Search

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hepatorenal syndrome is common in patients with decompensated cirrhosis with severe ascites. Liver transplantation (LT) is the only viable option. Combined Liver-Kidney transplantation (CLKT) is recommended in cases with irreversible renal damage. Recovery of the renal functions following LT is common. We aimed to present a pediatric patient with biliary atresia with full recovery of renal functions after retransplantation for chronic rejection and biliary obstruction. Living donor LT (LDLT) was performed on a 4-year-old female patient due to biliary atresia 6 years before the admission to our department. The patient suffered chronic anastomotic stenosis, cholangitis, and subsequent chronic rejection. On admission, the patient was severely icteric with massive ascites. The renal function was poor with no urine output and required hemodialysis. CLKT was planned but only LDLT could be performed due to deterioration of the patient's condition. However, the renal function improved dramatically in the postoperative period and the kidney transplant was not performed. The patient had an uneventful postoperative period. Hepatorenal syndrome, can resolve following LT. The patients who have a high risk of chronic liver failure should be determined before the LT procedure to plant a CLKT and to allocate insufficient organ resources. [ABSTRACT FROM AUTHOR]

Crigler-Najjar syndrome (CNS) type 1 is a rare autosomal recessive disorder caused by mutations in the UGT1A1 gene, leading to a complete deficiency of the enzyme uridine diphosphate-glucuronosyltransferase (UGT1A1). This enzyme deficiency results in severe unconjugated hyperbilirubinemia, which poses a high risk of neurological complications, particularly kernicterus, if left untreated. While phototherapy provides temporary relief in early childhood, its diminishing effectiveness over time requires liver transplantation (LT) as the only definitive treatment. In this report, we present three pediatric cases of CNS type 1 treated successfully with living donor liver transplantation (LDLT). The first case, an 11-year-old girl, presented severe jaundice and neurological impairment but showed significant improvement in bilirubin levels and neurological symptoms after transplantation. The second case, a 12-year-old boy, had persistently high bilirubin levels despite phototherapy, which normalized after LDLT. The third case, an 11-month-old infant without prior treatment, also achieved complete normalization of bilirubin levels after transplantation. These cases demonstrate that LDLT is highly effective in preventing kernicterus, normalizing bilirubin levels, and improving clinical outcomes in patients with type 1 CNS. Long-term post-transplant care, including immunosuppressive therapy and regular follow-up, remains essential for optimal management and patient well-being. [ABSTRACT FROM AUTHOR]

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hydatid cyst is a parasitic infection most commonly localized in the liver. They may not be diagnosed early because they remain asymptomatic at small sizes and may reach large sizes at the time of diagnosis. In this situation, compression symptoms may occur and they may present with serious complications such as rupture and anaphylactic shock, which are rare. Treatment methods are determined by classification according to the imaging techniques used in the diagnosis. In the present case, echinococcal cysts originating from segments 5, 6, and 7 in the right lobe of the liver, reaching 35 cm in diameter, caused compression symptoms. The diagnosis was made by abdominal tomography showing characteristic daughter vesicles and calcified cystic wall. The patient underwent pericystectomy and had an uneventful postoperative course with no recurrence in the 5-year follow-up. [ABSTRACT FROM AUTHOR]

Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient′s tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients.

Objective: In this retrospective study, we compared the postoperative complications by using both the Clavien--Dindo classification and the Revised 2016 International Study Group on Pancreatic Surgery (ISGPS) classification methods after pancreaticoduodenectomy. Materials and Methods: The data of patients were retrospectively reviewed. Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) were performed on 41 and 40 patients, respectively. The patients were assigned into two groups for anastomosis types and compared with each other according to postoperative complications. The postoperative follow-up period of the patients was limited to 90 days. Results: No significant difference was detected between the two groups in terms of gender (P = .581) and age (P = .809). According to the Clavien--Dindo classification system, grade 1 complication rates were 29.3% and 35.0% in PJ and PG groups, respectively. Also, grade 2 complication rates were 34.1% and 32.5% in PJ and PG groups, respectively. Besides, grade 3B complication rates were 9.8% and 17.5% in PJ and PG groups, respectively. No grade 3A, grade 4A, and grade 4B complications were detected in both groups. But, grade 5 complications rates were 2.4% and 5.0% in PJ and PG groups, respectively. Based on the ISGPS classification system, the pancreatic fistulas were classified. The biochemical leak rates were calculated as 26.8% and 37.5% in PJ and PG groups, respectively. The rates were 14.6% and 10% in PJ and PG groups, respectively, for grade B complications. Also, grade C complication rates were 9.75% and 12.5% in PJ and PG groups, respectively. No statistically significant differences were detected between the two groups for postoperative complications. Conclusion: The evidence from this retrospective study suggests that there is no difference between the two types of pancreatic anastomosis techniques (PJ or PG) in terms of the rate of postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract Introduction Spontaneous non-occlusive ischemic colitis involving the cecum alone (isolated cecal necrosis) is a rare condition that is generally due to a low-flow state: shock. It presents with right lower quadrant abdominal pain and may resemble acute appendicitis. Little is known about postoperative ischemic necrosis of the remaining colon after surgical treatment of isolated cecal necrosis. We report four cases of isolated cecal necrosis mimicking acute appendicitis seen at our institution within a 4-year period. Case presentation The patients were two men and two women with a mean age at diagnosis of 59 years (range 46-68). The patients were of Turkish ethnic origin. All patients presented to the emergency room with acute abdominal pain and had symptoms of nausea and vomiting. The medical histories for three of the patients revealed end-stage renal failure requiring hemodialysis. The other patient had chronic obstructive pulmonary disease. Right hemicolectomy with anastomosis was performed in three patients and cecal resection with ileocolostomy was performed in the remaining one patient. All of the patients healed without complications. Median follow-up of patients was 24.5 (range: 17-37) months. There was no recurrence of ischemia in the remaining colon during the follow-up period of the patients. Conclusion Isolated cecal infarction should be included in the differential diagnosis of acute pain in the right lower quadrant of the abdomen, especially in those patients on chronic hemodialysis. While diffuse ischemic disease of the intestine has high morbidity, mortality and recurrence rates, patients with isolated cecal necrosis have a good prognosis with early diagnosis and surgical treatment compared to those with diffuse ischemic disease.

Abstract Introduction Hydatid cyst disease is common in some regions of the world and is usually located in the liver and lungs. This report presents two cases of primary hydatid cysts located subcutaneously: one in the medial thigh and one in the left palm between the index and middle fingers. Case presentations A 64-year-old male farmer visited our hospital because a swelling on the right medial thigh had grown during the last year. Superficial ultrasound and computed tomography revealed a lesion resembling a hydatid cyst. A germinative membrane was encountered during surgical excision. Pathological examination was compatible with a hydatid cyst. The second case involved a 67-year-old male farmer who complained of a swelling that had grown in his left palm in the last year. The preliminary diagnosis was a lipoma. However, a hydatid cyst was diagnosed during surgical excision and after the pathological examination. The patient did not have a history of hydatid cyst disease and hydatid cysts were not detected in other organs. There has been no disease recurrence after following both patients for 3 years. Conclusion A hydatid cyst should be considered in the differential diagnosis of subcutaneous cystic lesions in regions where hydatid cysts are endemic, and should be excised totally, with an intact wall, to avoid recurrence.