Endoscopic retrograde cholangiopancreatography in the diagnosis and management of choledochal cysts.

Choledochal cysts are an uncommon anomaly of the biliary system manifested by cystic dilatation of the extra or intrahepatic biliary tree or both. It is most frequently found in Orientals and in females. Endoscopic retrograde cholangiopancreatography is a valuable imaging technique in the diagnosis of choledochal cysts in adults. Additionally, in selected cases, a choledochocele may be effectively managed by endoscopic sphincterotomy. We present clinical and endoscopic findings of six adult patients with choledochal cysts. Clinical symptoms were characterized by abdominal pain, jaundice and cholangitis. Associated hepatobiliary pathologic findings included cholelithiasis, recurrent acute pancreatitis, gallbladder carcinoma, Cystolithiasis, choledocholithiasis, biliary stricture and hepatic abscess.

Symptomatic giant cavernous haemangioma of the liver: is enucleation a safe method? A single institution report.

Twenty-three patients with symptomatic giant hemangioma of the liver were treated by surgery between 1979 and 1996 at the department of General Surgery, Faculty of Medicine, University of Cukurova. Twenty-three enucleations were performed in 21 patients, left lateral segmentectomy in one patient and enucleation plus left lobectomy in one patient. The tumors were enucleated along the interface between the hemangioma and normal liver tissue. The diameters of the tumors ranged from 5 x 5 to 25 x 15 cm. The mean blood loss for enucleations was 525 ml (range 500-1000 ml). There was no mortality and no postoperative bleeding. Three patients had postoperative complications. Enucleation is the best surgical technique for symptomatic giant hemangioma of the liver. It may be performed with no mortality, low morbidity and the preservation of all normal liver parenchyma.

Endoscopic management of biliary hydatid disease.

OBJECTIVE: To determine the effect of endoscopic sphincterotomy in the management of biliary hydatid disease. DESIGN: A case study between January 1992 and December 1994. SETTING: A university-affiliated hospital in Adana, Turkey. PATIENTS: Five patients with biliary hydatid disease, in which the cyst had ruptured into the biliary tree. The follow-up ranged from 3 to 12 months. INTERVENTIONS: Endoscopic sphincterotomy. MAIN OUTCOME MEASURES: Morbidity, morality and recurrence of the disease. RESULTS: All patients underwent successful endoscopic sphincterotomy, including removal of daughter cysts. During the follow-up period, ultrasonography and laboratory investigations showed complete cure in all patients. There were no complications due to endoscopic sphincterotomy. CONCLUSION: Endoscopic sphincterotomy is the treatment of choice for the management of hydatid cysts that have ruptured into the biliary tract causing obstructive jaundice.

Wrapping mesh for haemostasis in severe hepatic injury.

All the time, it can not be easy to achieve for haemostasis in liver injuries. Surgical techniques known may fail in major hepatic traumas. This study was performed on nine mongrel dogs to investigate the effectiveness of mesh wrapping technique in severe hepatic injuries. Before surgery, cefotaxime 2 g/day was administered for five days. Anaesthesia was induced with 30 mg/kg thiopental sodium. During the operation, six dogs underwent uniform deep stellate injuries with a haemostatic forceps, three dogs received blunt injuries with a surgical hammer, and finger fracture technique was used to produce injuries in the right lobes of the livers. Then total wrap technique was performed with a cotton mesh graft. All dogs survived. This high survival rate shows that, total wrap technique is effective for haemostasis of severe hepatic injuries.

Alveolar hydatid disease of the liver: a report on thirty-nine surgical cases in eastern Anatolia, Turkey.

The charts of 39 consecutive patients who underwent surgery between 1979 and 1989 with a diagnosis of alveolar hydatid disease (AHD) of the liver were reviewed. The analysis of these cases from eastern Anatolia, which is the endemic region in Turkey, was undertaken to determine the current experience for AHD lesions. Of these patients, 33 (84.6%) had unresectable disease and the remaining six patients (15.4%) were treated by hepatic resection of the primary lesion. In the unresectable cases, laparotomy with biopsy was the most commonly used surgical procedure (56.4%), followed by tube drainage of the necrotic cavity (18.0%), marsupialization (5.1%), and cystojejunostomy (5.1%). Diagnostic studies and operative findings were useful in detecting the AHD lesions. Differential diagnosis was established mainly by histopathologic examination of a biopsy specimen or resected tissue. Pulmonary metastases were seen in two cases, and mortality occurred due to brain metastases in two other cases. Mebendazole was administered postoperatively to 19 patients with indications for 1) advanced AHD, 2) adjuvant therapy to radical and palliative surgical procedures, and 3) recurrences of disease after hepatic resection. The patients were treated with daily doses of approximately 50 mg/kg for periods of one and six years (median 3.2 years). Encouraging results were obtained in 11 of nineteen patients. Five-year survival was seen in 8 of the patients with AHD in this series. There were 18 deaths (46.2%) in our 39 patients. Long-term follow-up was not possible in four cases, and 17 patients (43.6%) were still living. The causes of mortality were advanced AHD in 14 cases, brain metastases in two, and acute myocardial infarction in another two.(ABSTRACT TRUNCATED AT 250 WORDS)

Tuberculous enteritis and peritonitis.

In Turkey, diseases associated with Mycobacterium tuberculosis are common. Intestinal tuberculosis has generally been a complication of pulmonary tuberculosis, but recently there has been an increase in the frequency of intestinal tuberculosis without the pulmonary form. The authors present their experience over 8 years in 41 patients (aged 15 to 56 years) who underwent surgery for tuberculous enteritis (14), peritonitis (13), a combination of the two (5), genital tuberculosis and peritonitis (5) and tuberculous mesenteric lymphadenitis (4). Of these, 29 had no associated pulmonary tuberculosis. Eighteen of the 41 patients had complications of their disease-bowel obstruction in 13, intestinal perforation in 2, intestinal bleeding in 2 and enterocutaneous fistula in 1. The diagnosis was established at operation and by the appearance of caseating granuloma on histologic examination and isolation of the causative organism. Twenty-four patients required emergency surgery; 2 who had bowel perforation died. Operative procedures included laparotomy with biopsy (17), resection of intestine (10), division of adhesions (7), evacuation of mesenteric abscesses (4) and bypass (3). There were seven (17%) operative deaths. The authors recommend that noninvasive procedures be used for the diagnosis of intestinal tuberculosis, but if these fail, surgery is indicated.

Surgical management of hydatid disease of the liver.

The authors review 143 consecutive, surgically treated cases of hydatid disease of the liver seen over the past 10 years. Of the 208 cysts found, 82 (39.4%) were complicated; the remainder were simple. The complications included rupture into the biliary system (16.3%), suppuration (11.0%), partial calcification of the pericyst (5.8%), intraperitoneal rupture (4.8%), bronchobiliary fistula (0.9%) and cystocutaneous fistula (0.5%). External capitonnage was the most commonly used surgical technique (63.0%), followed by cystectomy (17.8%), omentoplasty (10.6%), tube drainage (7.7%) and cystojejunostomy (0.9%). Capitonnage was carried out with or without tube drainage. The complications of surgery were higher with drainage than without. The main complications of surgery were infection in the residual cavity and biliary fistula. The patients who underwent external capitonnage without drainage or omentoplasty had good results with minimal complication rates (3.5% and 4.5% respectively). For the patients in whom the cystectomy was established, the complication rate was 8.1%.