BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury.
DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords “bile duct injury”, “cholecystectomy”, and “classification”. Additional papers were identified by a manual search of the references from the key articles.
RESULTS: Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. However, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg’s classification made Bismuth’s classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification.
CONCLUSIONS: None of the classification system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classification system will be published in the near future.

BACKGROUND: Portopulmonary hypertension (PPH) is defined as the development of pulmonary arterial hypertension associated with increased pulmonary vascular resistance complicated by portal hypertension, with or without advanced hepatic disease. In spite of the relatively rare prevalence, the clinical implications of PPH are significant. It has high perioperative morbidity and mortality. This review is an update of current pathogenesis, diagnosis and therapy of PPH.
DATA SOURCES: An English-language literature search was conducted using PubMed (1980-2006) on portopulmonary hypertension.
RESULTS: Echocardiographically identified patients with elevated pulmonary artery systolic pressure (>50 mmHg) receive right heart catheterization. Epoprostenol (prostacyclin), a potent pulmonary and systemic vasodilator with anti-platelet aggregating activity, and bosentan, an endothelin receptor antagonist, have so far proven beneficial to patients with PPH.
CONCLUSIONS: After an accurate diagnosis of PPH, treatment should (at a minimum) focus on reduction of mean pulmonary arterial pressure to less than 35 mmHg prior to orthotopic liver transplantation. However, orthotopic liver transplantation currently remains the only therapy to resolve PPH.

BACKGROUND: Bile leak remains a main complication in liver transplantation patients with poor biliary tract conditions, mainly caused by an insufficient blood supply or dysplasia of the biliary tract. Although Roux-en-Y modus operandi can be adopted, the risk of other complications of the biliary tract such as infection increases. Using pedicled greater omentum flaps to wrap the anastomotic stoma, which increases the biliary tract blood supply, may reduce the incidence of bile leak.
METHODS: Fourteen patients undergoing piggy-back liver transplantation and having poor biliary tract conditions were treated with pedicled greater omentum flaps to wrap the anastomotic stoma of the biliary tract. Their clinical data were analyzed retrospectively.
RESULTS: Of the 14 patients, only one (7.1%) had a mild bile leak on the 8th day post-operation and fully recovered after symptomatic treatment. The other patients had no biliary complications.
CONCLUSIONS: Using pedicled greater omentum flaps to wrap the anastomotic stoma of the biliary tract is an effective way to prevent bile leak in liver transplantation patients, especially those with poor biliary tract conditions. However, experience with this surgical technique still needs to be further explored.

BACKGROUND: With the development of the associated technology, interventional treatment has become an important method for the treatment of hepatic artery occlusion in some countries. This study was undertaken to evaluate the role of interventional methods in the diagnosis and treatment of acute hepatic artery occlusion after liver transplantation.
METHODS: The diagnosis and treatment of 9 cases of acute hepatic artery occlusion after liver transplantation were retrospectively analyzed.
RESULTS: In 109 cases of liver transplantation, 9 were diagnosed by angiography. Among them, 7 were diagnosed by Doppler ultrasound. After transcatheter thrombolysis, the hepatic arteries were partially or totally patent again in 6 cases of hepatic artery occlusion after liver transplantation, and stent placements in the hepatic artery were performed in 5 cases. All stents proved patent and no patient required another liver transplantation. 
CONCLUSIONS: Angiography plays an important role in diagnosing hepatic artery complications after liver transplantation. Interventional therapy is a valuable method in the treatment of acute hepatic artery occlusion after liver transplantation.

