P. Raju

Anomalous middle hepatic artery in laparoscopic cholecystectomy: Wolf in sheep's clothing

Laparoscopic cholecystectomy is a simple but dangerous operation. The complex anatomy and frequent anomalies of the hepatic arterial and biliary system are often a shocking surprise to the laparoscopic surgeon. When these vital structures cannot be identified correctly, potentially crippling serious vascular and biliary injury can occur. A very rare case of middle hepatic artery encountered in the Calots coursing over the gall bladder and travelling extraparenchymal into segment IV is reported. Identification and preservation of the middle hepatic artery is essential to prevent the possibility of hepatic artery thrombosis and to avoid ischemic cholangiopathy of segment IV duct. A comprehensive understanding of the hepatic arterial and biliary anatomy of the liver will empower laparoscopic surgeons to avoid crippling vascular and biliary injury.

Mediastinal Pseudocyst: Varied Presentations and Management—Experience from a Tertiary Referral Care Centre in India

Pseudocysts are a recognised complication following acute or chronic pancreatitis. Usually located in peripancreatic areas, they have also been reported to occur in atypical regions like liver, pelvis, spleen, and mediastinum. Mediastinal pseudocysts are a rare entity and present with myriad of symptoms due to their unique location. They are a clinical challenge to diagnose and manage. In this paper, we describe the clinical and radiological characteristics of mediastinal pseudocysts in 7 of our patients, as well as our experience in managing these patients along with their clinical outcome.