Intrahepatic biliary cystadenoma causing luminal common bile duct obstruction

BACKGROUND: Biliary cystadenomas are rare cystic tumours that arise in the liver or less frequently in the extrahepatic biliary system. They are commoner in middle-aged women, their most favoured site is the right hepatic lobe. METHODS: Case report and review of the literature. RESULTS: We present only the second case of an intrahepatic cystadenoma causing luminal obstruction of the common bile duct. Clinical presentation is often non-specific and can prove to be a diagnostic challenge. CONCLUSION: Wide local excision of biliary cystadenomas is recommended, with regular radiological follow-up.     

Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction

Persistent omphalomesenteric duct as a cause of small-bowel obstruction is an exceptional finding. A neonate presented with occlusion due to intestinal prolapse through a persistent omphalomesenteric duct. Remnants of the duct were successfully resected, and the postoperative course was uneventful. We discuss the presentation of omphalomesenteric duct and its management.     

Warthin's tumour of the parotid gland

The authors, after examining two recent cases, explain a number of basic concepts regarding the diagnosis and therapy of Warthin's tumour of the parotid gland. Despite their low frequency, such tumours are very important because of their aetiopathogenesis, which is still controversial, and the recent increase in their incidence in females. Today, the diagnostic protocol, undertaken after the necessary clinical examination, relies mainly on ultrasonography and CT, but only a postoperative histological examination is capable of yielding a sure diagnosis and establishing the main histomorphological characteristics of the tumour. The therapeutic approach can be limited to conservative treatment, sparing the parotid gland and its vascularization and innervation.     

Remnant of vitelline duct causing intestinal obstruction after commencement of CAPD

A 64-year old Japanese man began to experience intermittent epigastralgia, nausea, and vomiting just after commencing continuous ambulatory peritoneal dialysis (CAPD). Fourteen months after commencing CAPD, he had an intestinal obstruction. Because enhanced radiographs of the small intestine revealed that the occluded site was near the umbilicus, it was suggested that a remnant of the vitelline duct had adhered to and occluded the small intestine. Conservative treatment for the intestinal obstruction was not effective, and laparotomy was then performed. During the laparotomy, the first finding was a remnant of ligament-like vitelline duct connecting the protruding umbilicus and the small intestine. The second finding was that the small intestine was twisted around the remnant of the ligament-like vitelline duct at an angle of about 180° and completely occluded the intestine. Before the patient commenced CAPD, the remnant of the vitelline duct was asymptomatic, but it became symptomatic and finally caused intestinal obstruction after he commenced CAPD. This clinical course strongly suggested that the cue for the bowel obstruction caused by the remnant was the commencement of CAPD. This is the first report, to our knowledge, mentioning the relationship between CAPD and a remnant of the vitelline duct. Received: January 5, 2000 / Accepted: March 30, 2000     

Submandibular gland excision. Clinical experience

Submandibular gland excision is proposed for the treatment of both neoplastic and non-neoplastic diseases. This study examines four cases of patients who underwent submandibular gland excision performed by the transcervical approach: two cases of non-neoplastic disease (one sialolithiasis and one chronic sialoadenitis not correctly assessed by sonography), one case treated for chronic sialoadenitis who developed a non-Hodgkin lymphoma involving the oral mucosa, and one case with a benign neoplastic lesion (pleomorphic adenoma). The symptoms, physical findings, and diagnosis on pathological examination are discussed in each case. On the basis of the literature, the indications for submandibular transcervical excision and the postoperative neurological complications are discussed, emphasising that only a detailed knowledge of the anatomy of the region can reduce the morbidity of this operation.     

Submandibular duct sialolithiasis : an unusual presentation

Multiple calculi in a submandibular gland duct is an uncommon occurrence. One such case occurring in a young boy of 25 years is reported here where thirteen very small stones of 1-3 mm of maximum diameter were lined up in the Wharton's duct in such a way that they were difficult to appreciate on inspection and palpation. Successful exploration was done in two steps.     

Male accessory gland infection

Male accessory gland infection (MAGI) is a consequence of canalicular spreading of agents via urethra, prostate gland, seminal vesicles, deferent duct, epididymis and testis. Haematogenous infections are rare. The main infectious agents are Neisseria gonorrhoeae and Chlamydia trachomatis, and also enterobacteriae at a lesser frequency. Characteristic symptoms of MAGI are leukocytospermia, enhanced concentration of cytokines and reactive oxygen species. As complications, obstruction of the ductus epididymidis and/or another duct section, impairment of spermatogenesis in orchitis, impairment of sperm function, and dysfunctions of the male accessory glands may occur. Reduction of male fertility is a rare consequence. The treatment has to consider specific antibiotics.     

A rare case report of patent vitellointestinal duct causing bowel obstruction in an adult

IntroductionPatent vitellointestinal duct occurs in about 2% of the population which unusually leads to small intestinal obstruction associated with high morbidity and mortality. Here we are reporting an unusual case of patent vitellointestinal duct causing small intestinal obstruction in an adult patient.Presentation of caseA 22-year-old male without any medical illness presented as an emergency with a 3 day hystory of abdominal pain, multiple episode of vomiting and abdominal distention. Distended abdomen and sign of peritonitis were found on abdominal examination. Abdominal X-rays revealed multiple small intestinal air-fluid levels. A patent vitellointestinal duct extending from distal ileum to the posterior wall of the umbilicus was found causing closed loop ileal obstruction during laparotomy. Resection of a vitellointestinal duct along with gangrenous distal ileum and cecum with ileocolostomy was performed. He was discharged on the 8 th postoperative day.DiscussionDiagnosing and management of cause of intestinal obstruction in patients without history of abdominal surgery is very challenging. Early resuscitation and timely surgical intervention of intestinal obstruction due to a rare patent vitellointestinal duct can be life-saving measure.ConclusionThe patent vitellointestinal duct is an uncommon entity in adults and moreover this disorder leading to intestinal obstruction is very rare. Surgeons should be aware of this infrequent cause of small bowel obstruction to allow for early diagnosis and to facilitate better patient outcomes.     

Ejaculatory duct obstruction

Ejaculatory duct obstruction presents with infertility, pain, or hematospermia. Partial or functional forms of ejaculatory duct obstruction can be difficult to diagnose. Transrectal ultrasound has replaced formal vasography as the first-line diagnostic test but is not specific. Adjunctive procedures such as seminal vesicle aspiration, seminal vesiculography, and chromotubation further delineate the diagnosis. Using an evidence-based approach, this article reviews how best to approach the diagnosis and treatment of ejaculatory duct obstruction.