Gardner's syndrome(GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal s...Gardner's syndrome(GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and midrectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodenojejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.展开更多
BACKGROUND There is increasing interest in transplanting patients with hepatocellularcarcinoma (HCC) with tumors greater than 5 cm (Milan criteria).AIM To investigate possible prognostically-useful factors for liver t...BACKGROUND There is increasing interest in transplanting patients with hepatocellularcarcinoma (HCC) with tumors greater than 5 cm (Milan criteria).AIM To investigate possible prognostically-useful factors for liver transplantation inHCC patients with large tumors.METHODS In this clinical study, 50 patients with HCC who were transplanted at our LiverTransplant Center between April 2006 and August 2019 and had tumors greaterthan 6 cm maximum diameter were retrospectively analyzed. Their survival andfull clinical characteristics were examined, with respect to serum alphafetoprotein(AFP) and gamma glutamyl transpeptidase (GGT) levels. Kaplan-Meier survival estimates were used to determine overall survival and disease-freesurvival in these patients. The inclusion criterion was evidence of HCC. Exclusioncriteria were the presence of macroscopic portal vein thrombosis or metastasisand a follow-up period of less than 90 d.RESULTS Using receiver operating characteristic curve (ROC) analysis, cutoff values of AFP200 ng/mL and GGT 104 IU/L were identified and used in this study.Significantly longer overall survival (OS) and disease-free-survival (DFS) were found in patients who had lower values of either parameter, compared withhigher values. Even greater differences in survival were found when the 2parameters were combined. Two tumor size bands were identified, in searchingfor the limits of this approach with larger tumors, namely 6-10 cm and > 10 cm.Combination parameters in the 6-10 cm band reflected 5-year OS of 76.2% inpatients with low AFP plus low GGT vs 0% for all other groups. Patients withtumors greater than 10 cm, did not have low AFP plus low GGT. The mostconsistent clinical correlates for longer survival were degree of tumordifferentiation and absence of microscopic portal venous invasion.CONCLUSION Serum levels of AFP and GGT, both alone and combined, represent a simpleprognostic identifier in patients with large HCCs undergoing liver transplantation.展开更多
BACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually calledan accessory liver, and that without a connection to the mother liver, is calledectopic liver tissue.AIM To identify studie...BACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually calledan accessory liver, and that without a connection to the mother liver, is calledectopic liver tissue.AIM To identify studies in the literature on ectopic liver tissue located on thegallbladder surface or mesentery.METHODS We present two patients and review published articles on ectopic liver tissuelocated on the gallbladder surface accessed via PubMed, MEDLINE, GoogleScholar, and Google databases. Keywords used included accessory liver lobe,aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic livertissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopicliver tissue on the gallbladder. The search included articles published before June2020 with no language restriction. Letters to the editor, case reports, reviewarticles, original articles, and meeting presentations were included in the search.Articles or abstracts containing adequate information on age, sex, history of liverdisease, preliminary diagnosis, radiologic tools, lesion size, surgical indication,surgical procedure, and histopathological features of ectopic liver tissue wereincluded in the study.RESULTS A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 werefemale and 25 were male (no gender available for 4 patients), and the age rangewas 5 d to 91 years. Forty-nine patients underwent surgery for chroniccholecystitis or cholelithiasis, and 14 patients underwent surgery for acutecholecystitis. The remaining 28 patients underwent laparotomy for other reasons.Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. Theremaining 19 patients underwent various other surgical procedures such asautopsy, liver transplantation, living donor hepatectomy, Whipple procedure, andliver segment V resection. Histopathologically, hepatocellular carcinoma wasdetected in the ectopic liver tissue of one patient.CONCLUSION Ectopic liver tissue is a rare developmental anomaly which is usually detectedincidentally. Although most studies suggest that ectopic liver located outside thegallbladder has a high risk of hepatocellular carcinoma, this is not reflected instatistical analysis.展开更多
BACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.AIM To compare the demographi...BACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.AIM To compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard appendectomy.METHODS The demographic, biochemical, and histopathological data of 72 patients(Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients(Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1:4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced pathologists.RESULTS Statistically significant differences were found between groups in terms of age(P= 0.044), white blood cell count(P < 0.001), neutrophil(P < 0.001), lymphocyte(P< 0.001), red cell distribution width(P = 0.036), mean corpuscular hemoglobin(P= 0.001), bilirubin(P = 0.002), appendix width(P < 0.001), and presence of acute appendicitis histopathologically(P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis(72.2%), fibrous obliteration(9.7%)and acute appendicitis(6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis(62.8%), perforated appendicitis(16.7%), lymphoid hyperplasia(8.3%), and appendix vermiformis(6.3%).CONCLUSION Careful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that experience is parallel to the surgeon's foresight, and we should not hesitate to perform incidental appendectomy when展开更多
