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Unusual complication in patient with Gardner's syndrome: Coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding: A case report and review of literature

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World Journal of Clinical Cases 2018年第10期6卷 393-397页

作者： Sami Akbulut cemalettin koc Abuzer Dirican Department of Surgery and Liver Transplant Institute Inonu University Faculty of Medicine

Gardner's syndrome(GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and midrectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodenojejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.

关键词： Gastrointestinal perforation Gastrointestinal bleeding Adenosquamous carcinoma Complications Gardner’s syndrome

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Xanthogranulomatous appendicitis: A comprehensive literature review

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World Journal of Gastrointestinal Surgery 2021年第1期13卷 76-86页

作者： Sami Akbulut Khaled Demyati cemalettin koc Adem Tuncer Emrah Sahin Mehmet Ozcan Emine Samdanci Department of Surgery and Liver Transplant Institute Inonu University Faculty of MedicineMalatya 44280Turkey Department of Surgery An-Najah National UniversityNablus44839Palestine Department of Pathology Inonu University Faculty of MedicineMalatya 44280Turkey

BACKGROUND Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes,plasma cells,neutrophils,and often multinucleated giant cells with or without cholesterol *** To review the medical literature on xanthogranulomatous appendicitis(XGA).METHODS We present a patient with XGA and review published articles on XGA accessed via the PubMed,MEDLINE,Google Scholar,and Google *** used were“appendix vermiformis,”“appendectomy,”“acute appendicitis,”and“XGA.”The search included articles published before May 2020,and the publication language was not *** search included letters to the editor,case reports,review articles,original articles,and meeting *** or abstracts containing adequate information about age,sex,clinical presentation,white blood cells,initial diagnosis,surgical approach,histopathological and immunohistochemical features of appendectomy specimens were included in the *** A total of 29 articles involving 38 patients with XGA,were retrospectively ***(52.6%)of the 38 patients,aged 3 to 78 years(median:34;IQR:31)were female,and the remaining 18(47.4%)were ***-five patients were diagnosed with acute appendicitis,ruptured appendicitis,or subacute appendicitis,and the remaining 13 patients underwent surgery for tumoral lesions of the ileocecal ***-two of the patients underwent urgent or semi-urgent surgery,and the remaining 16 patients underwent interval *** Xanthogranulomatous inflammation rarely affects the appendix *** is associated with significant diagnostic and therapeutic dilemmas due to its variable *** is often associated with interval appendectomies,and a significant number of patients require bowel resection due to the common presentation of a tumoral *** is usually identified retrospectively on surgical pathology and has no unique features in preo

关键词： Appendix vermiformis Acute appendicitis Appendectomy Interval appendectomy Xanthogranulomatous inflammation CD68 antibody staining

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Comparison of clinical and histopathological features of patients who underwent incidental or emergency appendectomy

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World Journal of Gastrointestinal Surgery 2019年第1期11卷 19-25页

作者： Sami Akbulut cemalettin koc Huseyin kocaaslan Fatih Gonultas Emine Samdanci Saim Yologlu Sezai Yilmaz Department of Surgery and Liver Transplant Institute Inonu University Faculty of Medicine Department of Pathology Inonu University Faculty of Medicine Department of Biostatistics Inonu University Faculty of Medicine

BACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular *** To compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard *** The demographic, biochemical, and histopathological data of 72 patients(Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients(Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1:4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced *** Statistically significant differences were found between groups in terms of age(P= 0.044), white blood cell count(P < 0.001), neutrophil(P < 0.001), lymphocyte(P< 0.001), red cell distribution width(P = 0.036), mean corpuscular hemoglobin(P= 0.001), bilirubin(P = 0.002), appendix width(P < 0.001), and presence of acute appendicitis histopathologically(P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis(72.2%), fibrous obliteration(9.7%)and acute appendicitis(6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis(62.8%), perforated appendicitis(16.7%), lymphoid hyperplasia(8.3%), and appendix vermiformis(6.3%).CONCLUSION Careful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that exp

关键词： Living donor hepatectomy Incidental appendectomy Acute appendicitis

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Is right lobe liver graft without main right hepatic vein suitable for living donor liver transplantation?

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World Journal of Hepatology 2020年第7期12卷 406-412页

作者： Khaled Demyati Sami Akbulut Egemen Cicek Abuzer Dirican cemalettin koc Sezai Yilmaz Department of Surgery and Liver Transplant Institute Inonu University Faculty of MedicineMalatya 44280Turkey An-Najah National University Hospital An-Najah National UniversityNablus 11941Palestine

BACKGROUND Since the first living donor liver transplantation(LDLT)was performed by Raia and colleagues in December 1988,LDLT has become the gold standard treatment in countries where cadaveric organ donation is not *** hepatic venous outflow reconstruction in LDLT is essential to prevent graft congestion and its complications including graft ***,this can be complex and technically demanding especially in the presence of complex variations and congenital anomalies in the graft hepatic *** SUMMARY Herein,we aimed to present two cases who underwent successful right lobe LDLT using a right lobe liver graft with rudimentary or congenital absence of the right hepatic vein and describe the utility of a common large opening drainage model in such complex *** Thanks to this venous reconstruction model,none of the patients developed postoperative complications related to venous *** experience with venous drainage reconstruction models shows that congenital variations in the hepatic venous structure of living liver donors are not absolute contraindications for LDLT.