BACKGROUND: Tissue inhibitor of metalloproteinases (TIMPs) can restrain the tumor growth by their protein property and matrix metalloproteinases (MMPs) inhibition. There are currently four known TIMP family members-TIMP-1, 2, 3, 4. We determined whether increasing levels of TIMP-3 expression could suppress the malignant phenotype of human hepatocarcinoma cell line HCC-7721.
METHODS: A recombinant expression vector, which contained full-length cDNA of human TIMP-3, was constructed and transfected into the human hepatocarcinoma cell line HCC-7721 by the lipofectamine technique. In vitro and in vivo tests such as Western blotting, immunohistochemistry as well as xenografting in nude mice were used to analyze expression levels of TIMP and MMP, and changes in malignant phenotype after the gene transfection.
RESULTS: TIMP-3 expression in TIMP-3 gene-transfected HCC-7721 cells was upregulated as assessed by Western blotting. The ability of in vitro invasion through a Boyden chamber was significantly decreased compared to controls. Following subcutaneous injection into nude mice, the TIMP-3 transfected cells suppressed primary tumor growth, as characterized by reduced tumor weight, size and microvasculature as well as maintaining the extracellular matrix.
CONCLUSION: The results suggest that upregulation of TIMP-3 expression in HCC-7721 cells inhibits invasion capacity in vitro as well as tumorigenic and metastatic potential in nude mice.

BACKGROUND: Bangladesh is situated in the intermediate prevalence region of hepatitis B virus (HBV). The lifetime risk of acquiring HBV infection in Bangladesh is greater than 40%. It has been estimated that this virus is responsible for 10%-35% cases of acute viral hepatitis, 35.7% cases of fulminant hepatic failure, 33.3%-40.5% cases of chronic hepatitis and 46.8% cases of hepatocellular carcinoma in Bangladesh. The aim of this study is to compare the correlation between HBV DNA load and grade and stage of liver disease in patients with chronic hepatitis B (CHB).
METHODS: Percutaneous liver biopsies done in 159 CHB patients revealed 62.9% (100 patients) had wild type HBV infection and the rest 37.1% (59) had pre-core/core promoter mutant HBV infection. HBV DNA load was measured using PCR in all patients.
RESULTS: In the wild type CHB group, 97% (97 patients) had moderate to high HBV DNA load and 3% (3) had low to moderate HBV DNA. In the pre-core/core promoter mutant group, 74.6% (44 patients) had moderate to high HBV DNA and the rest 25.4% (15) had low to moderate HBV DNA. The patients with moderate to high HBV DNA of the patients with wild type CHB, 78.4% (76 patients) had minimal to mild chronic hepatitis (HAI-NI 0-8) and 21.6% (21) had moderate to severe chronic hepatitis (HAI-NI 9-18). 66.6% (2 patients) and 33.3% (1) patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively. In the moderate to high HBV DNA group, 77.3% (75 patients) patients had minimal to moderate fibrosis (HAI-F 0-2) and 22.7% (22) (HAI-F 3-4) had severe fibrosis to cirrhosis. These figures were 33.3% (1 patient) and 66.6% (2) respectively in the patients with low to moderate HBV DNA load. On the other hand in case of patients with pre-core/core promoter mutant type CHB, in the moderate to high HBV DNA group, 79.5% (35 patients) had minimal to mild chronic hepatitis (HAI-NI 0-8) and 20.5% (9) had moderate to severe chronic hepatitis (HAI-NI 9-18). 93.3% (14) and 6.7% (1) patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis respectively. In the moderate to high HBV DNA group, 68.2% (30 patients) had minimal to moderate fibrosis (HAI-F 0-2) and 31.8% (14) (HAI-F 3-4) had severe fibrosis to cirrhosis. These figures were 86.7% (13) and 13.3% (2) respectively in patients with low to moderate HBV DNA load.
CONCLUSIONS: The study shows that high HBV DNA load does not correlate with necro-inflammatory activity or extent of fibrosis in the liver in patients with either wild type or pre-core mutant type CHB.

