Alaattin Öztürk

Small intestinal obstruction due to self-deflated free intragastric balloon

Morbid obesity has become a severe health problem, especially in Western countries. The prevalence of morbid obesity has been gradually increasing in recent years. Morbidly obese people develop concomitant diseases, in addition to the severity of the obesity itself. Obesity can be treated using several methods—employed individually or combined—such as diet, a change in eating habits, exercise, medical therapy, intragastric balloon implantation, or surgery. Depending on the medical condition and socioeconomic status of the patient, 1 of these methods, or a combination of them, can be used. Each method has its pros and cons. Implanting a balloon device in the stomach is a method that can accelerate weight loss by giving the patient the sensation of satiety. In the present report, we describe patients with an obstructed intestine related to the spontaneous deflation of a free intragastric balloon. Case report A 32-year-old female patient was given a free intragastric balloon implant using endoscopy at another medical center 8 months previously. The patient stated that she had lost weight after implantation of the device but reported that the weight loss had ceased during the past 2 months. She added that the sensation of satiety had also disappeared. She complained of intermittent severe stomach pain that had started 3 days before she came to our hospital. She had experienced no defecation or flatulence in those 3 days, but had vomited 7 times. Our evaluation of the patient in the emergency room revealed abdominal distension and oversensitivity. The blood test results included hemoglobin 12 mg/dl, hematocrit 39%, and white blood count 12,000/mm3. The urea, alanine aminotransferase, and aspartate aminotransferase values were normal. She informed us of the presence of an intragastric balloon (Heliosphere Intragastric Air Balloon, Helioscopie Medical Implements, Vienne, France). We ordered an abdominal computed tomography scan to investigate the possibility of a relevant complication. The computed tomography scan revealed a hyperdense material measuring 10 3.5 cm in the intestines in the right lower segment of the abdomen. The scan confirmed the presence of a dislocated implant. Dilation was present in the proximal intestine segments, which clearly verified the obstruction (Figs. 1 and 2). Thus, the patient was immediately prepared for surgery with the diagnosis of intestinal obstruction due to a deflated intragastric balloon. The abdomen was explored by way of a vertical right pararectal incision. Serous fluid was detected in the abdomen. The deflated balloon had resulted in complete obstruction in the terminal ileum. No necrosis or perforation was observed. The balloon was removed by way of enterotomy (Figs. 3 and 4). The intestine was sutured primarily. The patient was discharged on the third postoperative day.

A Case of Duodenal Obstruction and Pancreatitis Due to Intragastric Balloon

BACKGROUND Intragastric balloons have several advantages such as easy placement and low complication rates over other bariatric procedures. It is very rare for intragastric balloons to dislodge and give rise to pancreatitis. In this article, we present a case of duodenal obstruction caused by a gastric balloon leading to pancreatitis. CASE REPORT A 38-year-old obese female patient had undergone intragastric implantation one month before admission. The patient was admitted to our hospital because of sudden onset of abdominal pain. On the abdominal ultrasonography and tomography, edematous pancreatitis and cholelithiasis were observed. The patient was given medical treatment for pancreatitis. Abdominal ultrasonography was repeated on the next day, and a distended gallbladder was revealed. Thus, the patient was operated on with the pre-diagnosis of acute cholecystitis and biliary pancreatitis. Laparoscopic cholecystectomy was performed. During the operation, a hard and trapped object was determined in the second part of the duodenal lumen. The patient was reevaluated on the second postoperative day as her pain had increased. On direct abdominal X-ray and computed tomography scan, the tubular part of the gastric balloon was found to be stuck in the duodenum. A gastroscopy was performed, but the balloon could not be removed. Therefore, an immediate laparotomy was performed, and the balloon was removed via gastrotomy. CONCLUSION Although intragastric balloons are designed to reduce the risk of displacement, all unexpected patient complaints should lead to a thorough examination of the position and status of the balloon.

A Rare Parasitic Infection: Primary Intradural Extramedullary Hydatid Cyst.

Echinococcus granulosus infrequently induces spinal hydatid cysts, and intradural hydatid cysts are extremely rare among these spinal hydatid cysts. We report a 30-year-old man with a history of progressive back pain caused by a previous back injury. Magnetic resonance imaging revealed a spinal intradural cystic lesion. After surgical removal, histopathological diagnosis was a hydatid cyst. The patient had no other symptoms of systemic hydatid cyst disease. Diagnosis of hydatid cyst should be considered prior to surgery, especially in young patients with spinal intradural cystic lesions, as leakage of the hydatid cysts fluid during surgery is a frequent case of recurrence.

Recurrent and synchronous intussusception of the small intestine: a rare presentation of Peutz-Jeghers syndrome -

Peutz-Jeghers syndrome is an inherited, autosomal dominant disorder, characterized by hamartomatous polyps in the gastrointestinal tract and pigmented lesions in mucocutaneous membranes and skin. The polyps can lead to intestinal obstruction due to intussusception. Intussusception may recur in some patients, but synchronous intussusceptions are rare. A 36 years old man was admitted to hospital with abdominal pain. The abdominal tomography revealed an obstruction in the small intestine caused by invagination and a polyp in the large intestine. He had an operation due to intestinal obstruction caused by polyps 16 years ago. The patient was operated. Segmental ileum resections were performed in two different parts of ileum. The colonic polyp was removed by colotomy. The presented case is interesting because of recurrent and synchronous intussusceptions associated with Peutz-Jeghers syndrome. We want to emphasize that follow-up of patients is important as intussusception may recur.

