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In 2010, the World Health Organization classified mucin-producing bile duct tumors of the liver into two distinct entities; mucinous cystic neoplasm of the liver (MCN-L) and intraductal papillary mucinous neoplasm of the bile duct. We present the case of a patient with MCN-L having a uniquely pedunculated shape. A 32‐year‐old woman was referred to our institution with a diagnosis of biliary cystic neoplasm. She had undergone left salpingo-oophorectomy for ovarian cancer 15 years ago. Imaging studies showed an 8 cm-sized well defined, multiloculated cystic lesion suggesting a mucinous cystic neoplasm. The cystic mass was pedunculated at the liver capsule and pathologically diagnosed as MCN-L. The mass was resected with partial hepatectomy. The patient recovered uneventfully. She was discharged 7 days postoperatively. The patient has been doing well for 6 months after the operation. The patient will be followed up annually because of the favorable postresection prognosis of MCN-L.

OBJECTIVES We aimed to examine management of double hepatic artery reconstruction in patients under going living-donor liver transplant. MATERIALS AND METHODS Between January 2002 and June 2014, one thousand thirty-six living-donor liver transplants were performed at the Liver Transplant Institute of Malatya Inonu University. Living liver grafts with a single hepatic artery were used in 983 living-donor liver transplants, while grafts with double hepatic artery branches were used in 53 living-donor liver transplants. All of the liver grafts with double hepatic artery branches were right lobe grafts. Hepatic artery anastomosis technique and the other medical data of recipients who used grafts with double hepatic arteries were analyzed retrospectively. RESULTS A double hepatic artery anastomosis was created in 43 recipients, while a single anastomosis was created in the remaining 10 because of ligation of the nondominant hepatic artery branch. In 40 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right and left hepatic artery. In the remaining 3 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right hepatic artery and large segment 4 hepatic arteries. Postoperative complications related with hepatic artery anas-tomoses developed in 3 recipients: hepatic artery thrombosis (n = 1), hepatic artery aneurysm (n = 1), and hepatic artery stenosis (n = 1). A recipient with hepatic artery aneurysm immediately underwent a retransplant. A recipient with a hepatic artery thrombosis relapsed and required retransplant, which was treated with thrombectomy on postoperative day 10. A recipient with hepatic artery stenosis was followed conservatively. In our series, the incidence of complications related with double hepatic artery anastomosis was found to be 6.9%. CONCLUSIONS According to our experiences, a double hepatic artery anastomosis does not increase the risk of hepatic artery thrombosis and can be performed safely by surgeons who are experienced with hepatic vascular reconstructions in a living-donor liver transplant recipient.

Rupture of a metastatic liver tumor associated with laryngeal cancer is a very rare complication with no previous case in the literature. We present a case of ruptured liver metastases which was treated conservatively. Dynamic contrast-enhanced computed tomography demonstrated active extravasation and discontinuity of liver capsule. When the patient came to our hospital from the external medical center, we did not see active extravasation on control computed tomography. This case highlights the role of radiologic imaging in the diagnosis and follow-up of ruptured hepatic metastases.

Plastic and metal biliary stents can fail to function properly, such failure being due to a positioning error or to the migration, occlusion, or fracture of the stent. An obstructed biliary stent can act as a nidus, causing complications such as recurrent persistent cholangitis. It can also cause vascular complications (such as bleeding and the formation of pseudoaneurysms), perforate the liver capsule (causing biloma or abscess), or, in rare cases, cause intestinal obstruction or perforation. In this pictorial essay, we demonstrate various interventional radiology techniques for the treatment of biliary stent dysfunction in patients with obstructive biliary disease.Disfunção das próteses biliares plásticas ou metálicas pode ser causada por migração, oclusão, mau posicionamento ou fratura. Uma prótese disfuncional na via biliar pode atuar como

The perihepatic space is frequently involved in a spectrum of diseases, including intrahepatic lesions extending to the liver capsule and disease conditions involving adjacent organs extending to the perihepatic space or spreading thanks to the communication from intraperitoneal or extraperitoneal sites through the hepatic ligaments. Lesions resulting from the dissemination of peritoneal processes may also affect the perihepatic space. Here we discuss how to assess the perihepatic origin of a lesion and describe the magnetic resonance imaging (MRI) features of normal structures and fluids that may be abnormally located in the perihepatic space. We then review and illustrate the MRI findings present in cases of perihepatic infectious, tumor-related, and miscellaneous conditions. Finally, we highlight the value of MRI over computed tomography.

Background: Angiomyolipoma (AML) is an uncommon mesenchymal tumour usually found in the kidney. The most common extrarenal site is usually the liver. We report a case of adrenal AML with a predominant vascular component co-existing with an adrenal adenoma. Case report: A fifty-year-old male presented with two months history of dysuria. Computed tomography showed a heterogeneous lesion involving the right adrenal gland abutting the right kidney and adjacent liver capsule. Urine noradrenaline levels were elevated. Adrenalectomy specimen showed an encapsulated mass measuring 8 x 5 x3.5 cm with a lobulated, grey to tan brown cut surface with areas of haemorrhage and tiny cystic spaces. Another yellowish nodule measuring 1.3 x 1.2 x 1 cm was also noted at one pole. Microscopy showed a neoplasm composed predominantly thick-walled vascular channels admixed with foci of smooth muscle bundles and adipocytes. Yellowish nodule showed features of adrenal adenoma. HMB-45 was negative and CD34 positivity highlighted the thick and thin walled vessels. Conclusion: We present the very first case of HMB-45 negative adrenal AML with a predominant vascular component and a synchronous adrenal adenoma.

The role of the hepatic transudation barrier in determining ascites volume and protein content in chronic liver disease is poorly understood. Therefore, the purpose of the present study was to characterize how chronic sinusoidal hypertension impacts hepatic transudation barrier properties and the transudation rate. The suprahepatic inferior vena cava was surgically constricted, and animals were exposed to either short-term (SVH; 2–3 wk) or long-term venous hypertension (LVH; 5–6 wk). Compared with SVH, LVH resulted in lower peritoneal fluid pressure, ascites volume, and ascites protein concentration. The transudation barrier protein reflection coefficient was significantly higher, and the transudation barrier hydraulic conductivity, transudation rate, and transudate-to-lymph protein concentration ratio were significantly lower in LVH animals compared with SVH animals. The sensitivity of transudation rates to acute changes in interstitial fluid pressures was also significantly lower in LVH animals compared with SVH animals. In contrast, there was no detectable difference in hepatic lymph flow rate or sensitivity of lymph flow to acute changes in interstitial fluid pressures between SVH and LVH animals. Taken together, these data suggest that decreased hepatic transudation barrier permeability to fluid and protein and increased reflection coefficient led to a decrease in the hepatic contribution to ascites volume. The present work, to the best of our knowledge, is the first to quantify an anti-ascites adaptation of the hepatic transudation barrier in response to chronic hepatic sinusoidal hypertension.

