Saburo Fukuda

Biliary Complications after Duct-to-duct Biliary Reconstruction in Living-donor Liver Transplantation: Causes and Treatment

BackgroundIn living-donor liver transplantation (LDLT), biliary complications are recognized as a significant cause of post-transplantation morbidity.MethodsEighty patients who underwent LDLT with duct-to-duct biliary reconstruction at Hiroshima University Hospital were enrolled in this study. The mean follow-up was 24 months (range, 3–72 months). Eighteen patients underwent the basiliximab-based immunosuppressive therapy, and 62 patients underwent non-basiliximab-based immunosuppressive therapy. The development of biliary complications after LDLT was retrospectively analyzed. Biliary complications were initially treated by endoscopic or radiological modalities.ResultsBiliary leakages and strictures occurred in 12 (15%) and 20 (25%) of the 80 patients, respectively. Stepwise multivariate analysis demonstrated bile leakage to be an independent risk factor for the development of biliary stricture (p = 0.001) and basiliximab-based immunosuppressive therapy to be an independent protective factor for postoperative biliary leakage (p = 0.005). The 1-week total doses of steroids were significantly lower in the basiliximab-based immunosuppressive regimes (mean dose: 573mg) than in the non-basiliximab-based ones (mean dose: 1,121mg) (p = 0.01). All patients with biliary leakage were successfully treated with endoscopic or radiological modalities, except one patient who was treated by surgical treatment. Endoscopic or radiological modalities were successful as primary treatment modalities in 12 (60%) of 20 patients with biliary strictures. Lastly, six patients were treated surgically with long-term success, except for one patient with chronic cholangitis who died after 16 months.ConclusionsSteroid-sparing basiliximab-based immunosuppressive therapy reduced the incidence of biliary leakage, and biliary leakage was the independent factor for biliary stricture. The non-surgical and surgical treatments for biliary complications were satisfactory.

Safety of donor right hepatectomy for adult-to-adult living donor liver transplantation.

The purpose of this study was to ascertain the usefulness of preoperative evaluations of donors by computed tomography (CT) volumetry and CT cholangiography for prevention of unexpected liver failure and biliary complications after donor right hepatectomy for adult‐to‐adult living donor liver transplantation. Fifty‐two donors who underwent right hepatectomy without the middle hepatic vein were enrolled in this study. The values of graft weight (GW) were significantly correlated with those of estimated graft volume (GV; P < 0.0001). GW was predicted by the following formula: GW = 155.25 + 0.658 × GV; r2 = 0.489. CT cholangiography revealed anatomical variants of biliary structure in one‐third of the donors and also clearly showed one or two small biliary branches from the caudate lobe to the right hepatic ducts or the confluence in 58% of the donors. Biliary leakage, which was treated by conservative therapy, occurred in only one donor (1.9%). No donors received homologous blood transfusion. Hyperbilirubinemia (serum total bilirubin >5 mg/dl) occurred in 5.8% of the donors during their early postoperative periods. Precise evaluations of liver remnant volume by CT volumetry and biliary variation by CT cholangiography are essential for performing safe donor hepatectomy, preventing hepatic insufficiency and minimizing the risk of biliary tract complications.

A tailgut cyst found accompanying rectal cancer: Report of a case

Tailgut cysts are rare congenital lesions. To date, only four cases have been reported in Japan, and the occurrence of a tailgut cyst with rectal cancer has never been documented. We describe here the case of a patient in whom a tailgut cyst in the retrorectal space was associated with rectal cancer. Preoperative computed tomography scans and endorectal ultrasonography failed to identify the lesion as cystic, instead suggesting an involved lymph node. This case emphasizes the necessity for careful diagnosis of masses in the retrorectal space in patients with rectal cancer.

Angiomyolipoma of the colon: Report of a case

Angiomyolipomas are benign mesenchymal tumors mostly arising from the kidney. Angiomyolipoma of the colon is extremely rare. Here we report the findings of a 51-year-old man who presented with a submucosal tumor covered with normal mucosa and hemorrhage in the descending colon. He underwent a partial resection of the descending colon. A histopathological examination showed that the tumor of 5.7 cm in diameter included smooth muscle (spindle cell type), mature adipose tissue, and vessels, and therefore a diagnosis of angiomyolipoma was made. A submucosal type of angiomyolipoma of the colon is extremely rare. If a renal angiomyolipoma is larger than 4 cm, there is a risk of rupture. When colonoscopy shows a submucosal tumor of the colon with hemorrhage, angiomyolipoma should be considered. If an angiomyolipoma of the colon is large, surgical resection should be considered as a treatment option due to the risk of hemorrhage.

Reconstruction of the middle hepatic vein tributaries draining segments V and VIII of a right liver graft by using the recipient’s own middle hepatic vein and vascular closure staples

A right liver graft lacking the middle hepatic vein can result in congestion of the anterior segment. We describe a method of reconstructing the middle hepatic vein tributaries by using the recipient’s own middle hepatic vein with vascular closure staples. During a living donor right liver transplantation, the middle hepatic vein tributaries draining segments V (V5) and VIII (V8) of the right lobe graft were reconstructed using the recipient’s own middle hepatic vein and secured with vascular closure staples. Computed tomography showed good venous outflow from the middle hepatic vein and no congestion or atrophy of the anterior segment of the right liver grafts. Thus, using the recipient’s own middle hepatic vein is a suitable option for reconstructing the middle hepatic vein tributaries (V8 and V5) in right-liver living donor transplantation and the application of vascular closure staples helps to accomplish this.

A case of pancreatic schwannoma showing increased FDG uptake on PET/CT

Highlights • Pancreatic schwannoma is rare and preoperative diagnosis is difficult due to the lack of specific symptoms, radiological characteristics and tumor markers.• Incidental detection of pancreatic schwannoma is predicted to increase due to the widespread use of CT and MRI. It is important to take into account this tumor in the differential diagnosis of pancreatic tumors.• We should be aware that FDG-PET/CT shows abnormal accumulation in a benign pancreatic schwannoma.

A colovesical fistula with a persistent descending mesocolon due to partial situs inversus: A case report

Highlights • Colovesical fistula was occered in the extremely rare condition: partial situs inversus with persistent descending mesocolon (PDM).• Distinctive features of PDM were shortening adhesions noted at the dorsal aspect of the descending and sigmoid mesocolon without marginal vessel.• In this case, these congenital abnormalities might help the suture failure during the operation of sigmoid colectomy.

A solid pseudopapillary neoplasm of the pancreas in a man presenting with acute pancreatitis: A case report

Highlights • Small SPN of the pancreas is sometimes difficult to diagnose preoperatively and mimicking pancreatic cancer.• The clinical presentation of SPNs is nonspecific, but acute pancreatitis is rare in the reported literature.• We should be aware that SPN of the pancreas can become a cause of acute pancreatitis.

Acute diffuse peritonitis due to spontaneous rupture of a primary gastrointestinal stromal tumor of the jejunum: A case report

Highlights • Completely different types of GIST rupture have been reported as same perforation type.• We classified retrieved cases of GIST rupture to three types: abscess type, hemoperitoneum type, bowel perforation type.• Each type demonstrates a specific mechanism of perforation causing characteristic complaints.