- [Show abstract] [Hide abstract] ABSTRACT: A 58-year-old male patient presented with an anorectal verrucous carcinoma, also known as Buschke–Lowenstein tumor. Clinically, the lesion of the patient best resembled giant condyloma acuminatum with a cauliflower-like appearance. The diagnosis was confirmed with biopsy and an abdominoperineal resection was performed. The perineal defect was reconstructed with bilateral gluteal musculocutaneous V-Y advancement flap. Both functional and cosmetic results 6 years after the operation were excellent. To date, no recurrence has been noted. As long as one is aware of its existence and of its characteristic appearances, the Buschke–Lowenstein tumor is fairly easily diagnosed. The treatment of choice remains surgical resection, and adequate follow-up is essential.
- [Show abstract] [Hide abstract] ABSTRACT: Primary anorectal malignant melanoma is an exceptionally rare neoplasm associated with poor prognosis. Anorectal malignant melanoma has been very rarely described with coexisting primary tumors of the colorectum. A 56-year-old female patient was admitted with a history of rectal bleeding. She had experienced increasing constipation and a sense of obstruction in the rectum for 6 months. Flexible rectosigmoidoscopy showed a large, pedinculated polypoid lesion extending from the anal canal to the rectum. She underwent a transanal local excision and was diagnosed with a melanoma of the anorectum with positive margins. Therefore, a formal abdominoperineal resection was performed. In addition to multiple synchronous anorectal malignant melanoma, we incidentally found another primary tumor in the proximal surgical margin of the resected specimen. Histopathologically, the lesion was an intramucosal adenocarcinoma of the sigmoid colon. Postoperatively, the patient received adjuvant chemotherapy of six cycles duration. At present, the patient has completed 18 months of follow-up.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to determine whether intraoperative Ankaferd blood stopper (ABS) application into the pancreatic channel and to the pancreatic remnant surface following distal pancreatectomy can or cannot prevent postoperative pancreatic fistula formation. Three pigs underwent distal pancreatectomy under general anesthesia. In two of the pigs, 0.5 ml of ABS was applied to the stump surface area after adding 0.5 ml of ABS into the pancreatic channel. The remaining one animal served as the control. The pigs were sacrificed on the seventh postoperative day for autopsy. The pancreatic remnants from the animals were then taken for histopathological analyses. It was observed that the oral intake had been broken and abdominal distention had developed in the control pig following on the third postoperative day. However, no significant clinical changes were observed in the ABS-applied pigs. In the autopsy, it was found that the control pig had generalized peritonitis with pancreatic necrosis. On the other hand, the ABS-applied pigs had either macroscopically and microscopically normal pancreatic tissue architecture with an occluded Wirsung duct at the pancreatic stump. It was concluded that application of ABS on the transected surface and into the pancreatic channel could prevent pancreatic fistula formation and improve wound healing in the residual pancreatic tissue following distal pancreatectomy.