Fevzi Cengiz

Management of rectal foreign bodies

BackgroundEntrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault.MethodsBetween 1999 and 2009, 15 patients with foreign bodies in the rectum were diagnosed and treated, at Izmir Training and Research Hospital, in Izmir. Information regarding the foreign body, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients.ResultsAll patients were males, and their mean age was 48 years (range, 33–68 years). The objects in the rectum of these 15 patients were an impulse body spray can (4 patients), a bottle (4 patients), a dildo (2 patient), an eggplant (1 patient), a brush (1 patient), a tea glass (1 patient), a ball point pen (1 patient) and a wishbone (1 patient, after oral ingestion). Twelve objects were removed transanally by anal dilatation under general anesthesia. Three patients required laparotomy. Routine rectosigmoidoscopic examination was performed after removal. One patient had perforation of the rectosigmoid and 4 had lacerations of the mucosa. None of the patients died.ConclusionsForeign bodies in the rectum should be managed in a well-organized manner. The diagnosis is confirmed by plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is only possible for very low-lying objects. Patients with high- lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body.

Sentinel lymph node biopsy in breast cancer: predictors of axillary and non-sentinel lymph node involvement.

BACKGROUND Sentinel lymph node biopsy is a standard method for the evaluation of axillary status in patients with T1-2N0M0 breast cancers. AIMS To determine the prognostic significance of primary tumour-related clinico-histopathological factors on axillary and non-sentinel lymph node involvement of patients who underwent sentinel lymph node biopsy. STUDY DESIGN Retrospective clinical study. METHODS In the present study, 157 sentinel lymph node biopsies were performed in 151 consecutive patients with early stage breast cancer between June 2008 and December 2011. RESULTS Successful lymphatic mapping was obtained in 157 of 158 procedures (99.4%). The incidence of larger tumour size (2.543±1.21 vs. 1.974±1.04), lymphatic vessel invasion (70.6% vs. 29.4%), blood vessel invasion (84.2% vs. 15.8%), and invasive lobular carcinoma subtype (72.7% vs. 27.3%) were statistically significantly higher in patients with positive SLNs. Logistic stepwise regression analysis disclosed tumour size (odds ratio: 1.51, p=0.0021) and lymphatic vessel invasion (odds ratio: 4.68, p=0.001) as significant primary tumour-related prognostic determinants of SLN metastasis. CONCLUSION A close relationship was identified between tumour size and lymphatic vessel invasion of the primary tumour and axillary lymph node involvement. However, the positive predictive value of these two independent variables is low and there is no compelling evidence to recommend their use in routine clinical practice.

Extramedullary plasmacytoma of the colon: a case report

Kolonda nonobstruktif kitle nedenleri arasinda cok nadir gorulen, siklikla akla pek gelmeyen nedenlerden biri de ekstrameduller plazmasitomlardir. Plazmasitomlar plazma hucrelerinin anormal proliferasyonu sonucunda olusur- lar. Sistemik tutulum varliginda multipl miyelom olarak adlandirilirlar. Nadir olarak ise (%4) ekstrameduller alan- larda gorulurler, siklikla ust solunum yolunu tutarlar. Ekstrameduller plazmasitomlar nadir olarak gastrointestinal sistemi tutarlar. Bu olguda gastrointestinal kitleye neden olan nadir gorulen ekstrameduller plazmasitomlarin nadir tutulum sekli olan inen kolonda plazmasitom olgusu sunulmaktadir. Anahtar Kelimeler: Ekstrameduller plazmasitom, multipl miyelom, kolon kanserleri A rare and elusive cause of nonobstructive mass in colon is extramedullary plasmacytoma. Plasmacytoma is a neo- plastic proliferation of plasma cells; when systemic involvement occurs, the disease is named multiple myeloma. Extramedullary plasmacytomas comprise 4% of all plasma cell tumours and occur mainly in the upper respiratory tract; gastrointestinal system involvement is rare. In this case we describe a rare cause of gastrointestinal system mass: extramedullary plasmacytoma involving the left colon.Extramedullary plasmacytoma is a rare cause of nonobstructive colonic masses, which is often disregarded. Plasmacytoma is a neoplastic proliferation of plasma cells; when systemic involvement occurs, the disease is named multiple myeloma. Extramedullary plasmacytomas comprise 4% of all plasma cell tumours and occur mainly in the upper respiratory tract; gastrointestinal system involvement is rare. In this case we describe a rare cause of gastrointestinal system mass: extramedullary plasmacytoma involving the left colon.

