We were able to detect the presence of bile excretion at the time of HPE intraoperatively and successfully evaluated the extent of bile excretion using this new technique. Furthermore, the ICG-FCG findings may provide information leading to a new classification and potentially function as an indicator predicting the clinical outcomes after HPE.

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Adenomyomatosis of the Gallbladder With Pancreaticobiliary Maljunction in a ChildAn 8-year-old girl referred for recurrent abdominal pain for 1 year had a normal physical examination except mild tenderness in the right hypochondrium and normal laboratory values such as AST/ALT 23/12 U/L, GGT 15 U/L, total bilirubin 0.9 mg/dL, and lipase 11 U/L. Magnetic resonance cholangiopancreatography (MRCP) showed thickening of the gallbladder wall, multiple heterogeneous hyperintense cysts of the gallbladder fundus, and no dilatation of the bile duct (Fig. 1). Endoscopic retrograde cholangiopancreatography showed pancreaticobiliary maljunction (PBM) not previously seen on MRCP (Fig. 2). The length of the common channel was approximately 1 cm outside duodenal wall (Fig. 2). She was diagnosed with adenomyomatosis of the gallbladder (AMG) accompanied by PBM and underwent total resection of the extrahepatic bile duct and Roux-en-Y hepaticojejunostomy. Histopathology showed typical AMG findings and no malignancy. She remained free of abdominal pain at 5 months after surgery.AMG is relatively common in adults ( 1), but we know of only 4 previously reported pediatric cases (2). Once the diagnosis of PBM is established, immediate prophylactic surgery is recommended irrespective of biliary dilatation because biliary cancers are frequent in adults with PBM (3). AMG with PBM has been reported previously in adults (4) but not in children. Tanno et al (4) reported that chronic inflammation and/or increased intraluminal pressure caused by regurgitation of pancreatic juice into the gallbladder may lead to AMG in patients with PBM. MRCP and/or endoscopic retrograde cholangiopancreatography should be performed to ensure prompt diagnosis of PBM.

Introduction Gastrointestinal stromal tumor (GIST) is rare neoplasms of the gastrointestinal tract associated with high rates of malignant transformation. GIST has been found largely in the stomach, small bowel, colon and rectum, and esophagus, but about 5% are found in other locations. We herein report a 56-year-old woman with a GIST in perforated Meckel's diverticulum. After encountering this patient, a review of the literature found reports of 18 similar patients. Case presentation A 56-year-old woman diagnosed with galactosialidosis (β-galactosidase-neuraminidase deficiency) presented with vomiting. On contrast-enhanced computed tomography, peritonitis due to perforation of the intestine was diagnosed based on the free air and dilated loop of the small bowel. Laparotomy revealed perforation of Meckel’s diverticulitis located 50 cm from the ileocecal valve. Partial resection of the ileum, including the diverticulum, and end-to-end anastomosis of the small intestine were performed. Regarding the pathological findings, the edge of the diverticulum wall consisted of a solid mass measuring 1.0 cm in size, and the tumor cells were spindle-shaped with 1 mitosis present per 50 high-power fields. The diagnosis was established as GIST of the Meckel's diverticulum. The postoperative period was uneventful. Follow-up at two years revealed no evidence of recurrence. Conclusion GIST in perforated Meckel's diverticulum is very rare. The potential for the coexistence of GIST or other tumor should be considered in the treatment of perforated Meckel's diverticulum.

Introduction:Lipoblastoma is a rare benign soft tissue tumor that occurs most commonly in infants and children. However, retroperitoneal lipoblastomas are rare, occurring in <5% of cases. We report a case of large retroperitoneal lipoblastoma and the largest collection of known retroperitoneal lipoblastomas in children in the literature.Case presentation:A 3-year-old girl presented with left abdominal mass. Magnetic resonance imaging (MRI) revealed a soft tissue mass measuring 12 × 8 × 6 cm in the retroperitoneal region. The mass had a clearly defined margin and a reticular pattern with an interposing fat component. Based on these findings, the mass was suspected to be a soft-tissue tumor, most likely lipoblastoma.Laparotomy with resection of the retroperitoneal mass was performed. The tumor was easily dissected from the retroperitoneal space without injury to surrounding structure.A histopathological examination demonstrated the mature proliferation of adipocytes and spindle-shaped cells separated by fibrovascular septa accompanied by myxoid changes. The cells were separated into lobules by septa, and areas of immature adipocytes showing a signet-ring or multivacuolar appearance were present at the periphery. Histopathological diagnosis was lipoblastoma. Follow-up at 6 months revealed no evidence of recurrence.Conclusion:Retroperitoneal lipoblastoma is rare and tends to be large in size when diagnosed at presentation. Complete resection should not be delayed, as impingement on the surrounding structures is imminent.