A solitary hepatic tumor in a 50‐year‐old woman, which was observed as a hemangioma, ultimately was resected because it increased in size. The tumor volume doubling time was 28.8 months over the observed period of 30 months. The histologic diagnosis was carcinoid tumor. Immunohistochemical staining showed strong focal reactivity for gastrin and diffuse reactivity for pancreatic polypeptide, vasointestinal polypeptide, calcitonin, and parathormone. Preoperative gastric hyperacidity with diarrhea and a body weight loss of 7 kg, moderately controlled by cimetidine on admission, suggested high serum gastrin levels produced by the tumor. Her symptoms resolved after surgery, and she had a normal serum gastrin level with negative secretin stimulation test results. A review of six cases of hepatic gastrinoma suggests that surgical resection, if feasible, would be the treatment of choice.
A case of traumatic common bile duct (CBD) obstruction is reported. A 38-year-old male was admitted to the hospital because of injury of the liver and pancreas by a traffic blunt trauma. CT 10 days after the trauma showed a cystic change of the pancreas head. The cyst almost disappeared 1 month later and strictures of the CBD and main pancreatic duct were recognized in the pancreas head on ERCP. The patient was once discharged with almost normal labolatory data. Three months later, however, he was re-admitted because of obstructive jaundice, which was managed by PTBD. Cholangiogram with both PTBD tube and ERCP showed a complete obstruction of CBD, 7 mm in length, at the pancreas head. Fistulous tract of PTBD was dilated and re-cannalizatin with a cholangiofiberscopy was intended in vain. Choledocho-duodenostomy was performed without postoperative complications. Obstruction of CBD was inferred to be caused by CBD injury and fibrous change during cure of the pancreatic pseudocyst.
A case of congenital esophago-bronchial fistula with bronchiectasia in an adult is reported. A 49-year-old female was referred to our hospital because of abnormal esophagogram. The most significant diagnostic image was bronchogram, which showed cystic bronchiectasia in the upper segment of the left lower lobe and a fistula measured 2cm in length and 7mm in diameter between the bronchus and esophagus. A closure of the fistula with left lower lobectomy was performed through 5th intercostal thoracotomy. The below findings are compatible with congenital natures of the fistula. 1) The fistula was associated with few adhesion and was divided easily. 2) Histologically, the fistulous tract was lined with squamous epithelium with muscularia mucosa.
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