Percutaneous thrombolysis via cholecystostomy catheter to dissolve biliary clots causing obstructive jaundice.

Haemobilia, or bleeding within the biliary tree, is rare. It can cause biliary obstruction secondary to blood clots. A comorbid 87-year-old was admitted to hospital with acute cholecystitis, choledocholithiasis, and an bacteremia.

Perioperative Blood Transfusions and Anastomotic Leak After Colorectal Surgery for Cancer in an Australian Hospital.

Purpose: Peri-operative blood transfusion has been identified as a risk factor for anastomotic leak in recent studies, but little is known about which patients are at risk for blood transfusion. This study aims to assess the relationship between blood transfusion and anastomotic leak and factors predisposing to leak in patients undergoing colorectal cancer surgery.

Methods: This retrospective cohort study was conducted in a tertiary hospital in Brisbane, Australia, between 2010 and 2019.

Massive pulmonary embolism and intra-cardiac thrombus requiring systemic thrombolysis 9-hours post emergency laparotomy.

The link between abdominal surgery and venous thromboembolism (VTE) has been well established with recent evidence exploring the optimal VTE risk reducing strategy. However, despite these strategies pulmonary embolisms (PEs) do occur, which in the immediate post-operative setting creates a dilemma; to treat the VTE with anticoagulation but balance against the risk of hemorrhage. Treatment guidelines often do not include post-operative patients leaving the decision up to the treating physician to weigh the relative risks on an individual basis.

Open splenic artery aneurysm repair in a patient with previous laparoscopic sleeve gastrectomy.

We present the case of a female patient in her 40s who underwent a splenic artery aneurysm (SAA) repair following a previous laparoscopic sleeve gastrectomy (SG). We aim to discuss the management approach to SAAs and considerations in the setting of previous bariatric surgery.The patient consented to this case report.

Effect of obesity on post-operative outcomes following colorectal cancer surgery.

Background: Colorectal cancer (CRC) resection is currently being undertaken in an increasing number of obese patients. Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery.

Aim: To evaluate the post-operative outcomes of obese patients following CRC resection, as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery.

Double trouble: synchronous extrahepatic cholangiocarcinoma and gallbladder cancer in a Caucasian woman with no pancreaticobiliary maljunction.

Synchronous malignancies of the bile duct and the gallbladder are rare. These cases are often associated with pancreaticobiliary maljunction which is characterized by a long common shared pancreatobiliary channel leading to the Sphincter of Oddi. This predisposes the biliary epithelium to pancreatic enzyme reflux and makes the development of neoplasia more likely.

The impact of comorbidities on post-operative complications following colorectal cancer surgery.

Background: Colorectal cancer surgery is complex and can result in severe post-operative complications. Optimisation of surgical outcomes requires a thorough understanding of the background complexity and comorbid status of patients.

Aim: The aim of this study is to determine whether certain pre-existing comorbidities are associated with high grade post-operative complications following colorectal cancer surgery.

Acute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome: A case report.

Introduction: Acute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome (MS) is a complex surgical problem both diagnostically and in terms of management as it mimics both xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma.

Presentation Of Case: A 48-year-old gentleman was referred to us with biliary colic and weight loss with ultrasound findings of gallstones. At subsequent follow-up he became deeply jaundiced with deranged liver function and a CT showing a gallbladder mass and dilated biliary tree.

Recurrent pancreatitis in the setting of gallbladder agenesis, ansa pancreatica, Santorinicoele and eventual intraductal papillary mucinous neoplasia (IPMN).

Gallbladder agenesis is a rare condition. Patients with gallbladder agenesis can present with biliary type symptoms and rarely pancreatitis. We present the case of a 35-year-old gentleman who was admitted and treated for recurrent pancreatitis on a background of gallbladder agenesis, ansa pancreatica and Santorinicoele.

Unusual Presentation of a Sigmoid Mass with Chicken Bone Impaction in the Setting of Metastatic Lung Cancer.

