Tıkanma sarılığının nadir sebebi: Kolanjiyokarsinomu taklit eden Fasiola hepatika

Fasiola hepatika, Turkiye ve komşu ulkelerinde gorulen endemik bir hayvan hastalığıdır. Parazitin hayat siklusunda insanlar rastlantı olarak konakcı olurken asıl konakcı koyunlardır. Hastalığın hepatik (akut) ve biliyer (kronik) olmak uzere iki evresi vardır. Parazitler biliyer sisteme ulaştıklarında kolestaza ba.lı kolanjit semptomları gorulur ve bu durum kolaylıkla tıkanma sarılı.ının diğer nedenleri ile karıştırılabilir. Biz bu calışmada kolanjiyokarsinomdan guclukle ayırt edilebilen Fasiola hepatikalı bir olguyu sunuyoruz. Turkiyenin doğu kesiminde yaşıyan 47 yaşında kadın hasta ateş, sarılık ve karın sağ üst kadranda ağrı şikayeti ile klini. imize başvurdu. Total bilirubin değeri 4.2 mg/dl, aspartat aminotransferaz 55 iu/L, alanin aminotransferaz 65 iu/L, alkalen fosfataz 325 iu/L, ve gamma-glutamil transpeptidaz 172 iu idi. Ca19.9 ve karsinoembriyonik antijen dahil tum tumor belirtecleri normal sınırlardaydı. Detaylı bir değerlendirmeden sonra laparatomi yapılarak, kolesistektomi, koledokotomi ve T-tup drenaj yapıldı. Koledoktan cok sayıda parazit cıkartıldı. Cıkartılan parazitlerden biri parazitoloji laboratuvarına gonderildi. İndirekt hemaglunitasyon testi 1/320 (+) bulundu. Sonuc olarak bu paraziter hastalığın kronik evresi tıkanma sarılı.ının di.er nedenleri ile kolaylıkla karışabilir. Bu nedenle Fasiola hepatika, ozellikle endemik bolgelerde, tıkanma sarılığının ayırıcı tanısı yapılırken akılda tutulmalıdır.Fasciola hepatica is an endemic zoonotic disease in Turkey and neighboring countries. The usual definitive host is the sheep; humans are accidental hosts in the life cycle of the Fasciola. There are two disease stages: the hepatic (acute) and biliary (chronic) stages. When the flukes enter the bile ducts, the symptoms of cholestasis and cholangitis may present, which can easily be misdiagnosed as obstructive jaundice of other causes. We present a case of fascioliasis, which was difficult to differentiate from cholangiocarcinoma. A 47-year-old woman from Eastern Turkey presented with fever, right upper quadrant abdominal pain, and jaundice. Total bilirubin was 4.2 mg/dl, aspartate aminotransferase 55 IU/L, alanine aminotransferase 65 IU/L, alkaline phosphatase 325 IU/L, and gamma-glutamyl transpeptidase 172 IU/L. All tumor markers including carcinoembryonic antigen and Ca19-9 were in normal values. After extended evaluation, an explorative laparotomy with cholecystectomy, choledochostomy and T-tube drainage was performed. Multiple flukes were removed from the choledochus. One of the parasites was sent to the parasitological clinic for identification. The result of an indirect hemagglutination test for F. hepatica was 1/320 (+). In conclusion, the chronic phase of this zoonotic infection can be easily misdiagnosed as any other cause of obstructive jaundice. Thus, F. hepatica should be considered in the differential diagnosis of common bile duct obstruction, especially in endemic areas. To

A case of uneventful ABO-incompatible liver transplantation from a deceased donor managed with routine immunosuppressive treatment

ABO-incompatible liver transplantation (ILT) was formerly contraindicated because of the increased risk of antibody-mediated humoral graft rejection due to preformed anti-A/-B antibodies on recipient endothelial cells. A 2.5-year-old girl with end-stage liver disease underwent cadaveric donation ILT because of acute liver failure and esophageal variceal bleeding before transplantation. The patient's blood type was A Rh (-) and the donor's blood type B Rh (+). The operation and postoperative course were uneventful. The immunosuppression consisted of steroids, and tacrolimus was initiated on the day of the surgery. The patient's hemoglobin level did not change, and direct Coombs test performed daily was consistently negative. Anti-B titer was observed at a maximum of 1/8. The patient was followed up during the first year. This case of ILT from a cadaveric donor is significant because the 2.5-year-old recipient did not experience any complications after undergoing routine immunosuppressive treatment.ABO-incompatible liver transplantation (ILT) was formerly contraindicated because of the increased risk of antibody-mediated humoral graft rejection due to preformed anti-A/-B antibodies on recipient endothelial cells. A 2.5-year-old girl with end-stage liver disease underwent cadaveric donation ILT because of acute liver failure and esophageal variceal bleeding before transplantation. The patient's blood type was A Rh (-) and the donor's blood type B Rh (+). The operation and postoperative course were uneventful. The immunosuppression consisted of steroids, and tacrolimus was initiated on the day of the surgery. The patient's hemoglobin level did not change, and direct Coombs test performed daily was consistently negative. Anti-B titer was observed at a maximum of 1/8. The patient was followed up during the first year. This case of ILT from a cadaveric donor is significant because the 2.5-year-old recipient did not experience any complications after undergoing routine immunosuppressive treatment

