Bahadır Celep

A Rare Cause of Acute Abdomen: An Isolated Falciform Ligament Necrosis

The falciform ligament is one of the anatomical structures which attach the liver to the diaphragm and anterior abdominal wall. Primary falciform ligament is very rare. In this article, we present a case of an isolated falciform ligament necrosis, a rare primary pathology of the falciform ligament, who was admitted with acute abdomen. Case presentation: A 64-year-old female patient was admitted with the complaints of pain. Laboratory test results showed a leukocyte count of 17,000/mm3. Imaging studies demonstrated intra-abdominal reactionary fluid along with a heterogeneous mass localized in the falciform ligament. Exploratory laparotomy revealed a necrotic mass of the falciform ligament. No other pathology responsible for falciform ligament necrosis was found. We believe that falciform ligament necrosis should be considered a preliminary diagnosis, if any ligament abnormality, tumor, intraligament air density, or the presence of reactionary fluid surrounding the ligament is detected through abdominal imaging studies.

Does topical rifampicin reduce the risk of surgical field infection in hernia repair

OBJECTIVE Inguinal hernia operations are common procedures in general surgery. There have been many approaches in the historical development of hernia repair; tension free repair with mesh being the most commonly used technique today. Although it is a clean wound, antibiotic use is still controversial due to concerns about infection related to synthetic mesh. We aimed to determine the probable role of topical rifampicin in patients with tension-free hernia repair and mesh support. MATERIAL AND METHODS The charts of patients who underwent tension-free inguinal hernia repair were retrospectively analyzed. Information and operative notes on patients, in whom synthetic materials were used, were identified. The patients were divided into two groups, placebo group (G1) and patients with application of topical rifampicin on the mesh (G2). Infection rates between the groups in the early postoperative period were compared. RESULTS The mean age of the 278 patients who were included in the study was 49.6±15.39 and the female/male ratio was 10/268. There were recurrent hernias in four patients and superficial wound infections in 22 patients in the early period. One patient had testicle torsion and underwent an orchiectomy. There were no significant differences between the groups in terms of age and gender. The types of hernia and body mass index were homogenous between the two groups. In the early postoperative period the infection rates were 16/144 (11.1%) and 6/134 (4.48%) in the groups, respectively, with the difference being statistically significant (p=0.041). CONCLUSION We suggest that applying rifampicin locally can decrease surgical site infection in hernia operations where meshes are used.

Extralevator abdominoperineal excision versus conventional surgery for low rectal cancer: a single surgeon experience

OBJECTIVE Extralevator abdominoperineal excision (ELAPE) reduces the risk of positive circumferential resection margin (CRM) and of intraoperative perforation (IOP), both of which are associated with high local recurrence rates and poor survival outcomes for rectal cancer. The aim of this study was to compare the results of ELAPE with conventional abdominoperineal excision (APE) for low rectal cancer. MATERIAL AND METHODS A total of 25 consecutive patients underwent ELAPE for low rectal cancer between November 2008 and September 2011. Fifty-six patients treated by conventional APE prior to 2008 were selected from our rectal cancer database for comparison as a historical cohort. RESULTS The mean follow-up was 44.7 months in the ELAPE group, and 70.6 months in the APE group. Patients undergoing ELAPE had a lower CRM positivity and IOP rate than APE (12% vs. 20%, p=0,531; 4% vs. 8,9%, p=0,826; respectively). The ELAPE group was associated with higher perineal wound complications than the APE group (16.0% vs. 1.8%, p=0.030). Local recurrence rates for patients in both groups did not differ significantly (4.0% vs. 3.6%, p=1.0). CONCLUSION The results of this study suggest that ELAPE technique was associated with less CRM involvement and reduced rates of IOP but markedly higher rates of postoperative perineal complications occurred as compared to conventional surgery. ELAPE must be reserved for advanced low rectal cancers.

The effect of enoxaparin on seroma and mesh-tissue adhesion in a hernia model

The aim of this study was to investigate whether enoxaparin (ENX) administration would increase seroma risk and worsen mesh tissue recovery in an experimental rat hernia repair model. Fifty‐six adult male Wistar–Albino rats were included in the study. Rats were equally and randomly separated into seven groups: Group 1, Control, only subcutaneous dissection was performed; group 2, Sham, Hernia defect was primary sutured; Group 3, Prolene mesh; Group 4, Dual mesh; Group 5, ENX + Sham; Group 6, ENX + Prolene mesh; Group 7, ENX + Dual mesh. ENX was subcutaneously injected at a dose of 180 U/kg per day for 7 days. Rats were killed after the amount of subcutaneous seroma was determined by ultrasound on day 7 following the surgical procedure. Mesh‐tissue healing was evaluated using histopathological and immunohistochemical (CD31) staining methods. The mean seroma amount significantly increased in Groups 5–7 compared to Groups 2–4. CD31 immunostaining showed a reduction in neovascularization in Groups 6 and 7, compared to Groups 3 and 4. Neovascularization decreased and hemorrhage, necrosis and oedema findings remarkably increased in Groups 6 and 7, when compared to Groups 3 and 4. Fibroblastic activity and inflammation were more prominent in Groups 3 and 4. It should be kept in mind that ENX interferes with inflammation, which is desired in the early period of healing and leads to an increase in overall seroma amount with anti‐coagulant effects, which in turn may disrupt wound healing and mesh‐tissue adhesions, as was indicated in our study.