Pseudolipoma, also known as pseudolipoma of the Glisson's capsule, is an encapsulated lesion that contains degenerated fat and is enveloped by the liver capsule. In this report, we discuss a 37-year-old male presenting with dysuria and microscopic hematuria who revealed an incidental finding of a pseudolipoma on a CT scan of the abdomen.

A 57-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side whilst cycling but had not sought medical attention. On admission, a CT scan showed small bowel obstruction and he underwent an emergency laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis. Small bowel obstruction is a common presentation in A&E and is responsible for half of emergency laparotomies in the UK each year. Although hepatic haematomas are also a relatively common complication of blunt trauma to the abdomen, associated bowel herniation into the liver capsule is very unusual. We believe this is the first time such a case of small bowel obstruction has been reported in the literature and we discuss details of operative management and highlight key learning points.

Background In metabolic associated fatty liver disease (MAFLD) vibration controlled transient elastography (VCTE) by Fibroscan has emerged as a non-invasive diagnostic tool for the measurement of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), which are surrogate markers for hepatic steatosis and fibrosis, respectively. However, obesity constitutes a limitation in terms of creating unreliable examinations due to increased skin to liver capsule distance. Here, we aimed to investigate the feasibility of VCTE in the evaluation of hepatic steatosis and fibrosis in obese individuals. Methods A total of 126 consecutive obese patients (body mass index ≥30 kg/m2) without a known history of MAFLD enrolled in the study. We performed CAP and LSM measurements and calculated Fibrosis-4 Index for each patient and included data of those patients to the analysis, from whom valid measurements were able to be taken. Results Reliable VCTE measurements were able to be obtained in 122 patients (97%), from those in 34 patients with M and 88 patients in XL probe (median age: 50 [18-75], 45 males and 77 females). In 1 patient VCTE failed to take any measurements and in 3 the measurements were classified as unreliable. The mean CAP value was 323 ± 48 dB/m and the median LSM value 5.3 [1.8-34.3] kPa. Conclusion CAP and LSM assessments by Fibroscan are reliable diagnostic tools for the early diagnosis of hepatic steatosis and fibrosis in obese individuals.

Ultrasound examination (ultrasound) takes the first place first among visual methods for analyzing the state of the liver parenchyma. Despite the improvement of ultrasound technology, it does not provide the necessary diagnostic accuracy in determining the stages of liver fibrosis. In this regard, it is necessary to search for additional diagnostic criteria to judge the state of the liver tissue and its superficial structures, primarily liver capsules.Materials and methods: the state of the liver capsule was assessed in 73 children of four age groups (2-18 years) without pathological changes in the hepatobiliary system, which were performed by ultrasound of the abdominal organs during preventive examinations. The structure of the capsule of the liver and visceral peritoneum was evaluated. Results. Direct dependence of the thickness of the liver capsule on the age of children was established (rs = 0.577, p = 0.0000). The capsule and visceral peritoneum represented a single and even echogenic structure (95.9%). Stratification of the leaves was detected in 8 children. A change in the shape of the edge of the right lobe of the liver was observed in 4 children. An increase in the severity of subcapsular blood flow in the liver was not detected in any healthy child.

An incidental chest x-ray finding of an oval soft tissue opacity in the right costophrenic recess in a 55-year-old man prompted further investigation by unenhanced CT which demonstrated a 3.9 cm diameter lesion of fluid density intimately related to the lateral aspect of the right hemidiaphragm and right lobe of the liver. It was not possible on CT to determine whether this was intrapulmonary, an unusual exophytic hepatic simple cyst, or a diaphragmatic cystic abnormality. Subsequent ultrasound, however, allowed the diagnosis of a diaphragmatic mesothelial cyst by confirming an anechoic, thin-walled cystic structure separate from the liver capsule, from which it moved independently, with a fixed relationship to the diaphragm and splitting of muscular fibres of the right hemidiaphragm around its periphery. This case serves to highlight a rare congenital abnormality of the hemidiaphragm as a cause of a pulmonary nodule visible on a chest radiograph and to illustrate the usefulness of ultrasound in confirming the diagnosis. It also allows a critical review of the literature on intradiaphragmatic mesothelial cysts in adults and children. Keywords: Diaphragm, Mesothelial cyst, Intradiaphragmatic, Congenital

Aim: The difficulty of detecting lesions smaller than 1 cm in the preoperative period is still a continuing problem in peritoneal carcinomatosis. Methods: The prospective data of 106 peritoneal carcinomatosis patients were included this study. Preoperative AFP, carcinoembryonic antigen, CA19.9, CA125, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, mean platelet value, platelet distribution width, red cell distribution width and radiological findings compared according to Glisson capsule tumor involvement. Results: Preoperative radiological imaging methods have low accuracy in demonstrating Glisson capsule involvement. Inflammatory and serum tumor markers, except CA125, have been shown to be ineffective at detecting preoperative Glisson capsule involvement. CA125 levels higher than 52.4 were found to be significant in indicating Glisson's capsule involvement. Conclusion: CA125 is more sensitive than radiological and nuclear imaging methods in detecting tumors smaller than 1 cm.

