Summary Arterial steal syndrome (ASS) after liver transplantation has been reported. ASS causes arterial hypo‐perfusion of the graft liver and devastating consequences. However, the diagnosis tends to be delayed. We present the recognized case of a gastroduodenal artery (GDA) steal syndrome that was diagnosed with intraoperative Doppler ultrasound and treated with GDA ligation during the liver transplantation. The patient had variation of hepatic artery anatomy (low bifurcation of the hepatic artery). Graft liver had the common hepatic artery and aberrant left hepatic artery. Doppler ultrasound of the liver was performed after the arterial reconstruction between the donor common hepatic artery and recipient right hepatic artery. It showed low hepatic arterial flow. There is no backflow bleeding from the donor aberrant left hepatic artery stump. After ligating big GDA, hepatic arterial waveform inside the liver drastically improved and strong backflow bleeding was recognized from the donor left aberrant hepatic artery stump. The current case should show the efficacy of intraoperative Doppler ultrasound of the liver on ASS and alert clinician to ligate GDA to prevent ASS if hepatic arterial flows are suboptimal.

Abstract. The present study reports a case of eosinophilia-associated rectal cancer that was successfully stabilized using chemotherapy, and reviews the mechanisms of eosinophilia and the importance of chemotherapy. A 65-year-old man, who had previously been diagnosed with suspected rectal cancer, presented with the chief complaint of melena. Eosinophilia, abnormal blood coagulation, and elevated carcinoembryonic antigen and carbohydrate antigen 19-9 tumor marker levels were observed, and the patient was subsequently diagnosed with advanced rectal cancer accompanied by multiple lymph node metastases that extended from the para-aortic lymph nodes to the left axillary lymph nodes. The complication of deep vein thrombosis was also observed. Tumor hemorrhage was exacerbated, and thus, Hartmann's procedure was performed. Pathological findings included poorly-to moderately-differentiated adenocarcinoma; however, no eosinophil infiltration was observed within the tumor. Following surgery, the eosinophilia and lymph node metastasis were exacerbated, and an oxaliplatin plus capecitabine chemotherapy regimen was initiated. The patient's eosinophil count and tumor marker levels normalized, and the lymph nodes decreased in size; however, re-enlargement of the lymph nodes was observed 6 months after surgery. The patient was then administered a chemotherapeutic regimen of irinotecan/fluorouracil/folinic acid + bevacizumab, and stable disease was maintained until pleural and peritoneal dissemination were observed at 22 months post-surgery. Following a rapid deterioration in condition, the patient succumbed to the disease at 23 months post-surgery. The present case indicates that although eosinophilia-associated colon cancer exhibits a poor prognosis, early chemotherapeutic intervention may improve this. IntroductionEosinophilia is known to cause complications in allergic disease and parasitic infections, and may occasionally cause complications in malignant tumors. Previous studies have indicated that eosinophilia-associated complications may arise not only in hematopoietic malignancies, but also in lung cancer (1), gastric cancer (2) and renal cell carcinoma (3); however, the mechanism has not been elucidated. Approximately 0.5-1.0% of cases of eosinophilia are associated with malignancies (2-4). Eosinophilia in solid malignancies is rarely reported,and there are a limited number of cases describing eosinophilia in rectal cancer. A number of previously reported cases have involved advanced cancers accompanied by metastases, and the majority have exhibited a poor prognosis. Peripheral hypereosinophilia is considered to be a poor prognostic sign, which is frequently associated with extensive metastatic disease (4-8) The present study reports the case of a patient with eosinophilia-associated advanced rectal cancer, which was successfully stabilized using chemotherapy. The possible mechanism underlying eosinophilia-associated complications in the present case and the importance of early chemotherapeutic intervention in treating ...

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