Every year the number of operations on the hepatobiliary zone is steadily increasing due to diseases of the bile ducts. Against this background, there is a need for an accurate diagnosis of complications of these interventions; classical magnetic resonance cholangiopancreatography (MRCP) is of limited use. With the introduction of a liver-specific contrast agent (Gd-EOB-DTPA), the possibility of diagnosing diseases of the bile ducts has expanded. In this clinical review, we review the technical aspects and benefits of Gd-EOB-DTPA-enhanced MR cholangiography. Various types of contrast agents, methods of their use in MRI, the dependence of the signal intensity in the bile ducts on the time of administration of the substance, the presence of chronic liver diseases are covered in detail. Separately, studies are given on the diagnosis of diseases of the bile ducts with altered biliary anatomy, biliary fistulas after surgical interventions. In conclusion, data are presented on promising studies of the functional state of the liver based on the use of MRI with hepatotropic contrast enhancement.

Aim. To study the long-term results of surgical treatment in patients with “complex” hepatic echinococcosis.Materials and methods. The results of surgical treatment of 118 patients with hepatic echinococcosis from 2015 to 2020 at the A.V. Vishnevsky National Medical Research Center of Surgery were analyzed. The term “complex” hepatic echinococcosis has been proposed. A comparative analysis of the number and type of complications and surgical interferences 2 groups of patients was carried out: 66 patients with hepatic echinococcosis, 52 patients with complex hepatic echinococcosis.Results. During the observation period, no any recurrence was recorded. 55 (44%) of 118 patients had complex hepatic echinococcosis. Isolated liver damage was found in 74% of cases, combined liver and lung damage in 20% cases and with other organs – in 6%. In most cases, pericystectomy was performed (82%), 8% of patients underwent atypical hepatectomy, 4% – segmental resection, 3% – laparoscopic intervention, 3% – hemihepatectomy. Postoperative complications were recorded in 22 (18,6%) of cases. Accumulations of bile and biliary fistulas formed in 45% of cases, pneumotothorax or hydrothorax – in 23%, wound abscess – in 18%, hematomas in the hepatectomy zone – in 14% of the cases.Conclusion. Surgical treatment of complex hepatic echinococcosis requires an individual approach to the choice of the operation option. Preference should be given to parenchyma-preserving radical operations. When the liver lobe is totally replaced with a hydatid cyst and in case of cystobiliary fistulas hemihepatectomy should be performed, and it is acceptable to leave the fibrous capsule on large tubular structures.

Cholangioblastic variant of intrahepatic cholangiocarcinoma is a rare, extremely malignant liver tumor. Currently, only six clinical cases have been described worldwide. Following the bibliographic research, the authors of the paper introduced main features of the tumor, methods of its diagnosis and treatment. A clinical observation of a patient with cholangioblastic variant of intrahepatic cholangiocarcinoma is presented. The course of the disease was complicated by tumor thrombosis of the left hepatic and inferior vena cava with thrombus flotation in the right atrium. The paper describes the stages of the disease diagnosis and surgical treatment of the patient, providing insight into the patient surveillance in such cases. Given the low incidence of such neoplasms, each clinical case reported in the scientific literature is of great value and practical interest.

Background. Biliary cystadenomas and cystadenocarcinomas are rare cystic tumors of the liver. Complicated differential diagnostics for simple cysts often leads to errors in surveillance of patients with these tumors. Cystadenoma and cystadenocarcinoma should be suspected upon detection of single or multilocular cystic neoplasms of the liver with septa and blood flow loci  in the cyst wall, especially in middle-aged women. The localization of the tumor is critical. The most common localization is segment IV of the liver. Urgent intraoperative biopsy is required to determine the extent of surgery.Case description. Clinical observations with analysis of the examination and treatment data of two female patients aged 38 and 56 were presented. Both clinical observations illustrate the underestimation of the preoperative examination data that served as a ground for diagnosis of liver cysts with inadequate extent of surgery. In the first case, the resection was incomplete, and, as such, the biliary cystadenoma recurred in the resection area, the capsule of the neoplasm was ruptured and an encysted fluid collection was formed. In the second case, lack of histological examination of the excised neoplasm, due to confidence in its morphological verification as a cyst, resulted in cystadenoma recurrence in the resection zone with metastasis to the contralateral lobe of the liver.Conclusion. Hepatic cystadenomas and cystadenocarcinomas are often misdiagnosed as simple cysts. These tumors should be suspected in central localization of the tumor in the liver, especially in young women. The clinical and instrumental symptomatology and radiological semiotics of the disease require careful evaluation. The recurrence of a cystic lesion in the resection zone in a patient previously operated for a hepatic cyst serves as an additional signal for detecting biliary cystadenoma. Rational strategy for surgical management of cystic liver lesions should include hepatectomy within healthy tissues (both anatomical and atypical) with mandatory intraoperative ultrasound and urgent histological examinations.

Aim: the reason for the publication was the rare occurrence, as well as the non-specificity of symptoms of the cystic form of duodenal dystrophy. The listed features of this disease lead to difficulties in its differential diagnosis and the choice of the optimal method of treatment.General statements. The report is devoted to the description of a case of successful treatment of a cystic form of duodenal dystrophy — a chronic inflammation of the pancreatic tissue, ectopic in the wall of the duodenum. A 47-year-old patient was admitted to the clinic with complaints of persistent abdominal pain, periodic vomiting, general weakness, weight loss of 20 kg in three months. With the help of computed tomography, the diagnosis was established, the tumor process was rejected, and chronic pancreatitis was detected in the orthotopic pancreas. Due to the presence of changes in the main pancreas, the patient underwent pancreatoduodenal resection. The features of the operation were pronounced infiltrative changes and pronounced vitreous tissue edema, which made it difficult to mobilize the hepatic flexure of the colon and duodenum.Conclusion. Pancreatoduodenal resection is the optimal surgical intervention for the combination of cystic form of duodenal dystrophy with sub-/decompensated duodenal stenosis.