Intrahepatic cholangiocarcinoma (ICC), which is ordinarily a very invasive tumor and often takes a rapid and fatal course, sometimes shows macroscopic intra bile duct extension. We present a case of a 45-year-old Indian gentleman who presented with jaundice. Further evaluation with contrast enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) abdomen revealed mass lesion in segment 4 of liver with extension into the bile duct. A formal left hepatectomy with gall bladder and bile duct tumour thrombus extraction with bile duct excision followed by a Roux-en-Y hepaticojejunostomy was performed. Intra bile duct growth of ICC may reflect indolent biological behavior and thus warrants an aggressive surgical approach, which appears to give a good prognosis.

Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the native aorta and anywhere within the gastrointestinal tract. It is extremely rare and fatal condition which usually presents as a painless upper gastrointestinal bleed. This condition is often overlooked because of it's rarity and low index of suspicion by physicians despite the availability of a wide range of diagnostic tools. Computed tomography angiography (CTA) is the most common investigation done to diagnosis PAEF. This paper reports a case of 49 years old female with massive upper gastrointestinal (GI) bleeding. A PAEF was diagnosed by CTA which called for an emergency laparotomy with surgical repair of the fistula with a synthetic vascular bypass graft. The patient recovered well.

Introduction:The Budd chairi syndrome caused by occlusion of the major hepatic veins often of unknown etiology is typically characterized by massive ascites, hepatomegaly, abdominal pain due to congestion of the liver. The long-term outcome of these patients is fatal without an improper management. In a significant proportion of patients, surgical decompressive procedure (shunt operations) are effective in decongesting the liver and improving the survival before on set of end stage liver disease or cirrhosis. SSPCS side to side portocaval shunt proved to be most widely applied and durable. Methods: A 26-year-old male presented with chief complaints of painless progressive abdominal distension and loss of appetite since 4 months. He was evaluated as a case of chronic budd chairi syndrome with out signs of hepatic decompensation and was planned for side to side portocaval shunt. Due to extensive caudate lobe hypertrophy IVC-PV could not be approximated, in such challenging situation intraoperatively he was planned for partial/complete caudate lobe excision, during which there was torrential bleed from retroperitoneal collaterals, and procedure to excise caudate lobe was abandoned. Results: Portocaval interposition shunting was performed using PTFE graft. On follow up for 18 months, flow across the graft was patent, there was no signs of jaundice or ascites. Conclusions: Shunt surgeries still offer better outcomes and long term survival in patients with preserved liver function where organ donor for liver transplantation is limited. Though SSPCS has best outcome for BCS in studies, interposition grafts can be used in unpredictable and difficult situations with graft patency rate of almost 52% in 5 years.

No abstract