Akın Önder

Pilonidal sinus disease: risk factors for postoperative complications and recurrence.

The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P  =  0.039). Regarding recurrence, family tendency (P  =  0.011), sinus number (P  =  0.005), cavity diameter (P  =  0.002), and primary closure (P  =  0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.

Unusual Noncommunicating Isolated Enteric Duplication Cyst in Adults

Duplication cysts are rare gastrointestinal congenital abnormalities and can occur anywhere within the gastrointestinal tract. Duplication cysts are firmly attached to or share the wall of the alimentary tract and have a common blood supply with the adjacent segment of the bowel. Completely isolated duplication cysts are an extremely rare variety of gastrointestinal duplications with their own exclusive blood supply, and they do not communicate with the intestine. These cysts are usually diagnosed during early childhood, and very rarely detected in adults, mostly incidentally, due to a lack of symptoms. A 28-year-old male was admitted to our hospital with a chief complaint of lower abdominal pain and distention and a palpable mass for 1 month. Based upon computed tomography and sonographic findings, a small bowel duplication cyst was tentatively diagnosed. The cyst had no connection to the gastrointestinal tract. Herein we report the case of a noncommunicating isolated ileal duplication cyst in an adult. Resection of the cyst was performed safely without requiring bowel resection.

Ellagic acid ameliorates lung injury after intestinal ischemia-reperfusion

Background: The aim of this study was to investigate the possible protective role of antioxidant treatment with ellagic acid (EA) on lung injury after intestinal ischemia-reperfusion (I/R) injury using biochemical and histopatological approaches. Materials and Methods: Forty rats were divided into four groups as control, control + EA, I/R, and I/R + EA. The control and control + EA groups were also anesthetized and subjected to laparotomy, but without clamp application. The control + EA and I/R + EA groups were given EA (85 mg/kg) orally prior to experiment. The I/R and I/R + EA groups underwent 30 minutes of intestinal ischemia and 1 hour of reperfusion. In all groups, serum total antioxidant capacity (TAC) and malondialdehyde (MDA) levels were determined. TAC, total oxidative status (TOS), and oxidative stress index (OSI) in lung tissue were measured. Lung tissue histopathology was also evaluated by light microscopy. Results: TAC levels were higher in control, EA, and I/R + EA groups while TOS, OSI, and MDA levels were lower in these groups compared with I/R group. Serum MDA levels were significantly higher in I/R + EA group than that of control group. Lung tissue TAC levels were lower in I/R + EA group while OSI values were higher in that groups compared with EA group. Histological tissue damage was milder in the EA treatment group than in the I/R group. Conclusion: These results suggest that EA treatment protected the rats lung tissue against intestinal I/R injury.

A Wandering Spleen Presenting as an Acute Abdomen: Case Report

BACKGROUND A wandering spleen, defined as a spleen without peritoneal attachments, is a rare entity characterized by splenic hypermobility due to laxity or maldevelopment of the supporting splenic ligaments. Patients with a wandering spleen may be asymptomatic, or may present with a palpable mass in the abdomen, or with acute, chronic, or intermittent symptoms due to torsion of the wandering spleen. Because early clinical diagnosis is difficult, imaging modalities play an important role in the diagnosis. Treatment should be planned according to the vitality of the spleen. CASE REPORT A 22-year-old woman presented with an acute abdomen that was found to be due to a wandering spleen with 720° anti-clockwise torsion around the pedicle. CONCLUSIONS Splenectomy is advocated in the presence of torsion, splenic vein thrombosis, or splenic infarction. Conversely, when a viable wandering spleen is found at laparotomy, detorsion with splenopexy is preferred.

Thymoquinone ameliorates bacterial translocation and inflammatory response in rats with intestinal obstruction

BACKGROUND Intestinal obstructions might cause mucosal disruption, motility dysfunction, increasing intestinal volume, and intestinal bacterial overgrowth; it might also result in bacterial translocation. Thymoquinone is a bioactive substance that might affect antioxidant, anticancer, antimicrobial, anti-inflammatory, and immunomodulatory activities. In this study, we aimed to investigate the effectiveness of thymoquinone against bacterial translocation and inflammatory response induced by mechanical intestinal obstruction. METHODS Thirty Wistar albino rats (200-250 g) were divided into three groups, as follows: Group 1 (sham), with only ileocaecal junction dissection; Group 2 (intestinal obstruction), with complete ileal ligation; Group 3 (intestinal obstruction+thymoquinone), with complete ileal ligation and given 10 mg/kg thymoquinone intraperitoneally. After 24 h, the rats were sacrificed by taking blood from the heart for biochemical analyses. Peritoneal swab cultures and the liver, mesenteric lymph nodes, spleen, and ileum were collected for microbiological and histopathological examinations. RESULTS Thymoquinone reduced the secretion of inflammatory cytokines, oxidative damage, and bacterial translocation, and prevented inflammatory changes in intestine and liver; it also significantly ameliorated intestinal mucosal damage after intestinal obstruction (P<0.05). CONCLUSIONS Thymoquinone was found effective in successfully controlling bacterial translocation and improving intestinal barrier function.

