Asymptomatic hepatic pseudoaneurysm identified 25 days after knife injury: a case report.

BACKGROUND: Hepatic pseudoaneurysm (HPA) is a rare complication that can occur after liver trauma and carries a high risk of rupture. HPA is usually asymptomatic until rupture, so performing routine surveillance of liver trauma patients is important. Most posttraumatic HPA occurs within the first week after injury, so surveillance imaging ~ 7 days postinjury is suggested. CASE PRESENTATION: We herein report a 47-year-old man who was diagnosed with asymptomatic HPA 25 days after a knife injury. The patient was transferred to the emergency room after attempting suicide by stabbing himself in his abdomen with a knife. The knife was surgically removed, and the postoperative course was uneventful. Computed tomography (CT) on postoperative day (POD) 12 showed no HPA. However, follow-up CT on POD 25 revealed HPA. The HPA was treated with coil embolization. The patient was discharged with no complications. One year after the injury, the patient had no recurrence or medical problems. CONCLUSION: When managing patients with penetrating liver trauma, it is important to note that HPA may not be identifiable on CT early after injury but may still develop later.

A patient with colitis-associated cancer who developed clinically manifest Crohn's disease only after surgery.

BACKGROUND: Patients with prolonged inflammatory bowel disease have a greater risk of colorectal cancer, known as colitis-associated cancer. Here we describe an unusual case of colitis-associated cancer. CASE PRESENTATION: The subject is a 41-year-old male who has not presented digestive symptoms and has an appreciable medical history. He consulted a nearby doctor with left flank pain. A colonoscopy revealed a lateral spreading tumor (granular-type) in his descending colon. With a clinical diagnosis of cancer, D3 left hemicolectomy was performed and a small intestine stoma was constructed. The pathological diagnosis of the tumor was mucinous adenocarcinoma, pT4a(SE), pN2a, which was associated with dysplasia in the surface area. Post-operative ileus was prolonged and the endoscopic examination revealed longitudinal ulcers in the ileum. These ulcers responded quite well to the administration of infliximab, confirming the final diagnosis of Crohn's disease. Pathological re-examination revealed that the tumor was dysplasia-associated type, and another dysplasia was confirmed near the tumor. Furthermore, mural scars and sporadic lymphoid aggregates were noted in the colon tissues, which suggested pre-existing Crohn's disease. The patient died of peritoneal dissemination of cancer on day 207 after surgery. CONCLUSION: The present case was diagnosed as colitis-associated cancer with clinically latent Crohn's disease, who developed clinically manifest Crohn's disease only after surgery. Our review of literature revealed no cases comparable to ours.

Pelioid-type well-differentiated hepatocellular carcinoma in a patient with a history of taking oral contraceptives: report of a case.

We report a case of pelioid-type well-differentiated hepatocellular carcinoma (HCC) in a 54-year-old woman with a history of taking oral contraceptives. She was not infected with hepatitis viruses and her liver function test results were normal. Contrast-enhanced computed tomography showed an irregular-shaped and remarkably enhanced tumor with central necrosis. The tumor was vaguely nodular without capsules, and consisted of multiple pelioid cysts and sinusoidal dilatations with transitional forms between them. The pelioid cysts were directly surrounded by neoplastic cells with fatty degeneration. Since pelioid-type HCC has similar radiological and pathological features to peliosis hepatis, it is difficult to differentiate them based on drug history and imaging studies. The detection of stromal invasion into the portal area is necessary to distinguish well-differentiated HCC from benign hepatic tumors.