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Gallbladder neurofibroma presenting as chronic epigastric pain - Case report and review of the literature
Iswanto Sucandy,Devesh Sharma,Gregory Dalencourt,David J. Bertsch
North American Journal of Medical Sciences , 2010,
Abstract: Context: Benign nonepithelial neoplasms of the gallbladder are unusual. The majority of gallbladder neurofibromas are found incidentally in the gallbladder specimens following cholecystectomy. There have been only few reports in the literature describing this rare entity. In this study we report a case of gallbladder neurofibroma presenting as chronic epigastric pain in a young patient. Case Report: A thirty two year old otherwise healthy man presented to our clinic with chronic epigastric pain symptom after eating. Physical examination, laboratory and radiologic workups were unremarkable for signs of biliary tract diseases. Past medical and surgical histories were significant only for neurofibromatosis type I. Due to persistent symptomatology, the patient was taken to the operating room for a diagnostic laparoscopy followed by laparoscopic cholecystectomy. Open conversion was necessitated because of the presence of a gallbladder mass preventing safe anatomic dissection. Surgical pathology revealed plexiform neurofibroma with noninflamed gallbladder. The postoperative course was unremarkable and the patient was pain free at 3 weeks postoperatively. Conclusions: Benign neoplasms such as gallbladder neurofibroma should be included in the differential diagnosis for chronic epigastric pain symptom in a young otherwise healthy patient with neurofibromatosis. Diagnostic laparoscopy should be considered in an individual presenting with this condition.
Multiple port-site metastasis of incidental gallbladder carcinoma after laparoscopic cholecystectomy  [PDF]
Ra?natovi? Zoran J.,Zari? Nemanja D.,Galun Danijel A.,Leki? Neboj?a S.
Acta Chirurgica Iugoslavica , 2012, DOI: 10.2298/aci1201105r
Abstract: Laparoscopic cholecystectomy is a surgical procedure of choice for benign gallbladder diseases. In about 1-2% of cases histopathological examination demonstrate incidental gallbladder cancer (GBCA). We report a case of a 61 year old woman who developed port site metastases after laparoscopic cholecystectomy for adenocarcinoma of the gallbladder. Metastases appeared on all four port sites. Review of literature regarding incidental GBCA an port site metastases was also performed. We conclude that the retrieval bag should be routinely used in laparoscopic cholecystectomy; the procedure should be performed with minimal trauma; in cases of incidental GB carcinoma, full thickness excision of the abdominal wall of the port sites demands additional studies; additional liver bed excision and local lymphadenectomy for T1b carcinoma are yet to be considered.
Port site and distant metastases of gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography  [cached]
Jian-Bin Hu, Xiao-Nan Sun, Jing Xu, Chao He
World Journal of Gastroenterology , 2008,
Abstract: We report port site and distant metastases of unsuspected gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography (PET) in two patients. Patient 1, a 72-year-old woman was diagnosed as cholelithiasis and cholecystitis and received laparoscopic cholecystectomy. Unsuspected gallbladder cancer was discovered with histological result of well-differentiated squamous cell carcinoma of the gallbladder infiltrating the entire wall. A PET scan using F-18-fluorodeoxyglucose (FDG-PET) before radical resection revealed residual tumor in the gallbladder fossa and recurrence at port site and metastases in bilateral hilar lymph nodes. Patient 2, a 69-year-old woman underwent laparoscopic cholecystectomy more than one year ago with pathologically confirmed unsuspected adenosquamous carcinoma of stage pT1b. At 7-mo follow-up after surgery, the patient presented with nodules in the periumbilical incision. Excisional biopsy of the nodule revealed adenosquamous carcinoma. The patient was examined by FDG-PET, demonstrating increased FDG uptake in the right lobe of the liver and mediastinal lymph nodes consistent with metastatic disease. This report is followed by a discussion about the utility of FDG-PET in the gallbladder cancer.
