Baran Tokar

Giant mesenteric lipoma.

Mesenteric lipoma is a rare benign tumor of mature fat cells. Asymptomatic abdominal mass, progressive abdominal distension, and intraperitoneal radiolucent fat density mass on computed tomography are the main diagnostic criteria. Main differential diagnosis is lipoblastoma or lipoblastomosis. Treatment is surgical excision. As an unusual case, a 3-year-old boy with a giant mesenteric lipoma is presented in this report.

Diagnostic steps and staged operative approach in Currarino's triad: a case report and review of the literature

Abstract The Currarino triad is a combination of a presacral mass, a congenital sacral bony abnormality and an anorectal malformation. It mostly presents with constipation. Rectal examination, plain radiographs and magnetic resonance imaging are the main tools for the diagnosis. If the mass is a meningocele, colostomy and neurosurgical exploration should precede ano- plasty due to the risk of meningitis. A 14-month-old female patient with anal stenosis, a sacral scimitar defect and an anterior meningocele is presented in this report.

Effects of the anti-ICAM-1 monoclonal antibody, allopurinol, and methylene blue on intestinal reperfusion injury

PURPOSE The aim of this study was to evaluate the effect of allopurinol, methylene blue, and a monoclonal antibody to the adhesion molecule ICAM-1 in intestinal ischemia and reperfusion injury. METHODS The rats were divided into 5 groups. CG (n = 8) was untreated controls, SISG (n = 11) received sterile isotonic saline solution, ICAMG (n = 12) received a monoclonal antibody to rat ICAM-1, ALLOG (n = 12) received allopurinol, and MBG (n = 14) received methylene blue. Intestinal ischemia was performed for 60 minutes followed by 60 minutes of reperfusion. The agents were injected 10 minutes before the reperfusion to animals. After 60 minutes of reperfusion, the plasma samples for myeloperoxidase (MPO) activity, tumor necrosis factor alpha (TNF-alpha) and uric acid levels, and the intestinal biopsies of ileum and jejunum for histopathologic examination were taken. RESULTS The mucosal damage was attenuated, and TNF-alpha level significantly decreased in ALLOG and ICAMG compared with SISG. The MPO activity was the lowest in ICAMG, and uric acid level was significantly decreased in ALLOG compared with the other groups. Methylene blue decreased TNF-alpha response to reperfusion injury but significantly increased the grade of the mucosal damage and the MPO activity. CONCLUSIONS This study shows that prereperfusion application of allopurinol and monoclonal antibody to the adhesion molecule ICAM-1 may attenuate the damage caused by intestinal ischemia and reperfusion, but the different time-points for application, the effects observed in the different ischemia and reperfusion durations, and the long-term results also should be investigated in the same experimental model before the final conclusion. Methylene blue was not effective to prevent or attenuate the intestinal tissue injury, but because this was the first study examining the effect of methylene blue on intestinal reperfusion injury, further studies with the different doses, ischemic duration, and application times will be needed.

Giant rectosigmoid lithobezoar in a child: four significant clues obtained from history, abdominal palpation, rectal examination and plain abdominal X-ray

Abstract Colonic bezoars, especially lithobezoars are very rare findings in children. We report a 6-year-old girl with a giant rectosigmoid lithobezoar. History of constipation and pica, abdominal palpation of intraluminal fecoliths, a prickly hard mass found on rectal examination and plain abdominal X-ray showing radioopaque innumerable calculi scattered in colon and congregated in rectosigmoid region provide important clues for diagnosis of colonic lithobezoar.

Neutropenic enterocolitis: is it possible to break vicious circle between neutropenia and the bowel wall inflammation by surgery?

BackgroundNeutropenic enterocolitis is a devastating bowel wall inflammation in patients with protracted neutropenia. The approach for diagnosis and treatment is still controversial, and it is difficult and challenging to decide on what should be the next step in the management.Case presentationWe report a 10-year-old boy who developed neutropenic enterocolitis in the course of the conservative treatment for aplastic anemia. Oral mucositis and the perianal fissure with an ulcer were important indicators for what was happening on the colonic mucosa. Colonoscopy and biopsy confirmed the diagnosis. A fast recovery was achieved with a right hemicolectomy and ileostomy.ConclusionRetrospective analysis of the long-term follow-up of our patient suggests that defunctioning the colon by ileostomy breaks the vicious circle between neutropenia and bowel wall inflammation, and an early surgical intervention could be considered as an adjunctive approach to the conservative management of persistent cases.

