Dursun Ali Sahin

A therapeutic and diagnostic dilemma: granular cell tumor of the breast.

Six to eight percent of granular cell tumors are seen in the breast. Although mostly benign, they rarely have malignant features clinically and radiologically reminding of breast cancer. This may lead to a potential misdiagnosis of breast carcinoma and overtreatment of patients. The final diagnosis is made by immunohistochemical examination. We performed excisional biopsy on a patient who was diagnosed to have a breast mass. The histopathological examination of the mass revealed granular cell tumor.

A rare cause of acute abdomen: jejunal diverticulosis with perforation.

Jejunal diverticulosis is generally asymptomatic and is associated with high morbidity and mortality secondary to complications, especially in elderly patients. We present a case report of a 74-year-old female patient with jejunal diverticulosis and perforation due to diverticulitis.

Paratesticular Liposarcoma: A Radiologic Pathologic Correlation

Spermatic cord liposarcoma is an uncommon paratesticular tumor. Patients usually present with a painless scrotal or inguinal mass, mimicking inguinal hernia. Clinical examination suggested an inguinal hernia. Computed tomography demonstrated a fat-containing mass in the right inguinal region. The mass was surgically removed, along with the right testis and spermatic cord. Histopathological examination revealed a well-differentiated liposarcoma. No evidence of recurrence or metastases has been noted during the two-year follow-up with postoperative adjuvant therapy.

Gastric Necrosis due to Acute Massive Gastric Dilatation

Gastric necrosis due to acute massive gastric dilatation is relatively rare. Vascular reasons, herniation, volvulus, acute gastric dilatation, anorexia, and bulimia nervosa play a role in the etiology of the disease. Early diagnosis and treatment are highly important as the associated morbidity and mortality rates are high. In this case report, we present a case of gastric necrosis due to acute gastric dilatation accompanied with the relevant literature.

Laparoscopic treatment of a phytobezoar in the duodenal diverticulum – Report of a case

INTRODUCTION Primer small intestine bezoar is seen rarely. It frequently arises from underlying small intestine pathologies (diverticle, tumor, stricture etc.). We report a very rare case of disopyrobezoar in the duodenal diverticulum, a kind of phytobezoar caused by persimmons, which was treated laparoscopically. PRESENTATION OF CASE The 47-year-old patient applied to polyclinic with complaints of epigastric tenderness, occasional distension, and acid regurgitation. In endoscopical examination, impacted bezoar was determined in the diverticulum in the duodenum. Because it is too hard, it was unable to remove endoscopically. On the abdominal tomography, a smooth-bounded non-homogeneous mass including gas and soft tissue areas in the 2nd portion of the duodenum was detected. A barium meal confirmed the presence of a 5cm diameter diverticulum on the lateral wall of the second portion of the duodenum. It also showed an intraluminalfilling defect as well as the mottled appearance of the bezoar. Learned from history of the patient, that the patient consumed over persimmon in childhood. DISCUSSION Generally, duodenal diverticles are asymptomatic. Surgical treatment is rarely necessary because of complications such as bleeding, perforation, abdominal pain, bezoar formation. As well as using methods such as gastric lavage, enzymatic dissolution, endoscopical fragmentation in the treatment of phytobezoar, their chances of success are low because its structure is rigid. Usually, surgical intervention is required. CONCLUSION For the treatments of bezoar cases located in the small intestine, laparoscopic surgical method is a safe and feasible method in selected cases.

Multiple Caeco-Appendiceal Fistulas and Diverticulosis: A Newly Defined Congenital Anomaly of the Appendix—Report of the First Case

IntroductionCongenital anomalies of the appendix are extremely rare. They are usually found incidentally during operations other than appendectomies. Congenital appendix diverticula are even less frequent.DiscussionCongenital caeco-appendiceal fistulae have not been reported until today. Herein, we present real diverticula of the appendix with multiple caeco-appendiceal fistulae which, to our knowledge, is the first in the literature.

Antral hyperplastic polyp: A rare cause of gastric outlet obstruction.

