Membranous obstruction of the inferior vena cava (MOVC) is a rare clinical entity. The incidence is higher in Japan and Africa than that in USA and Europe. MOVC is considered to be different from the Budd-Chiari syndrome. There are differences in clinical manifestation and pathologic changes in the liver. Findings of the liver revealed cirrhosis in all patients but in one. Ascites and esophageal varices could be observed in 79% and in 58% of the patients, respectively. According to Sugiura's classification, they consisted of Type Ia in 63%, Type Ib in 11%, Type II in 11%, and Type III in 16%. Portopulmonary shunt by splenopneumopexy was successfully performed on 19 patients with MOVC in this clinic, of which diagnosis was established by cavography.

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Twenty-two cholangiograms of adults with congenital dilatation of the common bile duct were studied and analyzed. Diagnosis of this disease was established by endoscopic retrograde cholangiopancreaticography in nine patients, by percutaneous transhepatic cholangiography in two patients, and by operative cholangiography in 11 patients. All patients, except one with Caroli's disease, were classified as type I according to Alonso-Lej. An anomalous junction of the pancreaticobiliary ductal system (AJPBDS) was observed in 15 cases. In nine patients the common bile duct joined the main pancreatic duct, and in the remaining six patients, the pancreatic duct was noted to join the common bile duct. These anomalies are considered to be an important etiologic factor in the development of choledochal dilatation. Total cyst excision and hepaticojejunostomy in a Roux-en-Y fashion is recommended as the procedure of choice in those cases with AJPBDS. This is based on the high incidence of cholangitis and the high propensity to induce malignancy of cystic wall following simple drainage.