İsmet Faruk Özgüner

Treatment of adolescent pilonidal disease with a new modification to the Limberg flap: Symmetrically rotated rhomboid excision and lateralization of the Limberg flap technique

BACKGROUND/PURPOSE Pilonidal disease is a common and frustrating problem among adolescents due to its high recurrence rate. The rhomboid excision and Limberg flap techniques promise successful results, but the lower part of the incision left on the intergluteal sulcus is prone to recurrences. Consequently, we have developed a new modification to this technique and have designed a descriptive prospective study to evaluate its efficiency. METHODS We conducted this prospective study between March 2011 and March 2012. All of the patients who were operated on for sacrococcygeal pilonidal disease were included in this study. The surgical procedure primarily consisted of symmetrically rotated (clockwise) rhomboid excision and lateralization of the Limberg flap in order to keep the inferior corner of the suture line apart from the intergluteal sulcus. RESULTS A total of 15 adolescents (8 boys and 7 girls) were included in the study group. Of the patients, 47% were normal, 13% were overweight, and 40% were obese. Five patients were operated on under general anesthesia, and 10 were operated on under spinal anesthesia. The length of the flap margins ranged from 2.5 to 7 cm (median=4 cm). The median duration of hospitalization was 5 days, and the median duration of suction drainage was 4 days. The median postoperative follow-up period was 4 months (ranging from 1 to 12 months), and we did not encounter any wound infection or recurrent disease during this period. Only one patient had wound hematoma as a result of drain breakdown and was treated with wound care without any additional complications. CONCLUSION Although the number of patients in this study was small and the follow-up period was short, we obtained satisfactory results without any recurrence by performing a symmetrically rotated rhomboid excision and lateralized Limberg flap procedure.

Are Neutrophil CD64 Expression and Interleukin-6 Early Useful Markers for Diagnosis of Acute Appendicitis?

BACKGROUND/PURPOSE The aim of the study is to evaluate the diagnostic value of interleukin-6 (IL-6) level and neutrophil cluster of differentiation 64 (CD64) expression in diagnosis of acute appendicitis (AA). METHODS A prospective controlled trail was performed. Children who were hospitalized with a diagnosis of right lower quadrant pain were our cohort. Serum samples for white blood cell, C-reactive protein (CRP), leukocyte CD64 expression, and IL-6 were obtained from the patients just after their admission. Operation was performed if appendicitis seemed probable, others were observed actively. Patients who had noncomplicated appendicitis were Group 1, patients who had complicated appendicitis were Group 2, and patients who had discharged after observation without operation with a diagnosis of nonspecific abdominal pain and had negative appendectomy without another surgical disease were Group 3. RESULTS In this study, 49 patients were enrolled. CRP and CD64 levels were found higher in Group 2. IL-6 levels were found to be lower in Group 3 than Groups 1 and 2. CONCLUSIONS There was a difference between Group 2 and the other groups about CD64 levels. The CRP level and expression of leukocyte CD64 level did not effectively predict the diagnosis of noncomplicated appendicitis, but it predicted well the patients with complicated appendicitis. However, IL-6 levels are statistically significantly different between Group 3 and Groups 1 and 2. According to this result, IL-6 levels predicted well the patient with appendicitis. Applying additional diagnostic methods such as IL-6 levels seems to be helpful in reducing the numbers of false-positive diagnosis of AA.

Evaluation of 968 children with corrosive substance ingestion

Background and Aims: The aim of the study was to evaluate the etiology, treatment, and prognosis in children who had presented at our clinic with corrosive substance ingestion and comparison of our results with the literature. Materials and Methods: The patients were put on nil by mouth and broad-spectrum antibiotics were administered. Oral fluids were started for patients whose intraoral lesions resolved and who could swallow their saliva. Steroids were not given, a nasogastric catheter was not placed, and early endoscopy was not used. Results: A total of 968 children presented at our clinic for corrosive substance ingestion during the 22-year period. The stricture development rate was 13.5%. Alkali substance ingestion caused a stricture development rate of 23%. A total of 54 patients required 1–52 sessions (mean 15 ±12) of dilatation. Conclusion: We do not perform early endoscopy, administer steroids, or place a nasogastric catheter at our clinic for patients who had ingested a corrosive substance. This approach has provided results similar to other series. We feel that determining the burn with early esophagoscopy when factors that prevent or decrease the development of corrosive strictures will be very important.

Congenital hemiscrotal agenesis: Report of a rare entity

Congenital scrotal agenesis is the rarest anomaly of scrotal development disorder and is characterized by the absence of scrotal rugae in the perineum between the penis and anus. We report here a case of hemiscrotal agenesis in a 2-year-old boy. To the best of our knowledge, our patient is the second reported case of hemiscrotal agenesis in the English literature.

The first male with thoracoschisis: case report and review of the literature

A male infant presented at birth with intestine and liver herniated through a defect 3 cm below the left nipple on the anterior thoracic wall. Riedel lobe, attached to the left liver lobe, and the transverse colon were seen protruding through the defect at the region of the left eighth intercostal space at surgery. A fibrous band extending from the lower defect border to the bladder was present. The hernia content was reduced inside the abdomen and the fibrous band, and Riedel lobe and necrotic-appearing omentum were excised. Thoracoschisis is a very rare congenital anomaly with only 4 cases reported. This is the first isolated thoracoschisis case without an accompanying diaphragmatic hernia.

