Background/Aim: Anastomotic stricture following choledochojejunostomy (CJS) is largely driven by fibrotic remodeling at the anastomotic site, a process mediated by transforming growth factor-β (TGF-β) signaling. This problem is particularly relevant in emergency biliary surgery, where CJS is frequently performed under suboptimal conditions and anastomotic leakage is common, predisposing to exaggerated fibrosis and late strictures. This study aimed to evaluate the effect of the TGF-β type I receptor (ALK5) inhibitor EW-7197 (vactosertib) on histopathological parameters of anastomotic healing, with a particular focus on fibrosis, in a rat CJS model. Materials and Methods: Twenty-four male Wistar Albino rats were randomized into three groups (n = 8 each): control (G1), CJS only (G2), and CJS plus EW-7197 (G3). EW-7197 was administered as a single intraperitoneal dose (20 mg/kg) immediately after completion of the anastomosis. On postoperative day 21, choledochojejunal anastomotic tissues were harvested and evaluated histologically using hematoxylin–eosin and Masson’s trichrome staining. Edema, hyperemia, inflammation, and fibrosis were graded using a semi-quantitative scoring system, and intergroup comparisons were performed using non-parametric statistical tests. Results: Compared with surgery alone, EW-7197 treatment resulted in a statistically significant reduction in fibrosis severity at the anastomotic site (p < 0.001) and a significant attenuation of hyperemia (p = 0.007). Edema scores showed a downward trend in the EW-7197-treated group but did not reach statistical significance, while inflammation scores did not differ significantly between the surgical groups. Conclusions: In this experimental rat choledochojejunostomy model, administration of the selective ALK5 inhibitor EW-7197 significantly reduced histopathological fibrosis and hyperemia at the anastomotic site on postoperative day 21 without affecting inflammation severity. These findings support the role of the TGF-β/Smad pathway in bilioenteric anastomotic fibrotic remodeling. However, further studies including molecular validation and functional assessments are required to clarify the translational relevance of these results.

Cystic stump leakage is the most common cause of bile leakage following cholecystectomy, representing a significant postoperative complication that requires prompt intervention. Currently, endoscopic treatment is the preferred management approach. This study aims to identify factors influencing the success of endoscopic therapy for cystic stump leaks by analyzing cases treated at our institution. Thirty-seven patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for cystic stump leakage were included in this study. Patient demographics, associated complications, and length of hospital stay were analyzed. All patients showed clinical improvement, with a mean hospital stay of 5.1 days. The presence of comorbidities, emergency surgery, or conversion to open surgery did not significantly impact treatment efficacy. Post-procedure, percutaneous drainage was required in 10 patients (27%). Procedure-related pancreatitis was noted in one patient (2.7%). Statistical analysis revealed that both the need for percutaneous drainage and the length of hospital stay were significantly lower in patients who had pre-existing drains (p<0.03). Additionally, early ERCP was associated with a significantly shorter hospital stay (p<0.01). Stent placement via ERCP is a safe and effective strategy for managing cystic stump leaks. Early ERCP intervention following cystic stump leak detection is recommended. Furthermore, percutaneous drainage may be necessary in patients who do not respond adequately to initial treatment.

Objectives: Demographic features of subjects, such as body mass index, height, weight, age, or sex, may affect diameters of vessels such as the splenic artery (SA) and splenic vein (SV). Some studies use alternative anatomical indicators, including the body of the first lumbar vertebra (L1), to improve standardization in the assessment of vascular pathologies. This study aimed to evaluate the relationship between splenic vessel diameters (SA and SV) and L1 using abdominopelvic computed tomography images obtained from individuals aged 1–80 years. Methods: Radiologic images of 800 subjects were included in the examination. Proximal (SA1 and SV1), middle (SA2 and SV2) and distal (SA3 and SV3) calibers of SA and SV were measured. Ratios of vessel calibers to the transverse diameter of the body of L1 (L1TD) were calculated. Results: Age had a clear influence on the diameters of SA and SV. SV1 showed a steady increase until the early fifties, followed by a decline beginning in the seventies. Both SV2 and SV3 enlarged until the early twenties, after which no significant variation was observed. SA1, SA2, and SA3 gradually increased from 1 year of age through the early fifties, but demonstrated a statistically significant reduction at older ages. The ratios of SA and SV diameters to L1TD were highest during the first decade of life and dropped markedly in the second decade. Following this period, these ratios generally tended to rise initially and then decline with further aging. Conclusions: This study provides age-specific CT-based reference values for SA and SV diameters and their ratios to the L1 vertebral body. Since L1 is readily identifiable on routine computed tomography, these ratios may provide a practical complementary anatomical reference. Further studies are warranted to validate their clinical applicability.

Objective: The inferior mesenteric vein (IMV) is an important component of the portal venous system; however, normative developmental data during childhood remain limited. This study aimed to evaluate age- and sex-related changes in IMV caliber using contrast-enhanced computed tomography in a pediatric population. Methods: Radiologic images of 200 subjects aged 1–20 years were included in the examination. Terminal (IMV1), intermediate (IMV2), and pelvic (IMV3) calibers of the IMV were measured. Ratios of vessel calibers to the transverse diameter of the first lumbar vertebral body (L1TD) were calculated. In addition, the drainage pattern of the IMV was recorded. Results: L1TD, IMV1, IMV2, and IMV3 demonstrated significant age-related changes (p < 0.001). All IMV calibers increased from infancy to the postpubescent period. Among the calculated ratios, IMV1/L1TD and IMV3/L1TD demonstrated significant age-related variation (p < 0.05), whereas IMV2/L1TD remained relatively stable throughout childhood and adolescence (p > 0.05). No significant sex-related differences were observed for most parameters, although IMV3 was significantly greater in males than in females (p = 0.043). The splenic vein was the most common termination site of the IMV (47.5%), followed by the superior mesenteric vein (29.5%) and the splenomesenteric confluence (23.0%). Conclusions: The present study provides normative age-specific values for IMV caliber and IMV-to-L1TD ratios in the pediatric population. These data may facilitate the radiological assessment of IMV-related abnormalities and provide a practical reference for routine computed tomography evaluation of the pediatric mesentericoportal venous system.