Robotic resection for hydatid disease of the liver

Robotic-assisted surgery for the management of hepatic echinococcosis was introduced in 2016. The advantage it offers over laparoscopy is less rigidity with the use of the 360° rotation of the Endo-Wrist technology, thus allowing the preservation of the integrity of the liver tissue. Herein, we report the first successful robotic resection of the left lobe of the liver for hydatid disease in the Middle East. Our patient is a 71-year-old man found to have a large left hepatic lobe hydatid disease on CT scan. The hydatid liver disease was resected completely with an operation time of 130 min and minimal intraoperative blood loss. Patient did well postoperatively and was discharged home on day 2. Our experience shows that robotic surgery for hydatid disease of the liver can be safely performed, with an excellent outcome to the patient. It also provides unique technical advantages in the field of minimal-invasive surgery.

Peritonitis and Necrotizing Hepatitis in Ara ararauna Caused by a Foreign Body

Background: The ingestion of foreign bodies in parrots has already been described and associated with the curious behavior of the birds or with stressful conditions. Foreign bodies in the gastrointestinal tract are usually diagnosed through clinical signs, laboratory tests, and radiographic findings in the historical data. Foreign bodies are usually metallic and can lodge in any segment of the gastrointestinal tract, commonly found in the proventricle and gizzard. This study investigated a case of necrotizing hepatitis due to a foreign body in Ara ararauna (Linnaeus, 1758).Case: An approximately 9-month-old specimen of caninde macaw, had sudden death and was referred for autopsy. The macroscopic examination revealed a fibrous, thick, reddish membrane involving the left hepatic lobe and partially the gizzard in continuity with the peritoneum. Inside the capsule, the liver had a friable and necrotic appearance and the gizzard had a focal perforation area containing a foreign body (gavage probe). We performed the histopathological examination of the liver and gizzard and observed that the membrane surrounding the liver and partially the gizzard had a chronic inflammatory process with a marked proliferation of fibrous tissue and fibrin deposition. The hepatic parenchyma of the left lobe showed diffuse and marked necrosis, with signs of ischemic necrosis. In the region of transmural perforation of the gizzard, the mucosa showed a focal area of extensive necrosis accompanied by the presence of intralesional bacteria. The lesions observed are attributed to the perforation of the organs by the foreign body. It is not known whether the bird ingested the object accidently during food handling as a young or due to the curious behavior of the bird or even the stress it may have been exposed to. The post-mortem examination revealed localized peritonitis and encapsulating necrotizing hepatitis, focally extensive and accentuated, associated with foreign body perforation.Discussion: The curious habit of parrots, can provide the ingestion of foreign bodies, in which they lodge in the gastrointestinal tract. Generally, the clinical signs are nonspecific, however, proventricular impaction, stasis and even perforations in the mucosa of organs can be observed. In the present study, we suspect that the Caninde macaw accidentally ingested a gavage probe during feeding management as a young. This object lodged in the bird's ventricle, perforating the organ and reaching the liver, due to intimate contact with the gizzard, providing a picture of ventriculitis and necrotizing hepatitis. Necrotizing hepatitis due to foreign body has been reported in the literature due to ingestion of perforating foreign body with lesion in the left ventricle and lobe, however we have no knowledge of reports with the presence of a capsule involving the left hepatic lobe, similar to a capsule like this, we understand that our report is the first description of encapsulating necrotizing hepatitis in birds. We believe that this capsule of connective tissue was formed, due to the inflammatory process in the peritoneal cavity, in birds the deposition of fibrin can form a structure similar to a capsule, in order to trap cells and the agent responsible for inflammation, preventing septicemia. Transmural perforation in the gizzard, observed in this case, allowed bacterial translocation that may have contributed to the worsening of the chronic condition and death due to the accumulation of toxins or bacterial translocation of the gastric tract, leading to liver infection and sepsis. We concluded that the presence of the perforating foreign body was responsible for the peritonitis and encapsulating necrotizing hepatitis in Ara ararauna.

