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Öğe A case of Krukenberg tumor, eight years after treatment of gastric cancer(Marmara Univ, Fac Medicine, 2018) Karagul, Servet; Sumer, Fatih; Onur, Asim; Tardu, Ali; Dagli, Adile Ferda; Kayaalp, CuneytKrukenberg tumor is a rare metastatic tumor of the ovary. The primary tumors are usually gastrointestinal cancers. Most of the Krukenberg tumors reported in the literature occurred within the first 2 years after treatment of the primary disease. Herein, we present a case of Krukenberg tumor in a 37-year-old woman who previously underwent surgery and chemotherapy for stomach cancer. This patient is noteworthy because it is one of the few documented cases of ovarian metastasis appearing after a disease-free period of 8 years following treatment of the primary tumor. Krukenberg tumors are associated with poor prognosis; therefore, regular gynecological examination in female patients with history of gastric cancer is very important for the early diagnosis and treatment of this disease.Öğe Case report of non-traumatic spontaneous intrahepatic bile duct rupture in an adult(Elsevier Sci Ltd, 2016) Sumer, Fatih; Kayaalp, Cuneyt; Karagul, Servet; Ertugrul, Ismail; Yagci, Mehmet Ali; Onur, AsimINTRODUCTION: Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose preoperatively and presents with acute abdominal symptoms. The treatment of this rare condition should be based on the individual's clinical status. We present peripheric biliary duct rupture (segment three) treated with external segment III drainage and postoperative endoscopic removal of the stones. PRESENTATION OF CASE: An 82-year-old male patient presented with abdominal pain and fever. An ultrasound (US) revealed a solid gall stone lesion, 3 cm in diameter, in liver segments three and four with additional intra-abdominal fluid accumulation without coexisting free air. A diagnostic laparotomy was then performed because the patient had signs of peritonitis. Exploration revealed a biliary leakage from the posterior surface of segment three. An external biliary drainage catheter was inserted to the perforated segment III duct via a 6 French (6F) feeding catheter. He was discharged after 10 days and his intracholedocal stent was removed postoperative after three months. The patient continues to be monitored. DISCUSSION: Spontaneous rupture of the intrahepatic biliary duct is a rare condition. Although occurrence is frequently reported as spontaneous, the majority of cases are related to choledocholithiasis. The role of surgical treatment in cases of spontaneous bile duct rupture is unclear. When biliary peritonitis is present, drainage of contaminated biliary fluid, T-tube drainage, closure of the biliary duct, as well as primary disease conditions, should be reviewed prior to treatment. CONCLUSION: Surgical treatment of spontaneous biliary duct rupture should be indicated only after careful consideration of the patient's clinical and comorbidity status. (C) 2016 The Authors. Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd.Öğe Colorectal stenting for obstruction due to retrorectal tumor in a patient unsuitable for surgery(Sciendo, 2017) Ersan, Veysel; Kutlu, Ramazan; Erdem, Ceyhun; Karagul, Servet; Kayaalp, CuneytFund of knowledge on palliative treatment of unresectable retrorectal tumors is scare. Here, we reported a non-surgical treatment of a huge retrorectal malignant tumor in an aged and debilitated patient complicated with colorectal obstruction. An 86-year-old male with severe comorbidities was admitted with acute colorectal obstruction owing to an untreated retrorectal malign epithelial tumor. There was a lobulated retrorectal mass, 20 cm x 15 cm at largest size, extending to the superior iliac bifurcation level, caused an obstruction of the rectal lumen. He was not suitable for surgical excision because of the severe comorbidities. Rectal obstruction was palliated by two self-expandable metallic stents. He tolerated the procedures well and post-procedural course was uneventful. After four months, stents were patent and the patient was continent. Stenting for colorectal obstruction owing to a retrorectal tumor can be feasible in patients who are not suitable for surgery (aged, debilitated, advanced tumor). It avoided the surgical trauma to a high-risk patient and ensured the continuity of continence. As far as we know, this was the first report on colorectal stenting for a retrorectal tumor.