Long-term complications following pancreaticoduodenectomy are rarely reported because of the poor longterm survival of these patients. Marginal ulcers can occur in both the short and long term, and they can become complicated by bleeding or perforation. Marginal ulcer with perforation is a rare incidence and only sparse literature evidence is available. Herein, we report on a patient who underwent pancreaticoduodenectomy 12 years ago for duodenal adenocarcinoma and was diagnosed to have perforation peritonitis. He underwent emergency laparotomy and lavage, and omental patch closure for marginal ulcer perforation at the gastrojejunostomy site. Truncal vagotomy and feeding jejunostomy were also done.

Introduction: Hepatolithiasis (HL) is the presence of stones in the bile ducts proximal to the confluence of the hepatic ducts. This study aims to analyse the case presentations of HL in a tertiary care centre in South India and define the role of hepatic resection in these cases and their outcomes.Methods: Retrospective data of all patients operated on for HL from 2012 to 2021 were analysed with regard to clinical parameters, biochemical parameters, and different types of surgical management. Descriptive data analyses were done.Results: A total of 42 patients underwent surgical treatment for HL between 2012 and 2021 in our institution. Of the patients, 64% were females. A total of 50% of patients were affected by bilateral HL. Of the patients, 95% had abdominal pain, 57% had a fever, and 29% presented with jaundice. A total of 38% of patients had a history of previous biliary surgery. Atrophy was present in 38% of cases. Choledochoduodenostomy was performed in 26%, and hepatic resection with bilio-enteric anastomosis was done in 36% of patients. Endoluminal access loop was done in 21%. Hepaticojejunostomy alone was done in 14%. On follow-up visits (mean: 61.5 months), 60% of patients were asymptomatic with no recurrence. There was nil 30-day postoperative mortality. Conclusion:The treatment options for HL were based on the extent of liver involvement. The bilio-enteric anastomosis was done after the clearance of stones for uncomplicated HL. Complicated HL may need liver resection with hepaticojejunostomy, with an endoluminal access loop for a good outcome.