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    Barolith as a rare cause of acute appendicitis: a case report
    (Turkish Assoc Trauma Emergency Surgery, 2013) Ince, Volkan; Isik, Burak; Koc, Cemalettin; Baskiran, Adil; Onur, Asim
    A barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualized in 80-90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90 similar to 95%), and 10% of the patients retain barium in the appendix beyond 72 hours. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double-contrast barium enema study. After barium studies, patients should be informed regarding retention of barium in the appendix and the possibility that it can cause acute appendicitis. Thus, if abdominal pain develops, the patient can be referred quickly to a medical center for the appropriate treatment and the complications of acute appendicitis can be prevented with early intervention.
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    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, Cuneyt
    Krukenberg 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.
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    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, Asim
    INTRODUCTION: 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.
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    Life-Threatening Near-Miss Complications of Donor in Living Donor Liver Transplantation
    (Lippincott Williams & Wilkins, 2015) Onur, Asim; Dirican, Abuzer; Soyer, Vural; Sarici, Baris; Koc, Suleyman; Ates, Mustafa; Koc, Cemalettin
    [Abstract Not Available]
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    Life-threatening or nearly life-threatening complications in living liver donors
    (Wiley, 2018) Onur, Asim; Akbulut, Sami; Dirican, Abuzer; Isik, Burak; Yilmaz, Sezai
    ObjectiveTo determine the relationship between a transplant center's experience and life-threatening or nearly life-threatening complications during living donor hepatectomy (LDH). MethodsThe medical records of 1140 patients who underwent LDH were analyzed. To determine the relationship between life-threatening complications and a transplant center's experience, the following comparisons between LDH cases were performed: first 100 vs subsequent 100; first 100 vs subsequent 1040; first 200 vs subsequent 940; right hepatectomy vs left hepatectomy; and first 5years of experience vs subsequent 5years. ResultsA total of 36 life-threatening or nearly life-threatening complications developed in 34 of 1140 (2.98%) healthy individuals undergoing LDH. Of these, 5 occurred intraoperatively, 26 within 1month, and 5 beyond 1month. The most common complications were biliary problems and postoperative bleeding. None of the donors died at follow-up. One donor underwent deceased donor liver transplantation (DDLT) for severe hepatic failure. Only 2 comparisons were significantly different with regard to life-threatening complications: the first 100 vs the subsequent 1040 (P=.03) and the first 200 vs the subsequent 940 (P=.01). ConclusionThis study indicates that the incidence of life-threatening or nearly life-threatening complications are reduced by increased center experience (>200 LDHs).
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    Living donor liver transplantation for Echinococcus Alveolaris: single-center experience
    (Wiley-Blackwell, 2015) Ozdemir, Fatih; Ince, Volkan; Barut, Bora; Onur, Asim; Kayaalp, Cuneyt; Yilmaz, Sezai
    Echinococcus alveolaris (EA) causes a hepatic zoonotic infection and behaves like a malignant tumor during invasion. Liver transplantation (LT) is the only curative treatment option for this unresectable disease. Here, we share our experience with living donor liver transplantation (LDLT) due to EA from the time between March 2002 and November 2014 at the Liver Transplantation Institute of nonu University. Ten patients (mean age, 38.6 years) undergoing LDLT because of unresectable EA were evaluated preoperatively, and the operative and follow-up data were analyzed retrospectively. The mean time interval between diagnosis and LT was 27 months. The mean operation time and mean intraoperative blood requirement were 613 minutes and 4 units of packed red blood cells, respectively. Diaphragmatic resections were performed in 3 patients, and vena cava replacement was performed in 2 patients because of difficulties in removing the extended disease. The local recurrence and distant metastasis rates were 10% and 20%, respectively. The mean survival time was 19.5 months (range, 0-54 months), and the mortality rate was 30%. Unresectable hepatic alveolar echinococcosis is a rare indication for LT and presents some technical difficulties during surgery because diaphragmatic resection, vascular reconstruction, or multiple blood transfusions may be needed. LDLT can be performed successfully in patients with this rare infectious disease, with careful follow-up for potential recurrence and metastasis and administration of low-dose immunosuppressive agents. Liver Transpl 21:1091-1095, 2015. (c) 2015 AASLD.
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    Use of the Right Lobe Graft With Double Hepatic Arteries in Living-Donor Liver Transplant
    (Baskent Univ, 2022) Cakir, Tugrul; Sabuncuoglu, M. Zafer; Soyer, Vural; Sarici, Baris; Koc, Suleyman; Onur, Asim; Unal, Bulent
    Objectives: We aimed to examine management of double hepatic artery reconstruction in patients under going living-donor liver transplant. Materials and Methods: Between January 2002 and June 2014, one thousand thirty-six living-donor liver transplants were performed at the Liver Transplant Institute of Malatya Inonu University. Living liver grafts with a single hepatic artery were used in 983 living-donor liver transplants, while grafts with double hepatic artery branches were used in 53 living-donor liver transplants. All of the liver grafts with double hepatic artery branches were right lobe grafts. Hepatic artery anastomosis technique and the other medical data of recipients who used grafts with double hepatic arteries were analyzed retrospectively. Results: A double hepatic artery anastomosis was created in 43 recipients, while a single anastomosis was created in the remaining 10 because of ligation of the nondominant hepatic artery branch. In 40 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right and left hepatic artery. In the remaining 3 recipients, double hepatic artery branches in the graft were anastomosed with the recipient's right hepatic artery and large segment 4 hepatic arteries. Postoperative complications related with hepatic artery anastomoses developed in 3 recipients: hepatic artery thrombosis (n = 1), hepatic artery aneurysm (n = 1), and hepatic artery stenosis (n = 1). A recipient with hepatic artery aneurysm immediately underwent a retransplant. A recipient with a hepatic artery thrombosis relapsed and required retransplant, which was treated with thrombectomy on postoperative day 10. A recipient with hepatic artery stenosis was followed conservatively. In our series, the incidence of complications related with double hepatic artery anastomosis was found to be 6.9%. Conclusions: According to our experiences, a double hepatic artery anastomosis does not increase the risk of hepatic artery thrombosis and can be performed safely by surgeons who are experienced with hepatic vascular reconstructions in a living-donor liver transplant recipient.