Liver fluke are common parasites of herbivores in most of Middle East countries and egypt. The chronic and acute infections with 10 & 20 metacercaria of this parasite cause biliary liver cirrhosis in rabbits that leads to huge economic losses. This cross-sectional study was carried out to determine the prevalence of fascioliosis in slaughtered rabbits in Giza governorate. In egypt Fasciola gigantica was responsible for V-Line and Black Baladi rabbits total liver condemnations in infected groups. The infection impacts on female rabbits was more than males (p

Background Fascioliasis is a food-borne hepatobiliary zoonosis caused by Fasciola hepatica and Fasciola gigantica. Human infestations are predominantly seen in developing countries where the disease is endemic, but, due to the increase in international travel rates, hepatic fascioliasis is also appearing in nonendemic areas including Europe and the USA. The clinical and laboratory findings are usually nonspecific. Cross-sectional imaging can be very helpful in the diagnosis of fascioliasis as well as to differentiate it from other liver diseases with a very similar clinical picture. The objectives of this case report are to discuss imaging findings of hepatic fascioliasis and to review the literature. Case presentation We report the case of a 35-year-old Iranian patient who presented with right upper quadrant pain, low-grade fever, fatigue, and anorexia. The patient had a history of recent travel to the Gilan Province of Iran, almost a month before the onset of symptoms, which is an endemic area of fascioliasis in the country. Laboratory examinations revealed eosinophilia, elevated hepatic enzymes, and slightly raised C-reactive protein. Contrast-enhanced computed tomography of the patient shows clusters of focal ill-defined hypodense lesions with mild peripheral enhancement in the right liver lobe and subcapsular regions. Magnetic resonance imaging of the liver revealed multiple ill-defined lesions of low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image, extending from the liver capsule into deeper parenchyma toward periportal regions, which shows mild peripheral enhancement on post-contrast images. Imaging-based diagnosis of fascioliasis was made depending on the characteristic distribution of subcapsular tracts/lesions on the above-mentioned imaging, which was then confirmed by serologic tests using enzyme-linked immunosorbent assay. The patient was treated with triclabendazole, showing great clinical improvement, and was eventually discharged in good health condition. Conclusion The imaging findings in this case report highlight the importance of cross-sectional imaging for further evaluation of suspected cases of fluke-induced liver disease. The hypothesis of hepatic fascioliasis should be always considered when consistent radiological findings are observed. Clusters of tortuous subcapsular lesions with peripheral contrast enhancement extending into deeper liver parenchyma are characteristic imaging findings that strongly suggest hepatic fascioliasis.

El hemoperitoneo secundario a estallido hepático no traumático es una causa poco frecuente de abdomen agudo. Se presenta el caso de una paciente con estallido hepático secundario a metástasis de un tumor del estroma gastrointestinal (GIST) que requirió una laparotomía emergente por inestabilidad hemodinámica. Se evidenció intraoperatoriamente una lesión de más de 20 cm dependiente de la pared posterior gástrica y un hemoperitoneo secundario a estallido de metástasis hepáticas y descapsulación de la cápsula de Glisson. Una complicación frecuente de los GIST es la rotura que ocasiona hemorragia digestiva o hemoperitoneo, como ocurrió en nuestro caso.

Hepatogenic photosensitization in cattle is a pathology that can be caused by several diseases, such as chronic fasciolasis, as a consequence of the damage provoked, causing an inability of the liver to excrete photodynamic agents. Fasciolasis is a disease of high prevalence in Uruguay. Photosensitization is one of the clinical signs that can be observed in chronic fasciolasis, based on its ability to produce liver fibrosis, cholangitis with biliary stasis. In this work, two outbreaks of hepatogenic photosensitization in cattle are described in the counties of Tacuarembo and Soriano (Uruguay). The disease affected a herd of Hereford and crossbreed cows, and a herd crossbreed heifers. In both outbreaks animals were grazing in humid woodlands. The main clinical signs observed were weight loss, crusting and peeling of the nose, photophobia, sialorrhea and eye shifts. Main macroscopic findings at necropsy were bilateral necrotic dermatitis of the eyelids, ulcers on the ventral side of the tongue. Thickening of the liver`s Glisson capsule, diffuse hepatic fibrosis and chronic cholangitis with canalicular calcification. Histopathology showed liver fibrosis and canalicular obstruction with the presence of Fasciola hepatica as main lesions. The clinical signs of hepatogenic photosensitization observed in animals are related to the described liver disorders caused by F. hepatica

Background: Obesity is a primary limiting factor in liver stiffness measurement (LSM). The impact of obesity has always been evaluated in terms of body mass index (BMI), without studying the effects of skin-to-liver distance (SLD) on LSM. We studied the impact of SLD on LSM in a cohort of obese patients undergoing bariatric surgery and intra-operatory liver biopsy. Materials and Methods: 299 patients underwent LSM by point-shear wave elastography (ElastPQ protocol), with two different ultrasound machines. SLD was measured as the distance between the skin and the liver capsule, perpendicular to where the region of interest (ROI) was positioned. We used the following arbitrary cut-offs

Due to the need for quick and effective treatments for liver diseases, which are among the most common health problems in the world, staging fibrosis through non-invasive and economic methods has become of great importance. Taking inspiration from diagnostic laparoscopy, used in the past for hepatic diseases, in this paper ultrasound images of the liver are studied, focusing on a specific region of the organ where the Glisson's capsule is visible. In ultrasound images, the Glisson's capsule appears in the shape of a line which can be extracted via classical methods in literature. By making use of a combination of standard image processing techniques and Convolutional Neural Network approaches, the scope of this work is to give evidence to the idea that a great informative potential relies on smoothness of the Glisson's capsule surface. To this purpose, several classifiers are taken into consideration, which deal with different type of data, namely ultrasound images, binary images depicting the Glisson's line, and features vector extracted from the original image. This is a preliminary study that has been retrospectively conducted, based on the results of the elastosonography examination., Comment: Paper accepted with content unaltered to publish with IEEE Xplore Digital Library - 2020 IEEE Malaysian International Biomedical Conference (MIBEC)

Background To assess the safety and efficacy of cryoablation (CA) devices for the treatment of liver cancer at special sites in a retrospective study. Methods Special site liver cancer was defined as the tumors directly abutting surrounding structures (such as the liver capsule, gallbladder, vessel, diaphragm, intestine, and adrenal gland) with a maximum distance of 1.0 cm between the tumor and these organs. Sixty-six patients (49 men, 17 women; mean age, 60.8 years; age range, 27-82 years) were included. CA procedure was performed to treat 69 tumors under the guidance of computed tomography or ultrasound. Local tumor progression was assessed during the follow-up. A visual analog scale (VAS) evaluated the pain degree. Complications were assessed during and after every procedure. Results The number of tumors under the liver capsule and adjacent to the gallbladder, portal or hepatic vein, diaphragm, intestine, and adrenal gland were 29, 5, 8, 14, 7, and 6, respectively. The median follow-up time was 14 months (range, 2-28 months). In the 69 procedures, the technical success rate was 100%. The cumulative local tumor progression rates at 6, 9, 15, and 24 months were 10.2%, 16.5%, 20.9%, and 30.5%, respectively. No cases of serious complications occurred. During operation, the occurrence rates of subcapsular hemorrhage and pneumothorax were 2.9% and 1.4%, respectively. After the operation, the occurrence rate of biloma, capsular injury, subcapsular planting metastasis, and pneumothorax were 1.4%, 18.8%, 1.4%, and 2.8%, respectively. The average score of 66 patients with a VAS was 2.15±0.63 during the operation. Conclusions Percutaneous CA is safe and effective for patients with special site liver cancer.

