Sami Akbulut

Liver Hydatid Cyst Rupture Into the Peritoneal Cavity After Abdominal Trauma: Case Report and Literature Review

The aim of this study was to review the literature regarding the rupture of hydatid cysts into the abdominal cavity after trauma. We present both a new case of hydatid cyst rupture that occurred after blunt abdominal trauma and a literature review of studies published in the English language about hydatid cyst rupture after trauma; studies were accessed from PubMed, Google Scholar, EBSCO, EMBASE, and MEDLINE databases. We identified 22 articles published between 2000 and 2011 about hydatid cyst rupture after trauma. Of these, 5 articles were excluded because of insufficient data, duplication, or absence of intra-abdominal dissemination. The other 17 studies included 68 patients (38 males and 30 females) aged 8 to 76 years who had a ruptured hydatid cyst detected after trauma. The most common trauma included traffic accidents and falls. Despite optimal surgical and antihelmintic therapy, 7 patients developed recurrence. Complications included biliary fistula in 5 patients, incisional hernia in 2 patients, and gastrocutaneous fistula in 1 patient. Death occurred from intraoperative anaphylactic shock in 1 patient and gastrointestinal bleeding and pulmonary failure in 1 patient. Rupture of a hydatid cyst into the peritoneal cavity is rare and challenging for the surgeon. This condition is included in the differential diagnosis of the acute abdomen in endemic areas, especially in young patients.

Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients.

The objective of this study was to analyze the clinical benefit of histopathologic analysis of appendectomy specimens from patients with an initial diagnosis of acute appendicitis. We retrospectively analyzed the demographic and histopathologic data of 1255 patients (712 males, 543 females; age range, 17-85 years) who underwent appendectomy to treat an initial diagnosis of acute appendicitis. Patients who underwent incidental appendectomy during other surgeries were excluded from the study. Histopathologic findings of the appendectomy specimens were used to confirm the initial diagnosis. Ninety-four percent of the appendectomy specimens were positive for appendicitis. Of those, 880 were phlegmonous appendicitis, 148 were gangrenous appendicitis with perforation, and the remaining 88 showed unusual histopathologic findings. In the 88 specimens with unusual pathology, fibrous obliteration was observed in 57 specimens, carcinoid tumor in 11, Encheliophis vermicularis parasite infection in 8, granulatomous inflammation in 6, appendiceal endometriosis in 2, and 1 specimen each showed mucocele, eosinophilic infiltration, Taenia saginata parasite infection, and appendicular diverticulitis. All carcinoid tumors were located in the distal appendix. Six of the 11 carcinoid tumors were defined by histopathology as involving tubular cells, and the other 5 as involving enterochromaffin cells. Six patients had muscularis propria invasion, 2 patients had submucosa invasion, 2 patients had mesoappendix invasion, and 1 patient had serosal invasion. All patients with tumors remained disease free during the follow-up (range, 1-27 months). We conclude that when the ratio of unusual pathologic findings for appendectomy specimens is considered, it is evident that all surgical specimens should be subjected to careful histologic examination.

Laparoscopic Trocar Port Site Endometriosis: A Case Report and Brief Literature Review

Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. It occurs most commonly in pelvic sites such as ovaries, cul-de-sac, and fallopian tubes but also can be found associated with the lungs, bowel, ureter, brain, and abdominal wall. Abdominal wall endometriosis, also known as scar endometriosis, is extremely rare and mainly occurs at surgical scar sites. Although many cases of scar endometriosis have been reported after a cesarean section, some cases of scar endometriosis have been reported after an episiotomy, hysterectomy, appendectomy, and laparoscopic trocar port tracts. To our knowledge, 14 case reports related to trocar site endometriosis have been published in the English language literature to date. Herein, we present the case of a 20-year-old woman (who had been previously operated on for left ovarian endometrioma 1.5 years ago by laparoscopy) with the complaint of a painful mass at the periumbilical trocar site with cyclic pattern. Consequently, although rare, if a painful mass in the surgical scar, such as the trocar site, is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis.

