Erdem Barış Cartı

Pancreatic Carcinosarcoma: Case Report of a Rare Type of Pancreatic Neoplasia

CONTEXT Carcinosarcoma of the pancreas is a rare entity comprising a small subset of all pancreatic neoplasms. Diagnosis is usually established by immunohistochemical examination of the resected specimen. Prognosis is limited to several months after resection. CASE REPORT We review the current literature on this rare type of neoplasia, considering histopathological and clinical features. The pathologic findings revealed areas of both adenocarcinoma and sarcoma of the pancreas. The adenocarcinomatous areas localized to the tumor within the head of the pancreas whereas the sarcomatous areas localized to regions of the intraductal component. DISCUSSION Carcinosarcoma of the pancreas is a rare disease having a dismal prognosis. To our knowledge, this carcinosarcoma is the very rare reported case of a primary pancreatic neoplasm with mixed carcinomatous and sarcomatous components.

Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin

Introduction Hypertriglyceridaemia (HT)-induced pancreatitis rarely occurs unless triglyceride levels exceed 1000 mg/dl. Hypertriglyceridaemia over 1,000 mg/dl can provoke acute pancreatitis (AP) and its persistence can worsen the clinical outcome. In contrast, a rapid decrease in triglyceride level is beneficial. Insulin-stimulated lipoprotein lipase is known to decrease serum triglyceride levels. However, their efficacy in HT-induced AP is not well documented. Aim To present 12 cases of AP successfully treated by insulin administration. Material and methods Three hundred and forty-three cases of AP were diagnosed at our clinic between 2005 and 2012. Twelve (3.5%) of these cases were HT-induced AP. Twelve patients who suffered HT-induced AP are reported. Initial blood triglyceride levels were above 1000 mg/dl. Besides the usual treatment of AP, insulin was administered intravenously in continuous infusion. The patients’ medical records were retrospectively evaluated in this study. Results Serum triglyceride levels decreased to < 500 mg/dl within 2–3 days. No complications of treatment were seen and good clinical outcome was observed. Conclusions Our results are compatible with the literature. Insulin may be used safely and effectively in HT-induced AP therapy. Administration of insulin is efficient when used to reduce triglyceride levels in patients with HT-induced AP.

Determination of optimal operation time for the management of acute cholecystitis: a clinical trial

Introduction Although all studies have reported that laparoscopic cholecystectomy (LC) is a safe and effective treatment for acute cholecystitis, the optimal timing for the procedure is still the subject of some debate. Aim This retrospective analysis of a prospective database was aimed at comparing early with delayed LC for acute cholecystitis. Material and methods The LC was performed in 165 patients, of whom 83 were operated within 72 h of admission (group 1) and 82 patients after 72 h (group 2) with acute cholecystitis between January 2012 and August 2013. All data were collected prospectively and both groups compared in terms of age, sex, fever, white blood count count, ultrasound findings, operation time, conversion to open surgery, complications and mean hospital stay. Results The study included 165 patients, 53 men and 112 women, who had median age 54 (20–85) years. The overall conversion rate was 27.9%. There was no significant difference in conversion rates (21% vs. 34%) between groups (p = 0.08). The operation time (116 min vs. 102 min, p = 0.02) was significantly increased in group 1. The complication rates (9% vs. 18%, p = 0.03) and total hospital stay (3.8 days vs. 7.9 days, p = 0.001) were significantly reduced in group 1. Conclusions Early LC within 72 h of admission reduces complications and hospital stay and is the preferred approach for acute cholecystitis.

Neutropenic enterocolitis secondary to propylthiouracil-induced agranulocytosis.

First described by Cooke in 1930 (1), neutropenic enterocolitis (NE), also termed necrotizing enterocolitis or neutropenic typhlitis, is a necrotizing inflammatory disease of the ileocecal region. Its pathogenesis is not entirely known. It is a complication of severe neutropenia and often occurs after high-dose chemotherapy. An association between NE and the use of certain antineoplastic drugs has been described (2,3). Propylthiouracil (PTU) is used widely in the treatment of hyperthyroid disorders. Its most notable side effect is decrease in the neutrophilic granulocyte count. Development of agranulocytosis is related to the dose of the anti-thyroid drug administered (4).

A rare cause of duodenal obstruction: Bouveret syndrome

Gallstone ileus is a relatively rare pathology, most commonly obstructing the terminal ileum. Bouveret syndrome is a syndrome found particularly in elderly patients, which develops as the result of a cholecystoenteric fistula. It leads to the gastric outlet obstruction and has an incidence of less than 1%. In this report, we presented a 95-year-old patient diagnosed with Bouveret syndrome.

Comparison of T and N Staging on Preoperative Magnetic Resonance Imaging and Postoperative Histopathologic Specimens in Rectum Cancer