Rektum tümörü metastazını taklit eden tüberküloz lenfadenit: Bir olgu sunumu

Tuberculous lymphadenitis mimicking metastasis of rectal cancer: a case report Treatment of rectal cancer varies on the presence of distant organ metastasis. Tuberculous lymphadenitis is a microbial disease involving mediastinal lymph nodes and may heal with anti-tuberculosis treatment. The coexistence of these two situations may lead to misunderstanding of lymphadenitis as metastasis of rectal cancer and end up with the wrong treatment strategy. We present an exemplary patient eliciting the importance of the correct diagnosis in planning the treatment.

Apandisit tanısıyla ameliyat edilen hastalarda tomografi ile Alvarado skorunun etkinliklerinin karşılaştırılması

OBJECTIVE The aim of this study is to compare the effectiveness of computed tomography and Alvarado scoring system in the diagnosis of acute appendicitis in patients who underwent appendectomy with the preliminary diagnosis of acute appendicitis. MATERIAL AND METHODS One hundred and one patients who underwent appendectomy with the diagnosis of acute appendicitis between January and December 2011 were included in the study. Alvarado scores were calculated, and abdominal tomography scans were obtained for each patient before surgery. Patients with Alvarado score ≥7 were considered to have appendicitis while patients with a score <7 were considered not to have appendicitis. Patients were classified into two groups based on the presence of appendicitis findings on abdominal tomography. Histopathological examination of the appendices was performed following appendectomy. All patients were classified into groups according to pathology results, Alvarado score and tomography findings. The effectiveness of Alvarado score and tomography were compared using the McNemar test. RESULTS Sixty patients (59.4%) were male and 41 (40.6%) were female, with a mean age of 32 years (5-85 years). The rate of negative appendectomy was 3.9%. In 78 patients (77.3%) the Alvarado score was ≥7, while 23 patients (22.7%) had Alvarado scores <7. The presence of appendicitis was determined by histopathology in 22 out of 23 patients whose Alvarado score was <7. Tomography indicated appendicitis in 97 patients (95.9%) whereas four patients (4.1%) exhibited no signs of appendicitis by tomography. However, histopathological evaluation indicated the presence of appendicitis in those four patients as well. CONCLUSION The study results imply that tomography is a more effective means of diagnosing acute appendicitis as compared to the Alvarado scoring system.

Bleeding after laparoscopic cholecystectomy: rare but serious complication -

Objective: The aim of this study is to review the data of patients who had hemorrhage due to laparoscopic cholecystectomy and to share our experience. Material and Methods: In our hospital, 865 patients underwent laparoscopic cholecystectomy between January 2006 and April 2015. Seven patients who had hemorrhage due to this surgery and needed additional surgery were included in this study, and their medical records reviewed. Patient’s age, sex, comorbid disease, hemorrhage detection time, the interventions in the second surgery, the bleeding site, bleeding causes, bleeding volume and post-operative complications were reviewed; the measures which prevent bleeding were discussed. Results: The mean age of the patients was 60 years. Three patients had comorbid disease. All patients had normal INR values preoperatively. Bleeding during surgery was detected in two patients and the operation was converted to open surgery. The bleeding of other five patients was detected 2-24 hours after surgery. Hemostasis was achieved immediately by laparotomy in two of the five patients, in two others by laparoscopy followed by laparotomy, and in one by laparoscopy alone. The bleedings were found from gallbladder bed in three patients, and the other four from cystic artery, epigastric port site, mesocolon and uncertain place. The amount of bleeding was determined to be between 300-3000 mL. No repeated bleeding or mortality was observed among our patients. Conclusion: Bleeding is a rare but serious complication after laparoscopic cholecystectomy. The most frequent bleeding location is the gallbladder bed. The patients who are suspected to have bleeding must be observed for 24 hours after surgery.

The Effect of Computed Tomography on Surgeons Decisions in Suspected Appendicitis Cases

1 Alaattin Öztürk1, Hakan Bozkurtoğlu2, Yeşim Üçkurt3, Cengiz Kaya4, Zuhal Demirhan Yananlı1, Ömer Faruk Akıncı1 1Fatih Üniversitesi Tıp Fakültesi, Genel Cerrahi Kliniği, Ankara, 2Central Hospital, Genel Cerrahi Kliniği, İzmir, 3Fatih Üniversitesi Tıp Fakültesi, Radyoloji Kliniği, Ankara, 4Pendik Devlet Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye Tomografinin Cerrahın Kararına Etkisi / The Effect of Tomography on Surgeon’s Decisions The Effect of Computed Tomography on Surgeon’s Decisions in Suspected Appendicitis Cases

Gastric necrosis due to type II paraesophageal hernia in obese patient with gastric band: rescue sleeve gastrectomy

Obesity is a risk factor for the development of paraesophageal hernia (PEH). The treatment of PEH depends on its subtype. Type I PEH is the displacement of the gastroesophageal junction into the thoracic cavity through the hiatus. In type II PEH, the gastroesophageal junction remains in its normal position but the gastric fundus migrates to the thoracic cavity. Type III PEH is a combination of types I and II. In type IV PEH, some abdominal organs, in addition to the stomach, exit through a hernia sac into the thoracic cavity. Some patients with type II PEH will be asymptomatic, and air bubbles in the thoracic cavity might be the only diagnostic finding in such cases. If gastric strangulation occurs, urgent surgical intervention is indicated. We report a case of gastric strangulation and ischemia associated with previous gastric banding in an obese patient with type II PEH.