Double Meckel’s Diverticulum Presenting as Acute Appendicitis: A Case Report and Literature Review

BACKGROUND Meckels diverticulum is the most common developmental anomaly of the gastrointestinal tract, affecting 1-3% of the general population. This anomaly is caused by incomplete obliteration of the omphalomesenteric duct during the 7th week of gestation and is located in the last meter of the ileum in 90% of patients. Meckels diverticulum is often an incidental finding during a laparotomy for other causes, such as acute appendicitis, and occasional complications are bleeding, obstruction, diverticulitis, and perforation. OBJECTIVE Primary aim of this study was to present and share an extremely rare case of double Meckels diverticulum. METHODS A 20-year-old woman who was admitted due to symptoms of right lower quadrant pain, nausea, and vomiting. A laparotomy with a McBurneys incision was performed because of a presumed diagnosis of acute appendicitis. The surgical exploration revealed a double Meckels diverticulum localized 50 cm proximal to the ileocecal valve, but no acute appendicitis. The operation was finished after a diverticulectomy and appendectomy. No complications occurred during the postoperative follow-up. CONCLUSIONS We conducted a literature review of studies published in the English language on double Meckels diverticulum, accessed via PubMed, Medline, and the Google Scholar databases. We found only five case reports of such a Meckels diverticulum variant.

Chylous ascites after liver transplantation: Incidence and risk factors†‡

In this study, we evaluated the diagnosis, epidemiology, risk factors, and treatment of chylous ascites developing after liver transplantation (LT). Between 2002 and 2011, LT was performed 693 times in 631 patients at our clinic. One‐hundred fifteen of these patients were excluded for reasons such as retransplantation, early postoperative mortality, and insufficient data. Chylous ascites developed after LT (mean ± SD = 8.0 ± 3.2 days, range = 5‐17 days) in 24 of the 516 patients included in this study. Using univariate and multivariate analyses, we examined whether the following were risk factors for developing chylous ascites: age, sex, body mass index, graft‐to‐recipient weight ratio, Model for End‐Stage Liver Disease score, vena cava cross‐clamping time, total operation time, Child‐Pugh classification, sodium level, portal vein thrombosis or ascites before transplantation, donor type, albumin level, and perihepatic dissection technique [LigaSure vessel sealing system (LVSS) versus conventional suture ligation]. According to a univariate analysis, a low albumin level (P = 0.04), the presence of ascites before transplantation (P = 0.03), and the use of LVSS for perihepatic dissection (P < 0.01) were risk factors for developing chylous ascites. According to a multivariate Cox proportional hazards model, the presence of pretransplant ascites [P = 0.04, hazard ratio (HR) = 2.8, 95% confidence interval (CI) = 1.1‐13.5] and the use of LVSS for perihepatic dissection (P = 0.01, HR = 5.4, 95% CI = 1.5‐34.4) were independent risk factors. In conclusion, the presence of preoperative ascites and the use of LVSS for perihepatic dissection are independent risk factors for the formation of chylous ascites. To our knowledge, this study is the most extensive examination of the development of chylous ascites. Nevertheless, our results should be supported by new prospective trials. Liver Transpl, 2012.

Open Surgery for Hepatic Hydatid Disease

Hydatid disease is a zoonosis caused by the larvae of Echinococcus granulosus . Humans are an intermediate host and are usually infected by direct contact with dogs or indirectly by contaminated foods. Hydatid disease mainly involves the liver and lungs. The disease can be asymptomatic. Imaging techniques such as ultrasonography and computed tomography are used for diagnosis. The growth of hydatid cysts can lead to complications. Communication between bile duct and cysts is a common complication. The goal of treatment for hydatid disease is to eliminate the parasite with minimum morbidity and mortality. There are 3 treatment options: surgery, chemotherapy, and interventional procedures. Medical treatment has low cure and high recurrence rates. Percutaneous treatment can be performed in select cases. There are many surgical approaches for managing hydatid cysts, although there is no best surgical technique, and conservative and radical procedures are used. Conservative procedures are usually preferred in endemic areas and are easy to perform but are associated with high morbidity and recurrence rates. In these procedures, the parasite is sterilized using a scolicidal agent, and the cyst is evacuated. Radical procedures include hepatic resections and pericystectomy, which have high intraoperative risk and low recurrence rates. Radical procedures should be performed in hepatobiliary centers. The most common postoperative complications are biliary fistulas and cavity-related complications. Endoscopic retrograde cholangiopancreatography can be used to diagnose and treat biliary system complications. Endoscopic sphincterotomy, biliary stenting, and nasobiliary tube drainage are effective for treating postoperative biliary fistulas.

