Within the largest multi-institutional analysis of 30-day outcomes after hepaticojejunostomies for BDI in the US, morbidity and mortality rates were established at 26.3% and 2% respectively. ASA class and preoperative functional status remain the main risk factors for surgery. Earlier repair in the face of ongoing sepsis and disability is associated with worse outcomes. A multidisciplinary approach at a specialized center aimed at controlling infection and improving functional status prior to surgical reconstruction is recommended.

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Summary:External biliary fistulae are rare. Only 65 cases have been reported in the literature and in each instance gallstones were a complicating factor. We report in this paper the first case of spontaneous external (cholecystocutaneous) biliary fistula uncomplicated by gallstones.

HighlightsSiliconomas of the breast develop as a result of implant rupture and present with many of the signs and symptoms of breast cancer.MRI is the preferred study for diagnosis and a preoperative tissue sample should be attempted.We present a patient with a giant breast siliconoma and perform a comprehensive literature review.Our patient underwent a modified radical mastectomy with delayed closure.The majority of patients should undergo surgery due to symptoms or the inability to rule out cancer.

HighlightsThere are several endoscopic, laparoscopic and open surgical procedures available for the management of GIST tumors near the GE junction.We present a case-report utilizing both endoscopy and laparoscopy to facilitate resection using the non-touch lesion-lifting technique.Pathology demonstrated a 4.7 cm GIST. The patient was discharged on post-operative day 3 with no complications.We include a full literature review and describe the various combined modalities available for successful resection.

HighlightsPrimary umbilical endometriosis is rare and the presence of an underlying hernia makes it a diagnostic challenge.Only 7 cases have been reported in the literature.Our patient underwent an en-bloc resection of the hernia sac, endometrioma and umbilicus with reconstruction. There is no disease recurrence at 6 months.MRI is the preoperative imaging modality of choice and there is a limited role for preoperative FNA and medical management.

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HighlightsIntrahepatic malignant mesotheliomas are exceedingly rare and have nonspecific symptoms.Unlike malignant peritoneal mesotheliomas, the intrahepatic variant is rarely associated with asbestos exposure.The diagnosis may be confirmed preoperatively using axial imaging and immunohistochemical staining.Liver resection with negative margins including a rim of involved diaphragm is the mainstay of treatment.