Imaging misdiagnosis and clinical analysis of significant hepatic atrophy after bilioenteric anastomosis: A case report.

BACKGROUND: The occurrence of long-term bilioenteric anastomotic stenosis can readily induce liver atrophy and hyperplasia, thereby causing significant alterations in the anatomical and morphological aspects of the liver. This condition significantly hampers the accuracy of preoperative imaging diagnosis, while also exacerbating the complexity of surgical procedures and the likelihood of complications. CASE SUMMARY: A 60-year-old female patient was admitted to the hospital presenting with recurring epigastric pain accompanied by a high fever. The patient had a history of cholecystectomy, although the surgical records were not accessible. Based on preoperative imaging and laboratory examination, the initial diagnosis indicated the presence of intrahepatic calculi, abnormal right liver morphology, and acute cholangitis. However, during the surgical procedure, it was observed that both the left and right liver lobes exhibited evident atrophy and thinness. Additionally, there was a noticeable increase in the volume of the hepatic caudate lobe, and the original bilioenteric anastomosis was narrowed. The anastomosis underwent enlargement subsequent to hepatectomy. As a consequence of the presence of remaining stones in the caudate lobe, the second stage was effectively executed utilizing ultrasound-guided percutaneous transhepatic catheter drainage. Following the puncture, three days elapsed before the drain tip inadvertently perforated the liver, leading to the development of biliary panperitonitis, subsequently followed by pulmonary infection. The patient and her family strongly refused operation, and she died. CONCLUSION: The hepatic atrophy-hypertrophy complex induces notable alterations in the anatomical structure, thereby posing a substantial challenge in terms of imaging diagnosis and surgical procedures. Additionally, the long-term presence of hepatic fibrosis changes heightens the likelihood of complications arising from puncture procedures.

A Novel Hepatectomy Model in Mice Using a Gutta Cutter Tool: A Feasibility Study and Preliminary Results.

BACKGROUND: A simple and reproducible model of hepatectomy provides an essential basis for the study of liver regeneration. However, current rodent models of hepatectomy involve lobectomy, which cannot simulate clinical liver resection with surgical margins. The main purpose of this study was to evaluate a novel murine modeling technique for hepatectomy using a gutta cutter. METHODS: Seventy-five C57BL/6 mice were randomly divided into 3 groups (n = 25 mice per group). Group 1 (control) underwent single ligature of the left lobe. Group 2 underwent left lobe local (5-mm diameter) hepatectomy by gutta cutter. Group 3 underwent partial left lobe resection (1.5 cm) by gutta cutter. Postoperative complications were analyzed. Serum aspartate transaminase, alanine aminotransferase, alkaline phosphatase, urea nitrogen, interleukin 6, and tumor necrosis factor-α were detected using an automatic biochemical analyzer. Hematoxylin-eosin and immunohistochemical staining was used to examine pathology, proliferating cell nuclear antigen, caspase-3, CD34, signal transducer and activator of transcription 3 (STAT-3), and phosphorylated STAT-3 (p-STAT-3). RESULTS: Major postoperative complications, hepatic enzymes, kidney function, interleukin 6, and tumor necrosis factor-α were similar among the groups (all P > .05). Histology showed little necrosis and a clear surgical boundary in groups 2 and 3. Groups 1 and 3 had higher positive cell levels (proliferating cell nuclear antigen, CD34, p-STAT-3) than group 2 (P < .05). There were no significant differences in caspase-3 and STAT-3 positive cells. CONCLUSIONS: Hepatectomy in mice using a gutta cutter to better mimic human liver resection shows potential as an alternative and safe animal model. This model may be useful in investigating methods of promoting liver regeneration.

Contrast enhanced ultrasound in diagnosing liver lesion that spontaneously disappeared: A case report.

BACKGROUND: Focal liver lesions (FLLs) are abnormal masses that are distinguishable from the surrounding liver parenchyma, solid or cystic and may be benign or malignant. They are usually detected incidentally on abdominal examinations. The classification of FLLs is very important as it directly determines the diagnosis and treatment of patients. CASE SUMMARY: A 46-year-old male patient was admitted into the hospital with tarry stool, during the investigation of this issue an incidental FLL was detected. Upon further investigation of this "incidentaloma" computerized tomography and magnetic resonance imaging reached contradictory conclusions. The lesion was then further investigated using contrast-enhanced ultrasound (CEUS) with an initial diagnosis of idiopathic FLL was acquired and observation of the FLL over time need for final diagnosis, however in the follow up the FLL disappeared spontaneously. CONCLUSION: CEUSs value for characterization of FLLs is undeniable, especially when other methods produce inconsistent results, is undeniable but with its limitations. Why and how the FLL disappeared is not known, and can be only hypothesized it was a pseudolesion.