Segment VII Research Articles

Rupture of intrahepatic bile duct after ERCP for common bile duct stone: A case report of rare complications.

Complications after endoscopic retrograde cholangiopancreatography (ERCP) are diverse and usually treated with nonoperative management or percutaneous drainage; however, there are still some rare, life-threatening complications. This is an extremely rare case of biliary peritonitis caused by rupture of the intrahepatic bile duct after ERCP. A 63-year-old male underwent ERCP for common bile duct stones. On the second day after the procedure, the patient developed sepsis and abdominal distention. Contrast-enhanced computed tomography revealed a subcapsular hepatic fluid collection attached to the bile duct of segment VII. Sepsis resulted in liver parenchyma rupture and intrahepatic bile duct injury after ERCP. Intraoperative cholangiography revealed a connection between a hole in the liver parenchymal surface and the intrahepatic bile duct. Surgeons performed the cholecystectomy, inserted a T-tube into the common bile duct stones, sutured the defect, and put 2 drainage tubes around the lesion. Postoperative recovery was uneventful, and the patient was discharged on the 17th postoperative day. Intrahepatic bile duct perforation after ERCP can lead to rupture of the liver parenchyma, biloma, or abdominal peritonitis. Multidisciplinary management is necessary to achieve favorable outcomes.

Laparoscopic Anatomical Cranial Sub-segmentectomy of Segment VII (S7) with Super-Selective Intra-arterial Nano-ICG Positive Staining-Guided Trans-Parenchymal Approach.

With introduction of "cone unit," which is the smallest resectable anatomical area supplied by a tertiary branch of Glissonean pedicle, more precise subsegmental anatomical resection has been proposed.1 Super-selective intra-arterial ICG staining, delivering ICG and lipiodol mixing to arterial branch using interventional radiology, has been proved feasibility especially for complicated anatomy.2-6 It was difficult to uniformly mix water-soluble ICG with lipophilic lipiodol, rendering to inconsistency development of liver segment between angiography and laparoscopy. Nano-ICG is a uniform mixing of ICG and lipiodol.7 We demonstrated an exclusive "two-step" method to perform LAR for cranial S7 via super-selective intra-arterial nano-ICG staining guidance. A 70-year-old male was admitted. CT scan showed tumor was located in cranial S7 with 2.1*1.9cm. Preoperative AFP was 4.66ng/ml and PIVKA-II was 2332mAU/ml. The liver function was Child-Pugh class A and ICG-15R was 7.8%. Given that tumor was confined to cranial S7, precise anatomical sub-segmentectomy was warranted. This study was approved by the West China Hospital, Sichuan University Ethics Committee (approval number: 2023-2327). The operation was performed "two step." "First step" was super-selective intra-arterial nano-ICG embolization in intervention room, while "second step" was performed in operation room. ICG demarcation line was clearly identified even after 7hr. After full mobilization of right hemiliver, we performed transparenchymal approach to find and clamp pedicle of cranial S7 under fluorescence guidance. Operation time was 150min with 20ml of blood loss with uneventful course. Although LAR of S7 remains challenging, super-selective intra-arterial nano-ICG positive staining guidance might be a feasible and safe option.

Microwave Ablation in the Thermal Treatment of Hepactocellular Carcinoma: Case Report

Hepatocellular carcinoma (HCC) stands as one of the most prevalent malignant tumors [1], and is the cause of over one million deaths annually worldwide [2]. While surgical resection remains the preferred treatment for early-stage hepatocellular carcinoma (HCC) in well-compensated cirrhosis patients, thermal ablation techniques offer a credible non-surgical option. Their minimal invasiveness, high tolerability, safety, established efficacy in local disease control, virtually unlimited repeatability, and cost-effectiveness render them valuable alternatives. Microwave ablation (MWA) of HCC appears to be a safe and effective treatment. Here we report a case of 53-year-old male, followed for hepatitis C complicated by compensated cirrhosis, During the follow up, Laboratory tests found liver function tests were eleveted, α-fetoprotein (AFP) was normal. Abdominal ultrasound showed a focal hepatic mass straddling segments VI and VIII, rounded, well-limited, with heterogeneous hyperechoic echostructure, and splenomegaly. Contrast-enhanced abdominal computed tomography showed a chronic liver desease with a focal lesion straddling segments VI and VIII, oval, tissue-like, hypodense in the center, measuring 50x41mm, with signs of early arterial enhancement consistent with HCC characteristics and signs of portal hypertension and a multicystic kidney. Hepatic MRI revealed a chronic liver disease straddling segments VII and VIII of a hepatic lesion measuring 23x 22mm classified as Li-RADS 4 with signs of portal hypertension and splenomegaly. Based on these results, the patient was diagnosed as HCC with well compensated cirrhosis, and in view of the fact that he had only a single lesion and was in functional grade A of Child-Pugh classification and staged as BCLC-A in the Barcelona Clinic Liver Cancer (BCLC) staging system, the patient benefited from microwave ablation for his HCC, with good clinical, biological and radiological evolution. Microwave Ablation (MWA) emerges ..........

