İhsan Yıldız

The Cause of Unexpected Acute Abdomen and Intra-Abdominal Hemorrhage in 24-Week Pregnant Woman: Bochdalek Hernia

Bochdalek hernia (BH) is the most common type of congenital diaphragm hernia and is rarely seen in adults. In adult patients, BH often remains asymptomatic or presents with nondiagnostic symptoms and may lead to complications, though rarely. The necrosis and perforations occurring in the hernia may lead to mortality. In this report, we present a 34-year-old pregnant woman at 24 gestational weeks who presented with Bochdalek hernia causing gastric volvulus associated with perforation and intra-abdominal hemorrhage associated with splenic rupture.

An unusual case of intraabdominal abscess and acute abdomen caused by axial torsion of a Meckel's diverticulum

Background Meckels diverticulum (MD), the most common congenital anomaly of the gastrointestinal tract, is a true diverticulum. MD is mostly seen in pediatric age groups but may be seen in adults as well. Is twice common in men than women. Surgical treatment is required in symptomatic MD patients. We present a 21-year-old female patient who was admitted with acute abdomen and underwent diverticulectomy with diagnosis of Meckels diverticulum. Presentation of case The 21-year-old female patient was admitted to emergency service with abdominal pain, nausea and vomiting. Physical examination revealed abdominal distention, rebound tenderness and defense. Abdominal radiography revealed air-fluid levels. White blood cell count was high. In the exploration, torsion of MD was observed and diverticulectomy was performed. Histopathologic analysis indicated the presence of MD. The patient recovered without complication, and was uneventfully discharged. Discussion MD is found in 2% of the general population. Common complications of MD include gastrointestinal bleeding, intestinal obstruction, perforation and diverticulitis. However, axial torsion of MD is a rare complication. Simple diverticulectomy is sufficient in the treatment of most MD cases; however, ileal resection may be required in some cases. Diagnosis of MD is established by histopathologic analysis. Conclusion Although MD is known as a pediatric disease, it is likely to occur in adults as well. Axial torsion of Meckels diverticulum should be kept in mind the adults presenting with symptoms of acute abdomen.

Urgent Organ Retrieval from Non-Heart-Beating Donor with Declared Brain Death: Harvest at Arrest.

OBJECTIVE Due to insufficient donor number to meet the needs of organ transplantation, new researches are ongoing. In this context, the cases with cardiac arrest and brain dead are assessed as probable donors in recent years. The aim of this study is to discuss the healthfully techniques of organs retrieval with minimum damage and maximum rapidity in conditions of our center and to present our own experiences. MATERIAL AND METHOD A total 4 of 13 patients brain dead declared and developed cardiac arrest while awaiting for laboratory test results in our center between 2015 and 2016, were urgently taken into operation under external heart massage and urgent organ retrieval were performed. The clinical data of this specific group were analyzed. Results: Thirteen donors with brain dead organ procurement were performed in our center between 2015 and 2016. Of the 13 cases, 9 had undergone urgent laparotomy and cannulation, and the organs were retrieved after in-situ cold perfusion and no problems occurred in these cases. However, in 4 cases who developed cardiac arrest ex-vivo cold perfusion was performed due to lack of facilities in operation room,vascular and paranchimal damage occurred in 2 livers and the 2 kidneys. With this technique, four liver and eight kidneys were removed and transplanted. CONCLUSION Urgent laparotomy, cannulation, and in-situ cold perfusion is ideal approach for shorter warm ischemia time and less organ damage in cadavers in difficult conditions such as sudden cardiac arrest in hospital, however ex-vivo cold perfusion technique should be kept in mind to meet the increasing of more and more organ needs.

What Kind of Incision Should Be Made to Reduce the Risk of Incisional Hernia in Kidney Transplantation

Background The incidence of incisional hernia following renal transplantation is 1.1% to 3.8%. The risk factors are immunosuppressive medications, impaired tissue quality, neuromuscular trauma due to the operation, and denervation. The incidence has been decreasing based on the shift from hockey-stick incision method to inguinal oblique incision method. The aim of this study was to minimize the development of incisional hernias due to renal transplantation. Material/Methods Twenty-four patients who underwent renal transplantation in 2015–2017 were retrospectively examined. All transplantations were performed with oblique incisions of 10–15 cm in the right or left inguinal region using polydioxanone (No. 2) loop sutures and continuous technique. Results The mean age of study patients was 43 years (range 24–67 years). The mean body mass index (BMI) was 29 kg/m2 (range 25–38 kg/m2). Of these patients, one had diabetes mellitus, two had chronic pulmonary disease, six were obese, one had poliomyelitis sequelae, and seven had hypoalbuminemia. None of the patients had ascites; five patients had a history of surgery for peritoneal dialysis. At the end of the one-year follow-up period, none of the patients had developed an incisional hernia. Conclusions We conclude that using the smallest possible semilunar line incision in the inguinal region would aid in preventing post-transplantation incisional hernias.

