Hakan Özdemir

Intestinal Obstruction due to Colonic Lithobezoar: A Case Report and a Review of the Literature

Bezoar is defined as the accumulation of undigested foreign bodies or nutrients in the gastrointestinal tract. These foreign bodies can be hair (trichobezoar), fibers or seeds of vegetables and fruits (phytobezoar), or remnants of milk (lactobezoar) and stones (lithobezoar). Lithobezoar, the accumulation of stones in the digestive tract, is commonly seen in stomach. In this paper, a 7-year-old girl with colonic lithobezoar who presented with constipation, abdominal pain, and the history of pica was successfully treated by the extraction of the stones under general anesthesia.

Rapunzel Syndrome Case Report: A 13-year-old Girl

Bezoars are masses, which are commonly encountered in patients after stomach surgery or in those with psychiatric problems, formed by the accumulation of intraluminal nondigestible substances that can lead to obstruction of the stomach and the small intestine. The anatomical changes in the gastrointestinal tract are known to cause bezoar formation. In the absence of an anatomical change, psychiatric disorders such as trichotillomania may lead to the formation of trichobezoars in the stomach. The so-called Rapunzel syndrome is the extension of the bezoars down to the duodenum and the jejunum, which is a rare condition. In this paper, a 13-year-old patient with trichotillomania is reported, who was admitted to our clinic with nausea, vomiting, and fatigue complaints, in whom a giant trichobezoar was identified, which completely filled the stomach and duodenum, without causing obstruction.

Comparison of the reliability of scoring systems in the light of histopathological results in the diagnosis of acute appendicitis

Background: Acute appendicitis is a very common surgical emergency. Early and correct diagnosis and early intervention are necessary to prevent complications. It is often diagnosed on clinical signs and a certain ratio of negative appendectomy is acceptable. For early and accurate diagnosis, various scoring systems such as Alvarado, Ohmann, Eskelinen and more recently Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) have been developed. Objective: In this study, we aimed to compare the effectiveness and accuracy of scoring systems. Materials and methods: The patients who attended emergency department and operated with acute appendicitis pre-diagnosis were evaluated retrospectively. Alvarado, Ohmann, Eskelinen, and RIPASA scores were calculated and compared with histopathologic results by reviewing the patient files. Results: A total of 76 patients (44 males and 32 females) were included in the study. The mean age was 33.8 ± 13.2 years. Of which, 59 patients (77.6%) were diagnosed to have acute appendicitis on histopathological examination. The mean leukocyte count was 13.9 ± 3.7 × 103 μL. Sensitivity and specificity of Alvarado, Ohmann, Eskelinen, and RIPASA were 36%–82%; 58%–71%; 36%–8%, and 68%–71%, respectively. Cut-off values were 8, 14, 55.63, and 10, respectively. RIPASA had the highest accuracy. The cut-off value of leukocyte counts was 13,900 × 103/μL. Sensitivity and specificity were 64% and 88%, respectively; positive predictive value was 95%. In the receiver operating curve analysis, the area under the curve was found to be 74%. Conclusion: The RIPASA scoring system is a more reliable scoring system than Ohmann, Eskelinen, and Alvarado scoring systems. In cases of suspected acute appendicitis, it may be useful to evaluate patients with RIPASA score in emergency departments by general practitioners, where there is no general surgeon. Thus, patients can be guided in a timely manner to reduce the complications that may arise from delays. The cut-off value of 13,900 × 103/μL is an important marker for the presence of acute appendicitis.