Four port-sites metastasis of gallbladder cancer after laparoscopic cholecystectomy: a case report
Ghafouri A,Nasiri Sh,Karam nejad M,Farshidfar F
Tehran University Medical Journal , 2008,
Abstract: "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Port-site metastasis following laparoscopic cholecystectomy with unsuspected gallbladder carcinoma is a serious problem. Gallbladder carcinoma is found in 1% of all biliary tract operations, in most being diagnosed only after histological examination of the gallbladder. The spread of cancer following laparoscopy appears aggressive and widespread, as noticed from re-operation for radical treatment. The pathologic findings of gallbladder were consisting of tumoral and necrotic tissue, indicating of well differentiated adenocarcinoma. Mucosa and submucosa were involved, but no evidence of invasion to muscular layer and gall bladder serosa was found (T1). In this article we present the first of an unusual case of four port site adenocarcinoma metastasis from gallbladder cancer."n"n Case report: A 63 year old woman underwent laparoscopic cholecystectomy for acute cholecystitis. Thirty months later, she was admitted to the hospital with a complaint of masses at the four trocar sites. A biopsy from the port sites was undertaken and led to the diagnosis of adenocarcinoma metastasis. There is no published report of all four port site metastasis of gallbladder cancer after laparoscopic cholecystectomy."n"nKeywords: Gallbladder, laparoscopic cholecystectomy, carcinoma.
Acute Fatal Hemothorax Following Placement of a Subcutaneous Implanted Port in a Cancer Patient  [PDF]
Ming-Hung Shih,Chao-Tsen Hung,Chih-Chung Lin,Ping-Wing Lui
Chang Gung Medical Journal , 2006,
Abstract: The placement of subcutaneous implanted ports has become a common procedure in themanagement of cancer patients, but it is not without risk. We report a patient, with cachexiaassociated with endometrial cancer, who died of acute hemothorax following placement of asubcutaneous implanted port. Death was most likely secondary to repeated venipunctureattempts in the right subclavian vein by an 18-gauge needle, resulting in perforation of theintrathoracic great vessels.
Carcinosarcoma of the gallbladder  [cached]
Agarwal Tanu,Jain Manoj,Goel Amit,Visayaragavan Paari
Indian Journal of Pathology and Microbiology , 2009,
Abstract: Carcinosarcoma of the gallbladder is an uncommon neoplasm. We herein report the case of a patient with carcinosarcoma of the gallbladder, treated by simple cholecystectomy for a tumor which was confined to the gallbladder.
Epigastric Heteropagus Twin  [cached]
Muhammad Qasim,Mahmood Shaukat
APSP Journal of Case Reports , 2011,
Abstract: Parasitic twining is a rare type of monozygotic monochorionic monoamniotic asymmetrical conjoined twin. We report a case of epigastric heteropagus twin. An ultrasound scan showed a defect of 1.5 cm in the epigastrium. CT showed soft tissue lobulated mass with fat and air components coming out of the epigastric defect. At operation rudimentary alimentary canal with no viscera, was found in the parasite. The parasite was easily separated from the host.
Modified port placement and pedicle first approach for laparoscopic concomitant cholecystectomy and splenectomy in children  [cached]
Pal Kamalesh
Journal of Indian Association of Pediatric Surgeons , 2010,
Abstract: Aim : Laparoscopy is becoming the preferred modality for concomitant cholecystectomy and splenectomy (CAS). Usually, six to seven ports are employed for CAS, and spleen is removed by classical lateral approach or anterior approach. We report here our modified five-port and pedicle first approach for CAS in children to minimize the intraoperative bleeding and maximize the access. Materials and Methods : Twenty-one children underwent laparoscopic CAS with this new approach and their data were recorded prospectively. Following cholecystectomy (with ports 1-4), left side was elevated by 30°. The spleen was lifted by a grasper/fan retractor through port no. 5. The pedicle was dissected and splenic vessels were divided by ligasure (vessels < 8 mm), and for bulkier pedicle, vascular endo-GIA stapler was used. Short gastric and gastrosplenic ligament, lower pole and phrenico-colic attachments and upper pole attachments were dissected by ligasure in that sequence. Spleen was placed in endosac and delivered by digital fracture technique. Occasionally, lower transverse incision was made to deliver a massive spleen. Results : There were 12 males and 9 females with an average age of 8 years. Fourteen had sickle cell disease (SCD) and 7 had SCD and beta thalassemia. All CAS were completed successfully without any complication. Total duration was 160 minutes. Cholecystectomy took an average of 35 minutes. Average blood loss was 140 ml. The mean splenic weight was 900 g and mean length was 20 cm. Duration of hospitalization was 3-4 days. Conclusion : CAS can be successfully performed by five ports. The pedicle first approach is extremely helpful in moderate to massive spleens as it reduces splenic size, vascularity and bleeding from capsular adhesions or inadvertant lacerations.
