Erhan Akgün

Outcome Analysis in Patients With Fournier’s Gangrene

AbstractINTRODUCTION: Despite antibiotics and aggressive debridement, the mortality rate of Fournier’s gangrene remains high. Attempts have been made to study factors that may affect prognosis; however, reliable criteria are still lacking. METHODS: The medical records of 45 patients with Fournier’s gangrene who presented at the Ege University Medical Faculty Hospital from January 1990 to May 2001 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality. Univariate analysis was performed using the chi-squared test and Fisher’s exact probability test, then multivariate analysis of statistically significant variables was performed using logistic regression. RESULTS: The most prominent associated disease was diabetes, affecting 55.6 percent of the patients. The overall mortality rate was 20 percent. However, the mortality rate among diabetics was 36 percent (P = 0.002). The other statistically significant predictors of outcome were the interval from the onset of symptoms to the initial surgical intervention (P = 0.001) and the need of fecal diversion (P = 0.009). Multivariate regression analysis disclosed that the interval from the onset of symptoms to the initial surgical intervention and diabetes were independent predictors of mortality (P = 0.001 and P = 0.003, respectively). CONCLUSION: The interval from the onset of clinical symptoms to the initial surgical intervention seems to be the most important prognostic factor with a significant impact on outcome. Given the significantly high mortality rate among diabetics, diabetes is also an independent prognostic factor. Despite the decreased number of idiopathic cases and extensive therapeutic efforts, Fournier’s gangrene remains a surgical emergency, and early recognition with prompt radical debridement is the mainstays of management.

Abdominal cocoon syndrome as a rare cause of mechanical bowel obstruction: report of two cases.

An abdominal cocoon is an extremely rare condition, and has been reported mainly in young adolescent women as a cause of small bowel obstruction. In these patients, the small bowel is encased in a fibrous sac called an abdominal cocoon. We hereby present two cases who were diagnosed only by laparotomy and their correlation with the literature. They both received early intervention, thus preventing the need for bowel resection. The pathology of both membranes showed inflammation.

Foreign bodies in the rectum: An analysis of 30 patients

PurposeA foreign body in the rectum is a rare clinical entity. These foreign bodies can be classified under two major groups: the ones that are inserted from the anus and the ones that are swallowed and thereafter become stuck in the rectum.MethodsData of patients admitted with a foreign body in the rectum between 1988 and 2008 were retrospectively analyzed. A total of 30 patients were reviewed.ResultsThe most common reason for a foreign body in the rectum was insertion for erotic purposes, which was seen in 19 of the 30 patients. All these patients were male. The remaining 11 patients reported nonerotic causes. The most efficient and implemented therapeutic method was simple extraction during the first examination.ConclusionsThe most common reason for a foreign body in the rectum is insertion for erotic purposes. The first target of therapy should be extraction of the foreign body using the simplest method possible. Meanwhile, protecting the integrity of the intestine is of the utmost importance. The care for maintaining the integrity of the rectum should include an evaluation of the patient’s psychological status.

Spontaneous intestinal intramural hematoma: What to do and not to do

OBJECTIVE Spontaneous intestinal intramural hematoma is a rare complication of anticoagulant treatment. In this study, we retrospectively evaluated 14 patients with the diagnosis of intramural hematoma of the small intestine who were followed-up and treated in our clinic, and we aimed to determine current approaches in the diagnosis and treatment of intramural hematoma. MATERIAL AND METHODS Between February 2010-October 2012, 14 patients diagnosed with small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients underwent operation with a histopathological diagnosis of intramural hematoma. RESULTS Abdominal computed tomography demonstrated ileal and jejunal wall thickening in 10 patients, while findings were consistent with mesenteric vascular disease in four. Five patients were operated due to mechanical bowel obstruction and acute abdomen. The other 9 patients were followed up with medical treatment and 8 of these patients were already using warfarin due to cardiac bypass and valve replacement. CONCLUSION Spontaneous intestinal intramural hematoma is a rare cause of small bowel obstruction due to intramural hematoma, which is encountered even more rarely. An intramural hematoma should be considered among differential diagnosis of patients who present with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and elevated International Normalized Ratio (INR) levels. Early diagnosis and medical follow-up can provide a good response to treatment in the majority of patients without requiring surgery.

Recurrent Pilonidal Sinus: Lay Open or Flap Closure, Does It Differ?

Treatment options of pilonidal sinus, which has high recurrence rates, is still controversial. In this study, we aimed to analyze for possible factors affecting recurrence. Forty-one patients with recurrent pilonidal sinus were included in this study. Of them, 33 were male and 9 were female (mean age, 24.9 years; age range, 16-42). Factors (i.e., risk factors) were detected in 32 patients. Excision-secondary healing and lay open was performed on 30 of the patients admitted with recurrence. Excision and flap closure was applied on 11 patients. Our recurrence rate was 9.7%. The recurrence rate of our study is compatible with the literature. Comparative studies are needed to determine the appropriate method to decrease recurrence rate.