Kolesistektomi sonrası kolestaz nedeni olarak Dubin-Johnson sendromu; Olgu sunumu ve literatür incelemesi

Dubin Johnson syndrome (DJS), also known as Sprinz-Nelson syndrome is a hereditary disease characterized by conjugated hiperbillirubinemi induced by chronic mild stress. DJS are frequently diagnosed during late adolescence and early adulthood. The patients apply with an itching jaundice, vague abdominal pain, nausea and vomiting. Physical examination is usually accompanied by jaundice, but sometimes hepatomegaly can find out. The disease is usually indolent and does not cause chronic liver failure. Although rifampicin and usodeoksikolik acid may be used in a therapy, the optimal treatment is not still found out. In this article we presented DJS to cause of persistent conjugated hiperbillirubinemi in patient undergoing laparoscopic cholecystectomy because of symptomatic cholelithiasis with literature data

Our results of lower gastrointestinal endoscopy: evaluation of 700 patients.

OBJECTIVE Although radiological imaging modalities like barium enema and computed tomography provide some clues, endoscopic methods still maintain superiority in assessment and differential diagnosis of large intestinal symptoms and complaints that require biopsy. We aimed to present the results of colonoscopic procedures performed in our general surgery clinic in detail. MATERIAL AND METHODS Seven hundred patients who presented to Afyon Kocatepe University, Faculty of Medicine, Department of General Surgery Endoscopy Unit between January 2011 and July 2012 with an indication for colonoscopy were retrospectively evaluated. RESULTS Out of the 700 patients enrolled in the study 356 (50.8%) were male while 344 patients (49.2%) were female. The mean age of the patients was found to be 49 years. Within the group of 700 patients who underwent colonoscopic examinations, the terminal ileum and cecum have been reached on the first attempt in 432 patients (61.7%) and colonoscopic success has been achieved. Results of colonoscopies performed on 700 patients in our clinic revealed malignancy in 42 (6%) patients, and all of these patients were treated surgically in our clinic. Mortality was not observed in this series. Procedure-related bleeding and perforation developed in 6 patients. One patient developed respiratory arrest due to sedation and patient was responsive to resuscitation. The complication rate in our series was 1%. CONCLUSION In the study where we revised our own clinical experience, we found that our success rate was lower than the literature, and our complication rate was higher. The main reasons are accepted as our colonoscopy units being young and the low patient volume.

WARFARİN OVERDOZUNA BAĞLI İNTRAMURAL İNTESTİNAL HEMATOM OLGUSU

Tromboembolik olaylarin onlenmesinde etkili olan warfarin tedavisinde duzenli ilac kullanimi ve koagulasyon degerlerinin takibi onemlidir. 70 yasinda erkek hasta karin agrisi ile basvurdu. Ozgecmisinde mitral kapak replasmani operasyonu ve tromboemboli profilaksisi icin warfarin tedavisi aldigi ogrenildi. Fizik muayenesinde yaygin periton irritasyon bulgulari mevcuttu. Karin tomografisinde ileum seviyesinde duvar kalinlasmasi, ince barsak mezenterinde ve pelvik peritoneal kompartimanlarda hemoraji ile uyumlu yuksek dansiteli serbest sivi saptandi. Takibinde akut karin ve ileus hali gerilemeyen hasta ameliyata alindi. Explorasyonda karin ici yaklasik 1000 ml kanli serbest mayi saptandi ve ileocekal valvin 150 cm proksimalinde yaklasik 20 cm lik ileumda intramural hematom ve perforasyon alanlari saptandi. Hastaya parsiyel ince barsak rezeksiyonu operasyonu uygulandi. Tedavisi oncelikle medikal olan intramural intestinal hematomda; barsak iskemisi, perforasyon, nekroz gelismesi durumunda cerrahi tedavi gerekebilir. Oral antikoagulasyon kullanan bir hasta sayet akut karin ya da ileus tablosu ile basvurdugunda koagulasyon ilacina bagli intramural intestinal kanama akilda tutulmalidir.

A retained plastic protective cover mimicking malignancy: Case report.

INTRODUCTION Cases of retained foreign bodies during surgery are more frequently seen in developing countries. Following surgical procedures, unintentionally retained foreign bodies can cause serious complications, in addition to medico-legal issues. PRESENTATION OF CASE A 60-year-old man presented with abdominal cramps. He had previously undergone a laparoscopic radical right nephrectomy due to renal cell carcinoma. Abdominal tomography revealed a mass surrounding the main vascular structures with malignant features in the location of previously performed nephrectomy. Further evaluation of the mass was undertaken by PET/CT. Increased FDG uptake on the PET/CT scan suggested disease recurrence. Retroperitoneal lymph node dissection was performed. The dissection specimen was opened to determine the nature of the mass. Retained plastic foreign bodies were found. There were no malignant cells in the histopathological examination of the surgical specimen. DISCUSSION A granulomatous reaction which is mainly responsible for morbidity occurs around the foreign bodies due to the inflammatory response. These granulomas may cause confusion during patient follow-up, especially in those who have undergone major abdominal surgery due to cancer. CONCLUSION Following surgical resection for malignancy, unintentionally retained foreign bodies can produce a moderate increase in FDG uptake mimicking disease recurrence.