Somatic mutations in PIK3CA and activation of AKT in intraductal tubulopapillary neoplasms of the pancreas.

Intraductal tubulopapillary neoplasm (ITPN) is a recently recognized rare variant of intraductal neoplasms of the pancreas. Molecular aberrations underlying the neoplasm remain unknown. We investigated somatic mutations in PIK3CA, PTEN, AKT1, KRAS, and BRAF.

One-step percutaneous transhepatic insertion of a balloon-expanding metallic stent for obstructive jaundice.

Background And Aim: The aim of this study was to evaluate the efficacy and safety of one-step percutaneous transhepatic insertion of the Express LD stent, a balloon-expanding stainless steel stent used for the management of distal artery stenosis in the treatment of obstructive jaundice caused by various inoperable malignancies.

Methods: Seventy-one consecutive patients with unresectable malignant biliary obstruction who underwent Express LD stent placement between 2007 and 2010 at our institute were reviewed.

Results: Mean stent patency was 165 ± 144 days and mean patient survival was 180 ± 156 days, while the cumulative stent patency rate and patient survival rate at 6 and 12 months were 79% and 65%, and 38% and 16%, respectively.

Giant liver hemangioma resected by trisectorectomy after efficient volume reduction by transcatheter arterial embolization: a case report.

Introduction: Liver hemangiomas are the most common benign liver tumors, usually small in size and requiring no treatment. Giant hemangiomas complicated with consumptive coagulopathy (Kasabach-Merritt syndrome) or causing severe incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. Here, we present the case of a giant hemangioma, which was, to the best of our knowledge, one of the largest ever reported.

Left hepatic trisectionectomy for hilar cholangiocarcinoma presenting with an aberrant biliary duct of segment 5: a case report.

Introduction: Management of the biliary ducts during liver resection is one of the most important challenges for hepatobiliary surgeons. Here, we report the case of a left hepatic trisectionectomy for hilar cholangiocarcinoma with a rare aberrant biliary duct of segment 5, which, to the best of our knowledge, has never been reported in previous literature.

Case Presentation: A 56-year-old Asian female initially presented with intrahepatic bile duct dilatation in the left lateral sector, left paramedian sector, and right paramedian sector.

Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage.

Objective: Postoperative pancreatic fistula (POPF) is a severe and frequent complication after pancreaticoduodenectomy (PD). The aim of this study was to identify an independent predictor of POPF and to assess the efficacy of preoperative multidetector row computed tomography (MDCT) images as an indicator for POPF.

Methods: A total of 122 patients who underwent PD with an end-to-side, duct-to-mucosa pancreaticojejunostomy between January 2005 and May 2009 were retrospectively reviewed.

Modified liver-hanging maneuver designed to minimize blood loss during hepatic parenchymal transection in hemihepatectomy.

Purpose: We evaluated the efficiency of a modified liver-hanging technique for minimizing intraoperative blood loss during right and left hemihepatectomy.

Methods: The lower end of the hanging tape was repositioned between the parenchyma of the left paramedian sector and the hilar plate. The upper end of the tape was positioned between the right hepatic vein and middle hepatic vein for right hepatectomy (Belghiti), and between the middle hepatic vein and left hepatic vein for left hepatectomy.

Diagnostic accuracy of multidetector-row computed tomography for hilar cholangiocarcinoma.

Background And Aim: The aim of this study was to investigate the diagnostic reliability of multidetector-row computed tomography (MDCT) for the evaluation of tumor spread in hilar cholangiocarcinoma.

Methods: Images obtained from a 16-detector row scanner of 22 patients were interpreted. The diagnostic accuracy of longitudinal ductal spread, vertical invasion (including hepatic parenchyma), and lymph node metastasis was assessed with reference to histopathological findings.

Preoperative evaluation of the longitudinal spread of extrahepatic bile duct cancer using multidetector computed tomography.

Background/purpose: The aim of this study was to compare the diagnostic accuracy of multidetector computed tomography (MDCT) and direct cholangiography in evaluating the longitudinal spread of extrahepatic bile duct cancer.

Methods: Images obtained from a 16-detector row scanner (MDCT) and from direct cholangiography (via either endoscopic naso-biliary drainage or percutaneous transhepatic biliary drainage) of 47 patients with histopathologically proven extrahepatic bile duct cancer were retrospectively interpreted. Differences between measures of longitudinal tumor spread determined by each modality and measures of macroscopic spread in resected specimens were assessed and compared.

Adult intussusception induced by the stump of the jejunal loop after liver transplantation.

Intussusception occurs rarely in adults compared with children, and in the case of adults, some organic disease, such as a benign or malignant tumor, can be found at the leading edge of the intussusception in about 90% of adult cases. This study reports a case of adult intussusception in which the stump of the jejunal loop in a Roux-en-Y bilioenteric reconstruction acted as a leading tip of the intussusception.

Hepato-pancreaticoduodenectomy with preservation of the collateral arterial arcade in the head of the pancreas in a patient with celiac axis stenosis.

Hepato-pancreaticoduodenectomy was performed for common bile duct carcinoma associated with celiac axis stenosis. To secure arterial blood flow to the upper abdominal organs, we preserved the anterior arcade in the pancreas head acting as a collateral pathway between the superior mesenteric artery and the celiac artery. This is another valid alternative procedure for pancreaticoduodenectomy in a patient with celiac axis stenosis.