Hemorrhagic Hepatic Cyst Mimicking a Cystic Neoplasm: Case Report

Background: Intracystic hemorrhage is an extremely rare complication of simple hepatic cysts. Clinical symptomatology is non-specific, and imaging frequently mimics a biliary cystadenoma or cystadenocarcinoma, which makes it challenging from a diagnostic point of view to an appropriate therapeutic approach. In this report, we present a case of a simple hemorrhagic hepatic cyst mimicking a cystic neoplasm. Case Report: 48-year-old men was referred to our hospital for periumbilical abdominal pain with asthenia and 11 kg weight loss. His physical examination and laboratory findings were unremarkable. Carcinoembryonic antigen concentration was three times higher than normal. Abdominal ultrasonography demonstrated an impure cystic mass measuring 120 x 96 x 108 mm on hepatic segments VI and VII. Abdominal CT showed a cystic mass at the liver possibly related to a cystadenocarcinoma. Abdominal MRI revealed a cystic mass with lobulated contours, located in segments VII, VIII and part of VI, measuring 11.8 x11.4 cm long axis, heterogeneous signal with intense fluid towards the top in T1 and T2 and intense fluid towards the decline in T2 and T1, with the appearance of a small inferior septum slightly enhanced after injection. These findings did not exclude the possibility of malignant cystic tumor, such as biliary cystadenocarcinoma. Therefore, endoscopic ultrasound showed a cystic lesion developing in the liver, with a thickened wall in places, mainly adjacent to an intracystic nodule of 25 mm, this nodule continued with the wall. Biopsy performed using a 22G ultrasound. Aspiration of liquid: string test negative. Pathological examination confirmed a hemorrhagic biliary cyst and there was no tumor tissue. We observed a significant improvement in symptoms and reduction in cyst size after needle aspiration and we decided to adopt a conservative approach. The patient was followed and one year later, the patient remained in good condition without any complaints. ................

Non-Contrast Enhanced Magnetic Resonance Venography Using the Fast Imaging Employing Steady-State Acquisition (FIESTA) Pulse Sequence in Preoperative Evaluation of Liver Donors: Can it Replace CT Venography?

Background: Liver transplantation has now become the preferred treatment for patients with liver failure. Pre-operative assessment of hepatic/portal vein anatomy of donors is necessary for which CT venography is most commonly used but it exposes the donors to huge radiation burden. To avoid this, non-contrast MR venography is the most preferred alternative for evaluation of veins. Objective: To determine diagnostic yield of magnetic resonance venography using Fast Imaging Employing Steady-State Acquisition (FIESTA) pulse sequence in comparison to computed tomography venography for the determination of portal/hepatic venous anatomy of potential liver donors. Methods: Retrospective study was conducted in which the venous phase CT scan and FIESTA (b-SSFP) sequence of 50 potential liver donors between 01-07-2021 and 30-11-2021 were reviewed. The hepatic and portal venous anatomy was reviewed. The assessment comprised the type of portal venous anatomy, the number of prominent tributaries from segment VIII and V of liver having diameter of 4mm or more emptying into the middle hepatic vein and the total number of accessory inferior right hepatic veins from segment VI and VII emptying into inferior vena cava (IVC). Results: With 100% sensitivity and specificity, the FIESTA sequence precisely identified the portal vein anatomy, total number of accessory inferior right hepatic veins, and the total number of 4 mm thick tributaries from segment V and VIII draining into middle hepatic vein Conclusion: We propose that magnetic resonance venography using FIESTA sequence can be used instead of CT venography to determine hepatic and portal vein anatomy of liver donors.