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: We aimed to investigate the effects of caffeic acid phenethyl ester (CAPE) on intestinal mucosal injury induced by superior mesenteric occlusion. Methods: This experimental study was conducted on 48 male Wistar-albino rats. The animals were randomly allocated into four groups: (i) Sham-operated group, laparotomy without intestinal ischemia/reperfusion (IR) injury (n = 12); (ii) Sham + CAPE group, identical to group 1 except for CAPE treatment (10 μmol/kg, intravenously) (n = 12); (iii) Intestinal IR group, 60 min of superior mesenteric ischemia followed by 3 hr of reperfusion (n = 12); and (iv) (IR + CAPE)-treated group, 10 μmol/kg injection of CAPE intravenously 30 min before the reperfusion period (n = 12). We evaluated the degree of intestinal mucosal injury on a grading scale, histopathologically, and by measuring oxidative stress markers and antioxidant parameters, biochemically. Intestinal edema was estimated by using wet/dry weight ratios. The plasma proinflammatory cytokine levels were measured. Animal survival was observed up to one week. Results: Intestinal mucosal injury scores were significantly decreased with CAPE administration (p < .05). CAPE treatment significantly reduced oxidative stress markers in the intestinal tissues (p < .05) and the plasma proinflammatory cytokine levels (p < .05), and significantly increased antioxidant parameters in the intestinal tissues (p < .05). Intestinal edema was significantly alleviated by CAPE treatment (p < .05). The survival rates of CAPE-treated IR animals were significantly higher than IR-subjected rats (p < .05). Conclusion: This study clearly showed that CAPE treatment significantly alleviated the intestinal mucosal injury caused by superior mesenteric ischemia/reperfusion. Further clinical studies are required to clarify whether CAPE has a useful role in reperfusion injury during particular surgeries in which IR-induced organ injury occurs.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: We aimed to investigate the effects of caffeic acid phenethyl ester (CAPE) on wound healing in left colonic anastomoses in the presence of intraperitoneal sepsis induced by cecal ligation and puncture (CLP) in a rodent model. Methods: This experimental study was conducted on 48 male Wistar albino rats. The animals were randomly allocated into four groups and a left colonic anastomosis was performed on the day following sham operation or CLP in all rats: (i) sham-operated control group, laparatomy plus cecal mobilization (n = 12) (Group 1), (ii) sham + CAPE group, identical to Group 1 except for CAPE treatment (10 μmol/kg, intraperitoneally, 30 min before construction of the colonic anastomosis) (n = 12) (Group 2), (iii) CLP group, cecal ligation and puncture (n = 12) (Group 3), and (iv) CLP + CAPE-treated group, 10 μmol/kg, intraperitoneally, 30 min before the construction of colonic anastomosis (n = 12) (Group 4). On the postoperative day 7, the animals were subjected to relaparotomy for in-vivo measurement of the colonic anastomotic bursting pressure. A colonic segment including the anastomotic site was resected for histopathological evaluation and biochemical analyses of hydroxyproline (Hyp) contents, myeloperoxidase (MPO) acivity, malondialdehyde (MDA) levels, reduced glutathione (GSH) levels, and superoxide dismutase (SOD) activity. Body weight changes were examined. Results: CAPE treatment significantly increased colonic anastomotic bursting pressures (p < .05), colonic anastomotic tissue Hyp contents, and enzymatic and nonenzymatic antioxidant markers (p < .05), and significantly decreased oxidative stress parameters in colonic anastomotic tissues (p < .05). Histopathological scores were significantly better by CAPE administration (p < .05). Conclusion: This study clearly showed that CAPE treatment prevented the detrimental effects of intraperitoneal sepsis on colonic anastomotic wound healing. Further clinical studies are required to determine whether CAPE has a useful role in the enhancement of gastrointestinal anastomotic wound healing during particular surgeries in which sepsis-induced organ injury occurs.