Öğe Comparison of Direct Trocar Entry and Veress Needle Entry in Laparoscopic Bariatric Surgery: Randomized Controlled Trial(Mary Ann Liebert, Inc, 2015) Ertugrul, Ismail; Kayaalp, Cuneyt; Yagci, Mehmet Ali; Sumer, Fatih; Karagul, Servet; Tolan, KeremBackground: We aimed to compare the direct trocar insertion (DTI) and Veress needle insertion (VNI) techniques in laparoscopic bariatric surgery. Materials and Methods: Eighty-one patients scheduled for bariatric surgery at Inonu University, Malatya, Turkey, were included in this study. In 39 patients, a bladed retractable nonoptical trocar was used for DTI, and VNI was performed in 42 patients. Intraoperative access-related parameters were compared. Data were analyzed with Student's t and chi-squared tests. A P value of <.05 was considered significant. Results: Both groups had comparable demographic profiles. Laparoscopic entry time was shorter in the DTI group (79.6 +/- 94.6 versus 217.6 +/- 111.0 seconds; P < .0001). Successful entry rates in the first attempt, CO2 consumptions, failed attempt rates, and overall intraoperative complication rates were similar. However, in the DTI group, 2 patients had mesenteric injuries, and 1 of them required conversion to open surgery due to the mesenteric hemorrhage. Conclusions: DTI in obese patients significantly shortens the entry time, but there can be severe complications with DTI when a nonoptical bladed trocar is used blindly. Actually, neither method can be recommended for entry into the abdomen in this population based on our results. If the surgeon has to choose a nonoptical trocar in bariatric surgery, preference for the VNI technique instead of the DTI technique is safer.Öğe Comparison of Harmonic scalpel and Ligasure devices in laparoscopic Roux-en-Y gastric bypass(Termedia Publishing House Ltd, 2017) Kirmizi, Serdar; Kayaalp, Cuneyt; Karagul, Servet; Tardu, Ali; Ertugrul, Ismail; Sumer, Fatih; Yagci, Mehmet AliIntroduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most preferred bariatric procedures in the world for surgical treatment of morbid obesity. The Harmonic scalpel (HS) and LigaSure (LS) are the most commonly used devices in laparoscopic surgery. As far as we know, there is no comparative study of the two energy devices in LRYGB for morbid obesity. Aim: To compare the intraoperative performances of the two energy devices in LRYGB for morbid obesity. Material and methods: The HS and LS were used in 43 and 42 cases, respectively. The patient demographics of both groups were comparable. The duration of the procedures (gastric pouch creation time and total operation time), quantity of bleeding (during gastric pouch creation and total quantities of bleeding) and the number of pneumoperitoneum desufflations due to smoking that impaired sight fields were recorded prospectively. Results: Gastric pouch creation time (HS: 22.5 +/- 9.5 vs. LS: 19.5 +/- 9.7 min, p = 0.15), bleeding during gastric pouch preparation (HS: 15.3 +/- 30.5 vs. LS: 17.5 +/- 31.3 ml, p = 0.74), total operation time (HS: 183.2 +/- 47 vs. LS: 165.3 +/- 37.1 min, p = 0.06) and total bleeding (HS: 110 +/- 195.5 vs. LS: 102.5 +/- 70 ml, p = 0.81) were similar in the two groups. Only the mean number of pneumoperitoneum desufflations due to smoking was lower in the HS group (HS: 0.28 +/- 0.49 vs. LS: 0.57 +/- 0.78, p = 0.04). Conclusions: The HS and LS performed similarly in LRYGB, with fewer desufflations from smoking in the HS group.Öğe Comparison of Plasmapheresis and Molecular Adsorbant Recirculation System Treatment Results for Posttransplant Liver Graft Dysfunction(Lippincott Williams & Wilkins, 2015) Otan, Emrah; Akbulut, Sami; Karagul, Servet; Aydin, Cemalettin; Kirmizi, Serdar; Colak, Cemil; Yilmaz, Sezai[Abstract Not Available]Öğe Comparison of Stapled Versus Stapleless Sleeve Gastrectomy with Natural Orifice Specimen Extraction (NOSE)(Wolters Kluwer Medknow Publications, 2021) Kirmizi, Serdar; Kayaalp, Cuneyt; Karagul, Servet; Tardu, Ali; Ertugrul, Ismail; Sumer, FatihBackground: Sleeve gastrectomy is a stapler dependent bariatric procedure. A stapleless sleeve gastrectomy can be necessary for certain circumstances. Aims: Here, we aimed to show whether laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction (NOSE) can be an alternative procedure o stapled sleeve gastrectomy. Patients and Methods: In the stapleless group (n = 6), no staplers were used and after vertical resection of the stomach by energy devices, the stomach remnant was closed by