Percutaneous Cholecystostomy in High-Risk Elderly Patients With Acute Cholecystitis: A Lifesaving Option

Purpose: To analyze the results of percutaneous cholecystostomy in in high-risk elderly patients with acute cholecystitis. Materials and Methods: Between June 2010 and May 2011, 11 patients aged over 60 who had at least 1 systemic disease and underwent percutaneous cholecystostomy were reviewed retrospectively. Results: The procedure was technically successful in 10 (90.9%) patients. Clinical improvement was achieved in 81.8% of patients within 72 hours. Two patients received emergency surgery while elective cholecystostomy was performed in 5 patients. Percutaneous cholecystostomy was performed singly in 4 (36.4%) patients. Early complication rate was 18.2%. Two (18.2%) patients died. Conclusion: Percutaneous cholecystostomy can be performed with low mortality and morbidity. Cholecystectomy should be performed in all patients with suitable general conditions due to the high recurrence rates of percutaneous cholecystostomy.

Peptik ülser perforasyonunda morbidite ve mortaliteye etkili risk faktörleri

OBJECTIVE Peptic ulcer perforation continues to be a major surgical problem. In this study, risk factors that influence morbidity and mortality in perforated peptic ulcer disease were examined. MATERIAL AND METHODS Files of 148 patients who were included in the study due to peptic ulcer perforation between January 2006 and December 2010 were retrospectively analyzed. Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, length of hospital stay, morbidity and mortality were recorded. RESULTS The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. CONCLUSION Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation.Results: The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. Conclusion: Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation.

Spontaneous intraperitoneal rupture of a hepatic hydatid cyst.

Hydatid cysts, which are endemic to certain areas, typically are found in the liver. Spontaneous intraperitoneal rupture, which can be life threatening, is rare. This article presents a case of spontaneous rupture of a hydatid cyst in a 69-year-old woman who was admitted to the emergency department. The patient had no history of trauma. Abdominal ultrasonography and computed tomography suggested rupture of a hydatid cyst. The patient underwent a partial cystectomy, and the cystic area was washed with hypertonic saline and the peritoneal cavity was washed with isotonic saline and drained. Postoperatively, the patient was treated with albendazole for 3 months. No additional pathology was observed at the 3-, 6-, and 9-month follow-ups. Although rare, a ruptured hydatid cyst should be considered in the differential diagnosis of the acute abdomen in a patient residing in an endemic area.

Unusual extraperitoneal rectal injuries: a retrospective study.

PurposeRectal injuries, which are rarely encountered because of the anatomic characteristics, occur due to penetrating traumas. In the current study, we aimed to present experiences gleaned from our clinic concerning rarely encountered unusual rectal injuries, including those cases presented for the first time.MethodsEleven patients who had been treated for unusual rectal injuries in the General Surgery Clinic of Dicle University between 2004 and 2011 were retrospectively reviewed.ResultsThe reasons for rectal injuries included foreign bodies in four cases, sexual intercourse in three cases, iatrogenic injuries in two cases, electric shock in one case, and animal horns in one case. All cases had extraperitoneal rectal injuries and all injuries were grade 2 injuries, except for the electrical burn. Primary repair was adequate for the treatment of six patients. Four patients underwent primary repair and ostomy, whereas one of the patients underwent debridement and an ostomy. The patients recovered without complications, except for one patient with sphincter insufficiency.ConclusionThe results of the current study suggested that primary repair is adequate in the patients with low-energy injuries and early presentation, whereas an ostomy is required for those with late presentation and for those with high-energy and destructive injuries.

Factors Affecting Morbidity and Mortality in Patients Who Underwent Emergency Operation for Incarcerated Abdominal Wall Hernia

Patients with incarcerated abdominal wall hernias (AWHs) are often encountered in emergency care units. Despite advances in anesthesia, antisepsis, antibiotic therapy, and fluid therapy, the morbidity and mortality rates for these patients remain high. Between 2006 and 2011, we retrospectively analyzed the cases of 131 patients who underwent emergency surgery for incarcerated abdominal wall hernias. Of these, there were 70 women (53.4%) and 61 men (46.6%) with an average age of 63.3 ± 17.4 years (range, 17-91 years). Morbidity was observed in 28 patients (21.4%), and the mortality rate was 2.3%. Intestinal resection, presence of concomitant disease, and general anesthesia were the independent variants that affected morbidity of patients with incarcerated abdominal wall hernias.