- [Show abstract] [Hide abstract] ABSTRACT: The objective of the present study was to assess the effects of oriental sweet gum (Liquidambar orientalis Mill.) storax on partial-thickness and full-thickness wounds compared to conventional wound dressings in a porcine model. Six young Yorkshire pigs were used. Sixteen square excisional wounds measuring 3 × 3 cm were performed per animal. The wounds were allocated to one of the four treatment modalities: storax, hydrocolloid dressing, silver sulfadiazine, and control groups. Partial-thickness wounds were created in two pigs, and tissue samples were harvested on days 4 and 8, respectively. Full-thickness wounds were created in four pigs, and tissue samples were taken on days 4, 8, 14, and 21, respectively. Histologically, all wounds were examined for re-epithelialization and granulation tissue formation. Tissue hydroxyproline content and wound contraction areas were measured. In storax-applied group, there was a greater depth of granulation tissue at 4 and 8 days compared to all other groups (p < .0125), and there was a faster re-epithelialization at 21 days compared to both hydrocolloid dressing and control groups in full-thickness wounds (p < .0125). Tissue hydroxyproline content and wound contraction did not differ significantly between the groups. The results of this study indicate that topical application of storax enhanced both re-epithelialization and granulation tissue formation in full-thickness wounds. Further studies are indicated in this important area of wound healing research to evaluate the clinical efficacy of this storax and search for the mechanisms that explain its effects.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: We aimed to investigate whether caffeic acid phenethyl ester (CAPE) prevents detrimental systemic effects of intestinal ischemia-reperfusion (IR) injury on colonic anastomotic wound healing. Methods: This experimental study was conducted on 48 male Wistar albino rats. The rats were randomly allocated into four groups and a left colonic anastomosis was performed in all rats: (i) sham-operated group (n = 12), laparatomy without intestinal IR injury; (ii) sham + CAPE group (n = 12), identical to Group 1 except for CAPE treatment (10 μmol/kg, intravenously); (iii) intestinal IR group (n = 12), 60 min of superior mesenteric ischemia followed by reperfusion; and (iv) IR + CAPE-treated group (n = 12) (10 μmol/kg, intravenously, 30 min before the construction of colonic anastomosis). On the postoperative day 7, the rats were subjected to relaparotomy for in vivo measurement of the colonic anastomotic bursting pressure. A colonic segment including the anastomotic site was resected for histopathological evaluation and biochemical analyses. The plasma proinflammatory cytokine levels were measured. Body weight changes were examined. Results: CAPE treatment significantly increased colonic anastomotic bursting pressures, and colonic anastomotic tissue hydroxyproline contents and antioxidant parameters (p < .05), and significantly decreased oxidative stress markers in colonic anastomotic tissues and plasma proinflammatory cytokine levels (p < .05). Histopathological scores were significantly better due to CAPE administration (p < .05). Conclusions: This study clearly showed that CAPE treatment prevented the delaying effects of remote IR injury on colonic anastomotic wound healing. Further clinical studies are required to determine whether CAPE has a useful role in the enhancement of gastrointestinal anastomotic wound healing during particular surgeries in which IR-induced organ injury occurs.
- [Show abstract] [Hide abstract] ABSTRACT: Choledochal cysts are rare congenital anomalies of the pancreaticobiliary system, whose etiology remains unknown. We aimed to review patients with choledochal cysts and to compare our results with current literature. Twenty-three patients diagnosed as having choledochal cysts between January 2004 and July 2010 were evaluated retrospectively. ResulTS: Thirteen patients had type I (56.5%), 3 patients type II (13%), 3 patients type III (13%), 1 patient type IV-A (8.3%) and the remaining 3 patients had type V (13%) choledochal cysts. All patients with type I cysts underwent cyst excision with Roux-en-Y hepaticojejunostomy. Two patients with type II cysts underwent cyst excision with choledochoduodenostomy, whereas cyst excision with T-tube drainage was applied to the other. Endoscopic unroofing was performed type III cysts. The patient with type IV-A cyst was not eligible for surgery due to low cardiopulmonary performance status but ERCP was applied successfully more than 3 times for the extraction of the stones which fell from the intrahepatic ducts into the common bile duct. Patients with Type V cysts underwent left hepatectomy, choledocoduodenostomy and cadaveric liver transplantation, respectively. Wound infection developed in 5 patients and anastomotic leakage occurred in 3; one died from sepsis. Choledochal cysts are rare congenital malformations. Although treatment varies depending on the type of the cysts, complete excision of the cysts should be performed if possible.