two rows of intracorporeal sutures. The resected specimen was removed through the mouth using an endoscopic snare. In the stapler group (n = 7), sleeve gastrectomy was carried out with linear stapler under the guidance of 36 Fr Bougie. The specimens were extracted from the left upper quadrant trocar site. Results: A total of 13 patients were compared (stapleless = 6 and stapled group = 7). All the sleeve gastrectomies were completed laparoscopically. The operative time was longer at 200 minutes (range 120-300) versus 120 minutes, (range 90-200) p = 0.07) and the amount of bleeding was higher at 100 ml (range 50-200) versus 30 ml (range 10-50) (p = 0.004) in the stapleless group. Leakage and gastrointestinal bleeding were seen in the stapleless group but no complications were found in the stapler group. No statistically significant difference was found between the metabolic outcomes of the two groups after the operation (p > 0.05). Decrease in BM at similar rates was observed in 5 postoperative year (stapleless group: 35 kg/m(2) (range 31-39) versus stapled group: 36.5 kg/m(2) (range 31-39), p > 0.05). Conclusion: Laparoscopic stapleless sleeve gastrectomy with natural orifice specimen extraction has longer procedure time, more blood loss and complications.Öğe Extramucosal pancreaticojejunostomy at laparoscopic pancreaticoduodenectomy(Medknow Publications & Media Pvt Ltd, 2018) Karagul, Servet; Kayaalp, Cuneyt; Sumer, Fatih; Yagci, Mehmet AliWhile the 'best pancreatic anastomosis technique' debate is going during Whipple procedure, the laparoscopic pancreaticoduodenectomy lately began to appear more and more often in the medical literature. All the popular anastomosis techniques used in open pancreas surgery are being experienced in laparoscopic pancreaticoduodenectomy. However, when they were adapted to laparoscopy, their implementation was not technically easy, and assistance of robotic surgery was sometimes required at the pancreatic anastomosis stage of the procedure. Feasibility and simplicity of a new technique have a vital role in its adaptation to laparoscopic surgery. We frequently use the extra-mucosal single row handsewn anastomosis method in open and laparoscopic surgery of the stomach, small and large bowel and we found it easy and reliable. Here, we defined the adaptation of this technique to the laparoscopic pancreas anastomosis. The outcomes were not inferior to the other previously described techniques and it has the advantage of simplicity.Öğe Extramucosal pancreaticojejunostomy at laparoscopic pancreaticoduodenectomy(Medknow publıcatıons & medıa pvt ltd, b-9, kanara busıness centre, off lınk rd, ghaktopar-e, mumbaı, 400075, ındıa, 2018) Karagul, Servet; Kayaalp, Cuneyt; Sumer, Fatih; Yagci, Mehmet AliWhile the 'best pancreatic anastomosis technique' debate is going during Whipple procedure, the laparoscopic pancreaticoduodenectomy lately began to appear more and more often in the medical literature. All the popular anastomosis techniques used in open pancreas surgery are being experienced in laparoscopic pancreaticoduodenectomy. However, when they were adapted to laparoscopy, their implementation was not technically easy, and assistance of robotic surgery was sometimes required at the pancreatic anastomosis stage of the procedure. Feasibility and simplicity of a new technique have a vital role in its adaptation to laparoscopic surgery. We frequently use the extra-mucosal single row handsewn anastomosis method in open and laparoscopic surgery of the stomach, small and large bowel and we found it easy and reliable. Here, we defined the adaptation of this technique to the laparoscopic pancreas anastomosis. The outcomes were not inferior to the other previously described techniques and it has the advantage of simplicity.Öğe Gastric bezoar after Roux-en-Y gastric bypass for morbid obesity: A case report(Elsevier Sci Ltd, 2016) Ertugrul, Ismail; Tardu, Ali Tardum; Tolan, Kerem; Kayaalp, Cuneyt; Karagul, Servet; Kirmizi, SerdarINTRODUCTION: We aimed to present a patient with gastric pouch bezoar after having a bariatric surgery. PRESENTATION OF CASE: Sixty-three years old morbid obese female had a laparoscopic Roux-en-Y gastric bypass surgery 14 months ago. She has lost 88% of her excess body mass index; but started to suffer from nausea, abdominal distention and vomiting lately, especially for the last two months. The initial evaluation by endoscopy, computed tomography (CT) and an upper gastrointestinal