Highlights • We made Roux-en-Y hepaticojejunostomy without transhepatic billiary stent and also without Witzel drainage one month after iatrogenic high transectional lesion (Class E) of both hepatic ducts during laparoscopic cholecystectomy was performed. • We created a part of anastomosis between the jejunum and liver capsula with polydioxanone suture (PDS) 4-0 because of poor quality of the remaining parts of the hepatic ducts. We had to made two separate hepaticojejunal anastomoses (left and right) that we partly connected to the liver capsule, where we had a defect of hepatic ducts, without Witzel enterostomy and transhepatic biliary stent. • There were no significant postoperative complications. • We did magnetic resonance cholangiopancreatography (MRCP) one year after the surgical procedure, which showed the proper width of the intrahepatic bile ducts, with no signs of stenosis of anastomoses. • We tried and managed to avoid such types of drainage and proved that in this way, without those types of drainage, we can successfully do duplex hepaticojejunal anastomoses and that they can survive without complications. • Our case indicates that this approach can be successfully used for surgical repair of iatrogenic lesion of both hepatic ducts., Introduction Most of the case reports about high type iatrogenic hepatic duct injuries reports how to treat and make Roux-en-Y hepaticojejunostomy below the junction of the liver immediately after this condition is recognised during surgical procedure when the injury was made. Hereby we present a case where we made Roux-en-Y hepaticojejunostomy without transhepatic billiary stent and also without Witzel drainage one month after the iatrogenic injury. Presentation of case A 21-year-old woman suffered from iatrogenic high transectional lesion of both hepatic ducts during laparoscopic cholecystectomy in a local hospital. Iatrogenic injury was not immediately recognized. Ten days later due to patient complaints and large amount of bile in abdominal drain sac, second surgery was performed to evacuate biloma. Symptoms reappeared again, together with bile in abdominal sac, and then patient was sent to our Clinical Center. After performing additional diagnostics, high type (Class E) of iatrogenic hepatic duct injury was diagnosed. A revision surgical procedure was performed. During the exploration we found high transection lesion of right and left hepatic duct, and we decided to do Roux-en-Y hepaticojejunostomy. We created a part of anastomosis between the jejunum and liver capsule with polydioxanone suture (PDS) 4-0 because of poor quality of the remaining parts of the hepatic ducts. We made two separate hepaticojejunal anastomoses (left and right) that we partly connected to the liver capsule, where we had a defect of hepatic ducts, without Witzel enterostomy and transhepatic biliary stent. There were no significant postoperative complications. Magnetic resonance cholangiopancreatography (MRCP) was made one year after the surgical procedure, which showed the proper width of the intrahepatic bile ducts, with no signs of stenosis of anastomoses. Discussion In most cases, treatment iatrogenic BDI is based on primary repair of the duct, ductal repair with a stent or creating duct-enteric anastomosis, often used and drainage by Witzel (Witzel enterostomy). Reconstructive hepaticojejunostomy is recommended for major BDIs during cholecystectomy. Considering that the biliary reconstruction with Roux-en-Y hepatojejunostomy is usually made with transhepatic biliary stent or Witzel enterostomy. What is interesting about this case is that these types of drainages were not made. We tried and managed to avoid such types of drainage and proved that in this way, without those types of drainage, we can successfully do duplex hepaticojejunal anastomoses and that they can survive without complications. Conclusion Our case indicates that this approach can be successfully used for surgical repair of iatrogenic lesion of both hepatic ducts.

Nitrite is toxic to fishes and is often encountered in recirculation aquaculture systems. The present study was carried out to study gills, liver and kidney histopathology in the juvenile freshwater fish Oncorhynchus mykiss which exposed to nitrite ( 1.2 ± 0.03 mg L -1 ) for 96 hours. Histopathological alterations in gills, liver and kidneys observed microscopically showed damage in the tissues while gills, liver and kidneys of control groups exhibited a normal architecture. The most characteristic features observed in nitrite exposed fish were hemorrhages in the oral cavity, in gills and on fish body surface; focal hemorrhages under the liver capsule and in the stratum of parenchyma; atrophy and destructive changes of hepatocytes; granular degeneration of liver and kidney; liver hyaline-drop dystrophy . The s tudy confirmed that histopathological biomarkers of toxicity in fish organs are a useful indicator of environmental pollution.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has been proven to be a safe and effective method for diagnosis and treatment of biliary and pancreatic disorders. Major complications of ERCP include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. We report a third case in literature of pneumoperitoneum after ERCP due to rupture of intrahepatic bile ducts and Glisson’s capsule in a peripheral hepatic lesion. Case Report: A 50-year-old male with a history of metastatic pancreatic neuroendocrine tumor and who had a partially covered metallic stent placed in the biliary tree 1 year ago presented to the oncology clinic with fatigue, abdominal pain, and hypotension. He was planned for ERCP for possible cholangitis secondary to obstructed previously placed biliary stent. However, the duodenoscope could not be advanced to the level of the major papilla because of narrowed pylorus and severely strictured duodenal sweep. Forward-view gastroscope was then passed with careful manipulation to the severely narrowed second part of the duodenum where the previously placed metallic stent was visualized. Balloon sweeping of stenting was done. Cholangiography did not show any leak. Following the procedure, the patient underwent CT scan of the abdomen that showed pneumoperitoneum which was communicating with pneumobilia through a loculated air collection in necrotic hepatic metastasis perforating Glisson’s capsule. The patient was managed conservatively. Conclusion: In our case, pneumoperitoneum resulted from rupture of intrahepatic bile ducts and Glisson’s capsule in hepatic metastasis. This case emphasizes the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP.