A new extraction technique for rectal foreign bodies with a rubber band ligation device

Foreign bodies in the rectum are a rare clinical condition that should be noted. The most frequently encountered cause is erotic activity. The first goal of the therapy is extraction of the foreign body using the simplest method possible while protecting the integrity of the intestine. Many instruments and methods have been suggested for this purpose. This report discusses a new management strategy for these patients along with a review of the literature.

Pancreatic Castleman's tumour: an unusual case.

Abstract We present an uncommon case of hyaline vascular type Castleman’s disease mimicking a pancreatic tumour. A 56-year-old woman with constitutional symptoms was investigated. Pre-operative interventions failed to produce a definitive diagnosis. Surgical excision was performed and the tumour was diagnosed to be the hyaline vascular type of Castleman’s disease histopathologically. Pancreatic Castleman’s disease should remain a consideration in the differential diagnosis of a pancreatic mass.

Complicated Meckel's diverticulum and therapeutic management.

OBJECTIVE This study aimed to investigate the treatment options and compare patient management with the literature for patients operated on for an acute abdomen who had complications due to inflammation of the Meckels diverticulum at our clinics. MATERIAL AND METHODS This study retrospectively evaluated 14 patients who had been operated on for acute abdomen and had been diagnosed with Meckels diverticulitis (MD) in Ege University Medical Faculty Department of General Surgery, between October 2007 and October 2012. RESULTS Fourteen patients with a diagnosis of Meckels diverticulitis (MD) were retrospectively analyzed. Radiologically, the abdominal computer tomography showed pathologies compatible with mechanical intestinal obstruction, Meckels diverticulitis and peridiverticular abscess, as well as detection of free air within the abdomen on direct abdominal X-ray. Among patients diagnosed with complicated Meckels diverticuli (obstruction, diverticulitis, perforation) 10 patients had partial small bowel resection and end-to-end anastomosis (71.5%), three patients underwent diverticulum excision (21.4%), and one patient underwent right hemicolectomy+ileotransversostomy (7.1%). CONCLUSION Meckels diverticulum is a vestigial remnant of an omphalomesenteric channel in the small bowel. It is a real congenital diverticular abnormality that contains all three layers of the small bowel. Surgical excision should be performed if Meckels diverticulum is detected in order to avoid incidental complications such as ulceration, bleeding, bowel obstruction, diverticulitis or perforation. Meckels diverticulitis does not have specific clinical and radiological findings. Delayed diagnosis can lead to lethal septic complications. Complications associated with Meckels diverticulitis, especially if a definite diagnosis is not made during the preoperative period, should be considered in the differential diagnosis. In the presence of a complicated diverticulum the appropriate treatment should be emergent surgical intervention.

Unexpected Benefit of the Positron Emission Tomography/Computed Tomography Using 18F-Fluorodeoxyglucose: Report of a Case

The positron emission tomography/computed tomography (PET/CT) has been a new tool utilized in the diagnosis and staging of various cancers. However, common worldwide utilization of the PET/CT includes some economic, legal, and ethic controversies. Although PET/CT scanning can detect colorectal premalignant lesions in an early treatable stage, most governments’ health care system does not pay for it as a screening test because of its economic burden. Thus, people are forced to make vital decisions about their health because of health policies of their governments. Here, we present an unusual case and discuss the utilization of PET/CT for detection of incidental neoplasms.

Steroid utilization in eosinophilic jejunitis: beneficial or harmful?

PurposeEosinophilic jejunitis is a rare disorder of undetermined origin, which is characterized by infiltration of eosinophils in the intestine. The aim of this study is to evaluate steroid therapy effect in patient treated for eosinophilic jejunitis to share our experience with other colleagues.MethodsWe report a patient with symptoms of small bowel obstruction whose diagnosis was confirmed by previous operation owing to a well-known pathology due to an unusual reason, perforation, which was masqueraded by therapeutic drugs.ResultThis clinical entity is usually encountered between the third and fifth decades. Stomach and small intestine are the most affected organs; however, it can affect any part of the gastrointestinal system. Abdominal pain and obstructive symptoms concomitant with weight loss are the common presenting complaints. According to current knowledge, avoiding unnecessary resection unless it is inevitable is an acceptable option for the management of eosinophilic jejunitis disease.ConclusionRecent data suggest that eosinophils may directly damage the gastrointestinal tract wall in eosinophilic gastroenteritis. A few limited literatures about this disease strongly recommends steroid therapy for treatment. Furthermore, beneficial or harmful effects of steroids in eosinophilic jejunitis and its treatment details are discussed and reviewed.