İsmail Özsan

Inflammatory Myofibroblastic Tumor of the Gallblader

BACKGROUND Inflammatory myofibroblastic tumors are rare benign tumors that can mimic malignancy. Their precise aetiology is unknown. They are seen more frequently in childhood and the most common involvement is seen in the lungs. Primary inflammatory myofibroblastic tumors of the gallbladder are rather infrequent. The present knowledge is based on case reports. CASE REPORT A 66 year-old male patient presented to the hospital with complaints of abdominal pain, nausea and vomiting. Upon physical examination, a clinical picture of abdominal tenderness on the right upper quadrant of the abdomen was identified. Laboratory examinations revealed leukocytosis and hypochromic microcytic anaemia with an increased erythrocyte sedimentation rates and C-reactive protein levels. A mass almost completely filling the gallbladder was detected by imaging studies. The patient was operated on with a malignant preoperative diagnosis and underwent a liver resection of segments 4 and 5, which included a cholecystectomy. The histopathological examination of the surgical specimen revealed an inflammatory myofibroblastic tumor including many histiocytes stained positively with CD 68. CONCLUSION Inflammatory myofibroblastic tumors can be localised in the gallbladder mimicking gallbladder cancer.

Diagnostic laparoscopy for pneumatosis intestinalis : To do or not to do?

Pneumatosis intestinalis (PI) is a rare clinical condition, which is commonly associated with mesenteric vascular ischemia, bowel obstruction, and chemotherapy. Although the pathophysiology of PI remains unclear, 2 theories, one mechanical and the other bacterial, have been proposed. Nonoperative medical treatment and observation should be considered in mild cases, but occasionally, the situation requires emergency surgical intervention. In cases of suspectful complicated PI, the clinician should not avoid performing diagnostic laparoscopy to rule out bowel ischemia and perforation.

Primary Malignant Melanoma of the Gallbladder: A Case Report and Review of the Literature

Malignant melanoma is characterized by the ability of diffuse metastases. Since the first report of an isolated malignant melanoma case of the gallbladder, it is already controversial whether isolated cases are metastatic or primary tumors. A 49-year-old woman appealed to the emergency unit because of abdominal pain. Ultrasonography revealed increased thickness of the gallbladder wall and a lesion with surrounding fluid sized 12 mm without acoustic shadow, which arose from the gallbladder wall and was consistent with a polyp. Histopathologic evaluation of the surgical specimen after laparoscopic cholecystectomy revealed malign epithelial tumor consisting of atypical cells with large eosinophilic cytoplasm and dense melanin pigment within the cytoplasm of the tumor cells. As no other focus was identified as a result of the evaluation, the patient was diagnosed with primary malignant melanoma of the gallbladder. In this paper, we aimed to define our treatment modality for a case with isolated malignant melanoma of the gallbladder.

Laparoscopic Appendectomy versus Mini-Incision Appendectomy in Patients with Lower Body Mass Index and Noncomplicated Appendicitis

Laparoscopic appendectomy has become favored over open surgical methods for its association with decreased postoperative pain, more rapid return to daily activities, and improved cosmetic results. Mini-incision appendectomy was being performed in our clinic for a long time especially in patients with noncomplicated appendicitis and in patients with appropriate body mass index. Although laparoscopy presents obvious advantages especially for obese patients and young women, with respect to the results of our study, mini-incision appendectomy seems to be an alternative for selected patient groups.

Early laparoscopic cholecystectomy with continuous pressurized irrigation and dissection in acute cholecystitis.

Background. The aim of this study was to evaluate the preliminary results of a new dissection technique in acute cholecystitis. Material and Method. One hundred and forty-nine consecutive patients with acute cholecystitis were operated on with continuous pressurized irrigation and dissection technique. The diagnosis of acute cholecystitis was based on clinical, laboratory, and radiological evidences. Age, gender, time from symptom onset to hospital admission, operative risk according to the American Society of Anesthesiologists (ASA) score, white blood cell count, C-reactive protein test levels, positive findings of radiologic evaluation of the patients, operation time, perioperative complications, mortality, and conversion to open surgery were prospectively recorded. Results. Of the 149 patients, 87 (58,4%) were female and 62 (41,6%) were male. The mean age was 46.3 ± 6.7 years. The median time from symptom onset to hospital admission 3.2 days (range, 1–6). There were no major complications such as bile leak, common bile duct injury or bleeding. Subhepatic liquid collection occurred in 3 of the patients which was managed by percutaneous drainage. Conversion to open surgery was required in four (2,69%) patients. There was no mortality in the study group. Conclusion. Laparoscopic cholecystectomy with continuous pressurized irrigation and dissection technique in acute cholecystitis seems to be an effective and reliable procedure with low complication and conversion rates.