A serious complication of chronic hepatic insufficiency is acute-on-chronic liver failure, a recognized syndrome characterized by acute decompensation of cirrhosis and organ/system failure. We investigated the use of adipose-derived mesenchymal stem cells (AD-MSCs) in an experimental model of acute-on-chronic liver failure, developed by microsurgical extrahepatic cholestasis in rats. Rats undergoing microsurgical extrahepatic cholestasis were treated by intraparenchymal liver injection of human or rat AD-MSCs, undifferentiated or previously differentiated in vitro toward the hepatocyte lineage. The groups treated with rat AD-MSCs showed less ascites, lower hepato- and splenomegaly, less testicular atrophy, and an improvement in serum biochemical hepatic parameters. There was also an improvement in histological liver changes, in which the area of fibrosis and bile duct proliferation were significantly decreased in the group treated with predifferentiated rat AD-MSCs. In conclusion, an isograft of hepatocyte-predifferentiated AD-MSCs injected intraparenchymally 2 weeks after microsurgery in extrahepatic cholestatic rats prevents secondary complications of acute-on-chronic hepatic failure. These data support the potential use of autologous AD-MSCs in the treatment of human cholestasis, and specifically of newborn biliary atresia, which could be beneficial for patients awaiting transplant.

INTRODUCTION Postoperative pain after laparoscopic cholecystectomy has three components: parietal, visceral and referred pain felt at the shoulder. Visceral peritoneal injury on the liver (Glisson’s capsule) during cauterisation sometimes occurs as an unavoidable complication of the operation. Its effect on postoperative pain has not been quantified. In this study, we aimed to evaluate the association between Glisson’s capsule injury and postoperative pain following laparoscopic cholecystectomy. METHODS The study was a prospective case–control of planned standard laparoscopic cholecystectomy with standardized anaesthesia protocol in patients with benign gallbladder disease. Visual analogue scale (VAS) abdominal pain scores were noted at 2 and 24 hours after the operation. One surgical team performed the operations. Operative videos were recorded and examined later by another team to detect presence of Glisson’s capsule cauterisation. Eighty-one patients were enrolled into the study. After examination of the operative videos, 46 patients with visceral peritoneal injury were included in the study group, and the remaining 35 formed the control group. RESULTS VAS pain score at postoperative 2 and 24 hours was significantly higher in the study group than control (P = 0.027 and 0.017, respectively). CONCLUSIONS Glisson’s capsule cauterisation in laparoscopic cholecystectomy is associated with increased postoperative pain. Additional efforts are recommended to prevent unintentional cauterisation.

BACKGROUND The recipient's pattern of hepatic veins (HVs) drainage into the inferior vena cava (IVC) (drainage pattern, for short) may influence outflow reconstruction and thus hepatic venous outflow obstruction (HVOO) in piggyback liver transplantation (PBLT). However, no previous study has investigated this association. MATERIAL AND METHODS A retrospective analysis of 202 PBLT (2000-2016) was conducted. Based on drainage patterns, the patients were divided into Group A (common trunk of left and middle HVs), Group B (common trunk of right and middle HVs), and Group C (common trunk of 3 HVs). Patients' demographic and surgical data were compared within the 3 groups, and risk factors for HVOO were tested using a multiple logistic regression model. RESULTS A chi-square test revealed a significantly higher HVOO incidence in Group 1 compared with the other groups (23.5% vs. 9.6% vs. 7.1%, p=0.047). The demographics and surgical data except angleÐAOB between the reconstructed outflow and IVC in cross-section of 3D image (∠AOB), ratio of the length of reconstructed outflow and ∠AOB (LRO/∠AOB ratio), and types of HV ligation did not differ significantly within the 3 groups. ∠AOB and LRO/∠AOB ratio were used to assess the level of anastomosis twisting and compression, respectively. Among the 3 groups, the largest ∠AOB and highest LRO/∠AOB ratio were observed in Group A and B, respectively. In addition, multivariate analysis indicated that the ÐAOB (OR=1.016, 95%CI: 1.006-1.027) and LRO/ÐAOB ratio (OR=2.254, 95% CI: 1.041-5.519) were risk factors for HVOO. CONCLUSIONS This study demonstrated that drainage patterns were associated with HVOO. The best choice for outflow reconstruction is Group C. The patients in Group A and B were likely to develop HVOO due to anastomosis twisting and compression, respectively.

Objective: To retrospectively evaluate the safety and technical efficacy of percutaneous radiofrequency ablation (RFA) of surface hepatocellular carcinoma (HCC) in comparison to intraparenchymal HCC in cirrhotic patients. Materials and Methods: Surface lesions were defined as tumours located or reaching within 1cm of liver capsule including exophytic lesions. Seventy-four surface HCC including 21 exophytic in 58 patients (surface group) and 60 intraparenchymal HCC in 54 patients (intraparenchymal group) measuring up to 4 cm in maximum extent underwent percutaneous [ultrasound (US) or computed tomography-guided (CT-guided)] RFA. The response to the treatment was assessed by contrast enhanced CT/magnetic resonance imaging (MRI) done at 1, 3, 6, 9, and 12 months of RFA and thereafter every 4–6 months. In case of features suggesting residual disease, a repeat RFA was performed. The technical success after single-session RFA, complications and disease recurrence rates were calculated and compared between two groups. Results: Technical success achieved after first session of RFA in surface HCC was 95% (70/74) and intraparenchymal HCC was 97% (58/60). Hundred percent secondary success rate was achieved in both groups after second repeat RFA in residual lesion. No major difference in complication and local recurrence rate in both group on follow-up in surface HCC and intraparenchymal HCC. No case of needle track, peritoneal seeding, and treatment mortality was found. Conclusions: The complication rate and efficacy of RFA for surface and exophytic HCC's were comparable to that of intraparenchymal HCC. Hence surface and exophytic lesions should not be considered a contraindication for RFA in cirrhotic patients.