contrast series overlooked the pathology in the gastric pouch and did not display any abnormality. However, a second endoscopy revealed a 5 cm in diameter phytobezoar in the gastric pouch which was later endoscopically removed. After the bezoar removal, her complaints relieved completely. DISCUSSION: The gastric bezoars may be confused with the other pathologies because of the dyspeptic complaints of these patients. The patients that had a bariatric surgery; are more prone to bezoar formation due to their potential eating disorders and because of the gastro-enterostomy made to a small gastric pouch after the Roux-en-Y gastric bypass surgery. CONCLUSION: Possibility of a bezoar formation should be kept in mind in Roux-en-Y gastric bypass patients who has nausea and vomiting complaints. Removal of the bezoar provides a dramatic improvement in the complaints of these patients. (C) 2016 The Author( s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.Öğe Hemobilia due to A Tubulopapillary Adenoma of the Gallbladder(Aves, 2016) Tardu, Ali; Yagci, Mehmet Ali; Karagul, Servet; Isik, Burak; Yilmaz, SezaiAdenoma of the gallbladder is an uncommon benign tumor among pediatric patients. Rarely, it can cause of hemobilia. A 7-year-old boy was referred to our clinic due to active bleeding of the ampulla vateri, which was detected by upper gastrointestinal endoscopy. Initial hemodynamic parameters were stable. Conjunctival icterus and melena were observed on performing the physical examination. Computed tomography revealed dilatation of the common bile duct. The bleeding point was not detected on scintigraphy and angiography. During diagnosis, the hemoglobin level decreased and hemodynamic instability occurred; exploratory laparotomy was planned due to suspicion of hemobilia. A mass of gallbladder was detected, and cholecystectomy was performed. An intraoperative evaluation of the gallbladder revealed two irregular polypoid masses with coagulum; they were approximately 1 and 2 cm in diameter and on the fundus. The patient was discharged on the postoperative 13th day uneventfully. A tubulopapillary adenoma of the gallbladder was diagnosed after the patients underwent a histopathological examination. Hemobilia is a term used to describe blood in the biliary tract, and it is a rare cause of gastrointestinal bleeding. The clinical presentation of gallbladder polyps with hemodynamic instability due to tumoral hemorrhage is a challenging course for physicians. Further, preoperative determination of the source of bleeding is not always possible. Hemobilia due to gallbladder polyps must be kept in mind when gastrointestinal bleeding is present among pediatric patients.Öğe Influence of repeated measurements on small bowel length(Springer International Publishing Ag, 2016) Karagul, Servet; Kayaalp, Cuneyt; Kirmizi, Serdar; Tardu, Ali; Ertugrul, Ismail; Tolan, Kerem; Sumer, FatihPurpose: Measurement of small bowel length (SBL) is a common procedure in gastrointestinal surgery. When required, repeated SBL measurements can be done during surgery. Our aim was to evaluate whether these repeated measurements differ in SBL results. Methods: Small bowel length was measured during laparotomy in 28 patients between ligament of Treitz and caecum, using a standard measure, two times in each patient consecutively by two different surgeons from the anti-mesenteric border of the bowel. Results: The median age was 33 (19-67) including 18 male. There were 16 healthy donors for living related liver transplantations. Second measurements, performed immediately after the first measurements, significantly shortened the measured SBLs in the same patients (580 +/- 103 vs. 485 +/- 78 cm, p < 0.001). Conclusions: During surgery, repeated length measurements caused contractions in the small bowel and this resulted to a significant decrease in the SBL. This should be keep in mind to prevent mismeasurements.