The duct of Luschka never crosses the segmental (5b) border. Therefore, its upstream region may not be injured by segmentectomy or more extensive liver resection. However, it is possible to injure the duct of Luschka at the common hepatic duct, even if right-sided hepatectomy is performed, as the sites of confluence included the common hepatic duct.

Preoperative diagnosis of cholecystocolonic fistula (CCF) is difficult and the contribution of gallbladder cancer or colon cancer is unclear when there is associated malignancy. We present a case that was diagnosed with acute cholecystitis associated with CCF by multidetector computed tomography (MDCT) preoperatively and malignant neoplasm during emergency surgery. She was finally diagnosed with gallbladder cancer after the operation and underwent a two-stage surgery for regional lymph node dissection. Gallbladder cancer can be a primary malignant cancer causing CCF, whereas MDCT is useful for preoperative diagnosis of CCF. A treatment plan in consideration of gallbladder cancer is advisable for CCF associated with malignant tumor.

Background Since intraductal tubulopapillary neoplasm (ITPN) is a rare disease, the clinical features of ITPN, especially the characteristics related to recurrence, have not been revealed. We performed a total remnant pancreatectomy for a patient whose ITPN recurred 16 months after pancreatoduodenectomy (PD). We report useful findings to clarify how ITPN reoccurs based on this experience and previously reported cases. Case presentation A 61-year-old male patient was diagnosed with pancreatic cancer and underwent PD. However, a postoperative pathologic examination diagnosed ITPN with invasive cancer. After receiving adjuvant chemotherapy, he was hospitalized for pancreatitis 16 months after the operation. He was diagnosed as having recurrence near the pancreato-jejunal anastomosis based on detailed examinations and underwent a remnant total pancreatectomy. From the results of the histopathological examination, he was found to have a recurrence of ITPN as a polypoid mass without invasion distant from the surgical stump of the first operation. Furthermore, tumor cells floating in the main pancreatic duct distant from the main tumor were observed at three locations. Review of the literature Including our case, five cases of recurrence in the remnant pancreas after surgery for ITPN have been reported. Recurrence in the main pancreatic duct was observed in four of these five cases. The primary tumor, which recurred in the remnant pancreas after surgery, was characterized as being relatively small and less invasive; however, Ki-67 labeling index was high. In immunohistochemical examination, the expression of MUC6, which is not one of characteristics of ITPN, tended to be positive. Conclusion In this case, tumor cells were floating inside the pancreatic duct at several locations. From the results of this case and a review of previous reports, the cause of ITPN recurrence in this case seemed to be due to tumor cells leaving the tumor and implanting into the pancreatic duct.

Background Dementia often adversely affects postoperative outcomes in surgical patients. This study evaluated postoperative outcomes among elderly patients with and without dementia undergoing early cholecystectomy for acute cholecystitis (AC). Methods A total of 182 patients over 85 years of age who were diagnosed with AC and treated from January 2005 to March 2018 were reviewed retrospectively; 59 patients who underwent early cholecystectomy were enrolled. The complication rates, length of postoperative hospital stay, and rates of routine discharge (i.e., returning to their preoperative living location) were compared between two groups of patients with and without dementia. Results The overall complication rate after early cholecystectomy for AC in 59 patients was 11.9%, and there was no mortality in this series. The median postoperative hospital stay was 9.0 days, and the routine discharge rate was 89.8%. Of the 59 patients, 22 patients (37.3%) had a history of dementia. Complication rates were comparable between the groups, despite the rate of delirium development being significantly higher in the dementia group. The median length of postoperative hospital stay and routine discharge rates did not significantly differ between groups. Conclusions Early cholecystectomy for patients with AC over 85 years of age was performed safely, and elderly patients with dementia had similar postoperative outcomes as compared with patients without dementia.

We evaluated the clinical usefulness of the preoperative risk assessment models in emergency gastrointestinal surgeries in elderly patients: the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), its Portsmouth (P-POSSUM) modification, the estimation of physiologic ability and surgical stress (E-PASS), the systemic inflammatory response syndrome (SIRS) and the quick sepsis-related organ failure assessment (qSOFA) score. Materials and Methods: A total of 107 elderly patients over 90 years of age, who underwent emergency gastrointestinal surgeries in our hospital between April 2013 and March 2018, were enrolled in this retrospective study. The morbidity and mortality risks were assessed using these models. Results: The reasons for emergency surgery in this study were strangulated intestinal obstruction (29.0%), strangulated hernia (17.8%), bowel perforation (16.8%) and acute appendicitis (12.0%). Postoperative complications were observed in 61 patients (57.0%) including 7 (6.5%) in-hospital deaths. Ninety patients (84.1%) returned to the same level of activity after discharge. There were statistically significant differences in the following three scores; the preoperative risk score (P=0.008) and comprehensive risk score (P=0.015) of the E-PASS score, and the SIRS score (P=0.045) between patients who died in the hospital and those who survived. Conclusions: The preoperative risk score and comprehensive risk score of the E-PASS score, and the SIRS score seemed to be useful for preoperative risk assessment of emergency gastrointestinal surgeries in patients over the age of 90.