Kolonda nadir görülen ekstramedüller plazmasitom olgusu

Kolonda nonobstruktif kitle nedenleri arasinda cok nadir gorulen, siklikla akla pek gelmeyen nedenlerden biri de ekstrameduller plazmasitomlardir. Plazmasitomlar plazma hucrelerinin anormal proliferasyonu sonucunda olusur- lar. Sistemik tutulum varliginda multipl miyelom olarak adlandirilirlar. Nadir olarak ise (%4) ekstrameduller alan- larda gorulurler, siklikla ust solunum yolunu tutarlar. Ekstrameduller plazmasitomlar nadir olarak gastrointestinal sistemi tutarlar. Bu olguda gastrointestinal kitleye neden olan nadir gorulen ekstrameduller plazmasitomlarin nadir tutulum sekli olan inen kolonda plazmasitom olgusu sunulmaktadir. Anahtar Kelimeler: Ekstrameduller plazmasitom, multipl miyelom, kolon kanserleri A rare and elusive cause of nonobstructive mass in colon is extramedullary plasmacytoma. Plasmacytoma is a neo- plastic proliferation of plasma cells; when systemic involvement occurs, the disease is named multiple myeloma. Extramedullary plasmacytomas comprise 4% of all plasma cell tumours and occur mainly in the upper respiratory tract; gastrointestinal system involvement is rare. In this case we describe a rare cause of gastrointestinal system mass: extramedullary plasmacytoma involving the left colon.Extramedullary plasmacytoma is a rare cause of nonobstructive colonic masses, which is often disregarded. Plasmacytoma is a neoplastic proliferation of plasma cells; when systemic involvement occurs, the disease is named multiple myeloma. Extramedullary plasmacytomas comprise 4% of all plasma cell tumours and occur mainly in the upper respiratory tract; gastrointestinal system involvement is rare. In this case we describe a rare cause of gastrointestinal system mass: extramedullary plasmacytoma involving the left colon.

Intestinal Necrosis due to Giant Ovarian Cyst: A Case Report

Intestinal pathologies due to ovarian cyst are observed rarely. Although a limited number of cases in neonatal and adolescent periods have been observed, no adult case has been reported in the literature. Two mechanisms are involved in intestinal complications due to ovarian cysts: torsion due to adhesion or compression of giant ovarian mass with a diameter of 9-10 cm. We report here a terminal ileum necrosis case due to compression by an ovarian cyst with 11 × 10 × 7 cm size in an 81-year-old woman.

Endoscopic extirpation of a fork after three days; Case report and review of the literature

DOI: 10.4328/JCAM.5790 Received: 26.02.2018 Accepted: 20.03.2018 Publihed Online: 21.03.2018 Printed: 01.09.2018 J Clin Anal Med 2018;9(5): 463-5 Corresponding Author: Fevzi Cengiz, Department of Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, 35360, Turkey. T.: +9

Adjuvant versus neoadjuvant chemoradiotherapy in distal rectal cancer: Comparison of two decades in a single center

OBJECTIVE Standard surgery alone was not able to decrease local recurrence (LR) rate below 20% in rectal cancer treatment. Thus, many centers administered neoadjuvant radiotherapy (preopRTx) with or without concomitant chemotherapy for the prevention of LR. In this study, the results of 164 consecutive patients with mid- and distal rectal cancer who received surgery and adjuvant chemoradiotherapy (Group A) or neoadjuvant chemoradiotherapy (Group NA) followed by surgery are presented. MATERIAL AND METHODS The staging system used in this study is that of the American Joint Committee on Cancer (AJCC), also known as the TNM system. Eligible patients were required to have radiologically assessed stage 1 (only T2N0M0) to stage 3C (T4bN1-2M0) tumor with pathologically confirmed R0 resection. The surgical method was total mesorectal excision (TME). Radiotherapy was applied with daily 180 cGy fractions for 28 consecutive days. Chemo-therapy comprised 5-fluorouracil (450 mg/m(2)/d) and leucovorin (20 mg/m(2)/d) bolus at days 1-5 and 29-33. RESULTS Nine patients (13%) in Group NA achieved pathologic complete response (pCR). In Group NA and Group A, locoregional recurrence (LRR) rates were 6.7% and 30.8%, (p<0.001), the mean LR-free survival was 190.0±7.3 months and 148.0±11.7 months (p=0.002) and the mean overall survival (OS) was 119.2±15.3 months and 103.0±9.4 months (p=0.23), respectively. A significant difference with regard to LR has been obtained with a statistical power of 0.92. Secondary outcome measures (DFS and OS) have not been met. CONCLUSION Neoadjuvant chemoradiotherapy with TME is an efficient treatment protocol, particularly for the treatment of magnetic resonance imaging-staged 2A to 3C patients with two or three distal rectal adenocarcinomas. Given that a considerable proportion of patients with cT2N0M0 would develop pCR, this method of treatment can be considered for further studies.