KESKiN KENARLI ÖZEFAGUS YABANCI CiSiMLERiNDE RiJiD ENDOSKOPiNiN ÖNEMi

Ozefagus perforasyonlari, yuksek mortaliteye sahip acil vakalardir. iyatrojenik, spontan veya ya- banci cisme bagli olabilir. Yabanci cisim varliginda, ilk teshis yontemi radyolojik goruntuleme ve en onemli mudahale yontemi, endoskopidir. Fleksibl endoskopi, kullanim kolayligi, yaygin kullanimi ve dusuk komplikasyon riski nedeniyle ilk secilecek yontemdir. Rijid endoskopi, deneyim ve genel anestezi gerektirmesi nedeniyle nadiren kullanilir. 54 yasinda kadin hasta yemek borusuna kaz kemigi parcasi takilmasi sikayetiyle basvurdu. Direk grafide servikal ozefagusda yabanci cisim goruldu. Fleksibl endoskopi ile cisim cikarilamadi ve kontrol BTsinde komsu dokularda serbest hava ve servikal ozefagusda perforasyon goruldu. Genel anestezi altinda rijid endoskop ile cikarildi. Ozefagus yabanci cisimleri, vakit kaybetmeden cikarilmalidir. Ozefagus perforasyonlarinda klasik yaklasim erken vakalarda primer tamir ve gec vakalarda rezeksiyon ve anastomozdur.. Klinigi stabil hastalar non-operatif takip edilebilir; endoskopik stent ve klip uygulama ve perkutan abse drenaji ile major cerrahi gereksinimi azaltilabilir. Fleksibl endoskopi keskin kenarli ozefagus yabanci cisim- lerini cikarmada yetersiz kalirsa, rijid endoskopi daha uygun olabilir. Anahtar kelimeler: Ozefagus; Yabanci cisim; Endoskopi ABSTRACT Esophageal perforations are emergent cases. They may be iatrogenic, spontaneous or because of foreign body. The first diagnostic tool and intervention are imaging and flexible endoscopy in the case of foreign body. Flexible endoscopy is easy to use, widely available and has a low complication rate. Rigid endoscopy needs experience and general anesthesia. 54-years-old female patient came with the complaint of goose bone piece impaction in esophagus. Direct graphs showed the foreign body in cervical esophagus. Flexible endoscopy failed and control CT revealed free air around cervical esophagus and perforation. It was removed by rigid endoscopy. Esophageal foreign bodies must be removed immediately. If perforation occurs, main approach is primary repair in early and, resection and anastomosis in late ones. Non-operative treatment may be tried in clinically stable patients. Endoscopic stenting, clip application, and percuatenous abcess drainage may decrease surgery need. If flexible endoscopy fails, rigid endoscopy may be more appropriate. Key words: Esophagus; Foreign body; Endoscopy

Akut Apandisiti Taklit Eden Nadir Bir Patoloji; Epiploik Apandajit

Özet Olgu Sunumu / Case Report Özdemir ve Ark. Akut Apandisiti Taklit eden Epiploik Apandajit Sakaryamj 2014;4(3):135-138 Giriş Apendices epiploicae are pedunculated formations that are developing in the 2nd trimester of the fetal period. They present on the colon from cecum to sigmoid colon in two lines, each are measuring 0.5-5 cm in length and have a peritoneum covering. Their blood supply come from the branches of colic arteries. Their peduncles allow them move freely and set the stage for infarct development by becoming torsed. Primary epiploic appendagitis (PEA) which is a self-limited inflammatory disease is rarely diagnosed clinically. The twisting of the epiploica results in ischemic, initially with venous comprimise (low pressure) and the arterial occlusion. This condition, defined as PEA, mimics surgical acute abdomen although it is not a pathology necessitating surgery. Case 1 A 20-year-old male patient weighing 78 kg, presented to the emergency room complaining of pain for 2 days localized at a point right of the umbilicus. Upon physical examination, bowel sounds were hypoactive and there was guarding and rebound tenderness in the right lower quadrant. He had a fever of 37.2 C with a leukocyte count of 12300/μL, with no nausea, vomiting or diarrhea. His laboratory tests were nonspecific. Abdominal ultrasonography (USG) demonstrated pericecal free fluid with no other pathology. The surgeon thought acute appendicitis and done laparotomy via McBurney insicion. Pericecal serous fluid with a torsed appendix epiploica was identified (Figure 1). There wasn’t any other pathology. The ischemic appendix epiploica was excised. Figure 1: Case 1. Primary epiploic appendagitis Case 2 An 18-year-old male patient weighing 65 kg, presented to the emergency department complaining of pain for 3 days, which gradually increased in intensity and localized at a point in the right lower quadrant. Bowel sounds were hypoactive on physical examination, the right lower quadrant was guarding, and there was rebound tenderness. He had a fever of 37.7 C with a leukocyte count of 11800/μL, with no nausea, vomiting or diarrhea. There were no pathological findings in the abdominal ultrasonography. The appendix was 6 mm in diameter on the abdominal computed tomography (CT), and there was free fluid next to it. The patient underwent laparotomy for the diagnosis of acute appendicitis. Pericecal serous fluid with a torsed appendix epiploica neighboring the appendix was identified upon exploration (Figure 2). This necrotic appendix epiploica was excised and an appendectomy was done. Figure 2. Case 2. View of cecal primary epiploic appendagitis Discussion PEA is seen more frequently in middle-aged males, though it can be seen in any age. Incidence of PEA is higher in the sigmoid colon, which is the place where appendix epiploica most 136

Sacrococcygeal Foreign Body Progressing with Pilonidal Sinus Clinical Picture: Report of a Case

BACKGROUND Pilonidal sinus is a benign anorectal disease that is frequently seen in the sacrococcygeal area when a foreign body reaction develops after the invasion of hair follicles. OBJECTIVES Trauma in this region and clinical abscesses that recur after trauma due to foreign bodies are not frequently observed. CASE REPORT This study presents the case of a patient with chronic leakage who had a history of three surgical procedures due to recurrent pilonidal abscesses and the presence of a foreign body in the sacrococcygeal area. CONCLUSION The presence of a foreign body in cases progressing with a single and wide inlet and frequently recurring abscess formation is a condition of which to be aware.