Clinicopathological studies on association of gallbladder carcinoma and pancreaticobiliary maljunction.
Egami K. Onda M. Uchida E. Matsuda T. Watanabe A. Arima Y. Kim T. Tajiri T. Okazaki S. Kobayashi M.
Department of Surgery, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan.
During the past 17 years, 1,722 of 4,832 consecutive patients investigated with endoscopic retrograde cholangiopancreatography (ERCP) were assessed by the radiological criteria of the Japanese Study Group of Pancreaticobiliary Maljunction (PBM). Out of these 1,722 patients, PBM was found in a total of 52, representing 3.0%, of which gallbladder carcinoma was associated with 14. These 14 with gallbladder carcinoma consisted of 10 (62.5%) of the 16 with PBM without association of congenital bile duct dilatation (CBDD) and 4 (11.1%) of the 36 PBM with CBDD. The relationship between PBM and gallbladder carcinoma was closely examined; PBM was noted in 14 (32.6%) of a total of 43 patients with gallbladder carcinoma compared to 38 (2.3%) among the 1,679 patients with various diseases excluding gallbladder carcinoma. Similarly, it was revealed that gallbladder carcinoma was predominantly noted in the 14 (26.5%) of the 52 patients with PBM in contrast to an incidence of 1.7% (29) among the 1,670 patients without PBM. As we studied the characteristic clinical features of the 14 gallbladder carcinoma patients with PBM when compared with 29 of those without PBM, the following was disclosed: on average, the patients with PBM were 10 years younger (49.4 vs 61.4 years in mean age); there was a preponderance of women (0/14 vs 12/17, male-female ratio); there existed a significantly lower incidence of associated gallstone disease (7.1% vs 72.4%). These figures were shown to be statistically significant. We concluded that the results prove a link between the crucial features of gallbladder carcinoma and PBM, and also suggest the promotive role of PBM in carcinogenesis of the gallbladder.
Spigelian hernia: case report.
Uchiyama K. Shibuya T. Watanabe Y. Chin K. Tanaka S.
Department of Surgery (II), Nippon Medical School, Kawasaki, Japan.
A spigelian hernia is an uncommon hernia of the anterior abdominal wall. We herein report a case of spigelian hernia, pre-operatively diagnosed as an incisional hernia. A 61-year-old woman had undergone an abdominal hysterectomy 14 years prior to her admission to our hospital complaining of a left lower abdominal mass with recurring pain. At the time of the operation the hernial orifice appeared not to be related to her previous surgical scar, but was located at the spigelian fascia below the level of the umbilicus. The hernial sac was dissected and the defect of the abdominal wall was closed. The diagnosis of a spigelian hernia can be difficult because of its nonspecific clinical findings and insidious nature. Diagnostic procedures and differential diagnosis are herein discussed with a review of the literature.