BACKGROUND Since the first living donor liver transplantation(LDLT)was performed by Raia and colleagues in December 1988,LDLT has become the gold standard treatment in countries where cadaveric organ donation is not s...BACKGROUND Since the first living donor liver transplantation(LDLT)was performed by Raia and colleagues in December 1988,LDLT has become the gold standard treatment in countries where cadaveric organ donation is not sufficient.Adequate hepatic venous outflow reconstruction in LDLT is essential to prevent graft congestion and its complications including graft loss.However,this can be complex and technically demanding especially in the presence of complex variations and congenital anomalies in the graft hepatic veins.CASE SUMMARY Herein,we aimed to present two cases who underwent successful right lobe LDLT using a right lobe liver graft with rudimentary or congenital absence of the right hepatic vein and describe the utility of a common large opening drainage model in such complex cases.CONCLUSION Thanks to this venous reconstruction model,none of the patients developed postoperative complications related to venous drainage.Our experience with venous drainage reconstruction models shows that congenital variations in the hepatic venous structure of living liver donors are not absolute contraindications for LDLT.展开更多
BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandem...BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appendectomy rate decreased.There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.展开更多
BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes,plasma cells,neutrophils,and often multinucleated giant cells with or wit...BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes,plasma cells,neutrophils,and often multinucleated giant cells with or without cholesterol clefts.AIM To review the medical literature on xanthogranulomatous appendicitis(XGA).METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed,MEDLINE,Google Scholar,and Google databases.Keywords used were“appendix vermiformis,”“appendectomy,”“acute appendicitis,”and“XGA.”The search included articles published before May 2020,and the publication language was not restricted.The search included letters to the editor,case reports,review articles,original articles,and meeting presentations.Articles or abstracts containing adequate information about age,sex,clinical presentation,white blood cells,initial diagnosis,surgical approach,histopathological and immunohistochemical features of appendectomy specimens were included in the study.RESULTS A total of 29 articles involving 38 patients with XGA,were retrospectively analyzed.Twenty(52.6%)of the 38 patients,aged 3 to 78 years(median:34;IQR:31)were female,and the remaining 18(47.4%)were male.Twenty-five patients were diagnosed with acute appendicitis,ruptured appendicitis,or subacute appendicitis,and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region.Twenty-two of the patients underwent urgent or semi-urgent surgery,and the remaining 16 patients underwent interval appendectomy.CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis.It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation.It is often associated with interval appendectomies,and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion.XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.展开更多
文摘Gardner's syndrome(GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and midrectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodenojejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.
文摘BACKGROUND There is increasing interest in transplanting patients with hepatocellularcarcinoma (HCC) with tumors greater than 5 cm (Milan criteria).AIM To investigate possible prognostically-useful factors for liver transplantation inHCC patients with large tumors.METHODS In this clinical study, 50 patients with HCC who were transplanted at our LiverTransplant Center between April 2006 and August 2019 and had tumors greaterthan 6 cm maximum diameter were retrospectively analyzed. Their survival andfull clinical characteristics were examined, with respect to serum alphafetoprotein(AFP) and gamma glutamyl transpeptidase (GGT) levels. Kaplan-Meier survival estimates were used to determine overall survival and disease-freesurvival in these patients. The inclusion criterion was evidence of HCC. Exclusioncriteria were the presence of macroscopic portal vein thrombosis or metastasisand a follow-up period of less than 90 d.RESULTS Using receiver operating characteristic curve (ROC) analysis, cutoff values of AFP200 ng/mL and GGT 104 IU/L were identified and used in this study.Significantly longer overall survival (OS) and disease-free-survival (DFS) were found in patients who had lower values of either parameter, compared withhigher values. Even greater differences in survival were found when the 2parameters were combined. Two tumor size bands were identified, in searchingfor the limits of this approach with larger tumors, namely 6-10 cm and > 10 cm.Combination parameters in the 6-10 cm band reflected 5-year OS of 76.2% inpatients with low AFP plus low GGT vs 0% for all other groups. Patients withtumors greater than 10 cm, did not have low AFP plus low GGT. The mostconsistent clinical correlates for longer survival were degree of tumordifferentiation and absence of microscopic portal venous invasion.CONCLUSION Serum levels of AFP and GGT, both alone and combined, represent a simpleprognostic identifier in patients with large HCCs undergoing liver transplantation.