Laparoscopic Approach to a Rare Cause of Ureteropelvic Junction Obstruction in a Child: Ureteral Polyp

Fibroepithelial polyps are a rare underlying reason of ureteropelvic junction obstruction. In the past, open surgery was the only option. However, due to development of minimal invasive technics, treatment alternatives have been changed. Resection by laparoscopy or endoscopy, laser fulguration and/or percutaneous resection are recommended in children and adults. Here, we present a 10-year-old boy with severe left hydronephrosis due to fibroepithelial polyp close to the ureteropelvic junction and our laparoscopic approach.

Çocuk Cerrahisi Ameliyatlarında Ameliyat Sürelerinin Belirlenmesi

Amac: Hastane verimliliginin artirilmasi ve basarili bir ameliyathane organizasyonu icin ameliyat surelerinin bilinmesi onemlidir. Bu calisma ile Cocuk Cerrahisinde en sik yapilan 3 cerrahi girisim icin ameliyathane surelerinin saptanmasi amaclanmistir. Gerec ve Yontem: Eskisehir Osmangazi Universitesi Tip Fakultesi Cocuk Cerrahisi Anabilim Dali’nda 02.01.2007–03.08.2009 yillari arasinda 3 ana grupta ameliyati gerceklestirilen toplam 860 olguda ameliyethanede gecen ortalama ameliyat oncesi, ameliyat ve ameliyat sonrasi sureleri belirlendi. Sunnet, kasik fitigi, inmemis testis nedeni ile opere olan olgular calismaya dahil edildi. Bu ana gruplar kasik fitigi ve inmemis testiste tek ve cift tarafli ve sunnetle beraber olmasina gore alt gruplara ayrildi. Bulgular: Hastalik gruplarina gore ortalama yas 1,6 yas ile 5,7 yas arasinda degismekteydi. Preoperatif ve postop bekleme sureleri degerlendirildiginde sadece sunnetin diger ameliyat alt gruplari ile karsilastirildiginda anlamli farklilik gosterecek duzeyde kisa oldugu gozlemlendi. Diger alt gruplar arasinda anlamli farklilik saptanmadi. Ortalama ameliyat sureleri tum alt gruplar icin 16,9 dakika ile 88,7 dakika arasinda degismekteydi. Ameliyat sureleri degerlendirildiginde sunnet ve tek tarafli kasik fitigi ortalama ameliyat surelerinin diger tum altgruplar ile karsilastirildiginda anlamli olarak kisa oldugu saptandi. Sonuc: Bu calisma, cocuk cerrahisinde en sik yapilan 3 ameliyat icin ameliyathane giris, ameliyat ve cikis surelerini tespit ederken, bu surelere etki eden muhtemel insan ve ameliyathane ortami ve hasta faktorlerini de tartismistir. Cerrahi girisimin surelerinin bilinmesi ameliyathanede basarili bir is akisini sagladigi gibi yasanabilecek olumsuzluklari da ortadan kaldirmaya yadimci olur

Para-axillary subcutaneous endoscopic approach in torticollis: tips and tricks in the surgical technique.

AIM An obvious scar on the neck may appear following the open surgery for congenital muscular torticollis (CMT). The cosmetic result may displease the patient and the family. In this study, we describe a minimally invasive technique, para-axillary subcutaneous endoscopic approach (PASEA) in CMT. PATIENTS AND METHODS A total of 11 children (seven girls and four boys with the age range between 1 and 15 years) were operated for torticollis by PASEA. All patients had facial asymmetry and head and neck postural abnormality. Following an incision at the ipsilateral para-axillary region, a subcutaneous cavernous working space is formed toward sternocleidomastoid (SCM) muscle. The muscle and fascia are cut by cautery under endoscopic vision. The patients had postoperative 2nd-week and 3rd-month visits. The incision scar, inspection, and palpation findings of the region, head posture, and shoulder position of the affected side were considered in evaluation of the cosmetic outcome. Preoperative and postoperative range of motion of the head and neck were compared for functional outcome. RESULTS We preferred single incision surgery in our last two patients; the rest had double para-axillary incision for port insertion. Incomplete transection of the muscle was not observed. There was no serious complication. Postoperatively, head posture and shoulder elevation were corrected significantly. Range of motion of the head was improved. Postoperatively, all the patients had rotation capacity with more than 30 degrees. The range of postoperative flexion and extension movements was between 45 and 60 degrees. CONCLUSIONS The open surgery techniques of CMT causes visible lifelong incision scar on the neck. PASEA leaves a cosmetically hidden scar in the axillary region. A single incision surgery is also possible. A well-formed cavernous working space is needed. External manual palpation, delicate dissection, and cutting of SCM muscle with cautery are the important components of the procedure. Surgeons having experience in pediatric minimal invasive surgery may consider PASEA as an alternative to the open approach in CMT. The surgeon should be familiar with surgical anatomy of the neck and must be highly competent in management of possible complications in the region.