Ogun Ersen

A rare condition: Ectopic liver tissue with its unique blood supply encountered during laparoscopic cholecystectomy.

Highlights • Developmental abnormalities of liver including ectopic liver are rare conditions.• Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction.• Ectopic liver has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed.• The vascular anatomy of ectopic liver should be identified before the dissection of gallbladder in order to prevent hemorrhage from the liver parenchyma.

Spontaneous postoperative choledochoduodenal fistula due to bile duct injury following laparoscopic cholecystectomy.

Highlights • Class E injuries are the most common major bile duct injuries and can cause serious clinical condition including bile leak.• Iatrogenic operative injuries may be a cause of spontaneous postoperative choledochoduodenal fistula even in transaction type complete injuries.• Spontaneous closure of a postoperative bile fistula doesn’t guarantee that it is not a transaction type injury.

Results of the open surgery after endoscopic basket impaction during ERCP procedure

AIM To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. METHODS Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. RESULTS Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13(th) day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

Avulsion of Ampulla of Vater Secondary to a Blunt Abdominal Injury Treated with Pancreatoduodenectomy; A Case Report and Literature Review

The incidence of complex hepatobiliary injury secondary to blunt abdominal injuries varies between 3.4 and 5%. A 25-year old male patient underwent an urgent operation due to a motorcycle accident. During intraabdominal exploration, Grade 4 laceration was detected at the liver and bleeding was controlled through primary repair. In the postoperative seventh day, he was referred due to 1500 cc bile leakage from the drainage tube. During the operation, an extensive Kocher maneuver was done and the second part of duodenum was observed to be exposed to total avulsion from the head of the pancreas. Pancreatoduodenectomy was planned due to presence of ischemic changes in the second part of duodenum. In the postoperative follow-up, the abdomen was closed with a controlled abdominal closure procedure. The clinical findings of biliary tract injuries secondary to blunt abdominal injuries often manifest themselves late and early diagnosis is possible only with suspicion.

Laparoskopik low anterior rezeksiyon sonrası oluşan anastomoz darlığında balon dilatasyon uygulaması: İki olgu sunumu

Benign anastomoz darliklari kolorektal cerrahi sonrasi ortaya cikabilen gec komplikasyonlardandir. Tedavide her ne kadar endoskopik girisimler onerilmekteyse de balon dilatasyonu dusunulmesi gereken ilk secenektir. Laparoskopi yardimli low anterior rezeksiyon ve stapler anastomoz yapilan iki hastamizdan birinde postoperatif 6. ayinda digerinde ise 9. ayinda ileri derecede anastomoz strikturu tespit edildi. Hastalardan biri ishal-kabizlik ataklari, rektal kanama gibi yakinmalarla basvururken diger hasta tamamen asemptomatikti ve anastomoz darligi kontrol kolonoskopisinde saptandi. Her iki hastaya da akalazya tedavisinde kullanilan “ower-the-wire” balonu ile iki seans endoskopik dilatasyon uygulandi.

Kolesistektomi sonrası kolestaz nedeni olarak Dubin-Johnson sendromu; Olgu sunumu ve literatür incelemesi

Dubin Johnson syndrome (DJS), also known as Sprinz-Nelson syndrome is a hereditary disease characterized by conjugated hiperbillirubinemi induced by chronic mild stress. DJS are frequently diagnosed during late adolescence and early adulthood. The patients apply with an itching jaundice, vague abdominal pain, nausea and vomiting. Physical examination is usually accompanied by jaundice, but sometimes hepatomegaly can find out. The disease is usually indolent and does not cause chronic liver failure. Although rifampicin and usodeoksikolik acid may be used in a therapy, the optimal treatment is not still found out. In this article we presented DJS to cause of persistent conjugated hiperbillirubinemi in patient undergoing laparoscopic cholecystectomy because of symptomatic cholelithiasis with literature data

Our results of lower gastrointestinal endoscopy: evaluation of 700 patients.

OBJECTIVE Although radiological imaging modalities like barium enema and computed tomography provide some clues, endoscopic methods still maintain superiority in assessment and differential diagnosis of large intestinal symptoms and complaints that require biopsy. We aimed to present the results of colonoscopic procedures performed in our general surgery clinic in detail. MATERIAL AND METHODS Seven hundred patients who presented to Afyon Kocatepe University, Faculty of Medicine, Department of General Surgery Endoscopy Unit between January 2011 and July 2012 with an indication for colonoscopy were retrospectively evaluated. RESULTS Out of the 700 patients enrolled in the study 356 (50.8%) were male while 344 patients (49.2%) were female. The mean age of the patients was found to be 49 years. Within the group of 700 patients who underwent colonoscopic examinations, the terminal ileum and cecum have been reached on the first attempt in 432 patients (61.7%) and colonoscopic success has been achieved. Results of colonoscopies performed on 700 patients in our clinic revealed malignancy in 42 (6%) patients, and all of these patients were treated surgically in our clinic. Mortality was not observed in this series. Procedure-related bleeding and perforation developed in 6 patients. One patient developed respiratory arrest due to sedation and patient was responsive to resuscitation. The complication rate in our series was 1%. CONCLUSION In the study where we revised our own clinical experience, we found that our success rate was lower than the literature, and our complication rate was higher. The main reasons are accepted as our colonoscopy units being young and the low patient volume.