A case report of hepatic angiomyolipoma, inflammatory subtype. Clinico-pathological characterization: a diagnostic challenge

BackgroundAngiomyolipoma is a benign mesenchymal neoplasm of a wide histological heterogeneity belonging to the PEComa “family.” The liver, after the kidney, is their second most frequent location. However, inflammatory hepatic AMLs constitute a rare entity, with only fourteen documented cases until 2020. These neoplasms can overlap morphological features of IgG4-related diseases, being of great diagnostic relevance to demonstrating myomelanocytic-lineage differentiation of the neoplastic cells. Case presentation: we present a new case of an inflammatory hepatic AML resembling an IgG4-related disease in a 35-year-old woman with a subcapsular 5 cm mass confined to segment VII of the right hepatic lobe. Although having reduced its size along the tumor’s natural evolution, complete tumor resection was decided due to its hypermetabolic behavior (max. SUV = 12,6) assessed by PET-CT scan. Finally, the patient underwent a right hepatectomy due to spontaneous rupture and bleeding of the lesion during the intervention. All the diagnostic and therapeutic procedures occurred in the last months of the COVID-19 pandemic. Conclusions: This review aims to describe inflammatory hepatic AML histological and immunohistochemical features. We further sought to establish a clinicopathological contextualization of this tumoral subtype.

The morphology of the free-living females of Strepsiptera (Insecta).

The morphology of the adult free-living females of Mengenilla moldrzyki and Eoxenos laboulbenei (Strepsiptera, Mengenillidae) was documented with µCT-based 3D reconstructions and histological serial sections. External and internal features of both species are characterized by far-reaching specialization and structural simplification. The well-developed mandibles are moved by large muscles. Other mouthparts and their corresponding musculature are simplified or absent. The brain is partly shifted into the prothorax. It is followed by a single postcephalic postcerebral ganglionic complex also containing the suboesophageal complex and an unpaired abdominal nerve. Postcephalic sclerites are absent, except for the plate-like pronotum and small pleural sclerites. Wings and associated muscles are missing. The lumina of the large midgut and the anterior hindgut are disconnected. Seven bulb-shaped Malpighian tubules in M. moldrzyki is the highest number yet described for Strepsiptera. The 10-segmented abdomen lacks appendages. An unpaired birth organ opens ventrally on abdominal segment VII. The entire body cavity is filled with numerous freely floating eggs, 1386 in the specimen M. moldrzyki and 721 in E. laboulbenei. Genital ducts, defined gonads, and genital glands are missing. The morphology of female Mengenillidae is discussed with respect to sexual dimorphism and structural features of the postembryonic stages. Phylogenetic implications are outlined. This article is protected by copyright. All rights reserved.

Laparoscopic liver posterior sectionectomy

Background: Our patient was a 67-year-old male with metastatic right colon cancer to the liver with lesions in segment II and segment VII. He had a BMI of 30, no prior abdominal surgical history, and normal baseline liver function. He had undergone 4 cycles of neoadjuvant FOLFOX with Bevacizumab.

Immediate outcome of microwave ablation for liver tumours in a single cohort of patients in Sri Lanka

Introduction and Objectives: Microwave ablation (MWA) is an emerging treatment modality for hepatocellular carcinoma (HCC) and other liver tumours. We aimed to assess the immediate success and complications of MWA in a cohort of patients. Method: Patients were assessed retrospectively, using an intervieweradministered questionnaire and a follow-up CECT/MRI at 6-weeks. Result: 55 patients underwent MWA from October 2021-May 2022, at Colombo-North Teaching Hospital, Ragama, Sri Lanka, and selected private hospitals( Durdans Hospital, Colombo, Nawaloka Hospital, Colombo, Lanka Hospital, Colombo). The median age was 64 (40-82) years, with a male preponderance (n=45, 81.1%). The indication was HCC in 54 (98.1%) and metastatic tumour in one (1.8%). The median tumour size was 28 (10-80) mm. Segment VII was the commonest site to be involved (n=18, 34.6%). The majority (n=40, 72.7%) was a single lesion. No participant underwent the procedure twice. The mean post-procedural hospital stay was 12 hours (95%CI=11.4-12.5, SD=2.0). In the 6-week follow-up, 2 recurrences (3.6%) and single death (1.8%) with no relation to the procedure, were reported. Another 2 (3.6%) denied the follow-up. Complete ablation was reported in 46 patients (83.7%), comparable to the rates in literature (95-97%), with only 7 patients (12.7%) having residual tumours. No major complications were reported. 9 patients (16.4%) developed 'Post ablation syndrome', not as common as in literature (34%). They presented with abdominal pain (7.3%), vomiting (7.3%), and fever (3.6%). Conclusion: MWA is a successful and safe treatment option for primary liver tumours in Sri Lanka, with ablation rates comparable to the western world.

