Rare entity: Ectopic liver tissue in the wall of the gallbladder - A case report.

Ectopic liver tissue (ELT) is a rare condition, which is usually not diagnosed preoperatively, but coincidentally during abdominal surgery. While the location of ELT can vary, it is usually localized on the gallbladder wall or in close proximity. ELT is associated with various complications, a major complication being extrahepatic hepatocellular carcinoma. A 59-year-old female underwent elective surgery for chronic cholecystitis with stones. During laparoscopic exploration, a 2-cm-diameter ELT was detected in the anterior gallbladder wall and a laparoscopic cholecystectomy was performed. The case is presented due to the rare nature of ELT and as a reminder of ELT-related complications.

Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome.

Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Abdominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of "recurrent characteristics of the complaints" that can be learned by a careful history, may be helpful in diagnosis.

Prevention of adhesion formations following repair of abdominal wall defects with prosthetic materials (an experimental study).

BACKGROUND/AIMS: Adhesion formation after abdominal surgery or incisional hernia repair with prosthetic materials may cause chronic pain, intestinal obstruction, enterocutaneous fistulae, difficulty in reoperative procedures and infertility in females. The aim of this study was to compare different modalities in terms of adhesion prevention in a rat model of abdominal wall defect repaired with prosthetic materials. METHODOLOGY: Forty-eight female Wistar-Albino rats were divided into four groups. In all rats, laparotomy was performed through a 3-cm midline incision and an abdominal wall defect (2 x 3 cm) was created in rats in groups II, III and IV. Following procedures were performed in all rats: seroza of the cecum was abraded and sutured with 4-0 silk and two ischemic buttons were created by ligating with 4-0 silk on the left and right sides of abdominal parietal peritoneum. In Group I, abdominal closure was obtained with a running 4-0 prolene suture. In Group II, abdominal wall defect was repaired with polypropylene mesh. In Group III, Seprafilm, an absorbable adhesion barrier, was laid over the abdominal viscera and defect was repaired with polypropylene mesh. In Group IV, defect was repaired with Composix mesh. Adhesion density score, adhered organ and strength of mesh incorporation were evaluated. Biochemical analysis and histopathological examination were performed. RESULTS: Groups II and III had more adhesion density scores than groups I and IV, (P < 0.001). Group II had more cecal and ischemic button adhesions than groups I, III and IV, (P < 0.001). Strength of mesh incorporation was higher in groups II and III than group IV, (P < 0.001). Abscess formation was more common in group IV than those in groups II and III, (P < 0.001). There were no differences between groups, regarding serum levels of C-reactive protein and fibrinogen. The most common adhered organ was omentum. CONCLUSIONS: There is no single treatment modality to prevent adhesion formation after abdominal wall defect repaired with prosthetic materials. While intraperitoneal adhesions were less common in Seprafilm group, adhesions to mesh were less common in the Composix mesh group.

Timing of cholecystectomy for acute biliary pancreatitis: outcomes of cholecystectomy on first admission and after recurrent biliary pancreatitis.

Biliary stones are the leading cause of acute pancreatitis. Although cholecystectomy and selective endoscopic retrograde cholangiography (ERC) comprise the current treatment in patients with acute biliary pancreatitis (ABP), the time of intervention is still controversial. In this study we evaluated the outcomes of cholecystectomy on first admission for ABP and in patients with recurrent biliary pancreatitis. A series of 43 patients with ABP between January 1997 and November 2000 were evaluated retrospectively. Patients were classified into two groups. Group I included 27 patients who underwent cholecystectomy on first admission before discharge from the hospital. Group II comprised 16 patients who had recurrent biliary pancreatitis and then underwent cholecystectomy. The severity of the pancreatitis was determined by Ranson's criteria. Age, gender, length of hospital stay, severity of pancreatitis, amylase level, and complications of cholecystectomy were evaluated in both groups. Patients in group I underwent cholecystectomy during the original hospital admission and patients in group II during an admission for a recurrence. There were 24 patients with a Ranson's score