BACKGROUND: Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions, particularly detoxification, synthetic functions, and metabolic regulation are impaired to different degrees, and may result in major life-threatening complications such as hepatic encephalopathy, ascites, jaundice, cholestasis, bleeding and hepatorenal syndrome. Plasma exchange (PE) has been found useful in treating patients with fulminant hepatic failure by removing hepatic toxins and replacement of clotting factors, so PE treatment has temporary supportive effects on liver failure caused by severe viral hepatitis. In this study, our aim was to predict the prognosis of patients with severe hepatitis after PE treatment using the end-stage liver disease (MELD) scoring system.
METHODS: Two hundred and twenty patients were randomly divided into PE and control groups, and the MELD score was calculated for each patient according to the original formula. The efficacy of PE was assessed by mortality or improvement in biochemical parameters and MELD score.
RESULTS: The levels of total bilirubin and international normalised ratio (INR) in patients whose MELD scores were between 30 and 39 were lower than those before PE treatment, as those in patients whose MELD scores were 40 or higher. The mortality of patients in the PE group with MELD scores from 30 to 39 was 50.0%, while it was 83.3% in the control group (P<0.01). The mortality of patients with MELD scores higher than 40 was 90.0% in the PE group and 98.0% in the control group (P>0.05).
CONCLUSIONS: PE treatment can decrease the serum total bilirubin level and INR and MELD score of patients with severe hepatitis and improve liver function. Compared with the control group, PE can significantly decrease the mortality of patients with MELD scores from 30 to 39, but has no effect in patients with MELD scores of 40 or higher.

BACKGROUND: A suitable perfusate is very important in reducing various problems in liver preservation, prolonging the time of organ preservation and enhancing the quality of donor tissue. University of Wisconsin (UW) solution is the most successful solution for preserving multiple organs at present, but it has many shortcomings. We set out to develop a new liver preservation solution (KYL solution) and study its effects on apoptosis in rat liver undergoing cold preservation. 
METHODS: Using non-circulated isolated perfused rat liver (IPRL), we randomly preserved Sprague-Dawley rat livers for 0, 4, 8, 16, 24, and 48 hours with KYL solution or UW solution. The effects were assessed by measuring the content of free radicals in Krebs-Henseleit solution and the intracellular calcium content of hepatocytes, assessing hepatocellular apoptosis and related-gene expression, and observing the morphological changes in liver. To evaluate the protection by KYL and UW solutions in rat liver perfusion and preservation, we chosed normal saline for negative comparison.
RESULTS: The intracellular calcium content of the liver preserved in KYL solution was less than that preserved in UW solution. At every different period of preservation, the malonaldehyde and superoxide dismutase content in Krebs-Henseleit solution, the percentage of apoptotic cells and the expression patterns of apoptosis-related-genes were similar in livers preserved in KYL and UW solutions. Morphological changes in the two groups were almost the same. The variables in both groups were better than those of livers preserved in normal saline. Both KYL and UW solutions protected rat liver from ischemia-reperfusion injury.
CONCLUSIONS: KYL solution is superior to UW solution in preventing calcium overload. More severe hepatocyte damage may appear in the KYL group than in the UW group and the effect of KYL solution on apoptosis in rat liver preservation is similar to that of UW solution.

BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectomy. Patients with XGC are frequently misdiagnosed intraoperatively as having carcinoma of the gallbladder and are treated with extensive excision. This study aimed at providing proper surgical treatment for patients with XGC.
METHODS: The clinical data of 33 patients with XGC definitely diagnosed by pathological examination over a period of 10 years were analyzed retrospectively (mean age of onset, 60 years; male/female ratio, 1.5∶1).
RESULTS: Preoperatively, the 33 patients were examined by abdominal B-ultrasonography while 20 of them were further examined by computed tomography (CT). Intraoperatively, XGC associated with cholecystolithiasis was found in 97.0% of the patients, thickening of the gallbladder wall in 90.9%, xanthogranulomatous tissue invading into other tissues in 87.9%, XGC associated with choledocholithiasis in 15.2%, and Mirizzi syndrome in 9.1%. In addition, a gallbladder fistula was observed in 4 patients. Open cholecystectomy was performed on 15 patients, partial cholecystectomy on 7, cholecystectomy and partial liver wedge resection on 5, and gallbladder cancer radical correction on 6. The intraoperative misdiagnosis rate was 24.2%. Frozen-section examination was carried out in 9 patients. Postoperative complications were observed in 5 patients.
CONCLUSIONS: XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis depends exclusively on pathological examination. Firm adhesions of the gallbladder to neighboring organs and tissues are common and lead to difficulty in surgical treatments. The mode of operation depends on specific conditions in varying cases, and since frozen-section examination plays an important role in determining the nature of the lesions, intraoperative frozen-section examination should be carried out to differentiate XGC from carcinoma of the gallbladder.