Highlights • Liver arterial flow does not depends solely on hepatic artery flow. • Temporary arterial liver ischemia causes formation of ‘bile lake’. • Bile lakes can be selective to the portion of the liver affected by the ischemia (no previous reports, normally this phenomenon is observed on the whole liver in liver transplantation complicated by hepatic artery thrombosis., Introduction Hepatic arterial liver flow is renowned for its redundancy. Previous studies have demonstrated that the common hepatic artery is not essential for liver survival. We present a case of a 31year-old involved in a high-speed motor vehicle accident whose liver survived thanks to the presence of an accessory hepatic artery. Presentaton of the case We present the case of a 31year-old male who sustained a traumatic injury of the proper hepatic artery following a motor vehicle accident. The patient suffered temporary right liver lobe ischemia due to the presence of an accessory left hepatic artery. This resulted in the selective formation of ‘biliary lakes' distinctively within the territory of the right hepatic artery supply. Simultaneously the patient developed a pseudo-aneurysm of the proper hepatic artery which required radiology intervention. At the time of pseudo-aneurysm embolisation, a rich network of arterial collaterals had formed between the accessory left hepatic and the inferior phrenic artery. On follow up the biliary lakes to the right lobe had resolved, but a small area at the periphery of the right lobe had encountered atrophy. Discussion This case report is an ‘in vivo’ demonstration of liver resilience to arterial flow re-distribution and demonstrates the ability of the biliary epithelium to recover from and ischemic injury. Conclusion Parenchymal liver survival is mostly independent from flow within the common hepatic artery. Acute and chronic liver parenchyma changes following interruption of hepatic artery flow can still occur.

BACKGROUND The laboratory rat is one of the most popular experimental models for the experimental surgery of the liver. The objective of this study was to investigate the morphometric parameters, physiological data, differences in configuration of liver lobes, biliary system, and vasculature (arteries, veins, and lymphatic vessels) of the liver in laboratory rats. In addition, this study supports the anatomic literature and identified similarities and differences with human and other mammals. MATERIAL AND METHODS Forty laboratory rats were dissected to prepare corrosion casts of vascular system specimens (n=20), determine the lymph vessels and lymph nodes (n=10), and for macroscopic anatomical dissection (n=10) of the rat liver. The results are listed in percentages. The anatomical nomenclature of the liver morphology, its arteries, veins, lymph nodes, and lymphatic vessels are in accordance with Nomina Anatomica Veterinaria. RESULTS We found many variations in origin, direction, and division of the arterial, venous, and lymphatic systems in rat livers, and found differences in morphometric parameters compared to results reported by other authors. The portal vein was formed by 4 tributaries in 23%, by 3 branches in 64%, and by 2 tributaries in 13%. The liver lymph was drained to the 2 different lymph nodes. The nomenclature and morphological characteristics of the rat liver vary among authors. CONCLUSIONS Our results may be useful for the planing of experimental surgery and for cooperation with other investigation methods to help fight liver diseases in human populations.

Background Intrahepatic cholangiocarcinoma (ICC) is often diagnosed in advanced stage. Aim of this study was to analyse the influence of resection margins and tumor distance to the liver capsule on survival and recurrence in a single center with a high number of extended resections. Methods From January 2008 to June 2018 data of all patients with ICC were collected and further analysed with Kaplan Meier Model, Cox regression or Chi2 test for categorical data. Results Out of 210 included patients 150 underwent curative intended resection (71.4%). Most patients required extended resections (n = 77; 51.3%). R0-resection was achieved in 131 patients (87.3%) with minimal distances to the resection margin > 1 cm in 22, 0.5-1 cm in 11, 0.1–0.5 cm in 49 patients, and 0.5 cm compared to 0.5–0.1 cm or R1 was better, but without reaching significance. All three groups had significantly better OS compared to the irresectable group. Recurrence-free survival (RFS) was also better in patients with a margin > 0.5 cm than in the Conclusions Wide resection margins (> 0.5 cm) should be targeted but did not show significantly better OS or RFS in a cohort with a high percentage of extended resections (> 50%). Wide margins, narrow margins and even R1 resections showed a significant benefit over the irresectable group. Therefore, extended resections should be performed, even if only narrow margins can be achieved.

Introduction Liver biopsy is the gold standard in diagnosing, staging and guiding clinical management in liver disease. There are currently no standard guidelines for liver biopsy recovery time. The aims of this project are to study the safety of a one-hour recovery time after percutaneous liver biopsies and to measure the rate of complications and identify risk factors. Methods A total of 500 consecutive subjects who underwent a percutaneous liver biopsy at a single-center teaching institution (Brooke Army Medical Center) were enrolled between December 2016 and October 2018. Biopsies were performed using a 14-gauge Bard® Monopty® core biopsy needle using bedside ultrasound. Complications were defined as: Pain level > 5 out of 10, hospitalizations, emergency department visits, or other. Major complications were defined as: hospitalizations and emergency department visits. Results The only complication that required hospitalization was identified during the first hour of recovery. Liver biopsies of subjects with body mass index (BMI) ≥35 kg/m2 were not associated with more complications when compared to patients less than 30 kg/m2. Using a spinal needle (3.5'') to anesthetize the liver capsule in subjects with excess subcutaneous tissue did not result in more complications when compared to the standard 1.5'' needle. Only 3% of the patients who received lidocaine alone for the biopsy required post-procedure medications. Conclusion Ultrasound-guided percutaneous liver biopsies, using a 14-gauge needle, were overall found to be safe. A one-hour post recovery period is adequate to identify all immediate major complications.

Pulmonary mucormycosis is a rare but life-threatening fungal infection. We report a post-haematopoietic stem cell transplant patient with pulmonary mucormycosis that extended to the diaphragm and subphrenic space. He underwent lung and diaphragm resection, debridement of liver capsule and diaphragm reconstruction using a pedicled latissimus dorsi flap. Following surgery, the patient remained well and has resumed his regular daily activities.

Spontaneous rupture of a liver metastasis is a life-threatening complication of metastatic liver disease. Although metastatic liver lesions are much more common than primary tumours, spontaneous rupture of a liver metastasis is rare. Therapeutic decisions must take into account the extent of metastatic liver disease and the patient’s performance status. Transarterial embolization may be considered in cases of ongoing haemorrhage despite initial conservative measures. We describe a case of haemoperitoneum due to spontaneous rupture of a liver metastasis in a 72-year-old patient with carcinoma of unknown origin who responded well to conservative management. LEARNING POINTS Spontaneous rupture of a liver metastasis is a rare but potentially life-threatening complication of metastatic cancer to the liver; risk factors include subcapsular location, rapid tumour growth and tumour necrosis (spontaneous or due to chemotherapy). Unexplained fever often precedes the spontaneous rupture, probably reflecting tumour necrosis or infiltration of the liver capsule, and may raise clinical suspicion for the diagnosis. Transarterial embolization may be considered in cases of ongoing haemorrhage despite initial conservative measures. Keywords: Liver, metastasis, rupture, haemoperitoneum CASE DESCRIPTION A 72-year-old woman was admitted to our hospital because of fever. Six months before admission, she had been diagnosed with metastatic carcinoma of unknown origin after a biopsy of an osteolytic lesion of the left femur. At that time, computed tomography (CT) of the chest and abdomen and a bone scan revealed extensive metastatic disease in the lung parenchyma, liver and bones (thoracic and lumbar spine, ribs, sternum, skull and femur). The patient underwent chemotherapy and palliative radiotherapy. One month before admission, a follow-up CT scan showed progression of the metastatic lesions of the bones and liver. Palliative radiotherapy was started and chemotherapy was deferred as the patient had a very poor performance status as she was confined to bed due to severe bone pain. She was admitted to our hospital a week after completion of the radiotherapy. At admission, the patient had fever but was otherwise stable, without symptoms or signs of infection. Laboratory studies showed a white cell count (WBC) of 11.5×109/l, a haemoglobin level of 9.7 g/dl and C-reactive protein (CRP) of 14.9 mg/dl (reference range

