INTRODUCTIONHepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. It is usually manifested in the 6th and 7th decades of life. Extrahepatic metastases are seen in 64% of patients with HCC. The most frequent sites of extrahepatic metastases are lung, abdominal lymph node and bone, but peritoneal dissemination is unusual [1,2] . The incidence of spontaneous rupture of HCC is about 8%-26% in Asia [3][4][5] and the mortality rate of HCC patients is 10% [6] . However, peritoneal metastasis of HCC after spontaneous rupture is seldom noted. Here, we report a case of intraperitoneal metastasis of HCC after spontaneous rupture 10 mo ago, which was treated with transarterial embolization. CASE REPORTA previously asymptomatic 72-year-old man had a history of chronic hepatitis C-related liver cirrhosis without regular follow-up. Sudden nausea and vomiting with watery diarrhea were noted on January 2006. Then he was sent to Yun-Lin Branch of National Taiwan University Hospital for help. Abdominal computer tomography (CT) scan showed a huge HCC that was suspicious of rupture. Under the request of his family, he was transferred to our hospital and transarterial embolization was performed on January 31, 2006. After discharge, he was regularly followed up at our Gastrointestinal (GI) Outpatient Department (OPD). Dull abdominal pain over the right upper quadrant area, accompanied with fullness sensation, was noted in November 2006. Besides, he also had body weight loss of about ten kilograms in one year. So he visited our hospital again. Abdominal CT scan revealed a peritoneal mass in the right upper quadrant peritoneal area and hepatoma recurrence was considered ( Figure 1). Transarterial embolization was arranged again, but failed. After consultation with the surgeon, he was admitted for surgical resection.Surgical intervention was arranged on January 24, 2007. Operative methods were segmental hepatectomy (S6 and partial S5), excision of extrahepatic tumor, and cholecystectomy. The operation showed a huge tumor (12 cm × 8 cm × 6 cm) over the right upper quadrant area just below liver parenchyma (Figure 2) with its blood supplied from the omentum. Besides, two small mass lesions (3 cm × 2 cm and 2 cm × 1 cm) were found over AbstractRupture of hepatocellular carcinoma (HCC) is a lifethreatening complication. Peritoneal metastasis of HCC after spontaneous rupture was seldom noted. We report a case of intraperitoneal metastasis of HCC after spontaneous rupture. A previously asymptomatic 72-yearold man was admitted due to dull abdominal pain with abdominal fullness. He had a history of HCC rupture 10 mo ago and transarterial embolization was performed at that time. Abdominal computer tomography (CT) scan showed a huge peritoneal mass over the right upper quadrant area. Surgical resection was arranged and subsequent microscopic examination confirmed a diagnosis of moderately-differentiated HCC.

FDG-PET was perform to detect metastatic lesions. F18-fluorodeoxyglucose-PET could detect hypermetabolic lesions in 17 patients but failed to demonstrate miliary pulmonary metastases in two patients. No definite lesion was found in FDG-PET, x-ray chest computed tomography (CT) and other imaging studies of the remaining one patient This study showed that FDG-PET is a useful tool in detecting metastatic lesions in PTC with elevated hTg but negative I-131 WBS. However, miliary lung metastases may be missed in FDG-PET. In this circumstance, chest CT should be included in the follow-up protocol.

Background: Mucoceles resulting from cystadenomas of the appendix are uncommon. Although rare, rupture of the mucoceles can occur with or without causing any abdominal complaint. There are several reports associating colonic malignancy with cystadenomas of the appendix. Herein, we report an unusual and interesting case of right inguinal hernia associated with left colon cancer.

LCBDE with a 100% ductal clearance rate is possible following an algorithm for various approaches. SILCBDE is feasible under a low threshold for procedure conversion. A transcystic approach should be tried first if indicated, and a longitudinal cystic ductotomy to the cystocholedochal junction is beneficial. Prospective, randomized trials comparing single-incision and multi-incision LCBDE are anticipated.

Background Near-infrared indocyanine green fluorescence cholangiography (NIRF) has shown promising results on delineating extra-hepatic biliary anatomy during laparoscopic cholecystectomy to avoid bile duct injury. However its routine usage remains in question. In this study, the technique was evaluated further with learning curve estimation and learning factors were observed. Methods One hundred ninety-nine cases which underwent laparoscopic cholecystectomy for acute or chronic cholecystitis within a 2-year period including 51 cases with initial use of NIRF by 2 surgeons were studied retrospectively. The learning curve was evaluated for a surgeon as primary objective. A case-matched comparison of the operative time between NIRF and conventional group, in terms of acute and chronic cholecystitis was also conducted as a secondary calculation. Results Learning curve was evaluated with 61% learning rate for NIRF experience. Cysto-biliary junction non-illuminated cases under fluorescent view, had mean operative time of 80.83 ± 22.82 min, which was shorter than the cysto-biliary junction illuminated cases. The NIRF group exhibited longer operative time compared with the conventional group with mean difference of 34.39 min (significant at P < .05). Conclusions While the initial learning phase might be affected by surgeons’ behavior and attitude, our results may provide a reference to learn at one’s own pace and to employ NIRF teaching strategies during surgical training programs to overcome the initial phase during training period itself and facilitate universal achievement.