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Background/Aim: In Endoscopic retrograde cholangiopancreatography (ERCP), Ampulla of Vater is found on the posteromedial wall of the second part of the duodenum. However, ectopic expansion of the common bile duct to the 3rd or 4th part of the duodenum or the proximal stomach, pylorus, or bulb was reported in the literature. This study primarily aims to investigate the risk of complications in patients with ectopic papillae and evaluate the applicability of endoscopic sphincterotomy in these patients. Methods: In this a case-control study, the data of 3,048 patients who underwent ERCP procedure in the ERCP unit of our clinic between January 2013 and December 2018 were retrospectively analyzed, and 30 patients with ectopic bulbar papillae and 30 randomly selected patients with normally localized papillae were compared in terms of age, gender, duration of the procedure, post-procedural biochemical tests, cannulation success, precision rate, postprocedural pancreatitis complications and the need for analgesics. Power analysis was performed with the G*power 3.1.9.7 package program (1-B = 0.95, alpha = 0.05). With a power of 0.954, the sample size to be reached was thirty-three for each group. Results: The rate of pancreatitis complications was higher in patients with ectopic bulbar papillae (50%) compared to those without (16.7%) (P=0.006). Even though the rate of pre-cut was higher in patients with ectopic bulbar papillae (33.3%) compared to patients with normally localized papillae (13.3%), this difference was not statistically significant (P=0.063). Cannulation success in patients with ectopic bulbar papillae (83.3%) was insignificantly lower than in patients with normally localized papillae (90.0%) (P=0.353). The need for both narcotic and non-steroidal anti-inflammatory analgesics was higher in patients with ectopic bulbar papillae (P

Aim: In endoscopic retrograde cholangiopancreatography (ERCP), a diverticulum increases complications such as perforation and pancreatitis. We must know which type of diverticulum increases the complications to develop a strategy. The aim of this study is to examine the safety of the ERCP procedure in terms of diverticulum types.Methods: A total of 864 patients aged 65 years and over who underwent ERCP from January 2010 to November 2019 were identified and analyzed in this retrospective cohort study. Demographic findings, indications, successful cannulation rates and complications were compared between groups with and without duodenal diverticula.Results: Of the patients who underwent ERCP, 56.4% were female. The mean age of all patients was 77.39 (65-90) years. The most common indications were common bile duct stones (92.1%). Other indications included cholangitis (1.4%), sphincter Oddi dysfunction (1.6%), pancreatitis (2.1%), Mirizzi syndrome (2.7%), postoperative gallbladder fistula (0.7%), periampullary tumor formation (0.57%) and biliary stenosis (0.23%). Among all patients, 848 (98.1%) had no complications, 2 (0.34%) developed pancreatitis, 1 (0.17%) developed cholangitis and bleeding occurred in 1 (0.17%) patient in the group without a duodenal diverticulum. Among patients with a type I diverticulum, 4 (12.9%) had pancreatitis and 3 (9.6%) had bleeding. One patient (1.16%) had pancreatitis, 1 (1.16%) had cholangitis and 2 (2.33%) had bleeding among the type II group, while in the type III group, 1 (0.64%) had pancreatitis and 1(0.64%) had a perforation. Mortality was seen in 2 (0.23%) patients. A total of 5 (0.57%) periampullary tumors were detected in the study.Conclusion: Our study revealed that patients with a duodenal diverticulum experience more complications than the normal population. Among them, the rate is insignificantly increased in those with a type I duodenal diverticulum. Further studies are needed on this subject., Amaç: ERCP prosedüründe divertikül oluşumu perforasyon ve pankreatit gibi komplikasyonları artırır. Hangi tip divertikülün komplikasyonları artırdığını bilmeli ve bunun için bir strateji geliştirebilmeliyiz. Bu çalışmanın amacı, ERCP işleminin güvenliğini divertikül türleri açısından incelemektir.Yöntemler: Ocak 2010'dan Kasım 2019'a kadar ERCP prosedürü uygulanan 65 yaş ve üstü 864 hasta retrospektif bir kohort çalışmasında belirlendi ve analiz edildi. Duodenal divertikülü olan ve olmayan gruplar arasında demografik bulgular, endikasyonlar, başarılı kanülasyon oranları ve komplikasyonlar karşılaştırıldı.Bulgular: ERCP uygulanan hastaların %56,4'ü kadındı. Tüm hastaların ortalama yaşı 77,39 (65-90) yıldı. En yaygın endikasyonlar %92,1 ile safra kanalı taşlarıdır. Diğer endikasyonlar arasında %1,4 kolanjit, %1,6 sfinkter Oddi disfonksiyonu, %2,1 pankreatit, %2,7 Mirizzi sendromu, %0,7 postoperatif safra kesesi fistülü, %0,57 periampullar tümör oluşumu ve %0,23 ile safra darlığıdır. 864 hastanın 848'inde (%98,1) komplikasyon görülmedi. Duodenal divertikülü olmayan grupta 2 (%0,34) pankreatit, 1 (%0,17) kolanjit ve 1 (%0,17) kanama meydana geldi. Tip I grupta 4 (%12,9) hastada pankreatit ve 3 (%9,6) hastada kanama görüldü. Tip II grupta 1 (%1,16) hastada pankreatit, 1 (%1,16) hastada kolanjit ve 2 (%2,33) hastada kanama meydana geldi. Tip III grupta 1 (%0,64) hastada pankreatit ve 1 (%0,64) hastada perforasyon gelişti. Mortalite 2 (%0,23) hastada görüldü. Çalışmada toplam 5 (%0,57) hastada periampuller tümör tespit edildi.Sonuç: Sonuç olarak, bu çalışmada duodenal divertikülü olan hastaların normal popülasyona göre daha fazla komplikasyon yaşadıkları gösterilmiştir. Ancak duodenal divertikül tipleri arasında özellikle tip 1 duodenal divertikülü olanların daha fazla komplikasyon yaşadığı görüldü, ancak istatistiksel olarak anlamlı değildi. Bu durum bize bu konuda yeni çalışmalara ihtiyaç olduğunu gösteriyor.

