Spilled gallstone mimicking intra-abdominal seeding of gallbladder adenocarcinoma: A case report

BACKGROUND Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status.The gallstones may sometime be spilled into the peritoneal cavity,resulting in intra-abdominal ab-scess if the gallstones were not retrieved.The diagnosis of intra-abdominal ab-scess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies,such as abdominal ultrasonography or computed tomo-graphy(CT).Here we present a case of abscess formation from unretrieved gall-stone following laparoscopic cholecystectomy,which mimics the imaging findings of metastatic gallbladder ade-nocarcinoma.CASE SUMMARY This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery.After adjuvant chemotherapy,the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered.Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone.CONCLUSION Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery.For spilled gall bladder stones,surgeons may consider regular computerized tomography follow-up,and if necessary,laparoscopic examination can be used as a means of confirming the diagnostic and treatment.

Necrotic stercoral colitis:Importance of computed tomography findings

AIM: To study the computed tomography (CT) signs in facilitating early diagnosis of necrotic stercoral colitis (NSC). METHODS: Ten patients with surgically and pathologically confirmed NSC were recruited from the Clinico-Pathologic-Radiologic conference at Chang Gung Memorial Hospital, Taoyuan, Taiwan. Their CT images and medical records were reviewed retrospectively to correlate CT findings with clinical presentation. RESULTS: All these ten elderly patients with a mean age of 77.1 years presented with acute abdomen at our Emergency Room. Nine of them were with systemic medical disease and 8 with chronic constipation. Seven were with leukocytosis, two with low-grade fever, two with peritoneal sign, and three with hypotensive shock. Only one patient was with radiographic detected abnormal gas. Except the crux of fecal impaction, the frequency of the CT signs of NSC were, proximal colon dilatation (20%), colon wall thickening (60%), dense mucosa (62.5%), mucosal sloughing (10%), perfusion defect (70%), pericolonic stranding (80%), abnormal gas (50%) with pneumo-mesocolon (40%) in them, pericolonic abscess (20%). The most sensitive signs in decreasing order were pericolonic stranding, perfusion defect, dense mucosal, detecting about 80%, 70%, and 62.5% of the cases, respectively. CONCLUSION: Awareness of NSC and familiarity with the CT diagnostic signs enable the differential diagnosis between NSC and benign stool impaction.

Study on the High Conductive Polymer as the Miniaturized Reference Electrode

The polypyrrole is the high conductive polymer which was coated onto indium tin oxide (ITO) glass substrate by electroplated technique to fabricate a miniaturized reference electrode.Besides,the morphology of the ITO glass reference electrode electroplated with pyrrole has been studied through the instrumental analysis utilizing cyclic voltammetry (CV). Furthermore,the sensing characteristics of the reference electrode have been measured by using commercial instrumental amplifier as the readout circuit.Using the high conductive polymer as miniaturized reference electrode has many advantages such as easy fabrication of coating polymer,without any expensive fabricating equipment,easy carry by the miniaturized technique.Hence,it is suitable for the reference electrode production.

Evaluation of remediation process with soapberry derived saponin for removal of heavy metals from contaminated soils in Hai-Pu, Taiwan

The use of a biodegradable natural plant-based surfactant extracted from soapberry is proposed for the remediation of Ni, Cr and Mn from industrial soil site in Hai-Pu, Taiwan. Batch experiments were performed under variation of fundamental factors （saponin concentration, pH, and incubation time） for metal remediation. Removal of Ni and Mn were increased with increasing saponin concentration （0.015-0.150 g/L）, whereas the removal of Cr was increased upto 0.075 g/L saponin. The Ni, Cr and Mn were removed significantly （p 〈 0.05） at near to the neutral and slightly acidic （pH 5 to 8） conditions. Removal efficiency of Ni （99%） from the soil was found to be greater than that of Cr （73%） or Mn （25%） in the presence of saponin at a concentration of 0.150 g/L at pH 5. The removal percentage increased with incubation time where the removal of Ni was faster than that of Cr and Mn. The result indicates the feasibility of cco-friendly removal of heavy metal （Ni, Cr and Mn） from industrial soil by soil washing process in presence of plant derived saponin.