PubMed · 10896489
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K Kawai. 2000. In the beginning.. https://doi.org/10.1016/s0016-5107(00)70314-2
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Imaging of the gallbladder and biliary tract has changed dramatically in the past 20 years. Magnetic resonancecholangiopancreatography provides a noninvasive alternative to endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography in the diagnosis of Mirizzi syndrome. In this laparoscopic era, when diagnosis is certain, surgeons must choose between a laparoscopic and a traditional open approach. The authors review their cases of hepatobiliary surgery during the period 1993-2000. Three cases of Mirizzi syndrome (0.4%) were observed among 712 surgical hepatobiliary patients (two type 1 cases and one type 2 case). The authors suggest that with Mirizzi syndrome type 1, laparoscopy together with peroperative cholangiography should be used to resolve anatomic doubts. If clipping of the cystic duct is possible and certain, then laparoscopy may be continued and finished. In the case of cholecystocholedochal fistula (Mirizzi syndrome type 2), when the diagnosis is determined before surgery, the authors believe that laparoscopy is dangerous. Adhesions, inflammation, and anatomy changes may cause injuries to the main bile duct, so an open traditional approach is suggested.
We describe a laparoscopic technique of pyloric exclusion with gastroenterostomy and common bile duct T tube insertion for obvious perforation at endoscopic retrograde cholangiopancreatography with papillotomy. The patient was operated on immediately after diagnosis of the lesion. The postoperative sequellae were very comparable to those of elective laparoscopic common bile duct exploration. We believe this approach is interesting, especially in the current era of frequent litigation.
Inflammatory myofibroblastic tumor (IMT) is an uncommon mass lesion composed of a variety of inflammatory and other mesenchymal cells. Although IMT was originally reported in the lung, it is now recognized that IMT can occur in a variety of organs. The occurrence of IMT in the pancreas, however, is rare. Here, we report a case of IMT arising from the head of the pancreas in a 55-year-old man. He underwent pancreaticoduodenectomy, with the diagnosis of carcinoma of the pancreas; the pathological diagnosis of the tumor was IMT. By referring to previously reported cases, we conclude that, in the management of IMT in the pancreas, surgical excision is the primary choice, in order to obtain a definitive diagnosis as well as to relieve symptoms, and strict follow-up after surgery is required.