Transvenous liver biopsy via the femoral vein.

AIM: To study the safety, effectiveness and diagnostic value of transvenous forceps biopsy of the liver in 54 patients with coagulopathy, gross ascites or morbid obesity and suspected liver disease in whom percutaneous liver biopsy was contraindicated. MATERIAL AND METHODS: Forceps biopsy of the liver via the femoral vein was attempted in 54 adult patients with advanced liver disease of unknown aetiology who had coagulation disorders (41 cases), gross ascites (11 cases) or morbid obesity (two cases). In each patient two to six biopsies (average four) were taken using a radial jaw forceps inserted via the right or left femoral vein. RESULTS: The procedure was successful in 53 cases. Hepatic vein catheterization failed in one patient. Adequate liver tissue for diagnosis was obtained in 84% of cases. One patient developed delayed haemorrhage at 12 h from a capsular leak that was undetected during the biopsy procedure. This patient required blood transfusions and laparotomy to control bleeding. There were no deaths in the 53 patients studied. Transient minor chest and shoulder pain was encountered during sheath insertion into a hepatic vein in 23 patients. Three patients developed a femoral vein haematoma, which resolved with conservative treatment. CONCLUSION: Transvenous liver biopsy via the femoral vein is another safe, effective, simple alternative technique of biopsy when the percutaneous route is contraindicated.

Surgical and radiological significance of variants of Bühler's anastomotic artery: a report of three cases.

Arterial anastomoses between the celiac trunk (CT) and superior mesenteric artery (SMA) include three variants. 1) The main anastomosis is the gastroduodenal artery (GDA), which is an important branch of the common hepatic artery and anastomoses with branches of the inferior pancreatic duodenal artery, a branch of the SMA. 2) The dorsal pancreatic artery (DPA) is usually a branch of the splenic artery, which anastomoses with the anterior and posterior pancreaticoduodenal arcades via a right transverse branch of the DPA (Kirk's arcade). 3) A less well known and rarely reported arterial anastomosis between the CT and SMA described by Buhler (1904). Three patients in whom variants of this anastomosis were present on retrospective analysis of three hundred consecutive combined CT and SMA arteriograms are reported. The embryological basis of its development, the surgical and radiological significance of the anastomotic artery are discussed.

Total anomalous arterial supply to the liver and gallbladder from the gastroduodenal artery: a case report.

Anomalous arteries to the liver are not uncommon and usually arise from the superior mesenteric artery, the left gastric artery or directly from the aorta. We report a case of total replacement of the arteries to the right and left liver by separate right and left hepatic arteries arising from the gastroduodenal artery. The proper hepatic artery was absent. The gallbladder was supplied from the anomalous right hepatic artery.

Acute hepatobiliary tuberculosis: a report of two cases and a review of the literature.

Two cases of hepatobiliary tuberculosis are described. Case one, the macronodular type of hepatic tuberculosis, presented as pyrexia of unknown origin and was eventually diagnosed by sectional imaging when a mass lesion developed in the liver and aspiration revealed acid-fast bacilli. Case two presented with jaundice due to a hilar bile duct stricture. The patient was successfully treated by repeated bile duct stenting and later chemotherapy for tuberculosis. In both cases previous positive histology or culture would have expedited diagnosis and treatment. Acute hepatobiliary tuberculosis remains a rare disease. Suspicion of the disease and adequate biopsy are important to allow prompt appropriate treatment.

Percutaneous placement of biliary stents for the treatment of high risk patients with jaundice due to common bile duct stones.

OBJECTIVE: Percutaneous treatment of eight high risk patients with jaundice due to common bile duct stones who were unfit for, or refused surgery and in whom endoscopic therapy failed. METHODS: Fine needle percutaneous cholangiography was followed by catheterization of the bile duct and insertion of a 10-Fr double pigtail Teflon stent in seven cases and a metal stent in one patient with bile duct stones and noncalculous lower common bile duct obstruction. RESULTS: Stent insertion was successful in all patients. Two patients showed pus in the common bile duct. Stent insertion in these relieved the jaundice, but one patient died from sepsis at 72 h. The other patient died from renal and respiratory failure 3 wk after stent insertion with resolution of the jaundice. In six patients, stent therapy relieved the jaundice for periods up to 3 yr or death from other causes. CONCLUSIONS: These findings suggest that percutaneous transhepatic stent insertion is a reasonable alternative for the management of common bile duct stones when endoscopic stent insertion fails.

Monolobar Caroli's disease.

Two cases of Caroli's disease confined to the left lobe of the liver are described. One patient is a 13-yr-old who presented with acute pancreatitis. The second patient presented with obstructive jaundice at age 60. In the latter case, the diagnosis was made by percutaneous transhepatic cholangiography, in the former by postoperative T-tube cholangiography. The diseased bile ducts were not resected in either patient. Both remain well at 4 and 5.5 yr postoperatively. Monolobar involvement in Caroli's disease has been described previously in only 34 published cases, and these are reviewed in detail.

Is hypertrophic osteoarthropathy really so rare in regional enteritis?

We describe a patient with hypertrophic osteoarthropathy secondary to regional enteritis, and review the literature on their association. The apparent different distribution of hypertrophic osteoarthropathy secondary to other causes may be artifactual and related to inadequate radiological investigation. Hypertrophic osteoarthropathy does not appear to be related to regional enteritis activity.