Amaç: Günümüzde rektum cerrahisinde preoperatif dönemde manyetik rezonans görüntüleme (MRG) en çok kullanılan tanı yöntemlerinden birisidir. Çalışmamızda rektum kanserli hastalarda, MRG’nin preoperatif evrelemesi ile histopatolojik evrelemenin uyumunu araştırmayı planladık. Yöntem: Adnan Menderes Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı’nda Eylül 2014-Kasım 2016 tarihleri arasında rektum kanseri nedeniyle ameliyat edilmiş 56 hasta çalışmaya dahil edildi. T ve N değerleri preoperatif ve histopatolojik olarak karşılaştırıldı. Bulgular: Çalışmaya 56 hasta alındı. Ortalama yaşı 66,05 (38-88) idi. Tümörlerin yerleşim yerine bakıldığında %29,8’i alt rektum, %32,3’ü orta rektum, %37,9’u ise üst rektum olarak gözlendi. MRG’de N(+) 21 olgu saptanırken bunlardan sadece 15’i patolojik olarak da N(+) olarak saptandı. MR’de 35 olgu N(-) saptanırken bunlardan 19’u patolojik olarak N(-) saptandı. N(+)’de duyarlılığı %71,4 iken, N(-)’lerde bu oran %54,3 olarak gözlendi. T değerlerine bakıldığında ise MR ile histopatolojik evreleme arasında istatistiksel bir anlamlılık olduğu gözlendi (p=0,049). Sonuç: Günümüz rektum kanserlerinde preoperatif görüntüleme yöntemlerinden ilk başvurulacaklardan birisi yüksek çözünürlüklü MRG olmakla birlikte, tanıda kuşku duyulması halinde ek görüntüleme yöntemleri de mutlaka kullanılmalıdır. Anahtar Kelimeler: Rektum kanseri, manyetik rezonans görüntüleme, evreleme ÖZ ABSTRACT

Obturator Hernia in Elderly Female Patients

Obturator hernia (OH) constitutes 0.07% to 0.4% of all intraabdominal hernias and 0.2% to 5.8% of small intestinal hernias. OH is usually seen in elderly, multiparous females and patients with a lo...

Recurrent Pilonidal Disease Surgery; Is It Second Primary or Reoperative Surgery?

OBJECTIVE Pilonidal sinus disease (PSD) effects mainly young mens social and work life with frequent recurrence rate. Reoperation for unimproved or recurrent disease is somehow troublesome. Surgeons may think that changing treatment strategy after recurrence may prevent further relapses of PSD. We analyzed patients with recurrent pilonidal sinus to determine their predisposing features for recurrence and the outcomes of the preferred surgical methods. MATERIAL AND METHODS From 2007 to 2012, out of 95 recurrent pilonidal sinus disease (rPSD) patients, 62 operated cases were included and examined retrospectively. Their retrospective data were examined for demographics, 1(st) and 2(nd) operation types, patient satisfaction and pain scores. For cases with insufficient preoperative or postoperative data, phone call and interviews were done to obtain data. Some were kindly invited to the outpatient examination. Students t test, Mann-Whitney U test, and Kaplan Meier test for disease free survival time were used where appropriate. P values less than 0.05 were accepted to be statistically significant. RESULTS Total of 62 rPSD patients were examined. Male:female ratio was 2.9:1. The mean age after 1(st) and 2(nd) operations were 24.7 and 28.1 years, respectively. One and five-year recurrence rates were 33.9% and 66.1%, respectively. The mean interval between the 1(st) and 2(nd) operations was 45.6 months. Excision and midline closure was the most frequent type of operation followed by flap reconstructions and excision-lay open procedures. The 1(st) operation types of rPSD cases were different from that of 2(nd) operations. Pain perception and satisfaction scores were better in flap reconstruction groups. CONCLUSION Reoperative surgery of rPSD is satisfactory with certain precautions. Relapses after flap reconstruction procedures with a well-being period should be referred as second primary disease. Changing surgical strategy is not always indicated as some patients with recurrence have relapsing or second primary disease that have distinct clinical course. Re-flap surgery after any kind of relapse is well appreciated.

A bizarre presentation of pancreatitis with Bryant's sign

Most patients with acute pancreatitis recover uneventfully with appropriate medical management. However, life-threatening complications develop in 20-25% of cases, and various early surgical measures have been proposed for treating these patients (1). A 57-year-old man was admitted because of abdominal pain and vomiting; he had a history of right inguinal hernia and type 1 diabetes mellitus. Physical examination revealed mild abdominal distention, no incision scar, abdominal tenderness, minimal bowel sounds, a tender and bruised scrotum, and an irreducible hernia. Abdominal radiography revealed abnormal small intestinal air fluid levels, and ultrasonography revealed fluid in the hernia and abdomen. Emergency surgery for the strangulated inguinal hernia was initiated, and opening of the hernia sac revealed intestinal segments with bloody, gray fluid. A midline incision subsequently re vealed necrotizing, hemorrhagic pancreatitis with cholelithiasis. Cholecystectomy and necrosectomy were performed, and multiple abdominal drainage catheters were placed. Somatostatin analogue (SSA) was started afterward for fistula control. However, we observed that jejunal fluid oozed from the drainage catheters, despite administration of SSA. At the sites of the midline, inguinal, and scrotal incisions, we also observed multiple fistulas oozing pancreatic fluid (Figure 1). En doscopic retrograde cholangiopancreatography (ERCP) revealed bile leakage from the cystic stump; therefore, a plastic stent was inserted into the ductus choledochus. Twenty days after the operation, ileum fluid was still ob served, and subsequent reoperation revealed perforation of the ileum at the ileocecal junction. Per-operative surgeon performed ERCP do not revealed any bile leakage, and plastic stent placement and maturation of the loop ileostomy appeared appropriate. Unfortunately, biliary fluid leakage persisted, and a third ERCP was per formed, during which leakage from the cystic stump was still noted. A nasobiliary drainage catheter was inserted, and the fistula subsequently resolved. At the 45th day after admission, the patient was discharged well and was recommended outpatient monitoring. He was well after 6months of discharge.