BACKGROUND: The prevalence of gallstones is low in Asians. In Iran, many factors influence the prevalence of this disease. The aim of this study was to determine the prevalence of gallbladder stones and their chemical characteristics in a population by the study of cadavers.
METHODS: In this cross-sectional study, autopsies were performed on 253 cadavers of more than 13 years old. The cadavers were studied to determine the number, location of stone formation, chemical composition, dry weight, and mean diameter of stones in the gallbladder and common bile duct.
RESULTS: The prevalence of gallstone disease in these cadavers was 6.3% (men 4.7%, women 8.6%, not significantly different, P=0.216). There was a positive relationship between the age and prevalence of gallstone disease (P=0.033). The most common stone compositions were cholesterol and oxalate. The mean diameter (P=0.0058) and dry weight (P<0.0001) of stones were higher in the gallbladder than in the common bile duct. Positive relations between the amount of oxalate and mean diameter, and between the amount of oxalate and mean dry weight of gallstones were found, but the relationship between the amount of cholesterol and mean diameter was inverse.
CONCLUSIONS: The prevalence of gallstones differed among age groups. Diameter and dry weight of gallstones were dependent on location of stone formation and chemical composition.

BACKGROUND: The effect of "intestinal transit" has become a new field of interest in the study of the pathogenesis of cholesterol gallstones. This study was undertaken to further test this notion and ascertain the relationship between impaired intestinal transit function and cholesterol gallstones.
METHODS: A total of 64 hamsters were divided into 2 groups, experimental and control. Each was subdivided into 4 subgroups for sacrifice at different time. A high-cholesterol diet and a standard diet were fed to each group. The geometric center, which represents the intestinal transit function was calculated.
RESULTS: The growth of all hamsters was normal. Cholesterol gallstones were found in 2 hamsters at the end of the 4th week. The geometric center values for the experimental and control groups were 2.3891±0.3923 vs. 2.7730±0.5283, at the end of week 3; 1.8148±0.4312 vs. 3.2294±1.1613 at week 4; 1.8451±0.3700 vs. 2.9075±0.3756 at week 5; and 1.8025±0.3413 vs. 3.0920±0.5622 at week 6.
CONCLUSION: A high cholesterol diet can significantly reduce the intestinal transit function and facilitate the formation of cholesterol gallstones.

BACKGROUND: Cholangiocarcinoma is a highly aggressive, fatal malignancy, which is resistant to all current therapeutic approaches. The recent elevation in the incidence of cholangiocarcinoma has highlighted the need for novel approaches targeting the molecular basis of its invasiveness. Previously we reconstructed a RhoC antisense eukaryotic expression vector and transfected it into a cholangiocarcinoma cell line (QBC939) by the lipofectamine method. This study was undertaken to determine the effect of the antisense RhoC gene on the proliferation and invasion capacity of QBC939. 
METHODS: Antisense RhoC cDNA was transfected into QBC939 with lipofectin 2000. The cell growth curve was constructed to determine the proliferation rate of cells; flow cytometry was used to analyze cell cycle changes of the tumor cells; and a Boyden chamber was used to assess the invasive ability of the cells before and after gene transfection. 
RESULTS: After the antisense RhoC cDNA was transfected, the number of colonies formed was significantly lower than that in the other two groups (54±8 vs. 91±11 vs. 90±9, P<0. 05) so was the number of the cells which crossed to the lower surface of the matrigel-coater filters (36±6 vs. 96±12 vs. 95±7, P<0.05). There was also a higher percentage of transfected cells in G1 phase than in the other two groups (52.5% vs. 43.4% vs. 43.7%).
CONCLUSION: The antisense RhoC gene can suppress the capacities of proliferation and invasion in a cholangiocarcinoma cell line in vitro.