- [Show abstract] [Hide abstract] ABSTRACT: Objectifs La chirurgie aortique abdominale peut causer des lésions d'ischémie/reperfusion (I/R) non seulement au niveau des membres inférieurs mais aussi des organes à distance tels que les reins. L'exclusion du volume de sang veineux de la veine cave inférieure (phlébotomie) ou/et le mannitol sont employés comme traitement des lésions d'I/R du rein chez l'homme, malgré le fait que l'efficacité des traitements est encore discutée. Le but de cette étude était d'évaluer les effets de la phlébotomie ou/et du mannitol sur des reins de rat de lésions rénales aiguës (LRA) dans un modèle d'I/R-induite des membres inférieurs. Matériel et méthodes Trente rats mâles albinos Wistar ont été employés et divisés en cinq groupes : (I) groupe opéré d'une façon simulée, laparotomie sans lésions d'I/R (groupe [S], n = 6) ; (II) groupe d'I/R, clampage aortique sous rénal pour induire une I/R des membres inférieurs, 3 heures d'ischémie suivies de 2 heures de reperfusion (groupe [I/R], n = 6) ; (III) groupe I/R + phlébotomie, identique au groupe [I/R] excepté 1 mL d'aspiration de sang de la veine cave inférieure juste après l'ischémie (groupe [P], n = 6) ; (IV) groupe I/R + mannitol, ces rats étaient soumis à I/R et recevaient une injection d'un bolus de mannitol (groupe [M], n = 6) ; et (V) groupe I/R + phlébotomie + mannitol (groupe [P + M], n = 6), les mêmes procédures étant faites que dans les groupes précédents. À la fin de la reperfusion de deux heures, tous les rats étaient sacrifiés. Les deux reins étaient prélevés pour analyse biochimique (activités myéloperoxydase [MPO] et superoxyde dismutase [SOD], et taux réduits de malondialdéhyde [MDA] et de glutathion) et pour examen histopathologique (nécrose tubulaire et inflammation aiguë du rein [scores ARI]). Résultats L'I/R aortique augmentait de manière significative le taux de l'activité MDA (reflétant la peroxydation des lipides), SOD (antioxydant endogène enzymatique), et MPO (reflétant l'infiltration neutrophile) (p < 0,05). Les traitements par phlébotomie ou/et mannitol diminuait de manière significative le niveau de l'activité MDA, SOD, et MPO et augmentait le taux de glutathion (antioxydant non-enzymatique des tissus rénaux) (p < 0,05). L'évaluation histologique des scores LRA montrait que l'I/R aortique (la valeur de p pour le groupe [S] contre le groupe [I/R] était 0,012), tandis que les traitements par phlébotomie ou/et de mannitol diminuait de manière significative la nécrose tubulaire et l'infiltration inflammatoire (les valeurs de p pour le groupe [I/R] contre les groupes [P], [M], et [P + M] étaient 0,043, 0,043, et 0,003, respectivement). Conclusion Cette expérience a clairement montré que les ARI induites par l'I/R des membres inférieurs étaient atténuées significativement par les traitements par phlébotomie ou/et mannitol. La phlébotomie et le mannitol sont un traitement plus efficace que la phlébotomie ou le mannitol seuls pour empêcher les ARI induites par l'I/R des membres inférieurs chez le rat. D'autres études cliniques sont requises pour clarifier si les traitements par phlébotomie ou/et mannitol sont salutaires pour réduire les ARI pendant la chirurgie aortique abdominale.
