No abstract

Biliary leakage (BL) is the most common cause of postoperative morbidity after conservative liver hydatid cyst surgery. The objective of this study was to determine incidence of BL and related risk factors in patients with solitary liver hydatid cyst who underwent conservative surgery. A total of 186 patients were included in this study. Age, gender, cyst recurrence, diameter, and localization, World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) classification, cavity management techniques, cyst content, and alkaline phosphatase (ALP) levels were evaluated with univariate and multivariate analyses. Of these patients 104 were female and 82 were male. The mean age was 43.5 ± 14.7 years. Postoperative BL was detected in 36 (19.4%) patients. Cyst diameter (P = 0.019), cyst localization (P = 0.007), WHO-IWGE classification (P = 0.017), and ALP level (P = 0.001) were the most significant risk factors for BL. Independent risk factors for BL were perihilar localization, large cyst diameter, high ALP level, and advanced age according to WHO-IWGE classification.

Abstract:Background: Hepatic artery aneurysm (HAA) is a rare clinical entity that can lead to potentially life threatening complications. We reported our personal experience of 4 cases, in which we used different procedures. Methods: The fi rst case had a pseudo-aneurysm involving the right hepatic artery. The second case had a pseudoaneurysm, which was localized distal to the accidentally ligated right hepatic artery from the previous cholecystectomy operation. The third case had multiple aneurysms with accompanying dissecting abdominal aortic aneurysm. The fourth case had a pseudo-aneurysm originating from the proper hepatic artery. A covered stent was successfully placed in the case 1. In the second case, the right hepatic artery was ligated distal to the aneurysm. In the third case, vascular structures were not appropriate for vascular reconstruction, and a covered stent placement and embolization were unsuccessful. In the fourth case, ligation of the proper hepatic artery and cholecystectomy was performed.Results: The third case with multiple aneurysms died from multi-organ failure due to sepsis. The remaining cases (case 1, 2, and 4) are disease free and alive. Conclusion: HAAs are more commonly observed clinical entities, and their treatment should be handled for each patient separately. Computerized tomography-Angiography and intraoperative Doppler ultrasound are useful radio-diagnostics for determination of aneurysm and planning the operative procedure (Fig. 5, Ref. 15). Full Text in PDF www.elis.sk.

Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. Pancreatitis are the most common cause of HP. Here, we report the case of a 48-year-old male with HP due to alcohol-induced chronic pancreatitis. Superior mesenteric angiography showed an inferior pancreaticoduodenal artery pseudoaneurysm. The patient underwent coil embolization for treatment of his pseudoaneurysm. Endoscopic retrograde cholangiopancreatography and pancreatic stents replacement was performed for pancreatic pseudocyst drainage. In patients with HP, angiographic and endoscopic combined treatment can protect from the risks of surgery.

INTRODUCTIONThe incidence of gastroesophageal junction (GEJ) tumors has been on a rapid upsurge in Western societies (1). Adenocarcinomas are the most frequent type within these tumors (2). Despite multimodality treatment, their prognosis is still poor with a 5-year survival rate of around 20% (1). The issue whether they should be treated like esophageal tumors or gastric tumors remains controversial due to their location. Siewert classified these tumors into three groups according to their anatomical locations in 1996 (3). By definition, all of these tumors invade the GEJ. The classification was revised in 2000, and type I tumors were defined as tumors within 1-5 cm above the GEJ, type II those within 1 cm above and 2 cm below the GEJ, and type III as tumors extending 2-5 cm below the GEJ (4). This classification is clinical and is based on barium study, endoscopy, computed tomography, and intraoperative evaluation findings (5). Type I tumors are distal esophageal tumors, type II tumors are true cardiac tumors, while type III tumors are subcardial gastric tumors. R0 resection is the most important determinant of long-term survival in GEJ tumors (6). The 5-year overall survival (OS) after R0 resection has been reported as 43.2%, and those of R1 and R2 resection as 11.1% and 6.2%, respectively (7). While Siewert I and II lesions are treated like esophageal tumors, Siewert III tumors are treated like gastric cancer (1). Due to screening and treatment of Barrett's esophagus, Siewert I tumors can be diagnosed at an early stage. Lymph node metastasis is another important predictor of survival, with a decrease from 53% to 11% in 5-year OS in case of presence of lymph node metastasis (8). For this reason, lymph node dissection should be included to surgery. The rate of lymph node metastasis increases from 10% to 67% in tumors with submucosal infiltration (9). The standard surgical treatment is subtotal esophagectomy and proximal gastrectomy with the exception of endoscopic treatment at a very early stage (10, 11). Distal esophagectomy and total gastrectomy are preferred in type II tumors (10, 11). The standard surgical approach in type III tumors is total gastrectomy and D1 lymph node dissection (12). Objective: The treatment of gastroesophageal junction tumors remains controversial due to confusion on whether they should be considered as primary esophageal or as gastric tumors. The incidence of these tumors with poor prognosis has increased, thus creating scientific interest on gastroesophageal cancers. Esophagogastric cancers are classified according to their location by Siewert, and the treatment of each type varies. We evaluated the prognostic factors and differences in clinicopathologic factors of patients with gastroesophageal junction tumor, who have been treated and followed-up in our clinics. Material and Methods:We retrospectively analyzed 187 patients with gastroesophageal junction tumors who have been operated and treated in the Oncology Department between 2005 and 2014. The chi-square test was used to eval...