INTRODUCTION Gastric polyps are usually found incidentally during upper gastrointestinal endoscopic examinations. These polyps are generally benign, with hyperplasia being the most common. While gastric polyps are often asymptomatic, they can cause gastric outlet obstruction. PRESENTATION OF CASE A 64 years-old female patient presented to our polyclinic with a history of approximately 2 months of weakness, occasional early nausea, vomiting after meals and epigastric pain. A polypoid lesion of approximately 25 mm in diameter was detected in the antral area of the stomach, which prolapsed through the pylorus into the duodenal bulbus, and subsequently caused gastric outlet obstruction, as revealed by upper gastrointestinal endoscopy of the patient. The polyp was retrieved from the pyloric canal into the stomach with the aid of a tripod, and snare polypectomy was performed. DISCUSSION Currently, widespread use of endoscopy has led to an increase in the frequency of detecting hyperplastic polyps. While most gastric polyps are asymptomatic, they can cause iron deficiency anemia, acute pancreatitis and more commonly, gastric outlet obstruction because of their antral location. Although there are no precise principles in the treatment of asymptomatic polyps, polyps >5 mm should be removed due to the possibility of malignant transformation. CONCLUSION According to the medical evidence, polypectomy is required for gastric hyperplastic polyps because of the risks of complication and malignancy. These cases can be successfully treated endoscopically.

A Rare Stoma-Related Complication: Parastomal Evisceration

Defunctioning stoma is a commonly used colorectal surgical procedures. The stomal complications recorded are usually classified as early and late complications. Parastomal hernia is a common complication of stomal surgery. We present a very rare stoma-related complication developed after parastomal hernia and described parastomal evisceration.

Obturator Hernia: A Rare Case of Acute Mechanical Intestinal Obstruction

Obturator hernia is a rare type of pelvic hernia which generally occurs in elderly patients with accompanying diseases. Because it is difficult to diagnose before surgery, the morbidity and mortality rates for obturator hernia are high. The most common symptom is strangulation combined with mechanical intestinal obstruction.

Jejunogastric intussusception: a rare cause of gastric outlet obstruction.

A 55-year-old male patient was admitted to the emergency department with complaints of severe colicky epigastric pain, bilious vomiting and haematemesis over the previous 2 days. The patient’s medical history indicated that gastrojejunostomy (Billroth II reconstruction) surgery was performed about 15 years before to correct a duodenal ulcer, and he admitted that he had not experienced any serious dyspeptic complaints thereafter. Abdominal examination revealed a painful mass in the epigastric region with palpation. The patient’s blood pressure was 120/70 mmHg and his pulse was 88 bpm. Laboratory investigations revealed that the haemoglobin (8.2 g/dL), white blood cell count (14.000/μL), and coagulation tests were within normal range. A solid mass covered with blood, fibrin, and food residues was observed during gastroscopy, and occupied a large part of the stomach (Fig. 1). Initially, haemorrhagic gastric tumor was considered. Contrast-enhanced abdominal tomography showed a heterogeneous mass consisting of loops of the small bowel inside the enlarged stomach (Fig. 2). Laparotomy was performed to confirm a diagnosis of jejunogastric intussusception (JGI). During laparotomy, we saw that part of the afferent loop ranging from 5-cm distal to the Traitz ligament to the gastrum and part of the efferent limb of the jejunum were nutritionally impaired. We also observed that parts of both of the afferent and efferent loops were intussuscepted into the stomach (type 3). Following gastrotomy from the anterior face near the large curvature, intussuscepted gangrenous jejunal limbs forming a mass in the gastric lumen were observed. We resected the intussuscepted bowel segment, nutritionally impaired segment of the afferent loop, and part of the gastrum containing the intussuscepted segments, and performed a Rouxand-Y gastrojejunostomy (Fig. 3). No pathologic finding, apart from necrosis, was observed on pathologic examination of the invaginated segment. The patient was discharged on the 8th postoperative day without complication. JGI is a rare complication of partial gastrectomy or gastrojejunostomy (0.15%). Early diagnosis and urgent surgical intervention is essential, because a delay in treatment of more than 48 h, following onset of severe symptoms in these cases is associated with a rise of mortality rate from 10% to 50%. JGI has been described in two clinical forms, acute and chronic. In the acute form, strangulation and incarceration are encountered more frequently. The most notable complaints are severe epigastric pain, vomiting and haematemesis. In the chronic form, spontaneous reductions are seen. Therefore, complaints are not severe and accurate diagnosis is quite difficult. Gastroscopy may help in diagnosis, however, in the presence of blood, the appearance of the intussuscepted bowel loops may resemble a bleeding gastric tumour. In the acute form of the disease and also during the symptomatic period of the chronic form of the disease, the contrastenhanced abdominal tomography may show a dilated stomach with intragastric filling by bowel loops. Three anatomic types of JGI have been described: intussusception of the afferent loop (type 1), efferent loop (type 2) and both loops