Laparoscopic resection for Meckel’s diverticulum causing intestinal obstruction

Meckels diverticulum (MD) is the most common congenital anomaly of the gastrointestinal system with an estimated incidence of approximately 2% of the population. Although most cases are asymptomatic, it has the potential to create complications, such as hemorrhage, inflammation, intestinal obstruction, perforation, and intussusception. Meckels diverticulum is generally diagnosed incidentally or upon investigation of unexplained gastrointestinal bleeding, perforation, inflammation, or obstruction for both pediatric and adult patients. Complications are often present as surgical emergencies and require resection of the diseased intestinal segment. In doubtful cases, laparoscopy should be the surgical method for both diagnosing and treating MD. Here we present a case of MD causing intestinal obstruction and that was treated by laparoscopic resection.

Laparoscopic splenectomy for a wandering spleen causing chronic pelvic pain

Wandering spleen is a rare condition with a reported incidence of less than 0.5% in which the spleen migrates from its normal anatomical location to any other position in the abdomen. Women constitute 80% of cases and one third of the overall patients are children. It has different clinical presentations such as asymptomatic, painless mass in the abdomen, intermittent abdominal pain and acute abdomen due to torsion of the vascular pedicle. Here we present a case of wandering spleen causing chronic pelvic pain. Laparoscopic splenopexy was the treatment choice but it could not be performed due to huge size of the wandering spleen.

Capillary refill time as a guide for operational decision-making process of autoimmune pancreatitis: Preliminary results.

AIM To investigate the efficacy of a novel intraoperative diagnostic technique for patients with preliminary diagnosis of autoimmune pancreatitis (AIP). METHODS Patients with pancreatic surgery were reviewed to identify those who received a preliminary diagnosis of AIP between January 2010 and January 2014. The following data were collected prospectively for patients with a pathological diagnosis of AIP: clinical and demographic features, radiological and operative findings, treatment procedure, and intraoperative capillary refill time (CRT) in the pancreatic bed. RESULTS Eight patients (six males, two females; mean age: 51.4 years) met the eligibility criteria of pathologically confirmed diagnosis. The most frequent presenting symptoms were epigastric pain and weight loss. The most commonly conducted preoperative imaging studies were computed tomography and endoscopic retrograde pancreaticodoudenography. The most common intraoperative macroscopic observations were mass formation in the pancreatic head and diffuse hypervascularization in the pancreatic bed. All patients showed decreased CRT (median value: 0.76 s, range: 0.58-1.35). One-half of the patients underwent surgical resection and the other half received medical treatment without any further surgical intervention. CONCLUSION This preliminary study demonstrates a novel experience with measurement of CRT in the pancreatic bed during the intraoperative evaluation of patients with AIP.

Safra Kesesi Karsinomunu Taklit Eden Ksantogranülomatöz Kolesistit

Şekil I: A: Mukozal ulserasyon ve kese duvarinda kolesterol kleftleri ve kopuklu makrofajlar ile karakterli ksantomatoz reaksiyon (x100, HE). B: Kolesterol kleftleri ve kopuklu histiositler yani sira az sayida lenfositler ile karakterli ksantogranulomatoz yangi (x200, HE)

Coexistence of Gallbladder Agenesis and Cholangiocarcinoma: Report of a Case

Gallbladder agenesis (GA) is a rare condition and was first described by Lemary in 1701. Nearly 400 cases of GA is described in the literature and it is associated with various congenital abnormalities and malformations in some cases. Cholangiocarcinoma (CCA) is the malignant tumor arising from bile ducts. A wide range of risk factors have been identified for cholangiocarcinoma. A case of cholangiocarcinoma in which gallbladder agenesis was found incidentally was described in this study.