Shiitake mushroom is a common ingredient in East Asian cuisines. Food processing/preparation can cause the mushroom to be soft and slimy, leading to accidental swallowing. Due to its high insoluble fibre content, it remains the same size and shape in the intestinal tract. We present two cases of small bowel obstruction caused by shiitake mushroom requiring surgical intervention. Preoperative imaging showed dilated small bowel with a suspicious mass in the ileum. However, the exact cause was unclear. For both cases, exploratory laparotomy and enterotomy were then performed and undigested shiitake mushroom was found. Both patients recovered well from the surgery.
sought to investigate the clinicopathologic and prognostic significance of BilIN-3 focusing on recurrence. Method: Patients who underwent major hepatectomy for PHCC with curative intent between 2000 and 2015 in Asan medical center were included in the study and were analyzed retrospectively. We stratified the patients focusing on the PM status of bile duct and excluded the patients who had distal and radial margin of BilIN-3 or R1. Result: Of the 312 patients who underwent surgery for PHCC, 246 (78.8%) had R0 PM, 10 (3.2%) had BilIN-3, and 56 (17.9%) had R1. There were total of 76 patients (24.4%) who had local recurrence. In R0 group, 55 patients (22.4%) out of 246 had local recurrence, 1 (10%) out of 10 in BilIN-3 group, and 20 (35.7%) out of 56 in R1 group. Systemic recurrence occurred in 103 patients (41.9%) in R0 group, 4 (40%) in BilIN-3 group, and 20 (35.7%) in R1 group. 5-year survival of each group was R0 34.2%, BilIN-3 48%, and R1 24.5% respectively. In BilIN-3 group, Bismuth classification consisted of type I 10%, II 10%, IIIa 30% and IV 50%. And among those patients, 4 patients (40%) had lymph node metastases. Conclusion: Our study suggests that local recurrence rate and overall survival of BilIN-3 group were close to R0 rather than R1, and clinical outcomes were comparable with R0 group. However further studies are needed to clarify the clinical significance of BilIN-3 with more accuracy.
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