Guo-Shiou Liao

Gallstone ileus with spontaneous resolution

Gallstone ileus is an unusual cause of intestinal obstruction. It is caused by impaction of one or more gallstones that enter the intestinal lumen via a cholecystoenteric fistula. Gallstone ileus is sometimes a challenge clinically and delayed diagnosis could carry a significant rate of complication and mortality. Resolution of gallstone ileus by spontaneous evacuation of gallstone is extremely rare. We present a case of gallstone ileus patient with a severe co-morbidity, treated with conservative treatment successfully by spontaneous evacuation of gallstone.

A paraduodenal hernia (Treitz's hernia) causing acute bowel obstruction

Paraduodenal hernias, also called Treitz’s hernia, are unusual causes of intestinal obstruction and account for 0.9% of all intestinal obstructions (1). Paraduodenal hernias constitute half of all internal abdominal hernias and occur when the small bowel herniates into the paraduodenal fossa with manifestation of intestinal obstruction (2). Specific clinical signs are often absent, leading to the frequent delay of correct diagnosis, with bowel necrosis resulting in up to 20% of patients (3). Herein, we present our case to increase the awareness of Treitz’s hernia and suggest the early CT scan intervention may be helpful to make the preoperative diagnosis of paraduodenal hernia.

Acute appendicitis with superior mesenteric vein septic thrombophlebitis.

Septic thrombophlebitis of the superior mesenteric vein (SMV) is rarely caused by acute appendicitis. The clinical symptoms of SMV thrombophlebitis are varied and atypical, so the diagnosis is commonly delayed, resulting in a reported mortality rate of 30%-50%. We report a case of SMV septic thrombophlebitis caused by acute appendicitis in which the patient was successfully treated with surgical intervention, appropriate antibiotics, and anticoagulation therapy. A follow-up abdominal computed tomography scan after 3 months of treatment showed that the SMV thrombosis had been resolved.

Spontaneous Rupture of a Large Exogastric Hemangioma Complicated by Hemoperitoneum and Sepsis

Hemangiomas are benign congenital tumors of mature blood vessels and usually consist of dense masses of capillaries or larger blood vessels. Hemangioma of the stomach presenting with spontaneous rupture and sepsis is rare. We report a 22-year-old male who presented at the emergency room with sudden-onset epigastric pain, intractable nausea, and vomiting. Fever, tachycardia, leukocytosis and peritonitis were found on examination after admission. Computed tomography revealed a single, well-defined homogeneous lesion measuring approximately 6 x 8 x 9 cm in size over the left upper abdomen and hemoperitoneum. Laparotomy was performed because of intra-abdominal hemorrhage, peritonitis, and fever. During the operation, a dark red tumor was found on the greater curvature side of the stomach, accompanied by bleeding and hemoperitoneum. The tumor was removed and a wedge resection of the stomach and partial omentectomy were performed. Histopathologic examination of the excised tumor revealed mixed cavernous-capillary hemangioma with central necrosis. The postoperative course was uncomplicated. The pathogenesis of spontaneous rupture and sepsis in this case may have resulted from pedicle torsion accompanied by ischemia, central necrosis, rupture of hemangioma and subsequent peritonitis and sepsis.

Predictive Risk Factors for Fracture at Catheter of Totally Implantable Venous Access Devices via Subclavian Vein Insertion

Background: Fracture of totally implantable venous access devices (TIVAD) is a rare but potential serious complication. We aimed to explore the risk factors for fracture at catheter of TIVAD via subclavian vein insertion. Materials and Methods: From January 2008 to July 2010 the records of 34 patients with fractured TIVAD were retrospectively reviewed. The comparison group included 170 randomly selected cases (5 for every patient with a fractured catheter) from 3919 cases of TIVAD implantations without catheter fracture. Variables associated with catheter implantation and the relationship between the catheter and the clavicle were analyzed. Results: Statistical analysis revealed implantation method, duration of implantation, brand of device, and port-clavicle distance were predictive risk factors for catheter fracture on univariate analysis. Duration of implantation ＞200 days and port-clavicle distance ＜2.5 cm were independent risk factors for catheter fracture on multivariate analysis. Stratified analysis indicated that a port-clavicle distance ＜2.5 cm in patients with duration of TIVAD implantation ＞200 days was associated with a significantly increased risk of catheter fracture. Conclusions: We suggested that TIVAD with a port-clavicle distance ＜2.5 cm could be removed to prevent catheter fracture when the implantation duration is more than 200 days.

Successful nonsurgical treatment for synchronous acute cholecystitis and acute appendicitis: A case report and review of the literatures

Acute appendicitis and acute cholecystitis are commonly seen in acute abdominal disease. However, it is rarely described that synchronous acute cholecystitis and acute appendicitis presented. Here, we present a case of 78-year-old male suffered from cholelithiasis with acute cholecystitis synchronized with acute appendicitis treated with nonsurgical management successfully.

A Comparison of Outcomes between Liver Transplant Recipients in China and those in Taiwan

Background: The outcome of liver transplantation in Taiwan and overseas has not been compared directly. We investigated differences in outcomes between liver transplant recipients in China and those in Taiwan. Materials and Methods: Ninety-two patients who underwent liver transplantation in China and were subsequently being followed at the Tri-Service General Hospital (TSGH; China group; CG) were compared with 107 patients who received transplants at TSGH (Taiwan group; TG). Donor and recipient characteristics, complications, and survival were analyzed. Survival was calculated using the Kaplan-Meier method, and univariate analysis was tested by the log-rank test. Then, regression analysis was performed using the Cox proportional hazard model. Results: The number of patients with hepatocellular carcinoma (HCC) beyond the Milan and University of California, San Francisco criteria was significantly higher in the CG than in the TG. The rates of HCC recurrence, intrahepatic biliary strictures, and mortality were also higher in the CG than in the TG. Univariate analysis revealed significant differences in 8 parameters between survivors and non-survivors, and Cox regression analysis further identified psychosocial problems, post-transplant de novo malignancy, HCC recurrence, and graft failure as mortality predictors. The overall survival rate was significantly higher in the TG than in the CG, with the former group showing a trend of greater mean survival duration. However, differences in survival were not significant after adjusting for risk factors. Conclusion: The outcomes of patients receiving livers donated after cardiac death may be comparable; however, patients with advanced HCC should not seek transplantation without appropriate pre-transplant tumor treatments.