Background: Ingestion of foreign bodies can cause various gastrointestinal tract complications including abscess formation, bowel obstruction, fistulae, haemorrhage, and perforation. While these foreign body-related complications can occur in normal bowel, diseased bowel from inflammation, strictures, or malignancy can cause diagnostic difficulties. Endoscopy is useful in visualising the bowel from within, providing views of the mucosa and malignancies arising from here, but its ability in diagnosing extramural malignancies arising beyond or external to the mucosa of the bowel as in the case of metastatic extramural disease can be limited.

Management of infected pancreatic necrosis in the setting of concomitant rectal cancer: A case report and review of literature.

Background: Pancreatitis with infected necrosis is a severe complication of acute pancreatitis and carries with it high rates of morbidity and mortality. The management of infected pancreatic necrosis alongside concomitant colorectal cancer has never been described in literature.

Case Summary: A 77 years old gentleman presented to the Emergency Department of our hospital complaining of ongoing abdominal pain for 8 h.

Cholecystoduodenal Stenting: An Option in Complicated Acute Calculous Cholecystitis in the Elderly Comorbid Patient.

We describe the course of an 84-year-old lady with acute calculous cholecystitis. She was unable to have a cholecystectomy due to multiple comorbidities including morbid obesity, type 2 diabetes, Guillain-Barrè syndrome, chronic sacral pressure ulcer, and severe cardiac disease. Conservative treatment with intravenous antibiotics was initially successful; however, she subsequently re-presented with an empyema of the gallbladder.

Ampullary cancer of intestinal origin and duodenal cancer - A logical clinical and therapeutic subgroup in periampullary cancer.

Periampullary cancers include pancreatic, ampullary, biliary and duodenal cancers. At presentation, the majority of periampullary tumours have grown to involve the pancreas, bile duct, ampulla and duodenum. This can result in difficulty in defining the primary site of origin in all but the smallest tumors due to anatomical proximity and architectural distortion.

Advances in Molecular Pathology and Treatment of Periampullary Cancers.

Objectives: Periampullary cancers (PACs) include the following 4 traditional anatomic subtypes: pancreatic, ampullary, biliary, or duodenal cancers. This review was performed to highlight recent advances in the genomic and molecular understanding of each PAC subtype and the advances in chemotherapeutic and molecular trials in these cancer subtypes.

Results: Recent advances have highlighted differences in the genomic and molecular features within each PAC subtype.

Vascular coil erosion into hepaticojejunostomy following hepatic arterial embolisation.

Background: Right hepatic arterial injury (RHAI) is the most common vascular injury sustained during laparoscopic cholecystectomy, occurring in up to 7% of cholecystectomies. RHAI is also the most common vascular injury associated with a bile duct injury (BDI) and is reported to occur in up to 41 - 61% of cases when routine angiography is employed following a BDI. We present an unusual case of erosion of vascular coils from a previously embolised right hepatic artery into bilio-enteric anastomoses causing biliary obstruction.

Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy.

Background: Pancreatic cancer (PC) has the worst survival of all periampullary cancers. This may relate to histopathological differences between pancreatic cancers and other periampullary cancers. Our aim was to examine the distribution and histopathologic features of pancreatic, ampullary, biliary and duodenal cancers resected with a pancreaticoduodenectomy (PD) and to examine local trends of periampullary cancers resected with a PD.

Large retroperitoneal isolated fibrous cyst in absence of preceding trauma or acute pancreatitis.

Background: Isolated retroperitoneal cystic masses are uncommon with an estimated incidence of 1/5750 to 1/250,000. The majority present with size related symptoms, complications, or a mass. Approximately a third of patients are asymptomatic and are diagnosed incidentally.

Oestrogen hormone receptors in focal nodular hyperplasia.

Background: The role of hormones in focal nodular hyperplasia (FNH) has been investigated with conflicting results.

Objective: The aim of this study was to evaluate oestrogen and progesterone receptor immunohistochemical expression in FNH and surrounding normal liver (control material).

Methods: Biopsy materials from FNH and control tissue were investigated using an immunostainer.

Anticoagulation policy after venous resection with a pancreatectomy: a systematic review.

Background: Portal vein (PV) resection is used increasingly in pancreatic resections. There is no agreed policy regarding anticoagulation.

Methods: A systematic review was performed to compare studies with an anticoagulation policy (AC+) to no anticoagulation policy (AC-) after venous resection.