Patient: Female, 76-year-old Final Diagnosis: Left hepatic cyst hidatic fistula to gall bladder Symptoms: Biliary colic • icterus • Sepsis Medication: — Clinical Procedure: Multidiscipliner treatment Specialty: Surgery Objective: Rare disease Background: Cholecysto-hydatid fistula is a rare complication of liver echinococcosis; suppurative cholangitis due to cholecysto-hydatid fistula is even rarer. A multidisciplinary approach is required by radiology and surgery departments during the preoperative diagnosis and treatment processes of these cases. In this paper, a patient treated with suppurative cholangitis due to cholecysto-hydatid fistula is presented. Case Report: A 76-year-old female patient was admitted to emergency services due to cholangitis. Abdominal computerized tomography (CT) examination revealed that the common bile duct was dilated through the right liver in a wide and torsional pattern; the gallbladder cleaved into hepatic flexura and its wall became irregular. There was a cystic appearance 10×13×12 cm in size on the lateral segment of the left liver lobe. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and it showed the communication between the hydatid cyst pouch and the bile duct. The patient was taken to open surgery, which confirmed the imaging findings. The gallbladder and the adjacent cyst were excised, and a T-tube was placed in the choledochus. Postoperative recovery was uneventful. Conclusions: We suggest that cholecysto-hydatid fistula is a severe problem that requires close workup with both the radiology and surgery departments. Preoperative ERCP is beneficial for the visualization of the fistulization between gallbladder and hydatid cyst and for the treatment of suppurative cholangitis.

Aim: The American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) cancer staging system is the strongest prognostic parameter for colorectal cancer. However, additional markers are needed to improve clinical decision making. The aim of this study was to investigate the effects of lenfovascular invasion (LVI), perineural invasion (PNI) and peritumoral lymphocytic reaction (PLR) on lymph node involvement in surgically treated colon cancer patients.Materials and Methods: The historical records of patients having undergone colon cancer surgery in the Department of General Surgery were evaluated. In addition to demographic data and pathological TNM staging, parameters including tumor location, type, differentiation, LVI, PNI, PLR and tumor growth pattern were recorded and analyzed. p