- [Show abstract] [Hide abstract] ABSTRACT: Abdominal aortic surgery can cause ischemic/reperfusion (I/R) injury not only in the lower limbs but also in remote organs such as kidneys. Venous blood volume exclusion from the inferior vena cava (phlebotomy) or/and mannitol are used as a treatment for I/R injury of kidney in humans, despite the fact that the effectiveness of these treatments is still debated. The aim of this study was to evaluate the effects of phlebotomy or/and mannitol on rat kidneys in a model of lower limbs I/R-induced acute renal injury (ARI). Thirty male Wistar albino rats were used and divided into five groups: (I) sham-operated group, laparotomy without I/R injury (group [S], n = 6); (II) I/R group, infrarenal aortic cross-clamp was used for lower limbs I/R, 3 hours of ischemia followed by 2 hours of reperfusion (group [I/R], n = 6); (III) I/R + phlebotomy group, identical to group [I/R] except for 1 mL of blood aspiration from the inferior caval vein just after ischemia (group [P], n = 6); (IV) I/R + mannitol-treated group, these rats were subjected to I/R and received a bolus injection of mannitol (group [M], n = 6); and (V) I/R + phlebotomy + mannitol-treated group (group [P + M], n = 6), the same procedures were performed as those described for previous groups. At the end of 2-hour reperfusion, all rats were sacrificed. Both kidneys were harvested for biochemical assay (myeloperoxidase [MPO] and superoxide dismutase [SOD] activities, and malondialdehyde [MDA] and reduced glutathione levels) and for histopathological examination (tubular necrosis and acute inflammation on kidney [ARI score]). Aortic I/R significantly increased the level of MDA (reflecting lipid peroxidation), SOD (enzymatic endogenous antioxidant), and MPO (reflecting neutrophil infiltration) activity (p < 0.05). Phlebotomy or/and mannitol treatments significantly decreased the level of MDA, SOD, and MPO activity and increased glutathione level (nonenzymatic antioxidant in the kidney tissues) (p < 0.05). Histological evaluation of ARI score showed that aortic I/R significantly increased (p value for group [S] versus group [I/R] was 0.012), whereas phlebotomy or/and mannitol treatments significantly decreased tubular necrosis and inflammatory infiltration (p values for group [I/R] versus group [P], [M], and [P + M] were 0.043, 0.043, and 0.003, respectively). This experiment clearly indicated that the lower limbs I/R-induced ARI attenuated significantly by phlebotomy or/and mannitol treatments. Phlebotomy plus mannitol is more effective treatment than phlebotomy or mannitol alone in preventing lower limbs I/R-induced ARI in rats. Further clinical studies are required to clarify whether phlebotomy or/and mannitol treatments are beneficial in alleviating of ARI during abdominal aortic surgery.
- [Show abstract] [Hide abstract] ABSTRACT: Mannitol is used as a treatment for ischemia/reperfusion (IR) injury of various organs in humans, despite the fact that its effectiveness in vivo is still disputed. The purpose of this study was to determine the effects of mannitol on acute lung injury (ALI) induced by infrarenal aortic occlusion. Male Wistar-albino rats were allocated into five groups: (i) sham-operated group, which received a laparotomy without IR injury (n = 12); (ii) IR group, which received 3 h of ischemia followed by 2 h of reperfusion (n = 12); (iii) IR + inferior caval phlebotomy (ICP) group, which was identical to group 2 except for 1 ml of blood aspiration from the inferior caval vein (n = 12); (iv) IR + mannitol-treated group, for which rats were subjected to IR and received a bolus injection of mannitol (n = 12); and (v) IR + ICP + mannitol-treated group, which underwent the same procedures as described for the previous groups. Arterial blood gas parameters were studied and bronchoalveolar lavage (BAL) was performed. Evans blue dye was injected into half of the rats. We biochemically assessed the degree of pulmonary tissue injury by investigating oxidative stress markers and enzymatic and nonenzymatic antioxidant markers, and evaluated ALI by establishing pulmonary leukosequestration and ALI scoring, histopathologically. Pulmonary edema was estimated by using Evans blue dye extravasation and wet/dry weight ratios. Hypertonic mannitol treatment significantly reduced oxidative stress markers, and significantly increased enzymatic and nonenzymatic antioxidant markers in the lung tissues (P < 0.05). Arterial blood gas parameters were significantly ameliorated (P < 0.05), the BAL cytology was significantly better (P < 0.05), pulmonary leukosequestration and ALI scores were significantly decreased (P < 0.05), and pulmonary edema was significantly alleviated (P < 0.05) by mannitol administration. This study clearly showed that mannitol treatment significantly attenuated the aortic IR-induced ALI. Further clinical studies are required to clarify whether mannitol has a useful role in ALI during surgeries in which IR-induced organ injury occurs.
