Vascular injuries during laparoscopic cholecystectomy can occur similar to biliary injuries and mostly represented by intraoperative bleeding. Hepatic artery system pseudoaneurysm are rare. It occurs in the early or late postoperative course. Patients present with pallor, signs of haemobillia and altered liver function. We report a case of right posterior sectoral artery pseudoaneurysm detected 2 weeks after laparoscopic cholecystectomy and successfully repaired laparoscopically. We also describe how laparoscopic pringle clamping saved the conversion. The actively bleeding right posterior sectoral artery pseudoaneurysm was diagnosed by CT angiogram. Embolisation, usually the treatment of choice, would have risked liver insufficiency as hepatic artery proper was at risk because the origin the bleeding artery was just after its bifurcation. Isolated right hepatic artery embolisation can also cause hepatic insufficiency. To our knowledge this is the first reported case of laparoscopic repair of post-laparoscopic cholecystectomy bleeding sectoral artery pseudoaneurysm.
Abstract:Leiomyosarcoma is a rare tumor of esophagus that accounts for 0.5% esophageal sarcomas. This paper presents two cases of leiomyosarcoma of esophagus in 45 years old lady and 52 years old gentleman who presented with dysphagia and they were evaluated to rule out malignancy, but they turned out to be rare leiomyosarcoma which were confirmed by immunohistochemistry. One patient underwent oesophagogastrectomy and other was treated with self-expandable metal stent (SEMS) in view of inoperability. Case presentations, diagnostic modalities and various management options are discussed.
Pancreatic incidentalomas are increasingly recognized entities that occur as a fallout of widespread availability of high definition imaging technology. These lesions offer diagnostic dilemmas to both clinicians and radiologists alike. Nevertheless, it is the advancement in diagnostic radiology that comes to the rescue in the management of these not-so-uncommon lesions.
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