Heterotopic gastric mucosa of upper oesophagus: evaluation of 12 cases during gastroscopic examination

Introduction Oesophageal heterotopic gastric mucosa mostly presents in the upper part of the oesophagus. It is commonly under-diagnosed because of its localisation. Aim To expose the association between heterotopic gastric mucosa and endoscopic features of the upper gastrointestinal tract. Material and methods A total of 1860 upper endoscopic examinations performed between January 2012 and July 2013 were analysed retrospectively. Endoscopic features and histological examinations of 12 heterotopic gastric mucosa (HGM) of the upper oesophagus were documented and evaluated retrospectively. Results There were 7 (58%) male and 5 (42%) female patients aged between 22 and 80 years with a mean age of 43.2 years. Heterotopic gastric mucosa was present in 12 (0.6%) of all patients. We were able to perform biopsy for histopathological observation on 8 (66%) of the 12 patients in which HGM was seen during endoscopy. Five (42%) patients with heterotopic gastric mucosa had oesophagitis. Los Angeles Grade A oesophagitis was found in all patients, and histologically proven Barretts oesophagus was detected in only one patient. Conclusions When a patient has ongoing dyspeptic complaints and reflux symptoms despite the treatment, one should be careful about possible HGM during upper gastrointestinal endoscopy. The point to be taken into consideration for patients who have metaplasia or dysplasia within HGM may need to be considered for surveillance.

A rare cause of acute abdomen: Splenic hematoma and rupture resulting from pancreatitis.

Splenic subcapsular hematoma and splenic rupture due to pancreatitis are rare causes of acute abdomen. Here we report a case of splenic hematoma and rupture resulting from a second attack of pancreatitis in a 38 year-old woman with chronic pancreatitis due to alcoholism. Her first pancreatitis attack, 4 months before the second, was complicated with a pancreatic pseudocyst that was drained and acute renal failure. The patient underwent pancreatic necrosectomy and splenectomy, and was discharged on the sixth postoperative day without any further complication. We conclude that splenic hematoma, a complication of pancreatitis attack, which may require emergency surgical intervention, must be kept in mind in order to make an early diagnosis. Considering a possible subsequent attack of pancreatitis and determining follow-up criteria, radical treatment must be planned immediately.

Same Surgery - Altered Techniques; Past, Present and Future of Laparoscopic and Endoscopic Surgery

Özet Tıp tarihinde ilk medeniyetlerden itibaren tüpler tedavi ve tanı koymak amacı ile kullanılmıştır. İlk tarif edilen endoskopik inceleme yöntemi rektal spekulumdur. 1805 yılında Phillip Bozzini günümüzdeki endoskopların ilkini icat etmiş, Antoine Jean Desormeaux Bozzini’nin Lichtleiter’ını geliştirerek çok amaçlı bir endoskop oluşturmuştur. 1901 yılında Georg Kelling sistoskopu karın boşluğunu incelemek için köpeğin karnına sokması ile tüplerin intraabdominal kullanımı(laparoskopi) başlamıştır. Kurt Semm’in, yaptığı çalışmalar sayesinde laparoskopik enstrümanlar ve teknikte gerçek dramatik gelişmeler olmuştur. John E.A. Wickham 1983’de ilk kez minimal invaziv cerrahi terimini kullanmıştır. Yazımızın amacı ortak başlangıcı olan endoskopi ve laparoskopinin 2004’de Natural Orifice Transluminal Endoscopic Surgery (NOTES) tekniğinin de gelişmesi ile cerrahları translüminal yaklaşıma yönlendirmektir.