- [Show abstract] [Hide abstract] ABSTRACT: Macroscopic appearance of the gallbladder is an important factor in laparoscopic cholecystectomy. The aim of this study was to evaluate surgical outcomes in patients with scleroatrophic gallbladders who underwent laparoscopic cholecystectomy. From 2002-2007, 295 patients were found to have a scleroatrophic gallbladder during laparoscopic cholecystectomy. The investigated variables included gender, age, body mass index, preoperative ultrasound evidence of gallbladder wall thickening, number of gallstones, diameter of common bile duct, preoperative endoscopic retrograde cholangiopancreatography, surgeon's experience, gallbladder adhesion score, drain use, conversion rate, operative time, intraoperative and postoperative complications, mortality, and length of hospital stay. Most of the patients were male (56.3%). Overall mean age was 55.50±13.75 years. Mean body mass index was 27.91±4.43 kg/m2. Based on preoperative ultrasound findings, thickened gallbladder wall was present in 30.8% of patients, dilated common bile duct in 30.2% and multiple gallstones in 83.1%. Preoperative endoscopic retrograde cholangiopancreatography was performed in 32.5% of patients. High-grade adhesions (≥III) were encountered in 68.1% of patients. The conversion rate was 23.1%. The overall intraoperative complication rate was 31.5%. Drains were used in 63.7% of patients. Mean operative time was 65.2±32.6 minutes. The rate of postoperative complications was 9.5%. Median hospital stay was 1 day (range: 1-31 days). Mortality occurred in 3 patients (1.0%). This study demonstrates that scleroatrophic gallbladders present more difficulties during laparoscopic cholecystectomy and are associated with a higher conversion rate. Therefore, it is highly important that patients whose preoperative imaging studies suggest a scleroatrophic gallbladder be referred to an experienced center for hepato-biliary surgery.
- [Show abstract] [Hide abstract] ABSTRACT: One of the major limitations in organ transplantation is the lack of suitable donors. As the demand for suitable organs exceeds the supply, identification of potential donors continues to evolve. Due to perceived risks of transmittable toxins and insufficient understanding of toxicological fate, poisoned patients are often overlooked as organ donors. A 16-year-old female attempted suicide with a poison. She was immediately transported to a state hospital and underwent cardiopulmonary resuscitation. The patient exhibited symptoms consistent with cholinergic poisoning and remained comatose. Diagnosis of brain death was confirmed three weeks after admission to the intensive care unit. The parentsagreed to donate the organs of their daughter. After reviewing of the available literature on the disposition and fate of pesticides in human tissues and comparing notes with medical toxicologists, we decided to harvest the patient's liver for transplantation. The liver was transplanted to a 36-year-old female suffering from chronic hepatitis B-induced liver cirrhosis. The recipient was well completely two years posttransplantation to the best of our knowledge, thigs is the first case ever reported ofliver transplantation from a carbamate insecticide-poisoned donor. This case of successful liver transplantation from a pesticide-poisoned donor underscores the fact that poisoned patients should not beoverlooked as organ donors. The decision to harvest the patient's organs should be made jointly by medical toxicologists and transplant team after careful evaluation of available data and the lack of clinical toxicity.