Correspondence of External Copulatory Structures in Male and Female Fagitana littera Guenée (Lepidoptera: Noctuidae)

The terminalia of Fagitana littera Guenée are described with a focus on the complex external copulatory coupling mechanism in the male and female. The female 7th sternite is robustly developed, enclosing a complex of sclerotized, scobinate structures and pockets, variously fused with elements arising from the sternum and intersegmental membrane of abdominal segments VII and VIII. This scaffold appears to accommodate the robustly developed male clasper, including a modification of the valva's outer margin. Such conspicuous and elaborate external coupling mechanisms are rarely reported in Noctuidae.

Safely Modified Laparoscopic Liver Resection for Segment VI and/or VII Hepatic Lesions Using the Left Lateral Decubitus Position

PurposeTo explore the feasibility and safety of using the left lateral decubitus position (LLDP) to perform laparoscopic liver resection (LLR) for the treatment of hepatic lesions in segment VI and/or VII.Patients and MethodsClinical data concerning 50 patients underwent LLR including 25 patients in the LLDP and the other 25 patients in the routine operative position (ROP) at Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College (Hangzhou, China) and Shulan (Quzhou) Hospital between March 2019 and May 2022 were retrospectively analyzed. All of the patients underwent LLR while in the LLDP or the ROP for the treatment of hepatic lesions located in segment VI and/or VII.ResultsThe preoperative clinical and laboratory parameters were comparable between the two groups (P > 0.05). All patients completed the surgery successfully. There were two patients required conversion to open resection in the ROP comparing with zero in the LLDP. The mean operative time was 256.9 ± 132.7 minutes in LLDP and 255.7 ± 92.1 minutes in ROP, while the median perioperative blood loss was 100 mL (range: 50–300 mL) in LLDP and 200 mL (range: 50–425 mL), respectively. The postoperative pathological examination showed that margin-negative resection was achieved all of the cases. The important postoperative parameters all returned to normal within five days after the LLR. The mean postoperative hospital stay (15.6 vs 19.3 days; p < 0.05) and the extraction of the drainage tube time (7.8 vs 10.4 days; p < 0.05) were shorter for patients in LLDP.ConclusionThe LLDP represents a safe and feasible position for performing LLR in selected patients with lesions in segment VI and/or VII. LLR in the LLDP is helpful in terms of the exposure of the surgical field and the recovery of the patient.

Assessment of Clinical Outcomes, Clinical Manifestations, and Risk Factors for Hepatic Infarction After Transjugular Intrahepatic Portosystemic Shunt Placement (TIPS): A Retrospective Comparative Study.

To describe the imaging findings of hepatic infarction after transjugular intrahepatic portosystemic shunt (TIPS) placement and identify risk factors, clinical manifestations, and outcomes of infarction after TIPS. In this retrospective analysis of a TIPS registry (1995-2021), cirrhotic patients with hepatic infarction (n = 33) and control patients without infarct (n = 33) after TIPS were identified. Laboratory values, ultrasound findings, and clinical variables were compared between groups to identify risk factors and differences in outcomes. A Cox proportional hazards regression model with propensity score was used to assess the effect of hepatic infarction on mortality and acute-on-chronic liver failure (ACLF) score. Hepatic infarction involved the right posterior segments (segments VI or VII) in 32 of 33 patients. Prolonged vasopressor requirement (p = 0.003) and intensive care unit stay (p = 0.001) were seen in patients with hepatic infarct, as well as trends toward lower post-TIPS portosystemic pressure gradient (p = 0.061) and higher risk of ACLF (p = 0.056). Procedure-related portal vein thrombosis or hepatic artery injury was identified in 12 and 5 patients with infarct, respectively. Patients with infarct had higher postprocedural aspartate aminotransferase (p < 0.001) and alanine aminotransferase (p < 0.001) levels, higher international normalized ratio (p = 0.016), lower platelet count (p = 0.042), and a greater decrease in hemoglobin level (p = 0.003). Hepatic infarction most frequently affects the right posterior hepatic segments after TIPS and results in a worse postprocedural course. Procedure-related complications and critically low portosystemic pressure gradient may contribute to TIPS-associated hepatic infarct.

Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle's maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Suitability of Laparoscopic Liver Resection of Segment VII: a Retrospective Two-Center Study

BackgroundResecting liver tumors located in Couinaud’s segment VII is challenging; the efficacy and safety of laparoscopic liver resection for segment VII lesions compared to open liver resection remain unclear. MethodsMedical records of 84 patients who underwent liver resection of segment VII at Kobe University Hospital and Hyogo Cancer Center between 2010 and 2021 were retrospectively analyzed. Surgical outcomes were compared between laparoscopic liver resection and open liver resection groups using propensity matching analysis. ResultsThirty-one and 53 patients underwent laparoscopic liver resection and open liver resection, respectively. After propensity matching, 29 patients were included in each group. The laparoscopic liver resection group had a significantly longer operation time (407 vs. 305 min, P = 0.002), lower blood loss (100 vs. 230 mL, P = 0.004), and higher postoperative alanine aminotransferase levels (436 vs. 252 IU/L, P = 0.008) than the open liver resection group. In patients with liver cirrhosis, the proportion of patients with postoperative liver-specific complications was higher in the laparoscopic liver resection group than in the open liver resection group (57% vs 11%, P = 0.049), although there was no significant difference in postoperative liver-specific complication rates between the groups in patients without liver cirrhosis. ConclusionsFor liver resection of segment VII, laparoscopic liver resection led to higher postoperative liver damage than open liver resection. Open liver resection may be better for patients with liver cirrhosis to avoid postoperative liver-specific complications. Laparoscopic liver resection could be an acceptable procedure for patients without liver cirrhosis, with some merits such as less blood loss.

A new species and new records of Gnorimoschemini (Lepidoptera, Gelechiidae) from Ecuador.

Scrobipalpula onorei sp. nov. is described from Las Pampas, Ecuador. The species is tentatively placed near Scrobipalpula densata (Meyrick, 1917) and S. caustonae Landry, 2010 based on both having a slender, elongate phallus and a bipartite corpus bursae without a signum. Eurysacca media Povoln, 1986 is recorded for the first time from Ecuador. Sexual dimorphism in structures of abdominal segments VIIVIII are described for the first time for E. media. The female of this species has patches of melanized scales on abdominal segment VII. The diagnosis of the species is updated with descriptions and illustration of additional details of external morphology and characters of male and female genitalia. We also provide an annotated list of Gnorimoschemini from Ecuador.

Role of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography in Detection of Portal Vein Tumor Thrombosis in Hepatocellular Carcinoma

A 56 year old gentleman with no known comorbidities presented with pain abdomen for 1 month. Triphasic CECT abdomen showed features of cirrhosis with surface irregularities, fissural widening and volume redistribution changes in the liver. Segment VII of liver showed an arterial enhancing lesion measuring 4.2 x 3.5cm showing washout in delayed phase. In view of BCLC A stage with Child Pugh B7, ablation was planned. Before proceeding with ablation, in view of very high alpha-fetoprotein (AFP) level of 9836 ng/mL, he was advised for metastatic evaluation with 18F-FDG PET-CT. The PET scan showed abnormal heterogeneous increased FDG uptake in segment VII of liver (SUV Max 4.7) with arterial enhancement and washout suggestive of metabolically active hepatocellular carcinoma. Also seen was an abnormal linear increased FDG uptake in right branch of portal vein (SUV Max 4.8) which was suggestive of portal vein invasion. In view of portal vein tumor thrombus, ablation procedure was deferred for the patient. Role of PET scan in HCC with vascular invasion is not yet defined. Poor specificity of FDG PET is the major hindrance in establishing PET scan as diagnostic tool for vascular invasion. In small segment invasion when CECT is not able to differentiate between tumour versus bland thrombus PET scan may be significant tool to differentiate between bland thrombus and tumour thrombus. Vascular invasion confirmation have treatment related and prognostic significance. There is a need for a prospective study evaluating the prognostic significance of PET scan based diagnosis of vascular invasion.

Proteonematalycus wagneri Kethley reveals where the opisthosoma begins in acariform mites.

It is generally thought that the anterior border of the opisthosoma of acariform mites is delineated by the disjugal furrow, but there is no evidence to support this other than the superficial appearance of tagmosis in some oribatids. It is proposed herein that the disjugal furrow is an apomorphic feature that does not correspond with any segmental borders. Although the disjugal furrow is absent from Proteonematalycus wagneri Kethley, the visible body segments of this species indicate that this furrow, when present, intersects the metapodosoma. Therefore, the disjugal furrow does not delineate the anterior border of the opisthosoma. Instead, this border is between segments D and E (segments VI and VII for all arachnids). This hypothesis can be accommodated by a new model in which the proterosoma warps upwards relative to the main body axis. This model, which is applicable to all Acariformes, if not all arachnids, explains the following phenomena: 1) the location of the gnathosomal neuromeres within the idiosoma; 2) the relatively posterior position of the paired eyes; 3) the shape of the synganglion; 4) the uneven distribution of legs in most species of acariform mites with elongate bodies.