Synchronous haemangioma of liver and diaphragma

Karaciğerde görülen en sık benign neoplazm hemanjiyomdur. Genellikle asemptomatik olup ender olarak komplikasyon oluşturabilir. Karaciğer ve senkron organ tutulumu görülebilir. Genellikle medikal takip edilir. Semptomatik, hızlı büyüme gösterir ve tanı kesin değilse cerrahi tedavi uygulanmalıdır. Bu yazıda karaciğer ve diaframda aynı dönemde görülen senkron hemanjiyomu olan bir olgu sunulmuştur.The most common benign neoplasm seen in the liver is haemangioma. It is usually asymptomatic and rarely causes complications. Liver and synchronous organ involvement can be seen. It is usually followed by medical. If symptomatic, rapid growth and diagnosis is uncertain, surgical treatment should be performed. In this article, a case who presented with synchronous haemangima on liver and diaphragma has been reported

Synchronous haemangioma of liver and diaphragma

Karaciğerde görülen en sık benign neoplazm hemanjiyomdur. Genellikle asemptomatik olup ender olarak komplikasyon oluşturabilir. Karaciğer ve senkron organ tutulumu görülebilir. Genellikle medikal takip edilir. Semptomatik, hızlı büyüme gösterir ve tanı kesin değilse cerrahi tedavi uygulanmalıdır. Bu yazıda karaciğer ve diaframda aynı dönemde görülen senkron hemanjiyomu olan bir olgu sunulmuştur.The most common benign neoplasm seen in the liver is haemangioma. It is usually asymptomatic and rarely causes complications. Liver and synchronous organ involvement can be seen. It is usually followed by medical. If symptomatic, rapid growth and diagnosis is uncertain, surgical treatment should be performed. In this article, a case who presented with synchronous haemangima on liver and diaphragma has been reported

Long-term Outcomes of Surgical Management of Insulinoma: Single Center Experience

Objective: Limited data are available in regards to the surgical management and outcomes of insulinoma. This study aimed to assess the outcomes associated with surgical treatment of insulinoma, as the most common pancreatic endocrine tumor. Methods: Medical records of patients who diagnosed as insulinoma from 2000 to 2010 at General Surgery Department of Cukurova University Hospital were retrospectively reviewed. Surgical treatment (resection vs. enucleation) was based on preoperative radiological investigations (abdominal spiral contrast tomography, ultrasound, selective angiography for selected cases) and intra-operative ultrasound imaging once indicated. Results: Surgically treated thirteen patients (F/M:9/4) who diagnosed with insulinoma were assessed with a mean follow-up of 5.3 (0.5-10) years. Enucleation and distal pancreatectomywere performed for 11 and 2 (one of those is spleen-preserving) patients, respectively. No mortality was recorded. All patients became normoglycemic after surgery without re-operation and with acceptable complication rates (n=3 pancreatic fistula, n=1 pancreatitis). Conclusion: Surgical treatment of insulinoma is associated with favorable outcomes.Intra-operative ultrasound with manual palpation is still the gold standard for localizing insulinoma. Location, size and relationship with main pancreatic duct of the lesions are key components for the selection of optimal surgical procedure

İnsülinomanin Cerrahi Yönetiminde Uzun Dönem Sonuçlar: Tek Merkez Deneyimi

Objective: Limited data are available in regards to the surgical management and outcomes of insulinoma. This study aimed to assess the outcomes associated with surgical treatment of insulinoma, as the most common pancreatic endocrine tumor Methods: Medical records of patients who diagnosed as insulinoma from 2000 to 2010 at General Surgery Department of Cukurova University Hospital were retrospectively reviewed. Surgical treatment (resection vs. enucleation) was based on preoperative radiological investigations (abdominal spiral contrast tomography, ultrasound, selective angiography for selected cases) and intra-operative ultrasound imaging once indicated. Conclusion: Surgical treatment of insulinoma is associated with favorable outcomes.Intra-operative ultrasound with manual palpation is still the gold standard for localizing insulinoma. Location, size and relationship with main pancreatic duct of the lesions are key components for the selection of optimal surgical procedure.Giriş: İnsülinomanin cerrahi yönetimi ve sonuçlarıyla ilişkili olarak sınırlı miktarda bilgiler mevcuttur.Bu çalısma en sık pankreatik endokrin tümör olan insülinomaların cerrahi tedavisiyle ilgili sonuçları değerlendirmeyi amaçlamıştır Yöntemler: Çukurova Üniverstitesi Genel Cerrahi Departmanında 2000 ile 2010 yılları arasında insulinoma tanısıyla ameliyat edilen hastalar geriye dönük olarak değerlendirildi. Rezeksiyon yada enükleasyondan oluşan cerrahi tedavi kararı preoperatif radyolojik değerlendirme (abdominalkontrastlı tomografi, ultrason ve endikasyou olan hastaraselektifanjiografi) ve intraoperatifultrasonografik görüntülemeye göre yapıldı. Bulgular: Cerrahi olarak tedavi edilen, insulinoma tanısı alan ve ortalama takip süresi 5.3 yıl (0.5-10) olan 13 hasta (K/E:9/4) calışmayadahil edildi. Enükleasyon 11 hastaya uygulanırken 2 hastaya distalpankreatektomi (biri dalak koruycu) uygulandı. Mortalite izlenmedi. Cerrahi sonrası tüm hastalar tekrar ameliyat gereksinimi olmaksızın kabul edilebilir komplikasyon oranları (panreatik fistül, n=3; pankreatit, n=1) ile normoglisemik hale geldi. Sonuç: İnsülinomanin cerrahi tedavisi olumlu klinik sonuçlarla ilişkilidir. İnsulinomanin lokalizasyonunu saptamada intraoperatifultrasonla birlikte palpasyonla yapılan değerlendirme altın standarda sahiptir. Uygun cerrahi prosedürü belirlemede lezyonun lokalizasyonu, boyutu ve ana pankreatik kanal ile ilişkisi kritik öneme sahiptir