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Highlights • The article represents recovering treatment of iatrogenic biliary tract injury by laparoscopic cholecystectomy. • Biliary tract stricture like Bismuth type 2 successfully treated by hepatic ductoplasty. • To emphasize the importance of avoiding biliary stricture is a key to prevent cholangitis and stone recurrences., Introduction Biliary enteric anastomosis is a well-known biliary reconstruction method. Anastomosis stricture is one of the complications of this procedure that occurs in some patients over the long-term. We report a successful case of hepatic ductoplasty combined with hepaticojejunostomy (H–J) for the treatment of iatrogenic Bismuth type 2 stricture. Presentation of case The patient was a 68-year-woman who had undergone choledochojejunostomy (C–J) 6 years earlier due to bile duct injury after laparoscopic cholecystectomy for cholelithiasis. She complained of recurrent chills and upper back pain. Cholangiography and computed tomography revealed a C–J anastomotic stricture with hepatolithiasis. The diagnosis was reflux cholangitis with hepatolithiasis due to C–J stricture and a fistula between the reconstructed jejunal limb and duodenum. Exploration was performed, and she underwent hepatic ductoplasty with H–J and hepaticolithotripsy. Surgery was performed uneventfully and the patient has remained well subsequently. Discussion and conclusion We propose hepatic ductoplasty as a useful technique for the treatment of selected patients with a C–J stricture or narrow hepatic duct.

Gallstone disease, cholecysto- and choledocho-lithiasis, is one of the most common digestive diseases. Most patients with symptomatic cholecystolithiasis are recommended to undergo cholecystectomy to alleviate their symptoms like abdominal pain and jaundice. Approximately 10–20% of patients who undergo cholecystectomy for gallstones have choledocholithiasis. Nowadays, endoscopic and/or laparoscopic approaches are widely accepted as the treatment for patients with gallstone. Patients with cholecystolithiasis are usually treated by laparoscopic cholecystectomy, whereas patients with choledocholithiasis are done by endoscopic sphincterotomy (EST) or laparoscopic common bile duct exploration (LCBDE). Additionally, some cases are treated by biliary reconstruction such as biliary enteric anastomosis. In this chapter, currently available laparoscopic approaches as a minimally invasive surgery are introduced and discussed on the basis of pathogenesis of the gallstone.

Objective: Sphingosine 1-phosphate (Sph-1-P), a bioactive lysophospholipid present in the plasma, is released from activated platelets. Our previous study demonstrated that Sph-1-P promoted the spreading on and migration of human umbilical vein endothelial cells (HUVEC) through the extracellular matrix (ECM), suggesting a possible induction of cell surface proteases in the Sph-1-P activated endothelial cells. In the present study, we examined whether seprase, a type II transmembrane serine protease (TTSP) usually absent in tissue cells, can be induced in endothelial cells activated by Sph-1-P. Methods: HUVEC migration through ECM was examined by modifi ed Boyden chamber assay. Western blotting and immunoprecipitation, using anti-seprase monoclonal antibodies (mAbs), were used to confi rm the seprase expression of HUVEC. Results: We show that Sph-1-P enhanced expression of active form seprase in a time- and dose-dependent manner in HUVEC. The Sph-1-P inducible active form seprase could be blocked by pertussis toxin and by C3 transferase, which inactivate Gi-type heterotrimetric G proteins and Rho, respectively. Conclusion: These results show that Sph-1-P can regulate migration of endothelial cells by inducing active form seprase expression, which, in turn, is mediated through a Gi-coupled cell surface receptor and the Rho protein.

Haemosuccus Pancreaticus in Chronic Pancreatitis — Diagnosis and Treatment