Amyloid Goiter Secondary to Ulcerative Colitis.

Diffuse amyloid goiter (AG) is an entity characterized by the deposition of amyloid in the thyroid gland. AG may be associated with either primary or secondary amyloidosis. Secondary amyloidosis is rarely caused by inflammatory bowel diseases. Secondary amyloidosis is relatively more common in the patients with Crohns disease, whereas it is highly rare in patients with ulcerative colitis. Diffuse amyloid goiter caused by ulcerative colitis is also a rare condition. In the presence of amyloid in the thyroid gland, medullary thyroid cancer should be kept in mind in the differential diagnosis. Imaging techniques and biochemical tests are not very helpful in the diagnosis of secondary amyloid goiter and the definitive diagnosis is established based on the histopathologic analysis and histochemical staining techniques. In this report, we present a 35-year-old male patient with diffuse amyloid goiter caused by secondary amyloidosis associated with ulcerative colitis.

The role of co-administration of damage control surgery and vacuum-assisted closure in the treatment of perineal wounds

Perineal wounds caused by high-kinetic-energy shotgun blasts have a high mortality risk because they are often accompanied by injuries of the anus, rectum, genitourinary system, and extremities. Mortality often results from hemorrhage in the early stage and from multiple organ failure caused by sepsis in the late stage. The primary step in the treatment of patients presenting with perineal wound and hemodynamic instability caused by severe hemorrhage is to control hemorrhage and contamination using damage control surgery. After achieving hemodynamic stability, vacuum-assisted closure can be used to reduce the risks of infection and sepsis. In this report, we present a case who had a perineal wound caused by a mine blast and was successfully treated by damage control surgery and vacuum-assisted closure.

Anal Fissür Tedavisinde Düşük Doz Botulinum Uygulaması ile Yüksek Doz Botulinum Uygulamasının Karşılaştırılması

Amac: Anal fissur tedavisinde kullanilan Botulinum toksininin kullanim dozlarinin komplikasyon, gec nuks ve tedavi etkinliginin arastirilmasi. Gerec ve Yontem: 2011-2013 yillari arasinda anal fissuru tedavisi icin Botulinum toksini injeksiyonu yapilan toplam 90 hastanin verileri retrospektif olarak incelendi. Uygulama sonrasi hastalarin dermografik ozellikleri ve erken (agri, hematom, infeksiyon, gaz inkontinansi, abse), gec komplikasyonlari (gayta inkontinansi, nuks) bakimindan incelendi. Bulgular: Tedavide 30 IU Botulinum uygulanan 44 hastadan 34 hastada anal fissurun tamamen iyilestigi goruldu. Iyilesme olmayan 10 hastaya 2. kez Botulinum enjeksiyonu yapildi. Semptomlari ve fissuru gerilemeyen 4 hastaya ise ayni tedavi 3. Kez tekrarlandi. 4 hastanin sonraki kontrollerinde 1 hastada tamamen iyilesme izlendi. 3 hastada yeterli iyilesme izlenmedi. Bir yillik kontrolde ise 3 hastada nuks anal fissur tespit edildi. Tedavide 90 IU ile uygulanan 46 hastadan 40 hastada anal fissurun tamamen iyilestigi goruldu. Iyilesme olmayan 6 hastanin ikisi kendi istekleri uzerine sfinkterotomi operasyonu ile tedavi edilirken diger 4 hastada yeniden Botulinum enjeksiyonu yapildi. Bu 4 hastanin sonraki kontrollerinde tamamen iyilesme izlendi. Bir yillik kontrolde ise 2 hastada nuks anal fissur tespit edildi. Sonuclar: Botulinum toksini enjeksiyonu dusuk komplikasyon ve yaklasik %90’na varan etkinligi ile guvenli bir sekilde uygulanabilir. Yuksek doz uygulamada gecici komplikasyonlar daha fazla gorulmekle birlikte tekrar uygulama gereksinimi dusuk doz uygulamaya nazaran anlamli sekilde dusuktur bu da hasta memnuniyeti ve maliyet acisindan yuksek doz uygulamayi daha tercih edilebilir bir yontem kilmaktadir.