A rare case of multiple skip segment Hirschsprung’s disease in the ileum and colon

As a rare form of Hirschsprung’s disease, skip segment Hirschsprung’s disease (SSHD) involves a “skip area” in normally ganglionated intestine, surrounded by aganglionosis. We report a case of multiple SSHD in the ileum and colon with total colonic aganglionosis. To our knowledge, this is the 27th case of SSHD, the third paper on multiple-segment SSHD, and the second patient with SSHD in the ileum to be reported in the English literature.

Complete urogenital nonunion

A 7.5-year-old boy was admitted to our department with left undescended testis. On surgical exploration, the vas deferens and epididymis were normal in appearance in its route to the scrotum, but no obvious testis or testis-like structure was identified. Exploration was extended to the abdominal cavity via the processus vaginalis, and the testis was found near the sigmoid colon without any connection to the vas deferens and epididymis. The testis was freed from surrounding structures preserving the testicular vasculature, and an orchidopexy was performed. In cases of nonpalpable testis with the vas deferens and epididymis reaching to the scrotum, an intra-abdominal testis owing to a nonunion phenomenon must be considered, and extended exploration should be performed.

Is color Doppler a reliable method for the diagnosis of malrotation

PurposeThe gold standard for the diagnosis of malrotation is barium contrast study of the upper gastrointestinal system (UGCS), while color Doppler ultrasonography (CDUS) is another method used in the diagnosis. We investigated the value of CDUS for the diagnosis of malrotation in this study.MethodsUGCS images, CDUS images, plain abdominal images, demographic data, and symptoms of 82 patients who were investigated for presumed malrotation during a 7-year period were evaluated, retrospectively.ResultsAll patients underwent CDUS, and 18% of these patients were diagnosed with malrotation as the superior mesenteric vein was seen to be on the left of the superior mesenteric artery. We found that 16% of the 75 patients who underwent UGCS were diagnosed with malrotation. The sensitivity and specificity of CDUS in the diagnosis of malrotation was found to be 93.8 and 100%, respectively. The respective values for UGCS were 91.7 and 98.4%.ConclusionCurrent data in the literature and our results underline that UGCS may yield false-positive and false-negative results. Although CDUS was found to be a reliable method for the diagnosis of malrotation in our study, the limitations of UGCS are also recognized for CDUS. Prospective studies are needed to determine the more valuable method.

Coexistence of Liver Hydatid Cyst and Brucellosis in an Adolescent

A 15-year-old girl, who was evaluated for arthralgia of knees, was diagnosed as having brucellosis by serum agglutination and enzyme linked immunosorbent assay tests. Physical examination of the patient revealed massive hepatomegaly. Abdominal ultrasonography and computerised tomography showed a single large cystic lesion of the liver. The echinococcus indirect haemagglutination was positive at a titre of 1/1280. A giant hydatid cyst was removed with surgical intervention; in addition, she was treated with albendazole and antibrucellosis drug combination with success. Here, an immunocompetent adolescent case with brucellosis and concomitant hydatid cyst disease was reported to emphasise that the coexistence of both entities are infrequent but may occur due to increased prevalence of the diseases.

Laparotomi yapılan hastalarda brid ileus risk faktörleri ve tedavi yaklaşımlarının değerlendirilmesi

Amac: Postoperatif yapisikliklar intestinal obstruksuyona yol acmasi, reoperasyon durumlarinda abdominal eksplorasyonu zorlastirmasi, organ yaralanmalarina sebep olmasi nedeniyle hem hasta hem de hekimler icin onemli bir klinik durumdur. Bu calismada brid ileus gelisimine etki eden faktorlerin saptanmasi ve brid ileusdaki tedavi sonuclarinin degerlendirilmesi amaclanmistir. Gerec ve Yontemler: 2005-2010 yillari arasinda cesitli nedenlerle laparotomi yapilan hastalar brid ileus gelisimi acisindan retrospektif olarak degerlendirildi. Bulgular: Bu calismaya l aparotomi yapilan 3271 hasta dahil edildi. Apandisit en sik laparotomi endikasyonuydu (%66). 152 hastada (%4,6) postoperatif brid ileus gelistigi tespit edildi. Bunlarin %88’inin postoperatif ilk 6 ayda, %99’unun da ilk 3 yil icinde gelistigi goruldu. Yas ve cinsiyet ile brid ileus gelisimi arasinda iliski yoktu. Vakalarin %23’u kirli vasifta ameliyatlardi. Temiz, temiz kontamine ameliyatlardan sonra brid ileus gelisme orani %3,4 iken, kontamine ve kirli ameliyatlardan sonra bu oran %10,9 olarak bulundu. Batin icerisine dren yerlestirilmesinin brid ileus gelisimini etkilemedigi saptandi. Ameliyat suresi uzadikca postoperatif brid ileus gelisme oraninin arttigi tespit edildi. Ayrica ameliyatta Meckel divertikulu gibi ek patolojiler arastirilan hastalarda brid ileus gelisme oraninin 3 kat arttirdigi goruldu. Brid ileus gelisen hastalarin %61’i nonoperatif-konservatif yollarla tedavi edilirken %39’unda cerrahi girisim gerektigi tespit edildi. Sonuclar: Calismamizda batin icinde uygulanan ek girisimlerin, operasyon suresinin uzun olmasinin ve intraperitoneal kontaminasyonun brid ileus gelisimini artirdigi gosterilmistir. Bu konulara dikkat edilmesinin brid ileus gelisimini azaltabilecegi dusunulmustur. Cocuk yas grubunda uygun vakalarda konservatif tedavi ile daha yuksek oranlarda basari saglanabilecegi kanisina varilmistir.