关键词： Living donor liver transplantation Congenital-absence of right hepatic vein Common large opening drainage model Case report

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Ectopic liver tissue (choristoma) on the gallbladder: Acomprehensive literature review

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World Journal of Gastrointestinal Surgery 2020年第12期12卷 534-548页

作者： Sami Akbulut Khaled Demyati Felat Ciftci cemalettin koc Adem Tuncer Emrah Sahin Nese Karadag Sezai Yilmaz Department of Liver Transplant Institute Inonu UniversityMalatya 44280Turkey Department of Surgery An-Najah National UniversityNablus 11941Palestine Department of Pathology Inonu University Faculty of MedicineMalatya 44280Turkey

BACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually calledan accessory liver, and that without a connection to the mother liver, is calledectopic liver *** To identify studies in the literature on ectopic liver tissue located on thegallbladder surface or *** We present two patients and review published articles on ectopic liver tissuelocated on the gallbladder surface accessed via PubMed, MEDLINE, GoogleScholar, and Google databases. Keywords used included accessory liver lobe,aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic livertissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopicliver tissue on the gallbladder. The search included articles published before June2020 with no language restriction. Letters to the editor, case reports, reviewarticles, original articles, and meeting presentations were included in the *** or abstracts containing adequate information on age, sex, history of liverdisease, preliminary diagnosis, radiologic tools, lesion size, surgical indication,surgical procedure, and histopathological features of ectopic liver tissue wereincluded in the *** A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 werefemale and 25 were male (no gender available for 4 patients), and the age rangewas 5 d to 91 years. Forty-nine patients underwent surgery for chroniccholecystitis or cholelithiasis, and 14 patients underwent surgery for acutecholecystitis. The remaining 28 patients underwent laparotomy for other *** was laparoscopic in 69 patients and open in 11 patients. Theremaining 19 patients underwent various other surgical procedures such asautopsy, liver transplantation, living donor hepatectomy, Whipple procedure, andliver segment V resection. Histopathologically, hepatocellular carcinoma wasdetect

关键词： Liver Gallbladder Ectopic liver tissue Hepatic choristoma Histopathological features Hepatocellular carcinoma

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Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

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World Journal of Clinical Cases 2022年第29期10卷 10487-10500页

作者： Sami Akbulut Adem Tuncer Zeki Ogut Tevfik Tolga Sahin cemalettin koc Emek Guldogan Ertugrul Karabulut Elif Seren Tanriverdi Ali Ozer Surgery and Liver Transplant Institute Inonu University Faculty of MedicineMalatya 44280Turkey Department of Biostatistics and Medical Informatics Inonu University Faculty of MedicineMalatya 44280Turkey Department of Public Health Inonu University Faculty of MedicineMalatya 44280Turkey Department of Surgery Inonu University Faculty of MedicineMalatya 44280Turkey Department of Medical Microbiology Inonu University Medical FacultyMalatya 44280Turkey

BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed *** coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and *** To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 *** The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) *** Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 ***-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital

关键词： SARS-CoV-2 COVID-19 pandemic Acute appendicitis Perforated appendicitis Negative appendectomy

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Liver transplant for large hepatocellular carcinoma in Malatya: Therole of gamma glutamyl transferase and alpha-fetoprotein, aretrospective cohort study

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World Journal of Gastrointestinal Surgery 2020年第12期12卷 520-533页

作者： Volkan Ince Brian I Carr Harika Gozukara Bag Veysel Ersan Sertac Usta cemalettin koc Fatih Gonultas Baris Kemal Sarici Serdar Karakas Koray Kutluturk Adil Baskiran Sezai Yilmaz Department of General Surgery Inonu UniversityLiver Transplantation InstituteMalatya 44280Turkey Department of Biostatistics Inonu UniversitySchool of MedicineMalatya 44280Turkey

BACKGROUND There is increasing interest in transplanting patients with hepatocellularcarcinoma (HCC) with tumors greater than 5 cm (Milan criteria).AIM To investigate possible prognostically-useful factors for liver transplantation inHCC patients with large *** In this clinical study, 50 patients with HCC who were transplanted at our LiverTransplant Center between April 2006 and August 2019 and had tumors greaterthan 6 cm maximum diameter were retrospectively analyzed. Their survival andfull clinical characteristics were examined, with respect to serum alphafetoprotein(AFP) and gamma glutamyl transpeptidase (GGT) levels. Kaplan-Meier survival estimates were used to determine overall survival and disease-freesurvival in these patients. The inclusion criterion was evidence of HCC. Exclusioncriteria were the presence of macroscopic portal vein thrombosis or metastasisand a follow-up period of less than 90 *** Using receiver operating characteristic curve (ROC) analysis, cutoff values of AFP200 ng/mL and GGT 104 IU/L were identified and used in this *** longer overall survival (OS) and disease-free-survival (DFS) were found in patients who had lower values of either parameter, compared withhigher values. Even greater differences in survival were found when the 2parameters were combined. Two tumor size bands were identified, in searchingfor the limits of this approach with larger tumors, namely 6-10 cm and > 10 *** parameters in the 6-10 cm band reflected 5-year OS of 76.2% inpatients with low AFP plus low GGT vs 0% for all other groups. Patients withtumors greater than 10 cm, did not have low AFP plus low GGT. The mostconsistent clinical correlates for longer survival were degree of tumordifferentiation and absence of microscopic portal venous *** Serum levels of AFP and GGT, both alone and combined, represent a simpleprognostic identifier in patients with large HCCs undergoing liver transplantation.

关键词： Hepatic malignancy Advanced Gamma glutamyl transpeptidase Living donor Beyond Extended

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