Gallbladder duplication  [PDF]
R. B?l?nescu,Laura Topor,Daniela Malureanu
Jurnalul de Chirurgie , 2012,
Abstract: Duplication of the gallbladder has been reported as an extremly rare congenital anomaly of the hepatobiliary system resulting fromabnormalities in embryogenesis during the fifth and sixth weeks of gestation, with an incidence of 1 in 3800-4000 autopsies. Duplicate gallbladder and its variable anatomy was first described byBoyden in 1926 and there are approximately 210 published cases to date. Variations include duplicate, triplicate and septated gallbladder. This anomaly is important in clinical practicebecause it may cause some clinical, surgical and diagnostic problems, and is important for surgeons because of associated anatomical variations of main bile duct and hepatic artery andincreased risk of common bile duct injury. Ultrasound is the preferred modality of imaging. Several entities may mimic a double gallbladder including a folded gallbladder, choledocal cyst,phrygian cap, pericholecystic fluid, gallbladder diverticulum, vascular band across the gallbladder and focal adenomyomatosis. Laparoscopic cholecistectomy has become a standard operation forthe great majority of benign gallbladder diseases including congenital anomalies of the biliary tree and the gallbladder. We present a case of duplicated gallbladder of 8 years old girl pacient who presented with recurrent upper abdominal pain and diagnosed intraoperatively with double gallbladder and treated during open surgery – cholecystectomy of duplicated gallbladder.
Gallbladder Disorders Detected by Ultrasound  [PDF]
Hamad Elniel H. Eltyib, Adel M. Al-Garni, Saddig D. Jastaniah
Open Journal of Medical Imaging (OJMI) , 2014, DOI: 10.4236/ojmi.2014.42012
Patients who have disease of the biliary tract commonly present with acute right upper quadrant pain, nausea or vomiting, mid-epigastric pain, and/or jaundice. Etiologies include inflammation with or without infection, noninflammatory disorders, and benign or malignant neoplasms of the gallbladder or bile ducts. Ultrasound (US) is now accepted as the initial imaging modality of choice for the work-up of suspected biliary tract disease. A retrospective study was carried out at King Abdulaziz University Hospital to discuss the protocol of ultrasound scanning in demonstrating incidence and complication of Gall-bladder (GB) pathologies. Known cases of GB pathologies (100 patients) were surveyed by ultrasound using spatial digital iU22 Philips Convex probe 3.5 MHz. All patients were evaluated with ultrasonogphy following the international scanning guidelines and protocols. The age of the patients is between (9 - 90) years, 68 Patients (68%) were females and 32 patients (32%) were males. Range of age group of accumulation for gallstone presence was (35 - 50) years in females and above 50 years in males. Incidence of gallbladder pathologies are 59% (female 46% and 13% male). Incidence of gallstone is 37%, and ratio of incidence is between male to female 1:3. Other pathologies of gallbladder were found to be acute cholecystities 12%, chronic cholocystities 5%, sludge 2%, carcinoma of the Gall-bladder 1%, Gall-bladder polyps 1% and Emphysematous choleycystities 1%. Ultransonography is a single imaging modality sufficient for evaluation of patient with suspected gallbladder pathologies (gallstone) which can provide information about the presence of gallstone and more over about site and cause of biliary tract obstruction. Ultrasound is highly sensitive and specific means for diagnosis of the gallbladder disorders.
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