Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction.

Background And Aim: The extent of liver drainage for palliative treatment of malignant hilar biliary obstruction is controversial. The aim of this study was to compare endoscopic unilateral versus bilateral drainage in patients with malignant hilar biliary obstruction using a self-expanding metal stent (SEMS).

Methods: We carried out a retrospective review of 46 consecutive patients with malignant hilar biliary obstruction who were treated by endoscopic biliary drainage using SEMS between 1997 and 2005.

Pseudocyst in the pancreatic tail associated with chronic pancreatitis successfully treated by transpapillary cyst drainage.

We report a 50-year-old male with pseudocysts in the pancreatic tail associated with chronic pancreatitis successfully treated by transpapillary cyst drainage. He had previously undergone ultrasonography-guided percutaneous cyst drainage for a pancreatic pseudocyst in our hospital. He was readmitted due to abdominal pain and fever.

A case of obstructive jaundice caused by impaction of a pancreatic stone in the papilla for which a needle knife precut papillotomy was effective.

Context: Obstructive jaundice in chronic pancreatitis is generally caused by stenosis of the bile duct in the pancreas. Obstructive jaundice caused by the impaction of a pancreatic stone in the papilla is markedly rare, with only seven cases reported to date.

Case Report: We report a case of obstructive jaundice caused by the impaction of a pancreatic stone in the papilla.

Rupture of hepatic aneurysm complicating hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) for which hepatic arterial coil embolization was effective.

A 74-year-old woman was transferred to our hospital for further examinations because of abdominal fullness and abnormal levels of serum liver/biliary enzyme persisting for 3 weeks. She had anemia and dilatation of many capillary vessels in her fingers, palms, and tongue in addition to reporting frequent incidences of nasal bleeding in herself and her family. Abdominal ultrasonography detected a cystic lesion in the right hepatic lobe, connected to a dilated tortuous hepatic artery.

Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures.

Background And Aim: Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated.

Methods: After endoscopic retrograde cholangiography, brushing cytology was performed, followed by forceps biopsy. In patients with obstructive jaundice, endoscopic biliary drainage (EBD) was subsequently performed.

Difficulty in diagnosing autoimmune pancreatitis by imaging findings.

Background: Autoimmune pancreatitis (AIP) presents as diffuse enlargement of the pancreas and as diffuse irregular narrowing of the main pancreatic duct. However, some AIP cases are difficult to diagnose because of atypical imaging findings.

Objective: To clarify a variety of imaging findings of AIP and the reason for its misdiagnosis.

[Clinical evaluation of covered self-expandable metallic stent for unresectable malignant stomach pyloric region and duodenal obstruction].

We evaluated palliative treatment for unresectable malignant stomach pyloric region and the duodenal obstruction using covered self-expandable metallic stent (SEMS). Fifty-seven patients (26 stomach pyloric stenosis, 31 duodenal stenosis) were underwent palliative treatment using covered SEMS. The covered SEMS was Ultraflex stent for esophageal obstruction.

Systemic extrapancreatic lesions associated with autoimmune pancreatitis.

Objectives: Autoimmune pancreatitis (AIP) is often associated with systemic extrapancreatic lesions. We studied 31 cases of AIP to clarify the diversity of associated systemic extrapancreatic lesions and the differences between AIP with and without systemic extrapancreatic lesions.

Methods: The clinical features and courses were compared by age, sex, and blood chemistry between those with and without systemic extrapancreatic lesions.

Intrahepatic biliary papilloma morphologically similar to biliary cystadenoma.

A 37-year-old man presented complaining of epigastralgia. Abdominal ultrasonography revealed the presence of a papillary tumor (9 mm in diameter) in the cystic lesion (18 mm in diameter) in hepatic segment 4, which was accompanied by mild intrahepatic bile duct dilatation. Although abdominal computed tomography also showed the cystic lesion, it did not show papillary tumors inside the lesion.

Exophytic pedunculated gastrointestinal stromal tumor with remarkable cystic change.

A 59-year-old man with bloody stools, and previously diagnosed with sigmoid colon carcinoma, visited our hospital. Preoperative abdominal ultrasonography (US) showed another tumor, with an uneven irregular surface, measuring about 9 x 5 cm, below the left hypochondrium. The tumor consisted of several cysts.

Intracystic hemorrhage of a simple liver cyst mimicking a biliary cystadenocarcinoma.

Simple liver cysts are rarely complicated by intracystic hemorrhage. We encountered a case of simple liver cyst that was morphologically similar to biliary cystadenocarcinoma, which was complicated by asymptomatic intracystic hemorrhage and successfully treated by right lobectomy. A large cystic lesion of the liver was detected in a 57-year-old woman during a mass screening health check.