Öğe Initial operative experience with pancreaticoduodenectomy after fellowship training(2019) Karakose, Oktay; Karagul, Servet; Arslan, FikriAim: Pancreaticoduodenectomy is a challenging procedure used primarily for the treatment of pancreatic head cancers. The aim of this study was to share early outcomes of the first pancreaticoduodenectomy operations performed by our surgery team after completing a gastroenterological surgery and surgical oncology fellowship program. Material and Methods: Patients who underwent pancreaticoduodenectomy by the same surgical team between November 2015 and August 2018 were retrospectively analyzed. The patients’ demographic data, diagnoses, tumor characteristics, postoperative complications, mortality, and clinical findings during follow-up were recorded. Results: A total of 35 patients (21 men and 14 women) with a mean age of 65.6±18.1 years were included in the study. Mean length of hospital stay was 16.8±7.3 days. Postoperative pancreatic fistula was observed in 5 patients. Postoperative hemorrhage occurred in 3 patients and delayed gastric emptying (DGE) in 2 patients. Three patients died in the early postoperative period. Mean follow-up time of the remaining 32 patients was 22.9±8.4 months. Conclusion: Our experience demonstrates that pancreaticoduodenectomy can be performed with acceptable outcomes after fellowship training that includes pancreatic surgery.Keywords: Whipple; pancreaticoduodenectomy; initial experience.Öğe Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy(Aves, 2016) Kayaalp, Cuneyt; Soyer, Vural; Ersan, Veysel; Aydin, Cemalettin; Karagul, ServetCongenital choledochal cysts are rare in adults. Due to the risk of developing cholangiocarcinoma, the current standard of care is complete excision of the cyst and reconstruction with hepaticojejunostomy. So far, more than 200 laparoscopic resections have been reported in adults, the majority being from Far Eastern countries over the last five years. Herein, the technique of laparoscopic type I choledochal cyst excision and hepaticojejunostomy is presented in a 37-year-old male with an accompanying video. The advantages of laparoscopic surgery are applicable for choledochal cyst excision as well. We believe that teamwork, expertise on intracorporeal suturing and hepatobiliary surgery are central issues for this operation.Öğe Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer(Korean Gastric Cancer Assoc, 2016) Sumer, Fatih; Kayaalp, Cuneyt; Karagul, ServetLaparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer.Öğe Laparoscopic Treatment of Primary Hydatid Cyst of Omentum(Int College Of Surgeons, 2019) Ertugrul, Ismail; Kayaalp, Cuneyt; Dirican, Abuzer; Tardu, Ali; Karagul, Servet; Kirmizi, SerdarOmental hydatid cysts usually secondarily exist after the spontaneous, traumatic, or iatrogenic perforation of primary abdominal hydatid cysts. An isolated omental hydatid cyst in the absence of other organ involvement is very rare. Here, we present a 49-year-old male with a primary omental hydatid cyst. He was living in an urban area, but he spent his childhood in rural areas and worked with livestock. The differential diagnosis was not easy because of the negative serological test. Laparoscopic exploration revealed the diagnosis of hydatid cyst and it was removed by laparoscopy without spillage of the cyst contents. After the total excision, no albendazole treatment was prescribed. Isolated omental hydatid cysts should be in the differential diagnosis of the peritoneal cysts and its laparoscopic total excision is a feasible treatment.Öğe Management of Acute Sleeve Gastrectomy Leaks by Conversion to Roux-en-Y Gastric Bypass: a Small Case Series(Springer, 2017) Saglam, Kutay; Aktas, Aydin; Gundogan, Ersin; Ertugrul, Ismail; Tardu, Ali; Karagul, Servet; Kirmizi, SerdarManagement of early sleeve gastrectomy leak remains challenging. The recommended approach is endoscopic stenting and abdominal drainage. Conversion to a Roux-en-Y gastric bypass (RYGB) is a common procedure used for late fistulas with distal obstruction. Here, we have presented three cases of early staple line leaks treated by conversion to RYGB. These patients had uncontrolled abdominal infections despite intensive medical treatments, and surgery was elected for abdominal drainage as well as to control the source of sepsis. All the patients were discharged without problems, and successful weight loss processes continued. Conversion to RYGB of a sleeve gastrectomy leak in an acute setting can be a feasible method in the case of inevitable surgical drainage for abdominal sepsis.