文摘BACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually calledan accessory liver, and that without a connection to the mother liver, is calledectopic liver tissue.AIM To identify studies in the literature on ectopic liver tissue located on thegallbladder surface or mesentery.METHODS We present two patients and review published articles on ectopic liver tissuelocated on the gallbladder surface accessed via PubMed, MEDLINE, GoogleScholar, and Google databases. Keywords used included accessory liver lobe,aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic livertissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopicliver tissue on the gallbladder. The search included articles published before June2020 with no language restriction. Letters to the editor, case reports, reviewarticles, original articles, and meeting presentations were included in the search.Articles or abstracts containing adequate information on age, sex, history of liverdisease, preliminary diagnosis, radiologic tools, lesion size, surgical indication,surgical procedure, and histopathological features of ectopic liver tissue wereincluded in the study.RESULTS A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 werefemale and 25 were male (no gender available for 4 patients), and the age rangewas 5 d to 91 years. Forty-nine patients underwent surgery for chroniccholecystitis or cholelithiasis, and 14 patients underwent surgery for acutecholecystitis. The remaining 28 patients underwent laparotomy for other reasons.Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. Theremaining 19 patients underwent various other surgical procedures such asautopsy, liver transplantation, living donor hepatectomy, Whipple procedure, andliver segment V resection. Histopathologically, hepatocellular carcinoma wasdetected in the ectopic liver tissue of one patient.CONCLUSION Ectopic liver tissue is a rare developmental anomaly which is usually detectedincidentally. Although most studies suggest that ectopic liver located outside thegallbladder has a high risk of hepatocellular carcinoma, this is not reflected instatistical analysis.
文摘BACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.AIM To compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard appendectomy.METHODS The demographic, biochemical, and histopathological data of 72 patients(Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients(Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1:4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced pathologists.RESULTS Statistically significant differences were found between groups in terms of age(P= 0.044), white blood cell count(P < 0.001), neutrophil(P < 0.001), lymphocyte(P< 0.001), red cell distribution width(P = 0.036), mean corpuscular hemoglobin(P= 0.001), bilirubin(P = 0.002), appendix width(P < 0.001), and presence of acute appendicitis histopathologically(P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis(72.2%), fibrous obliteration(9.7%)and acute appendicitis(6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis(62.8%), perforated appendicitis(16.7%), lymphoid hyperplasia(8.3%), and appendix vermiformis(6.3%).CONCLUSION Careful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that experience is parallel to the surgeon's foresight, and we should not hesitate to perform incidental appendectomy when
文摘BACKGROUND Since the first living donor liver transplantation(LDLT)was performed by Raia and colleagues in December 1988,LDLT has become the gold standard treatment in countries where cadaveric organ donation is not sufficient.Adequate hepatic venous outflow reconstruction in LDLT is essential to prevent graft congestion and its complications including graft loss.However,this can be complex and technically demanding especially in the presence of complex variations and congenital anomalies in the graft hepatic veins.CASE SUMMARY Herein,we aimed to present two cases who underwent successful right lobe LDLT using a right lobe liver graft with rudimentary or congenital absence of the right hepatic vein and describe the utility of a common large opening drainage model in such complex cases.CONCLUSION Thanks to this venous reconstruction model,none of the patients developed postoperative complications related to venous drainage.Our experience with venous drainage reconstruction models shows that congenital variations in the hepatic venous structure of living liver donors are not absolute contraindications for LDLT.
文摘BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appendectomy rate decreased.There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.
文摘BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes,plasma cells,neutrophils,and often multinucleated giant cells with or without cholesterol clefts.AIM To review the medical literature on xanthogranulomatous appendicitis(XGA).METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed,MEDLINE,Google Scholar,and Google databases.Keywords used were“appendix vermiformis,”“appendectomy,”“acute appendicitis,”and“XGA.”The search included articles published before May 2020,and the publication language was not restricted.The search included letters to the editor,case reports,review articles,original articles,and meeting presentations.Articles or abstracts containing adequate information about age,sex,clinical presentation,white blood cells,initial diagnosis,surgical approach,histopathological and immunohistochemical features of appendectomy specimens were included in the study.RESULTS A total of 29 articles involving 38 patients with XGA,were retrospectively analyzed.Twenty(52.6%)of the 38 patients,aged 3 to 78 years(median:34;IQR:31)were female,and the remaining 18(47.4%)were male.Twenty-five patients were diagnosed with acute appendicitis,ruptured appendicitis,or subacute appendicitis,and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal region.Twenty-two of the patients underwent urgent or semi-urgent surgery,and the remaining 16 patients underwent interval appendectomy.CONCLUSION Xanthogranulomatous inflammation rarely affects the appendix vermiformis.It is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation.It is often associated with interval appendectomies,and a significant number of patients require bowel resection due to the common presentation of a tumoral lesion.XGA is usually identified retrospectively on surgical pathology and has no unique features in preoperative diagnostic studies.