An Extremely Rare Bile Leakage: Aberrant Bile Duct in Left Triangular Ligament (Appendix Fibrosa Hepatis)

Background The anatomical variability of bile ducts can leave surgeons in very difficult conditions.Ultrasonography, computed tomography, magnetic resonance imaging (MRCP) and endoscopic imaging methods are used in diagnosis. In addition to conservative approaches, endoscopic procedures and laparoscopic or open surgical interventions may be necessary for treatment. In this article, we present a case of aberrant bile duct in left triangular ligament (appendix fibrosa hepatis), which is rarely seen. Case We report the case of a 67-year-old female patient who was operated on due to dumping syndrome symptoms and hiatal hernia. There was a drainage of bile from the left side of the liver which was placed under the cardioesophageal junction. MRCP found bile esophageal in the left triangular ligament of the liver. Aberrant bile ducts were found in the left triangular ligament and ligated. The patient was discharged on the 7th day after operation. Conclusion The anatomical variability of bile ducts can leave surgeons in very difficult conditions. We recommend that the dissected left triangular ligament should be ligated for the aberrant bile duct, especially in female patient.

Urgent Organ Retrieval from Non-Heart-Beating Donor With Declared Brain Death

Objective Due to insufficient donor number to meet the needs of organ transplantation, new researches are ongoing. In this context, the cases with cardiac arrest and brain dead are assessed as probable donors in recent years. The aim of this study is to discuss the healthfully techniques of organs retrieval with minimum damage and maximum rapidity in conditions of our center and to present our own experiences. Material and Method A total 4 of 13 patients brain dead declared and developed cardiac arrest while waiting for laboratory test results in our center between 2015 and 2016, were urgently taken into operation under external heart massage and urgent organ retrieval were performed. The clinical data of this specific group were analyzed. Results Thirteen donors with brain dead organ procurement were performed in our center between 2015 and 2016. Of the 13 cases, 9 had undergone urgent laparotomy and cannulation, and the organs were retrieved after in-situ cold perfusion and no problems occurred in these cases. However, in 4 cases who developed cardiac arrest ex-vivo cold perfusion was performed due to lack of facilities in operation room, vascular and paranchimal damage occurred in 2 livers and the 2 kidneys. With this technique, four liver and eight kidneys were removed and transplanted. Conclusion Urgent laparotomy, cannulation, and in-situ cold perfusion is ideal approach for shorter warm ischemia time and less organ damage in cadavers in difficult conditions such as sudden cardiac arrest in hospital, however ex-vivo cold perfusion technique should be kept in mind to meet the increasing of more and more organ needs. References: 1. Dornbierer M, Stadelmann M, Sourdon J, et al. Early reperfusion hemodynamics predict recovery in rat hearts: a potential approach towards evaluating cardiac grafts from non-heart-beating donors. PLoS One. 2012;7:e43642. 2. Kootstra G, Daemen JH, Oomen AP. Categories of non-heart-beating donors. Transplant Proc. 1995;27:2893–2894. 3. Sanchez-Fructuoso AI, Prats D, Torrente J, et al. Renal transplantation from non-heart beating donors: a promising alternative to enlarge the donor pool. J Am Soc Nephrol. 2000;11:350–358. 4. Martin-Villen L, Revuelto-Rey J, Aldabo-Pallas T, et al. Non-Heart-Beating Donor Program: Results After 3 Years of Experience. Transplant Proc. 2015;47:2567–2569. 5. Khodeli N, Chkhaidze Z, Partsakhashvili D, Pilishvili O, Kordzaia D. [Theoretical Background Of Finding Organs For Transplantation Among Non-Heart Beating Donors Under Unsuccessful Extracorporeal Resuscitation (Literature Review)]. Georgian Med News. 2016:92–97. Figure. No caption available.

Emergency Endoscopy and the Importance of Endoscopy Training in General Surgery Residency: A Survey-Based Study

Background Emergency endoscopy is a life-saving technique of great significance. The aim of our study was to draw attention to endoscopy training activities of general surgeons and their opinions on this issue. Material/Methods We asked general surgery specialists where they received their general surgery training, the institution where they currently worked, how many years they had been practicing, if they had endoscopy training during or after residency, if a gastroenterologist was available in their hospital, and whether they used endoscopy. We also asked some questions, including ‘Should general surgeons perform emergency or elective endoscopy?’, ‘Is endoscopy training required in general surgery’, and ‘What is your opinion regarding this issue?’, and we assessed the answers. Results Of the 138 general surgeons undertaking surveys, 63% of participants received their general surgery training in university hospitals and 37% in training and research hospitals. The duration of practicing as a general surgeon was 5 years for 23.9%, 5–15 years for 38.4%, 15–20 years for 20.3%, and over 20 years for 17.4% of participants. The rate of receiving endoscopy training at residency was 51.4%, 25.4% did not have endoscopy training, and 23.2% had postgraduate training. All participants replied affirmatively to the question ‘Should general surgeons perform emergency or elective endoscopy?’. Conclusions Although endoscopy has been widely used recently, gastroenterologists are not available in every hospital. Consequently, it is evident that endoscopy should be part of general surgery training.