Öğe Reresection of Colorectal Liver Metastasis with Vena Cava Resection(Hindawi Ltd, 2016) Tardu, Ali; Kayaalp, Cuneyt; Yilmaz, Sezai; Tolan, Kerem; Ersan, Veysel; Karagul, Servet; Ertugrul, IsmailThe best known treatment of the colorectal liver metastasis is the complete surgical excision with clean surgical margins. However, liver resections sometimes cannot appear technically feasible due to the high number of metastases in the liver, in cases of recurrent resections or invasion of the tumors to the major vascular structures or neighboring organs. Here, we presented a colorectal recurrent liver metastasis invading the retrohepatic vena cava, right adrenal gland, and right diaphragm. En masse resection of the tumor with caudate hepatectomy combined with vena cava resection and surrounding adrenal and diaphragm resections was accomplished. Caval reconstruction was done by a 5 cm in length cryopreserved vena cava homograft under isolated caval clamping. Postoperative period was uneventful and she was discharged on day 11. As a conclusion, combined liver and vena cava resection for a recurrent colorectal liver metastasis is a feasible procedure even with additional neighboring organ resections. Isolated vena cava occlusion with the preservation of the hepatic blood flow may decrease the risk of liver injury in case of previous chemotherapy for liver metastasis.Öğe Retroperitoneal mass presenting as recurrent inguinal hernia: A case report(Elsevier Sci Ltd, 2016) Tardu, Ali; Yagci, Mehmet Ali; Karagul, Servet; Ertugrul, Ismail; Kayaalp, CuneytINTRODUCTION: Retroperitoneal masses presenting as an inguinal hernia are rare conditions. PRESENTATION OF CASE: A 53 year old male admitted with the symptoms of weight loss, abdominal discomfort and left sided recurrent inguinal hernia. Physical examination demonstrated an abdominal mass in the left flank and an irreducible, painless scrotal mass. He had a history of left sided inguinal hernia surgery six years ago. Computed tomography revealed a large enhancing left sided retroperitoneal mass invading the colon, pancreas and kidney and it was going down towards the left scrotum. Unblock tumor resection including the neighboring organs (left kidney, left colon, distal pancreas with spleen) was performed. Scrotal extension of the tumor was also excised and the inguinal canal was repaired primarily. Histopathology of the mass was myxoid-liposarcoma. The patient has disease free, without hernia recurrence but poor in renal function after twenty months follow-up. DISCUSSION: Large retroperitoneal tumors may grow towards the inguinal region and they can mimic an inguinal hernia. An irreducible, painless and hard scrotal mass should be considered from this perspective. (C) 2016 The Authors. Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd.Öğe Small bowel perforation due to a migrated esophageal stent: Report of a rare case and review of the literature(Elsevier Sci Ltd, 2015) Karagul, Servet; Yagci, Mehmet Ali; Ara, Cengiz; Tardu, Ali; Ertugrul, Ismail; Kirmizi, Serdar; Sumer, FatihINTRODUCTION: Endoscopic esophageal stent placement is used to treat benign strictures, esophageal perforations, fistulas and for palliative therapy of esophageal cancer. Although stent placement is safe and effective method, complications are increasing the morbidity and mortality rate. We aimed to present a patient with small bowel perforation as a consequence of migrated esophageal stent. PRESENTATION OF CASE: A77-years-old woman was admitted with complaints of abdominal pain, abdominal distension, and vomiting for two days. Her past medical history included a pancreaticoduodenectomy for pancreatic tumor 11 years ago, a partial esophagectomy for distal esophageal cancer 6 months ago and an esophageal stent placement for esophageal anastomotic stricture 2 months ago. On abdominal examination, there was generalized tenderness with rebound. Computed tomography showed the stent had migrated. Laparotomy revealed a perforation localized in the ileum due to the migrated esophageal stent. About 5 cm perforated part of gut resected and anastomosis was done. The patient was exitus fifty-five days after operation due to sepsis. DISCUSSION: Small bowel perforation is a rare but serious complication of esophageal stent migration. Resection of the esophagogastric junction facilitates the migration of the stent. The lumen of stent is often allow to the passage in the gut, so it is troublesome to find out the dislocation in an early period to avoid undesired results. In our case, resection of the esophagogastric junction was facilitated the migration of the stent and late onset of the symptoms delayed the diagnosis. CONCLUSION: Patients with esophageal stent have to follow up frequently to preclude delayed complications. Additional technical procedures are needed for the prevention of stent migration. (C) 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
