Laparoscopic treated so-called reformed gallbladder in patient with postcholecystectomy chronic pain.

INTRODUCTION: Inadequate calculi removal, bile stasis, inflammation and strictures are causes of postcholecystectomy biliary syndrome. A cystic duct remnant is defined as a residual duct greater than 1 cm; it may predispose to chronic postcholecystectomy symptoms. CASE REPORT: We describe a case of a 33-years-old woman with recurrent epigastric pain radiating to right back. In the past medical history, an uncomplicated cholecystectomy was reported 11 years earlier. Imaging demonstrated a 2 cm impacted calculus within a cystic duct remnant, mimicking a so-called reformed gallbladder. At the magnetic resonance imaging the biliary tract was regular without dilatation. The patient was scheduled to laparoscopic exploration. Intraoperatively, the cystic duct stump containing the impacted calculus was easily found and meticulously dissected from extrahepatic bile structures. CONCLUSION: In our experience the laparoscopic removal was safely performed with complete cystic duct remnant excision and definitive cure of chronic painful symptoms. Therefore we think that, in selected cases, the reoperation is feasible by means of mininasive surgical procedures.

Endoscopic therapy for type B surgical biliary injury in a patient with short cystic duct.

Anatomical variations of the cystic duct are well-defined. The presence of short or absent cystic duct is unusual and represents a co-factor of biliary injury especially during laparoscopic cholecystectomy. Thus, its knowledge is important to avoid ductal injury in hepato-biliary surgery. We experienced the case of a 40-year-old woman with symptomatic cholelitiasis, who underwent to laparoscopic cholecystectomy. At surgery, an accidental bile duct lesion was carried, during Calot's triangle dissection, due the particular difficulties in dissecting an extremely short cystic duct found at the junction of the common hepatic duct and common bile duct. No vascular anomalies were present. The biliary leakage from the common bile duct was intraoperative identified and subsequentially treated by the endoscopic method. Laparoscopic cholecystectomy with sequential biliary endoprosthesis insertion was completed without conversion to open surgery. The endoscopic stenting was the definitive treatment for the leakage. No evidence of biliary stent complication was observed during the follow-up. This report documents a case of short cystic duct with particular emphasis to the biliary injury risk during the laparoscopic dissection of "unusual" Calot's triangle, and examines our mini-invasive therapeutic strategies in the management of bile leakage after laparoscopic cholecystectomy.

Chromosome abnormalities in lymphocytes and fibroblasts of subjects with multiple endocrine neoplasia type 1.

A consistent degree of chromosome instability was found in cultured lymphocytes and in fibroblasts derived from skin biopsies of three patients with multiple endocrine neoplasia type 1 (MEN1). In both tissues, there was a significant increase in chromosomal breakage. Dicentrics and tricentrics, rings, translocations, deletions, acentric fragments, and presumptive double minutes were the most frequent abnormalities in lymphocytes. The fibroblasts of two patients had large clones consisting of trisomy 7 and trisomy 18 cells, respectively.