Linear Morphometric Parameters of the Liver in Children and Adolescents according to Intravital Imaging Findings

The aim of the study is to define age and gender regularities of the linear morphometric parameters of the liver in children and adolescents on the basis of intravital imaging findings.Material and methods. The authors analyzed computed tomograms of the abdominal cavity in 75 children without visible pathology. All patients were divided into 4 groups depending on their age: early childhood, first childhood, second childhood, adolescence. The transverse, anteroposterior and vertical dimensions of the right and left hepatic lobes were investigated on 16-slice computed tomographs. The obtained findings were processed using variational statistical analysis, the mean value (M), standard error (m) and the statistical significance were defined using the Student's t-test.Results. There was a significant increase in the anteroposterior size of the right hepatic lobe in separate sections at different age periods. A statistical significance between the parameters of the anteroposterior size of the right hepatic lobe was registered in girls and boys within the following groups: on one section in the 2nd group of patients, on two sections in the 4th group of patients. A statistical significance between the parameters of the transverse size of the right hepatic lobe was registered on one section (ThXII) in the 2nd and 3rd groups, and on two (ThXI and LI) and three (ThXI, ThXII and LI) sections in the 3rd and 4th groups of girls and boys, respectively. A statistical significance between the parameters of the transverse size of the right hepatic lobe in girls and boys were recorded only in the 4th group on three sections (ThXI, ThXII and LI). The vertical size of the right hepatic lobe was significantly higher in the 2nd and 4th groups, and the differences in the parameters between girls and boys were noted only among adolescents. A significant increase in the anteroposterior size of the left hepatic lobe was registered only in girls of the 2nd and 3rd groups on two sections (ThXII and LI); a significant increase in the transverse size was only registered at the LI level in these groups of patients. A significant increase in the vertical size of the left hepatic lobe was only detected in girls of the first childhood compared with girls of the early childhood. No statistical significance was registered for any of the linear parameters of the left hepatic lobe between girls and boys of the same groups.Conclusion. Thus, there was a significant increase in the anteroposterior and transverse dimensions of the right hepatic lobe in separate sections and an increase in the vertical size between individual groups of the studied patients, as well as a statistical significance between girls and boys of the same group. A significant increase in the anteroposterior and transverse dimensions of the left hepatic lobe was detected only in girls of the 2nd and 3rd groups if compared with the girls of the 1st group. No significant differences were registered between girls and boys of the same groups for any of the linear parameters of the left hepatic lobe.

Giant gastric carcinosarcoma infiltrating the left hepatic lobe: a case report

Gastric carcinosarcoma is a rare biphasic tumor that consists of both carcinomatous and sarcomatous components. Clinical presentation and neoplastic markers are not specific for the disease. Moreover, CT scan cannot distinguish among gastric carcinoma, sarcoma or carcinosarcoma, so it is essential to perform histopathological and immunohistochemical analysis on biopsy specimens or resected tissue to ensure a correct diagnosis. A 72-year-old woman was transferred to our Department from another hospital with a diagnosis of a bleeding tumor localized on the lesser gastric curve, infiltrating the left hepatic lobe. The mass was treated as a gastric malignant mesenchymal neoplasia (gastro-intestinal stromal tumor versus sarcoma) infiltrating the liver. Owing to the bleeding, no further invasive examinations, such as fine needle aspiration biopsy, were planned. Furthermore, no neoadjuvant chemotherapy could be administered before surgery due to persistent anaemia. The scheduled surgical procedure was an atypical gastric resection with “en bloc” hepatic resection. This operation included upper polar and lesser curve resection, with tubulization of the stomach along the greater curve, as well as left lateral hepatic sectionectomy. Histopathological examination and immunohistochemical staining confirmed the diagnosis of gastric carcinosarcoma. This is first report of gastric carcinosarcoma with local liver infiltration, treated with surgical resection.

Severe case of post cholecystectomy vasculobiliary injury successfully treated by right hepatectomy with a jump graft to the remaining left hepatic lobe

Vasculobiliary injuries (VBI) caused by cholecystectomies are infrequent but extremely serious. We report a case of a severe VBI successfully treated at our center. A 22-year-old woman underwent an open cholecystectomy as treatment for acute cholecystitis and bile duct stones. She was transferred to our center on postoperative Day 4 because of progressive jaundice and encephalopathy. After a proper investigation, we found an extreme VBI with infarction of the right hepatic lobe associated with complete interruption of the portal vein and proper hepatic artery flows and full section of the common hepatic duct. Right hepatectomy with portal—Rex shunt revascularization of the left hepatic lobe and Roux-en-Y hepaticojejunostomy to the left hepatic duct was done. The patient was discharged on the 60th postoperative day. Discussion: This case shows the successful surgical treatment of a severe cholecystectomy’s VBI, avoiding an emergency liver transplant.