Sometimes, the presentation of some diseases can be fulminating. The authors present the case of a 51-year- old male brought to the emergency department visibly drunk and complaining of abdominal pain. Immediately, the diagnosis of hemorrhagic shock due to an accentuated drop of the hemoglobin level was made. After stabilization, he underwent a computed tomography of the abdomen, revealing a hepatocellular carcinoma with rupture of the Glisson capsule and massive intraperitoneal hemorrhage. With this case, the authors want to bring attention to a rare first presentation of hepatocellular carcinoma with a catastrophic result.

Hepatic splenosis is an uncommon condition that occurs following traumatic splenic rupture or splenectomy. The case of a 41-year-old male patient with multiple isolated liver masses indistinguishable from primary and metastatic liver tumours is reported. Following laparotomy, the liver lesions were resected and histopathology confirmed a diagnosis of hepatic splenosis. At an 18-month follow-up examination, no abnormalities in routine blood test, liver function, and liver computed tomography (CT) scanning were observed. After review of the literature, the following diagnostic criteria for hepatic splenosis are proposed: (1) a history of splenic trauma or splenectomy; (2) lesion(s) with a surrounding rim, particularly near the liver capsule identified by CT scanning; (3) findings on superparamagnetic iron oxide-enhanced magnetic resonance imaging or technetium-99m heat-damaged red cell scanning; and (4) histopathological findings (needle biopsy or surgical pathology). The following diagnostic process is also proposed: suspect diagnosis when criteria 1 and 2 are met; make diagnosis when criterion 3 is met; confirm diagnosis when criterion 4 is met. Laparotomy is recommended for either diagnosis or treatment when invasive procedures are necessary.

In addition to hepatocellular carcinoma, metastatic liver cancer (MLC) is another focus of hepatic surgeon. Good outcome of patients with liver metastasis (LM) from colorectal cancer or neuroendocrine tumor have been achieved. Ovarian cancer liver metastasis (OCLM) has its unique oncological characteristics and a variety of metastasis patterns, which brings a challenge to hepatic surgeon. Hepatic surgeons hold different views and techniques from gynecologists, which makes differences in the evaluation and treatment of the disease. We reviewed recent studies and, in combination with our own clinical experience, attempted to introduce the progress of surgical treatment of liver metastases from OC. In our experience, both preoperative imaging and surgical procedures are based on the assurance of R0 resection. R0 cytoreductive surgery (CRS) is the most favorable determinant for the prognosis of OC patients, and R0 liver resection (LR) is a component of R0 CRS. Gynecologists and hepatic surgeons should do their own preoperative and intraoperative evaluation for the extrahepatic and intrahepatic metastasis respectively. During the operation, regardless of the miliary nodules dissemination between the right hemidiaphragm and liver capsule, liver parenchymal infiltration (LPI) or liver parenchymal metastasis (LPM), 1–2 cm resection margin should be emphasized. For patients with liver portal lymph node metastasis (LPLNM), hepatic portal skeletonization should be performed, rather than portal lymph node dissection. The operation should be as radical as possible to ensure the patients to achieve good prognosis.

Fitz-Hugh–Curtis syndrome, a rare complication of pelvic inflammatory disease, is an inflammation of the liver capsule (thus called perihepatitis) and the surrounding peritoneum. It occurs extremely rarely in men and is typically characterized by a sudden onset of severe pain in the right upper abdominal quadrant. Ultrasound examination of the liver does not reveal any morphologic changes, and liver function tests are usually normal. Computerized tomography shows the thickening of the perihepatic fat, but definitive diagnosis is only possible by direct visualization by laparoscopy or laparotomy. We present a 33-year-old HIV-positive man with Chlamydia trachomatis proctitis who developed severe right upper abdominal quadrant pain. Abdominal ultrasound did not show any liver pathology, while computerized tomography revealed hepatic capsular thickening. After 21 days of doxycycline therapy, the patient’s symptoms subsided. Based on the clinical presentation and liver computerized tomography examination, the diagnosis of proctitis and the resulting Fitz-Hugh–Curtis syndrome was made. Although it is rarely seen in male patients, it should be a part of differential diagnosis in patients who present with right upper abdominal quadrant pain, especially in men who have sex with other men.

International audience; BACKGROUND & AIMS: Liver macrosteatosis (MS) is a major predictor of graft dysfunction after transplantation. However, frozen section techniques to quantify steatosis are often unavailable in the context of procurements, and the findings of preoperative imaging techniques correlate poorly with those of permanent sections, so that the surgeon is ultimately responsible for the decision. Our aim was to assess the accuracy of a non-invasive pocket-sized micro-spectrometer (PSM) for the real-time estimation of MS. METHODS: We prospectively evaluated a commercial PSM by scanning the liver capsule. A double pathological quantification of MS was performed on permanent sections. Initial calibration (training cohort) was performed on 35 livers (MS\textless/=60%) and an algorithm was created to correlate the estimated (PSM) and known (pathological) MS values. A second assessment (validation cohort) was then performed on 154 grafts. RESULTS: Our algorithm achieved a coefficient of determination R2=0.81. Its validation on the second cohort demonstrated a Lin's concordance coefficient of 0.78. Accuracy reached 0.91%, with reproducibility of 86.3%. The sensitivity, specificity, positive and negative predictive values for MS \textgreater/=30% were 66.7%, 100%, 100% and 98%, respectively. The PSM could predict the absence (\textless30%)/presence (\textgreater/=30%) of MS with a kappa coefficient of 0.79. Neither graft weight nor height, donor body mass index nor the CT-scan liver-to-spleen attenuation ratio could accurately predict MS. CONCLUSION: We demonstrated that a PSM can reliably and reproducibly assess mild-to-moderate MS. Its low cost and the immediacy of results may offer considerable added-value decision support for surgeons. This tool could avoid the detrimental and prolonged ischaemia caused by the pathological examination of (potentially) marginal grafts. This device now needs to be assessed in the context of a large-scale multicentre study. LAY SUMMARY: Macro-vacuolar liver steatosis is a major prognostic factor for outcomes after liver transplantation. However, it is often difficult for logistical reasons to get this estimation during procurement. Therefore, we developed an algorithm for a commercial, portable and affordable spectrometer to accurately estimate this content in a real-time fashion. This device could be of great interest for clinical decision-making to accept or discard a potential human liver graft.