BACKGROUND: With the objective of developing a locally-produced radioactive stent, the present study used in vivo animal experiments to explore apoptosis of proliferative smooth muscle cells resulting from facilitation of the expression of genes caused by γ-radiation in order to prevent bile duct restenosis. We therefore explored the effects and significance of γ-radiation on the activity of caspase-3, Fas and Bcl-2 genes in apoptosis of proliferative smooth muscle cells in the bile duct walls of dogs.
METHODS: Twelve dogs were randomly divided into 2 groups (6 in each group). A postinjury bile duct stenosis model was established and radioactive ¹⁰³Pd (¹⁰³palladium) or ordinary bile duct stents were implanted into the bile ducts. HE staining, RT-PCR and immunohistochemistry were used to detect the proliferation and apoptosis of bile duct smooth muscle cells in proliferative endomembrane and the expression of related caspase-3, Bcl-2 and Fas genes.
RESULTS: The expression of caspase-3 and Fas genes in the bile duct tissues of dogs with radioactive stents was higher than that of dogs with ordinary stents. There was significant apoptosis of proliferative smooth muscle cells in the bile ducts. The expression of the Bcl-2 gene in the bile duct tissues of dogs with radioactive stents was lower than that in those with ordinary stents. There was significant apoptosis of proliferative smooth muscle cells in the dogs with low Bcl-2 gene expression.
CONCLUSIONS: Radiation increases the activity of caspase-3 and Fas genes and is associated with apoptosis. The radioactive ¹⁰³Pd stent may facilitate apoptosis of proliferative smooth muscle cells in the bile ducts of dogs by activating these genes. The Bcl-2 gene expression level is correlated with the occurrence of apoptosis and the radiosusceptibility of cells.

BACKGROUND: The good therapeutic effects of large dose of dexamethasone on severe acute pancreatitis (SAP) patients have been proved. This study was designed to investigate the influence of dexamethasone on apoptosis of acinar cells in the pancreas of rats with SAP and the protein expression of the apoptosis-regulating genes Bax and Bcl-2.
METHODS: Ninety Sprague-Dawley rats with SAP were randomly divided into a model group and a dexamethasone treated group (45 rats in each group), and another 45 rats formed the sham operation group. Survival rates were calculated and gross pathological changes in the pancreas of each group were observed under a light microscope 3, 6 and 12 hours after operation. Tissue microarray technology was applied to prepare pancreatic tissue sections. The changes in Bax and Bcl-2 protein expression levels of pancreatic tissues from each group were assessed by immunohistochemical staining, and TUNEL staining was used to evaluate changes in apoptosis index.
RESULTS: The model and treated groups did not differ in mortality at each time point. The pathological score for the pancreas in the treated group was significantly lower than that in the model group at 3 and 6 hours. The positive rates of Bax protein expression in the head and tail of the pancreas in the treated group at all time points were all markedly higher than those of the model group. The positive rate of Bcl-2 protein expression in the head of the pancreas in the treated group was significantly higher than that of the model group at 3 hours. TUNEL staining showed that the pancreas head and tail apoptosis indices of the treated group were markedly higher than those of the model group after 6 hours.
CONCLUSIONS: Apoptosis may be a protective response to pancreatic cell injury. The mechanism of action of dexamethasone in treating SAP may be related to the apoptosis of acinar cells in the pancreas induced by apoptosis-regulating genes such as Bax and Bcl-2. The advantages of tissue microarrays in pathological examination of the pancreas include saving of time and energy, efficiency and highly representative.

BACKGROUND: In experimental acute pancreatitis, a large amount of reactive oxygen species are produced, and in turn cytoskeletal changes may be induced in pancreatic tissue. These changes contribute to an imbalance of digestive enzyme segregation, transport, exocytosis and activation, resulting in cell injury. In this study, we assessed the effects of chondroitin sulfate (CS) on attenuation of oxidative damage and protection of F-actin in rats with acute necrotizing pancreatitis (ANP).
METHODS: Ninety male Wistar rats were divided randomly into three groups.  Group A was infused with 5% sodium taurocholate; group B was treated with CS; and group C served as control. Rats from the three groups were killed at 1, 3 or 8 hours. The levels were measured of malonyl dialdehyde (MDA), total superoxide dismutase (SOD), glutathione synthetase (GSH), serum amylase (SAM) and adenosine triphosphate (ATP). F-actin immunostained with rhodamine-phalloidin was analyzed using a confocal laser scanning system and the content of F-actin protein was determined.
RESULTS: The levels of SAM increased in groups A and B, whereas the levels of GSH, SOD and ATP in group A decreased markedly during pancreatitis, and MDA increased significantly. The levels of GSH, SOD and ATP in group B were higher than those in group A, but the level of MDA was lower than in group A. At the same time, ANP resulted in early disruption of the cytoskeleton with dramatic changes and a loss of F-actin. Administration of CS moderated the damage to the actin cytoskeleton.
CONCLUSIONS: Retrograde infusion of sodium taurocholate via the pancreatic duct may produce pancreatic necrosis and a marked increase in serum amylase activity, induce a severe depletion of ATP level, prime lipid peroxidation, and damage F-actin. Treatment with CS can ameliorate pancreatic cell conditions, limit cell membrane peroxidation, protect F-actin, and attenuate pancreatitis.