- [Show abstract] [Hide abstract] ABSTRACT: Organ transplant recipients carry a greater risk for developing de novo malignancies. Recurrent or de novo malignancies are the second leading causes of late death in liver transplant recipients, following infectious complications. A high incidence of posttransplantation lymphoproliferative disease, skin carcinomas, Kaposi's sarcoma, and uterine cervical dysplasia hasbeen reported after solid organ transplantations. A 46-year-old female had undergone cadaveric orthotopic liver transplantation for chronic hepatitis B-induced liver cirrhosis. During a routine gynaecological examination 19 months posttransplantation, she received a Pap smear which was positive for a high-grade squamous intraepithelial lesion, and then she underwent colposcopic cervical biopsy which was positive for squamous cell carcinoma. Subsequently, a radical hysterectomy (Wertheim's procedure) was performed by thegynaecological oncology clinic. Histopathological examination of the resected specimen showed the uterus to be positive for large-cell keratinizing squamous cell carcinoma of the cervix. The disease stage was IIIb. Thereafter, she underwent adjuvant chemotherapy with cisplatin, and received external-beam radiation to the pelvis and intracavitary brachytherapy to the vaginal cuff. The patient was then evaluated at every 3 months, with gynaecological examinations in terms of the response to treatment, and a complete pathological response was achieved. The whole-body positron emission tomography was conducted with 18F- fluorodeoxyglucose, and there was no increased uptake at any site. The patient was all doing well at 33 months posttransplantation and 14 months after radical gynaecological surgery. Female patients with liver transplantation need continuous surveillance for cervical cancer with annual screening Pap smears and pelvic exam. In high-risk liver transplant recipients for developing gynaecological malignancies (those with prior malignancy or predisposing underlying disease), aggressive surveillance including colposcopy should be employed.
- [Show abstract] [Hide abstract] ABSTRACT: Adrenal cysts are rare and are usually discovered incidentally during diagnostic imaging, surgery, or autopsy. Most cystic lesions of the adrenal gland are nonfunctioning and become symptomatic when complicated by rupture, hemorrhage, or infection. A 40-year-old woman presented with a history of gradual-onset pain in her left flank region at 20 weeks' gestation. Ultrasound showed a 20-cm cystic mass in her left abdominal cavity. Pertinent laboratory tests were within normal limits. The patient underwent exploratory laparotomy, which revealed a 20 × 15-cm left adrenal cyst; thus, we performed left adrenalectomy with complete excision of the cyst. Histological examination confirmed a hemorrhagic adrenal pseudocyst. The patient had an uneventful postoperative course, and subsequent routine obstetric ultrasound examinations showed normal fetal activity and development until the pregnancy terminated with a stillbirth caused by pre-eclampsia at 34 weeks' gestation. To the best of our knowledge, this is only the 12th reported case of adrenal pseudocyst discovered during pregnancy. We analyze the clinicopathologic findings and discuss the possible association of pregnancy, with special reference to etiopathogenesis, presentation, diagnosis, and treatment.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to present a case of hepar lobatum resulting from metastatic rectal carcinoma. A 50-year-old man presented with a 2-year history of bleeding per anum, tenesmus, malaise and weakness. Initially, the patient received neoadjuvant chemoradiotherapy followed by abdominoperineal resection of the rectum. Abdominal computed tomography showed lobar enlargement and lobulated contour, mainly in the left lobe of the liver, but no primary or metastatic lesions were detected. Laparotomy revealed an irregularly lobulated hepatic deformity. Liver biopsy showed a necrotic tumor growth from adenocarcinoma of the rectum in subcapsular localizationof the liver. This case showed a patient with hepar lobatum carcinomatosum caused by metastatic rectal carcinoma. The report further highlights the need for clinicians and surgeons to keep in mind the possibility of hepar lobatum carcinomatosum while caring for rectal carcinoma patients, especially when the lobulated contour of the liver is detected at preoperative imaging studies or when the coarsely lobated liver is encountered during surgery for carcinoma of the rectum.
- [Show abstract] [Hide abstract] ABSTRACT: Jejunal diverticula are rare and usually asymptomatic. However, perforation of a diverticulum can lead to significant morbidity and mortality. There is no specific diagnostic method. Clinical signs may mimic acute appendicitis, acute cholecystitis, peptic ulcer perforation and colonic diverticulitis. The true diagnosis is usually made during the operation, and the resection of involved bowel segment is required. We herein present a case of acute abdomen caused by a jejunal diverticulum perforation which should be kept in mind in the differential diagnosis of acute abdomen.
Denisli, Denizli, Turkey
- Faculty of Medicine
Yüksek İhtisas Hastanesi, AnkaraEngüri, Ankara, Turkey