Gravescelik0958

Novel COVID-19 infectious disease typically presents with pulmonary symptoms like cough, shortness of breath, and fever. However, gastrointestinal manifestations of COVID-19 are increasingly being recognized and drawn significant attention. We report an atypical case of acute pancreatitis in a patient with SARSCoV2 infection. CT scan of the abdomen showed findings suggestive of acute interstitial edematous pancreatitis with a CT severity index was 3. HRCT chest revealed multifocal ground glass opacities in both lungs with a CORADS score of 5. Later, nasal swab for COVID RT-PCR tested positive. The patient was treated symptomatically with fluid replacement, optimization of electrolyte balance and oxygen supplementation. She had an uneventful recovery with gradual resolution of her abdominal and pulmonary symptoms. COVID-19 pathogenesis is believed to be mediated by the angiotensin converting enzyme 2 (ACE-2) receptor over the cell surface. ACE-2, which acts as a receptor for viral entry into host cells are highly expressed in pancreatic cells. All the reported cases of COVID-19 pancreatitis so far are known cases of COVID 19 pneumonia, developed acute pancreatitis or pancreatic injury in due course or during recovery of the illness. Ours is the first case to present with features of acute pancreatitis without any pulmonary symptoms, who turned out to be positive for COVID 19 during workup. Clinicians involved in the management of acute pancreatitis should be aware of its existence in the context of COVID-19. Further studies are needed to establish the real prevalence and clinical significance of pancreatic injury in COVID-19 patients.A 57-year-old Japanese female was considered for living donor liver transplantation (LDLT) due to end-stage liver cirrhosis caused by primary biliary cholangitis with portal vein thrombosis (PVT) formation. A 26-year-old daughter of the patient was selected as a living donor; however, a computed tomography examination revealed trifurcated-type portal vein anomaly (PVA). Preoperative liver volumetry showed that the right lobe graft was necessary for the recipient; therefore, reconstruction of the portal vein bifurcation during LDLT was necessary. We planned to extract the recipient's own hepatic vein grafts after total hepatectomy, and these would be attached with anterior and posterior portal branches as jump grafts. We performed laparoscopic donor hepatectomy as usual, and the recipient's hepatic vein grafts were anastomosed on the bench. Then, the liver graft was inserted, and the hepatic vein reconstruction was routinely performed. We confirmed the alignment between the recipient's portal vein and the bridged hepatic vein graft of the liver graft's posterior branch, and anastomosed these two vessels. Moreover, we confirmed the front flow and expansion of the reconstructed posterior branch by declamping only the suprapancreatic side of the portal vein. The decision regarding the punch-out location was crucial. We confirmed the alignment between the reconstructed posterior branch and the bridged hepatic vein graft of the anterior branch, and anastomosed these two vessels employing the punched-out technique. In LDLT, liver transplant surgeons occasionally encounter living donors with PVA or recipients with PVT. Our contrivance may be useful when the liver graft needs reconstruction of portal vein bifurcation.The impact and clinical spectrum of COVID-19 infection in liver transplant recipients/solid organ transplants are being unveiled during this recent pandemic. The clinical experience of use of current antiviral drugs and immunomodulators are sparse in solid organ transplantation. We present the clinical course of a 49-year-old male recipient who underwent living donor liver transplant for recurrent gastrointestinal bleed and contracted severe COVID-19 pneumonia during the third postoperative week. Herein we report the successful management of severe COVID-19 pneumonia using convalescent plasma therapy and remdesivir. Recipient's clinical deterioration was halted after three consecutive convalescent plasma transfusions with improvement in hypoxia and inflammatory markers (interleukin-6 and C-reactive protein). The use of convalescent plasma therapy along with remdesivir may be an ideal combination in the management of severe COVID-19 pneumonia in solid organ transplant recipients.Associated liver partition and portal vein ligation for staged hepatectomy - ALPPS - procedure emerged as an alternative to treat patients needing extensive hepatic resections, but with a small future liver remnant. Initially described using the left lateral segments as liver remnant, ALPPS has been adapted to leave as remainder only one segment. Describe a case of a patiente with bilobar colorectal liver metastasis submitted to segment 4-1 ALPPS. A 63-year-old man, previously submitted to transversostomy, due to a left colon stenosing adenocarcinoma, associated to bilobar liver metastasis, was referred for our evaluation, after receiving a FOLFOX based chemotherapy. Due to the large load of tumor within the liver, we opted to perform a segment 4-1 ALPPS, which was carried out with an interval of 21 days between first and second stages. The liver remnant increased from 250 cc to 694 cc (18% to 48% of standard liver volume). STING agonist The patient was discharged 15 days after second stage surgery and was subjected to left colectomy after five months. He is disease-free ten months after liver surgery. Monosegment ALPPS is a challenging, but feasible procedure, that should be criteriously indicated in selected patients and performed by a hepatobiliary surgery team with experience in complex major hepatectomies.Surgical resection for Hepatocellular carcinoma (HCC) with atrial tumor thrombus is a rare life saving procedure. A case of left lateral segment liver tumor (HCC) with atrial tumor thrombus resected with use of cardio-pulmonary bypass is presented.

In living donor hepatectomy, hepatic duct division is a crucial step and often a technical challenge, with the aim of obtaining a good hepatic duct for anastomosis in the recipient and an adequate stump in the donor for closure. Very rarely, after duct division, the remaining stump may not be adequate for primary closure. In such a difficult situation, the options would be either to close stump transversely or a Roux-en-Y Hepaticojejunostomy.

We describe a novel surgical technique of "Cystic duct patch repair", utilizing the available local tissues for closure of bile duct wall.

Two year follow up of this technique showed satisfactory results with no evidence of stricture and normal liver functions.

In living donor hepatectomy, "Cystic duct patch closure" may be used if the post closure cholangiogram is not satisfactory. Although the best method is prevention by ensuring a stump for closure, very rarely this error can occur and can be sorted by cystic duct patch repair.

In living donor hepatectomy, "Cystic duct patch closure" may be used if the post closure cholangiogram is not satisfactory.