A 61-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side while cycling, but had not sought medical attention. On admission, a CT scan showed small bowel obstruction (SBO) and he underwent an emergency open laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis. We believe this is the first reported case of SBO secondary to small bowel herniation into the liver capsule following trauma.

Fitz-Hugh-Curtis’s syndrome (FHCS) is defined as an inflammation of the liver capsule associated with pelvic inflammatory disease (PID). Here, we report a case of FHCS of a 37-year-old woman, presented with a history of the right upper quadrant (RUQ) abdominal pain. Physical examination revealed RUQ abdominal tenderness and vaginal secretions, pelvic pain that was denied by the patient. The diagnosis has been raised and a computed tomography (CT) scan was realized showing inflammatory changes in both pelvic and perihepatic regions.

Background: Perforated gallbladder is a common complication during laparoscopic cholecystectomy. Although morbidity is rare, serious complications can manifest subsequently. Patients may suffer long-term complications and laparotomy has been suggested to some for symptom relief. Patients and Methods: We present a case of laparoscopic cholecystectomy that was complicated by gallstone spillage. The patient presented later with a fistula, connecting the Glisson capsule to the subxiphoid trocar scar. Laparoscopic resection of the fistulous tract was recommended to the patient. Results: The post-operative course was uneventful and the patient remained asymptomatic 12 months after the procedure. Conclusion: Perforated gallbladder is a common complication during laparoscopic cholecystectomy and patients may suffer long-term complications. Some have had laparotomy recommended for symptom relief. However, recent research could not determine the best treatment modality. We have offered re-laparoscopy with ...

Background/aims Chronic liver disease leads to liver fibrosis, and although the liver does have a certain regenerative capacity, this disease is associated with dysfunction of the liver vessels. C-reactive protein (CRP) is produced in the liver and circulated from there for metabolism. CRP was recently shown to inhibit angiogenesis by inducing endothelial cell dysfunction. The objective of this study was to determine the effect of CRP levels on angiogenesis in a rat model of liver dysfunction induced by bile duct ligation (BDL). Methods The diameter of the hepatic vein was analyzed in rat liver tissues using hematoxylin and eosin (H&E) staining. The expression levels of angiogenic factors, albumin, and CRP were analyzed by real-time PCR and Western blotting. A tube formation assay was performed to confirm the effect of CRP on angiogenesis in human umbilical vein endothelial cells (HUVECs) treated with lithocholic acid (LCA) and siRNA-CRP. Results The diameter of the hepatic portal vein increased significantly with the progression of cirrhosis. The expression levels of angiogenic factors were increased in the cirrhotic liver. In contrast, the expression levels of albumin and CRP were significantly lower in the liver tissue obtained from the BDL rat model than in the normal liver. The CRP level was correlated with the expression of albumin in hepatocytes treated with LCA and siRNA-CRP. Tube formation was significantly decreased in HUVECs when they were treated with LCA or a combination of LCA and siRNA-CRP. Conclusion CRP seems to be involved in the abnormal formation of vessels in hepatic disease, and so it could be a useful diagnostic marker for hepatic disease.

Postoperative liver failure is one of the most critical complications following extensive hepatectomy. Although transplantation of allogeneic hepatocytes is an attractive therapy for posthepatectomy liver failure, transplanting cells via the portal veins typically causes portal vein embolization. The embolization by transplanted cells would be lethal in patients who have undergone massive hepatectomy. Thus, transplant surgeons need to select extrahepatic sites as transplant sites to prevent portal vein embolization. We aimed to investigate the mechanism of how liver cells transplanted into the mesentery protect recipient rats from acute liver failure after massive hepatectomy. We induced posthepatectomy liver failure by 90% hepatectomy in rats. Liver cells harvested from rat livers were transplanted into the mesenteries of hepatectomized rats. Twenty percent of the harvested cells, which consisted of hepatocytes and nonparenchymal cells, were transplanted into each recipient. The survival rate improved significantly in the liver cell transplantation group compared to the control group 7 days after hepatectomy (69 vs. 7%). Histological findings of the transplantation site, in vivo imaging system study findings, quantitative polymerase chain reaction assays of the transplanted cells, and serum albumin measurements of transplanted Nagase analbuminemic rats showed rapid deterioration of viable transplanted cells. Although viable transplanted cells deteriorated in the transplanted site, histological findings and an adenosine-5′-triphosphate (ATP) assay showed that the transplanted cells had a protective effect on the remaining livers. These results indicated that the paracrine effects of transplanted liver cells had therapeutic effects. The same protective effects were observed in the hepatocyte transplantation group, but not in the liver nonparenchymal cell transplantation group. Therefore, this effect on the remnant liver was mainly due to the hepatocytes among the transplanted liver cells. We demonstrated that transplanted liver cells protect the remnant liver from severe damage after massive hepatectomy.

In our study, in a 52-year-old man, specific and nonspecific findings of Schistosoma infestation were examined using ultrasonography, computed tomography, and magnetic resonance imaging. On computed tomography, capsular and septal calcifications and contrast enhancement of the liver capsule were seen. On T1-weighted magnetic resonance images diffuse hypointensity was seen in periportal spaces; on T2-weighted images in the same spaces, diffuse hyperintensity was seen. On dynamic contrast-enhanced T1-weighted images, in these same spaces marked contrast enhancement was manifested in the late venous phase. These signal changes indicate edema due to periportal fibrotic tissue inflammation and are accepted as pathognomonic for a liver infested by Schistosoma.