Ischemic cholangitis during Osler-Weber-Rendu disease: a case report

BackgroundOsler-Weber-Rendu disease (OWRD) is a rare autosomal dominant genetic disease that causes skin and mucosal telangiectasias and visceral arteriovenous malformations. These shunts can lead to high-output heart failure, portal hypertension, biliary or mesenteric ischemia. We report the case of a patient with OWRD complicated by ischemic cholangitis and biloma.Case presentationA 50-year-old female patient with personal history of spontaneous epistaxis and gingival bleeding, family history of Osler-Weber-Rendu disease (OWRD) in mother, and epistaxis in siblings. She consulted for intermittent and minimal biliary colic. Physical exam found mucocutaneous telangiectasia. Abdominal Doppler ultrasound/CT angiography showed arteriovenous shunts in the liver between hepatic artery and hepatic vein, hepatic artery and portal vein. Other sites of arteriovenous malformations were found in the nostril and jejunum. The diagnosis of OWRD was made. The evolution after 1 year was marked by the appearance of a slight anicteric cholestasis. MRCP found intrahepatic bilomas with associated ischemic cholangitis of segment VII. We decided to continue monitoring only.ConclusionThe management of OWRD is based on screening for visceral arteriovenous malformations and on symptomatic measures that are often disappointing. Ischemic cholangitis is a rare complication, the diagnosis is based on imaging, liver transplantation is the only therapeutic alternative in this cases.

Percutaneous Drainage as The Management of Amebic Liver Abscess (ALA): A Case Report

Background: Amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis caused by Entamoeba histolytica infection. Clinical diagnosis of ALA is often uncertain due to no specific signs and symptoms. Abscess aspiration or drainage had a vital role in the management of ALA, mainly in cases with inadequate treatment response and large abscesses at risk of rupture. Case Presentation: A 66-year-old male patient presented with right upper quadrant abdominal pain for two weeks. He was diagnosed with a liver abscess in another hospital and then referred to our hospital due to inadequate clinical response after the treatment. Ultrasonography showed a solitary hypoechoic lesion in the right lobe of the liver and the CT scan revealed a well-defined hypodense lesion with regular margins in segment VII of the liver. Metronidazole and ceftriaxone were given intravenously during hospitalization. Percutaneous drainage of the liver abscess was performed on the seventh day of hospitalization with the indication of inadequate treatment response, size, and location of the abscess. The culture of the discharge showed growth of E. histolytica. No complications were found and the patient was discharged on the twelfth day of hospitalization with optimal clinical improvement. Conclusion: We report a case of ALA with inadequate response to the conservative treatment. The percutaneous drainage was performed for abscess decompression based on the preoperative ultrasound and CT scan. There is no complication was found and the patient was discharged on the twelfth day of hospitalization with optimal clinical improvement.

Smicridea McLachlan (Trichoptera: Hydropsychidae) from mountain ranges in Bahia state, Brazil: new species and male-female associations

ABSTRACT Smicridea McLachlan comprises 253 species divided into two subgenera: Smicridea and Rhyacophylax Müller. Smicridea (Smicridea) comprises species with males possessing two pairs of internal glands in abdominal segments VI and VII and hind legs bearing two pairs of spurs. Among species of this subgenus, those assigned to the Smicridea (Smicridea) fasciatella species group are characterized by a simple tubular phallus, presenting an apex with eversible sclerites. The aim of this paper is to describe and illustrate two new species in the S. (Smicridea) fasciatella species group and the female of Smicridea (Smicridea) capao Vilarino, Dias & Calor, 2019. Fieldwork was carried out in mountain ranges located in Bahia State, northeastern Brazil, both in the Atlantic Forest biome (Serra Bonita Reserve) and in the Caatinga biome (Chapada Diamantina Complex, Parque Municipal de Mucugê). Smicridea (Smicridea) kamakan sp. nov. and Smicridea (Smicridea) serrati sp. nov. can be recognized mainly by the morphology of tergum X and the inferior appendages. In addition, two couples of S. (Smicridea) capao were collected and resulted in the direct association of males and females; the female has a very conspicuous, oval sclerite VIII, with the apex constricted in the anterior portion, in ventral view. urn:lsid:zoobank.org:pub:CF8BAE97-7D6B-4460-8A9D-35BBBACF2BE0