. Patients and Methods: We have treated 98 patients (21 males and 77 females, average = 48.0) with PBM. The PBM cases could be divided into 5 groups according to the maximum diameter of the extrahepatic bile duct:≤10, 11-15, 16-20, 21-30, ≥31mm. The clinicopathological findings of biliary carcinomas associated with PBM were examined and compared with 232 cases of gallbladder carcinoma and 159 cases of bile duct carcinoma that were not associated with PBM. Results: Gallbladder carcinoma occurred in 36 of 65 patients (55%) with PBM whose maximum diameter of the extrahepatic bile duct was ≤30 mm, but no gall bladder carcinoma occurred in patients with PBM whose maximum diameter of the extrahepatic bile duct was ≥31 mm. Bile duct carcinoma occurred in 6 of 52 patients (12%) with PBM whose maximum diameter of the extrahepatic bile duct was ≥21 mm, but no bile duct carcinoma occurred in patient with PBM whose maximum diameter of extrahepatic bile duct was ≤20 mm. The age at diagnosis of the patients with gall bladder (58.9 ± 8.8 vs. 69.4 ± 8.7 years old, p < 0.01) or bile duct carcinoma (54.8 ± 14.3 vs. 68.8 ± 9.1 years old, p < 0.01) associated with PBM was significantly younger than those without PBM. Gallstones were rarely detected in patients with gallbladder carcinoma associated with PBM (8% vs. 62%, p < 0.01). There were no significant differences between cases of gallbladder carcinoma associated with and without PBM in the location and histology, incidence of multiple biliary carcinoma. Multiple biliary carcinomas frequently occurred in the patients with bile duct carcinoma associated with PBM (50% vs. 4%, p < 0.01). Conclusion: PBM with an extrahepatic bile duct diameter ≤30 mm is associated with a high risk of gallbladder carcinoma. Furthermore, PBM with an extrahepatic bile duct diameter ≥21 mm is associated with a high risk of bile duct carcinoma. The treatment of choices for PBM with biliary dilatation is excision of extrahepatic bile duct and gallbladder with Roux-en-Y reconstruction of the biliary tree. However, given the present study, only cholecystectomy should be recommended as prophylactic treatment for patients with PBM without biliary dilatation.

Mucinous cystadenoma of the pancreas 17 years after excision of gallbladder because of a choledochal cyst

A 56-year-old woman who had undergone excision of the gallbladder because of a choledochal cyst had a tumorous lesion of the pancreas identified by upper abdominal ultrasonography, but an operation was not carried out, because there was no apparent increase in the cystic mass and no elevation of serum tumor markers. In October 2001, she was admitted to our hospital to check for malignancy because of elevated levels of the tumor marker Dupan-2. Abdominal enhanced computed tomography and upper abdominal ultrasonography revealed a large multilocular cystic mass in the body to tail of the pancreas. Endoscopic retrograde cholangiopancreatography showed elongation of the common duct that communicates with the common bile duct and the main pancreatic duct, indicating an anomalous arrangement of the biliary and pancreatic duct system. No apparent communications between the cystic mass and the main pancreatic duct were observed. In January 2002, the patient underwent a spleen-preserving distal pancreatectomy, and histopathological and immunohistochemical examinations led to the diagnosis of pancreatic mucinous cystadenoma with ovarian-like stroma. The mucinous cystadenoma was detected 17 years after the operation for the choledochal cyst. To the best of our knowledge, no documented case reports of mucinous cystadenoma of the pancreas associated with a choledocal cyst have been reported to date. We present here the first case report of pancreatic mucinous cystadenoma occurring in the body to tail of the pancreas, associated with a choledocal cyst.