Ismail Zengin

Treatment results of small bowel perforations due to unusual causes

Objectives: Although non-traumatic Small Bowel Perforations (SBPs) are rare, they have high rates of morbidity and mortality in case of late presentation. Aetiological factors vary across different geographical regions. In this paper, SBPs caused by anything other than trauma and other well-known causes are presented and the current literature is reviewed. Methods: The study was conducted at General Surgery Clinics of two different tertiary university hospitals between January 2008 and September 2016. The authors directly involved in managing the patients. This study was approved by the ethical institutional board and was performed at the Department of General Surgery, School of Medicine, Sakarya University. The medical records of patients retained in both hospitals are electronic. Medical records of subjects who had undergone emergency operations with a prediagnosis of acute abdomen in single center, and were determined to have SBPs due to unusual causes, were investigated retrospectively. Patients with aetiological factors such as trauma, mesenteric vascular disease, internal and external hernias, intra abdominal adhesions, inflammatory bowel diseases, and iatrogenic causes were excluded. Results: In total, 35 patients were evaluated, 20 (57.1%) males and 15 (42.9%) females. The mean age of the cases was 51.6 (18–88) years. Mean time until admission at the hospital was 1.4 days (range 0.25–7 days). The most frequent aetiological factors were various malignancies (10 cases, 28.5%) and perforation of Meckel’s diverticulum (8 cases, 22.8%). It was surprising to detect a considerable rate of perforation due to bezoars (6 patients, 17.1%). Conclusions: Post-operative consequences of SBPs due to unusual causes are similar with those related to common, known causes. Factors affecting the clinical course are presentation time and patients’ clinical status in admission, not aetiology.

Choledochal cysts- Classification, physiopathology, and clinical course

Although biliary canal cysts were first described around the 1720s, the aetiology, physiopathology, natural course, and treatment options of the disease remain controversial. These cysts are becoming more common and can now be more easily diagnosed thanks to recent developments in imaging methods. Nevertheless, if left un-diagnosed, the risk of progressive complications such as spontaneous perforation, cholelithiasis, choledocholi-thiasis, cholangitis, secondary biliary cirrhosis, portal hypertension, and development of malignancies should be considered. In this review, we discuss the epidemiology, classification, physiopathology, carcinogenesis, and clinical course of biliary cysts. Introduction Choledochal cysts (CCs) are rare medical conditions, which are congenital cystic dilatations of any portion of the bile ducts, most often occurring in the main portion of the common bile duct. Although choledochal cysts are considered a disorder of childhood and infancy, the ages in reported cases range from newly born to 80 years old; however 60% of such cysts are diagnosed in patients less than 10 years old [1-6]. Epidemiology Choledochal cysts (CCs) are extremely rare with an incidence of about 1/100–150,000 in Western societies. The disease affects 1 in 13,500 live births in the USA and 1 in 15,000 live births in Australia. It is seen more fre-quently in Asians; two out of three cases are of Japanese origin despite the reported incidence of 1/1,000. There is significant female gender predominance (F/M: 3–4/1). The cause of this female and Asian origin predomin-ance is unknown [6]. Classification Alonso-Lej defined three types of biliary dilatations in 1959; this classification system has since been widely accepted. Todani expanded this classification in 1977 and divided the CCs into five subgroups. Todani re-modified the classification to include pancreatic junctional abnormalities, and the resulting system became the final and most commonly used classification method [6] (Table 1) (Figure 1). According to the Todani classifi-cation, CCs are classified as follows: Correspondence to: Mustafa Yener Uzunoglu, Sakarya Üniversitesi Egitim ve Arastırma Hastanesi, Adnan Menderes Cad. Sağlık Sok. No: 195 Adapazarı, 54100, Sakarya, Turkey, Tel: +905056503394, E-mail: drmyuzunoglu@gmail.com

Coexisting Situs Inversus Totalis and Immune Thrombocytopenic Purpura

Situs inversus totalis is a rare congenital abnormality with mirror symmetry of mediastinal and abdominal organs. Immune thrombocytopenic purpura is an autoimmune disease with destruction of thrombocytes. This paper is presentation of surgical approach to a case with coexistence of these two conditions.

Retroanastomotic hernia after Moynihan's gastroenterostomy.

Retroanastomotic hernias after gastroenterostomies-either antecolic or retrocolic-are extremely rare but are associated with high mortality rates due to delayed identification which precludes immediate surgical reduction. In this report, we present a 77-year-old man with retroanastomotic herniation of the efferent loop segments that occurred 14 years after a Moynihans gastroenterostomy.

Indirect inguinal hernia sac containing testis and spermatic cord in an adult patient with cryptorchidism.

Sliding hernias are those in which part of the sac wall is formed by a retroperitoneal organ and/or its mesentery protruding outside the abdominal wall cavity. The hernia sac may contain jejunum, ileum, vermiform appendix, Meckels diverticulum, stomach, ovary, fallopian tube or urinary bladder. Our report features an adult case with cryptorchidism in which testis and spermatic cord constitute a component of the indirect inguinal hernia sac.