An unusual cause of acute appendicitis: Appendiceal endometriosis

INTRODUCTION While endometriosis is a common disorder in women of reproductive age, appendiceal endometriosis accounts for less than 1% of all pelvic endometriotic lesions. Appendiceal involvement may present as acute appendicitis and definitive diagnosis is made by only postoperative histological examination. PRESENTATION OF CASE In this study, we present two cases of female patients who underwent an appendectomy presumed diagnosis as acute appendicitis, and a histopathological examination of the retrieved specimen revealed appendiceal endometriosis. DISCUSSION Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. Gastrointestinal endometriosis is observed in 3-37% of all endometriosis cases, whereas appendiceal endometriosis accounts for only about 3% of gastrointestinal endometriosis. Appendiceal endometriosis is usually asymptomatic, although it sometimes causes abdominal cramps, nausea, chronic pelvic pain, lower gastrointestinal hemorrhage, intussusception, perforation, or acute appendicitis. CONCLUSION Appendiceal endometriosis is an unusual histopathological finding. A preoperative diagnosis is difficult, but this condition should be considered when women of childbearing age present with clinical symptoms of acute appendicitis.

Chronic Graft-Versus-Host Disease After Liver Transplantation: A Case Report

Graft-versus-host disease (GVHD) after orthotopic liver transplantation (OLT) is a rare but significant complication, occurring in 1%-2% of cases with a mortality rate of 85%- 90%. It occurs when donor passenger lymphocytes mount an alloreactive response against the hosts histocompatibility antigens. It presents as fever, rash, and diarrhea with or without pancytopenia. Between March 2002 and September 2011, among 656 OLT patients 1 (0.15%) had acute GVHD. A biopsy at the 7th posttransplantation month revealed chronic GVHD. Consequently, in the cases that had fever, rash, and/or desquamation of the any part of body after liver transplantation, GVHD must be considered and skin biopsies must be planned for the diagnosis.

Role of Chemotherapeutic Agents in the Management of Cystic Echinococcosis

Hydatid disease is caused by infection with the metacestode stage of Echinococcus tapeworms of the family Taeniidae. The primary carriers are dogs and wolves, and humans are accidental hosts that do not contribute to the normal life cycle of this organism. The liver is the most commonly involved organ in the body by cystic echinococcosis (CE) secondary to infection with Echinococcus granulosus . Management options for CE should depend on the World Health Organization (WHO) diagnostic classification. Small (<5 cm) WHO stage CE1 and CE3a cysts may be primarily treated with benzimidazoles; the first-choice drug is albendazole. In some situations the combination of albendazole and praziquantel may be preferred. Chemotherapy with a benzimidazole or albendazole plus praziquantel is also used as adjunctive treatment to surgery and percutaneous treatment. Drug treatments have been the indispensable therapeutic modalities for cystic echinococcosis.

Mesenteric Inflammatory Pseudotumor: A Case Report and Comprehensive Literature Review

PurposeThis study aims to provide an overview of the literature on mesenteric/omental inflammatory pseudotumors (IPTs).MethodologyWe present a new case of mesenteric IPT. We also conducted a systematic search of the English-language medical literature using PubMed, Medline, Google, and Google Scholar related to mesenteric or omental IPTs. The following search terms were used in various combinations: inflammatory myofibroblastic tumor, IPT, mesentery, and omentum. The search included articles published in the English language between January, 1978 and April, 2014. Studies were excluded if the full text was unavailable or missing information prohibited comparisons.ResultsA total of 30 reports concerning 36 patients with inflammatory pseudotumors meeting the aforementioned criteria were included. The patients were aged from 10 months to 68 years (mean, 19.98 ± 20.5 years); 12 were female (16.75 ± 16.97 years; range, 10 months to 68 years) and 24 were male (21.6 ± 21.9 years; range, 18 months to 63 years). Detailed clinical and pathologic characteristics of 36 patients with IPTs are provided in Table 1.ConclusionIPTs may be definitively diagnosed only by histopathological examination and are most effectively treated by resection with negative surgical borders. No consensus has yet been reached regarding when nonsurgical treatment options are most appropriate in management of these lesions. IPTs often recur locally, while distant metastases are very rare. Postoperative close surveillance is essential to detect recurrences early.