BACKGROUND: Islet stem cells are more or less retained in the procedure of islet isolation and purification, and are transplanted together with islet grafts. Keratoprotein (CK-19) and pancreatic duodenal hox gene 1 (PDX-1) are markers of stem cells. This study was undertaken to examine the expression of these markers in pancreatic islet samples of different purity from rats.
METHODS: A total of 30 male Sprague-Dawley rats were randomly assigned to 3 groups to undergo perfusion with V-type collagenase via the pancreatic duct, then the pancreas was excised, diced, shaken, digested and centrifuged to obtain islet sediments. The sediment from group A was not purified, while that from group B was purified with 25% Ficoll-400 and that from group C with 25% and 11% Ficoll-400. RNA was extracted from the different islet samples for reverse transcriptase-polymerase chain reaction (RT-PCR). The expression of the pancreatic stem cell markers CK-19 and PDX-1 was assessed.
RESULTS: The purity of islets in samples was (43.6±6.29)% in group A; (65.3±4.40)% in group B; and (77.6±6.36)% in group C (P<0.05). The expression of CK-19 and PDX-1 mRNA was significantly higher in group A than in groups B and C, but group C showed the lowest level of expression.
CONCLUSION: The expression of CK-19 and PDX-1 mRNA in islet samples of different purity suggests the presence of stem cells in all islet samples.

BACKGROUND: Neuroendocrine tumors (NETs) arising in the biliary tree are extremely rare, and 37 cases were identified in the English literature.
METHODS: A well-differentiated NET was found arising from the junction of the cystic and common hepatic ducts, in a 51-year-old male presenting with pedal edema and weight loss with abnormal liver enzymes and a normal serum bilirubin level. No mass was seen on radiological imaging and biopsy of the liver was suggestive of an early cholangiopathy. A bile leak complicating the liver biopsy led to an ERCP that demonstrated a filling defect suggestive of a mass in the common bile duct (CBD).
RESULTS: He underwent a successful excision of the tumor with a Roux-en-Y hepaticojejunostomy. The diagnosis of NET was made on histological and immunohistochemical analysis of the resected specimen. He remains well and disease free 22 months after surgery.
CONCLUSIONS: Recognition of biliary NET continues to be a challenge and an increased awareness of these tumors in rare sites will result in optimal management of these tumors.

BACKGROUND: The presence of pancreatic ductal intraepithelial neoplasia in patients with chronic pancreatitis is a risk factor for development of pancreatic adenocarcinoma.
METHOD: A case of pancreatic ductal adenocarcinoma associated with pancreatic ductal intraepithelial neoplasia was diagnosed in the setting of chronic pancreatitis.
RESULTS: Distal pancreatectomy combined with splenec-tomy was performed with a diagnosis of pancreatic body carcinoma. Histopathological examination suggested adenocarcinoma associated with pancreatic ductal intraepithelial neoplasia. The tumor was detected in the remaining head of the pancreas, for which a total pancreatectomy was done.
CONCLUSIONS: When a patient with pancreatic ductal intraepithelial neoplasia associated with adenocarcinoma of the pancreas in the setting of chronic pancreatitis is at an increased risk of recurrence in the remaining pancreatic parenchyma, total pancreatectomy may be feasible.