Dong Eun Park

Management of inferior vena cava thrombosis after blunt liver injury.

Inferior vena cava (IVC) thrombosis after traumatic liver injury is an extremely rare condition, and only 12 cases have been reported in the English literature since 1911. We report a case of a 26-year-old man who presented with IVC thrombosis after blunt liver injury. IVC thrombosis was incidentally detected by computed tomography 15 days after conservative management of blunt liver injury. The patient denied any symptoms of thrombophlebitis and did not have any evidence of hypercoagulable state. We placed an IVC filter via the right jugular vein and started the anticoagulation treatment. The patient recovered successfully without operative treatment and IVC thrombosis disappeared completely two months later. We suggest that that the possibility of IVC thrombosis should be considered in patients with a large hematoma of the liver, which may cause compression of the IVC.

Comparison of Virtual Unenhanced Images Derived From Dual-Energy CT With True Unenhanced Images in Evaluation of Gallstone Disease

OBJECTIVE The aim of this study was to compare gallstones on virtual unenhanced images and true unenhanced images acquired with dual-energy CT (DECT). MATERIALS AND METHODS We enrolled 112 patients with right upper quadrant pain and clinically suspected acute cholecystitis or gallstone who underwent DECT--including unenhanced, arterial, and portal phases. Eighty-three gallstones with composition proven by semiquantitative Fourier transform infrared spectroscopy from 45 patients who had undergone cholecystectomy (40 cholesterol gallstones from 21 patients, 43 calcium gallstones from 24 patients) were included. CT images were retrospectively evaluated for stone size, contrast-to-noise ratio (CNR) of gallstone to bile, and visibility and density of gallstones for each image set. The visibility of each type of stone was compared with a paired t test. RESULTS Both cholesterol and calcium stones measured smaller on virtual unenhanced images than on true unenhanced images, yielding a lower sensitivity of virtual unenhanced images for detecting small gallstones. Mean CNR of cholesterol stones was 2.45 ± 1.32 versus 1.67 ± 1.55 (p < 0.032) and that of calcium stones was 10.59 ± 7.15 and 14.11 ± 9.81 (p < 0.001) for virtual unenhanced and true unenhanced images, respectively. For calcium stones, two readers found 43 of 43 (100%) on true unenhanced images; one reader found 41 of 43 (95%) and the other, 37 of 43 (86%) on virtual unenhanced images. For cholesterol stones, one reader found 20 of 40 (50%) and the other 19 of 40 (47%) on true unenhanced images versus 34 of 40 (85%) and 30 of 40 (75%), respectively, on virtual unenhanced images. The visibility of cholesterol stones was higher on virtual unenhanced images, but that of calcium stones was lower. CONCLUSION Virtual unenhanced images at DECT allow better visualization of cholesterol gallstones, but true unenhanced images allow better visualization of calcium and small gallstones.

Timing of Cholecystectomy after Percutaneous Cholecystostomy for Acute Cholecystitis

BACKGROUND/AIMS Laparoscopic cholecystectomy is the standard treatment for acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment to resolve acute inflammation in patients with severe comorbidities. The purpose of this study is to determine the optimal timing of laparoscopic cholecystectomy after percutaneous cholecystostomy for the patients with acute cholecystitis. METHODS This retrospective study was conducted in patients who underwent cholecystectomy after percutaneous cholecystostomy from January 2010 through November 2014. Seventy-four patients were included in this study. The patients were divided into two groups by the operation timing. Group I patients underwent cholecystectomy within 10 days after percutaneous cholecystostomy (n=30) and group II patients underwent cholecystectomy at more than 10 days after percutaneous cholecystostomy (n=44). RESULTS There was no significant difference between groups in conversion rate to open surgery, operation time, perioperative complications rate, and days of hospital stay after operation. However, complications related to cholecystostomy such as catheter dislodgement occurred significantly more often in group II than group I (group I:group II=0%:18.2%; p=0.013). CONCLUSIONS Timing of laparoscopic cholecystectomy after percutaneous cholecystostomy did not influence postoperative outcomes. However, late surgery caused more complications related to cholecystostomy than early surgery. Therefore, early laparoscopic cholecystectomy should be considered over late surgery after percutaneous cholecystostomy insertion.