Gossypiboma mimicking hepatic hydatid cyst after 22 years: a case report.

Gossypiboma is a non-absorbable material that is forgotten during surgery. These are medicolegal pathology that leads to diagnostic confusion from abscess to tumor. We present the case of gossypiboma detected in laparotomy in a 57-year-old male patient who had a history of operation due to a hydatid cyst 22 years ago and was referred to our center due to hydatid recurrence. The case should suggest a history of surgical gossypiboma, especially in asymptomatic patients. In this preventable pathology, the strategy during sur-gery and the careful and proper attitude of the surgical team are the main determinants.

Early results of conservative and surgical approach in Endoscopic Retrograde Cholangiopancreatography (ERCP) Perforations Single center experience.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy, and after perforation (ERCP-P), which is a common method used for the diagnosis in the past and treatment today in hepatopancreatobiliary cases, is a rare complication with high mortality. While surgery has been at the forefront in perforations after ERCP in previous years, conservative treatment is widely accepted today, except for some special conditions. The aim of this study was to determine the incidence of ERCP-P in a hepatobiliary center, the outcome of the treatment modalities applied, and the risk factors for mortality due to perforations. MATERIALS AND METHODS: Patients hospitalized in our clinic with the diagnosis of ERCP-P were retrospectively analyzed. Age, gender, ERCP indication, method of treatment applied, time between ERCP-P diagnosis and treatment, injury class, length of stay (LOS) and early results of the patients were examined. RESULTS: 45 patients were hospitalized in our clinic upon the development of ERCP-P between the years of 2006 and 2022. 37 of these patients underwent conservative and 8 patients underwent surgical treatment. When the perforation types were examined, Stapfer Type 1 was found in 4 patients, Type II in 6 patients, Type III in 3 patients and Type IV ERCP-P in 32 patients (71.1%). LOS was longer in the surgical group than in the conservative treatment group (p=0.040). Mortality was observed in 15.56% of patients. 57.1% of these patients were in the surgical group. In the multivariate analysis, the time between diagnosis and treatment of ERCP-P, which is the only factor affecting mortality, was found. The risk of death was found to be 30.61 times higher in patients with a time elapsed between ERCP-P diagnosis and treatment exceeding 24 hours compared to patients with a time elapsed ≤24 hours (p=0.030). DISCUSSION: In our study, it was observed that the prognosis of the patients in the surgical group was poor and the length of stay was significantly longer. At the same time, the only effective factor on mortality is the time between ERCPP diagnosis and treatment. KEY WORDS: Endoscopic Retrograde Cholangiography, Perforation, R Factors.

Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report.

Endoscopic retrograde cholangiopancreatography (ERCP) has been a widely used procedure in the diagnosis and treatment of various pancreaticobiliary disorders. Although widely considered a safe procedure, ERCP is associated morbidity and occasional mortality. The most common complications include acute pancreatitis, hemorrhage, and duodenal perforation. Portal vein cannulation is a rare complication of ERCP. We described a case of placement of an endoscopic biliary stent in the portal vein during ERCP and sphinc-terotomy. A 54-year-old female patient underwent laparoscopic cholecystectomy with a pre-diagnosis of chronic cholecystitis with gallstones. She visited emergency unit with the complaint of jaundice and itching on the 4th post-operative day. On the magnetic res-onance cholangiopancreatography, the intrahepatic and the extrahepatic bile ducts were dilated and a 7.5×5.5 mm stone at common bile duct. Sphincterotomy was performed by ERCP, the stones were removed, and then a 10F 7 cm stent was installed. Abdominopelvic computed tomography (CT) was performed on the 4th day of ERCP in the patient whose fever and total bilirubin levels persisted at 5 mg/dL, considering cholangitic abscess and/or ERCP complication. On the CT, the proximal end of the stent in the common bile duct was observed to enter into the main portal vein and the tip was observed to be thrombosed. Therefore, it was decided to remove the stent endoscopically under operating room conditions. After the anesthesia induction, the stent was endoscopically removed by the gastroenterology team. The abdominal cavity of patient was explored laparoscopically in the during of stent removal. The patient did not experience hemodynamic instability and did not require transfusion during anesthesia but had melena once on the clinical follow-up. The patient was discharged with low molecular weight heparin and oral cephalosporin and was advised to return for polyclinic control. Doppler ultrasonography (USG) was performed to evaluate the thrombosis of the portal vein in the patient who had intermittent fever during the controls. Doppler USG revealed a thrombosed appearance in the main portal vein and its branches. The patient, who was in good general condition and had no abdominal pain, was switched to high-dose low molecular weight heparin and followed under the control of the gastroenterology and general surgery outpatient clinic. This rare life-threatening complication should always be kept in mind especially during the procedure and/or in the clinical follow-up of the patient.

Solid pseudopapillary neoplasms of the pancreas: Is there a factor determining the prognosis? Experience of a single institution.

Solid pseudopapillary neoplasms (SPNs) are frequently seen in young women. Although the behavior pattern varies, these rare lesions generally have a low malignant potential. In this study, the aim was to investigate the effect of clinicopathological features of lesions on the recurrence in and survival of patients. In this study, patients of our clinic who were pathologically diagnosed with SPN after pancreatic surgery between July 2008 and December 2020 were evaluated retrospectively. Patients' age, gender, comorbidities, symptoms at the time of application, preoperative CA 19-9, CEA value, preoperative cross-sectional diagnostic imaging method and lesion characteristics, surgery, postoperative complications, length of hospital stay, and histopathological features were evaluated. Early and late mortality, overall survival, disease-free survival, and recurrence rate were determined. Four of the 23 patients diagnosed with SPN were male and the median age was 29 (23-47) years. Of the study patients, 69.56% experienced pain symptoms and 30.43% were asymptomatic. The median tumor size was 4 cm (1.5-15). The most common surgical procedure was distal pancreatectomy (56.5%). The median length of hospital stays was 5 (3-120) days and morbidity was observed in 9 cases (39.13%). The mortality rate was 4.35%. The mean follow-up period in the series was 53 (8-132) months and none of the patients developed recurrence. In this study, no significant difference was found regarding recurrence in patients with SPN with histopathologically aggressive biological behavior. The overall survival rate was 95.7%. SPNs are rare lesions with low malignant potential. SPNs are associated with longer-term survival after surgical resection.