A case of laparoscopic spleen-preserving distal pancreatectomy for small solid pseudopapillary neoplasm in an adult male with anomalous splenic vein confluence.

Although anomalies of the celiac and/or superior mesenteric arteries are occasionally encountered during abdominal surgery, anomalous venous confluence is seldom reported during pancreatic surgery. Herein, we present a rare case of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for the treatment of a solid pseudopapillary neoplasm in an asymptomatic 37-year-old male with an anomalous splenic vein (SpV) confluence. Computed tomography angiography (CTA) revealed an anomaly of the SpV, which coursed transversely through the superior border of the pancreas, over the celiac artery and into the portal vein, along the superior line of the common hepatic artery.

Percutaneous stone removal using cobra-shaped sheath and cholangioscopy for multiple hepatolithiasis with choledochoduodenal anastomotic stenosis.

Management of multiple hepatolithiasis with choledochoenteral anastomotic stenosis remains difficult and time-consuming. We report a case of a 77-year-old man with severe right hypochondoralgia, treated with percutaneous transhepatic balloon dilatation of choledocoduodenal anastomotic stenosis and percutaneous stone removal using 8Fr. cobra-shaped sheath and cholangioscopy.

The Acute Onset of Autoimmune Hepatitis During Pregnancy in the Absence of Hypergammaglobulinemia and Autoantibodies.

The onset of autoimmune hepatitis (AIH) during pregnancy is rare and often poses a diagnostic challenge. A 29-year-old Japanese woman experienced epigastric pain and nausea during the third trimester of her third pregnancy. Three days after the symptom onset, an emergency Caesarean section was performed because of suspected acute fatty liver of pregnancy; however, the patient's liver dysfunction worsened afterward.

[A case of pancreatic cancer with clusters of invasive micropapillary carcinoma markedly reduced by chemotherapy].

A man in his 60s was hospitalized with multiple cerebral infarctions and referred for Trousseau's syndrome. Computerized tomography confirmed a 60-mm mass in the pancreatic head and swollen lymph nodes around the abdominal aorta. Fine needle aspiration cytology of the pancreatic lesion and laparoscopic para-aortic lymph node biopsy revealed adenocarcinoma, including clusters of invasive micropapillary carcinoma (IMPC).

Hepatoid Adenocarcinoma of the Extrahepatic Bile Duct in a Patient with Polysplenia Syndrome.

Hepatoid adenocarcinoma (HAC) is a rare subtype of extrahepatic adenocarcinoma that is characterized by its morphological and functional similarities to hepatocellular carcinoma. We herein present a novel case of HAC arising from the extrahepatic bile duct in a 75-year-old Japanese woman with polysplenia syndrome. This is the second reported case of HAC arising from this site.

Highest power magnification with narrow-band imaging is useful for improving diagnostic performance for endoscopic delineation of early gastric cancers.

Background And Study Aims: Magnifying endoscopy with narrow-band imaging (ME-NBI) is more reliable than chromoendoscopy (CE) for delineating the horizontal extent of early gastric cancers prior to endoscopic submucosal dissection (ESD). However, the added benefits of ME-NBI over CE in terms of the difference in magnification level have yet to be elucidated. The aim of this study was to investigate the improvement in diagnostic accuracy for tumor delineation obtained with different magnification levels of ME-NBI following CE.

Gastric mucosal levels of prostaglandins and leukotrienes in patients with gastric ulcer after treatment with rabeprazole in comparison to treatment with ranitidine.

Aim: Prostaglandins (PGs) and leukotrienes (LTs) are major factors involved in the defense of the gastric mucosa against ulcer formation. However, little is still known about the gastromucosa-protecting action of proton pump inhibitors (PPIs) and histamine H(2) receptor antagonists (H(2) blockers) in patients with gastric ulcer. We therefore examined the effectiveness of a PPI in protecting the gastric mucosa.

Duodenal lymphangitis carcinomatosa: endoscopic characteristics and clinical significance.

Background And Aim: Duodenal lymphangitis carcinomatosa has been sporadically described, but so far little attention has been paid to duodenal lymphangitis carcinomatosa.

Methods: Four cases with duodenal lymphangitis carcinomatosa were endoscopically and histologically examined.

Results: The four cases exhibited multiple polypoid lesions along the Kerckring's folds and/or were covered by characteristically granular, non-ulcerated mucosa upon thickening.

Colonic pseudolipomatosis, microscopically classified into two groups.

Background: Colonic pseudolipomatosis is rare and the pathogenesis is controversial. The purpose of the present paper was to clarify endoscopic and histological characteristics of colonic pseudolipomatosis and to discuss the etiology.

Methods: A total of 15 lesions from 14 patients was reviewed.

Intestinal Behcet's disease with esophageal ulcers and colonic longitudinal ulcers.

Intestinal Behcet's disease in a 38-year-old woman was diagnosed because of the history of recurrent oral aphthous ulcers, erythema nodosum-like eruptions, genital ulcer, and endoscopic findings of esophageal and ileocolonic punched-out ulcers with colonic longitudinal ulcers. Esophageal lesions and colonic longitudinal ulcers are rarely seen in intestinal Behcet's disease. The ulcers of esophagus and ileocolon healed with 3 wk of treatment with prednisolone and mesalazine without any adverse effect.

A patient with adult extrahepatic portal obstruction, of which distinction from intrahepatic cholangiocarcinoma was difficult.

A 51-year-old Japanese male with chief complaints of slightly high fever and epigastralgia was hospitalized at our facility. The inflammatory response was enhanced, and liver dysfunction was observed. Abdominal ultrasonography demonstrated a hyperechoic lesion occupying the left portal vein, and abdominal plain CT indicated a low density of the lesion with a clear boundary, measuring about 3 cm x 2 cm, between the porta hepatis and segment IV of the liver.

A patient with octopus pot-shaped cardial cancer that metastasized to multiple organs.

A 71-year-old male was admitted for abdominal fullness. The condition rapidly deteriorated in a short period (3 weeks), and the patient died. Autopsy revealed a protruding lesion measuring about 3 cm with erosion measuring 5 mm in diameter immediately below the esophago-gastric conjugation site, suggesting primary cardial undifferentiated adenocarcinoma.

Hepatic portal venous gas disappearing within 24 hours.

Hepatic portal venous gas (HPVG) was detected by CT in a 64-year-old woman who suddenly complained of lower abdominal pain. However, the abdominal symptoms disappeared rapidly, and lower gastrointestinal endoscopy indicated only terminal ileitis. Conservative treatment alone was performed, and HPVG completely disappeared approximately 18 hours later.