Mehmet Fatih Benzin

Omental torsion with left-sided inguinal hernia: a rare preoperative diagnosis

Omental torsion is a rare disease. It can be difficult to identify if it is not clinically considered in the preoperative period, and this pathology may lead to an acute abdomen. We present the characteristic computed tomography findings and clinical particulars in a 34-year-old male patient with longstanding left inguinal hernia associated with an extraordinary diagnosis.

Small bowel perforation due to fish bone: A case report

Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patients diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen.

Bogota Bag Use in Planned Re-Laparotomies

Background Planned re-laparotomies are a series of surgical interventions that are rarely used and have a high mortality rate. The aim of this study was to investigate the factors affecting mortality and the effectiveness of the use of the Bogota bag for temporary closure of the abdomen in patients for whom re-laparotomy was planned. Material/Methods A retrospective examination was made of data of patients in whom a Bogota bag was used in planned re-laparotomies for various reasons in the General Surgery Department of Suleyman Demirel University Medical Faculty between June 2008 and April 2014. Results Bogota bags were used in a total of 38 patients, comprising 23 (60.5%) males and 15 (39.5%) females, with a mean age of 58.94±17.89 years. The mean period of hospitalization was 14.5 days (range, 1–143 days) and the mean number of operations during that time was 3 (range, 1–11). The mean duration of intensive care unit stay was 6 days (range, 1–143 days). Malignancy was determined in 8 patients (21.1%). Indications were intra-abdominal sepsis in 23 patients (60.5%), mesenteric vascular disease in 10 patients (26.3%), and packing was required in 5 patients (13.2%). Mortality developed in 25 patients (65.8%). A significant relationship was determined between mortality and a diagnosis of mesenteric artery ischemia (p: 0.035). The mortality rate was 56% (n: 13) in patients diagnosed with intra-abdominal sepsis. A relationship was determined between mortality and age (p: 0.015), duration of hospital stay (p: 0.007), need for cardiac inotrope (p: 0.01), and need for mechanical ventilation (p: 0.01). The mean Apache II score was 26.4±5 for patients who died and 15.8±5.2 for surviving patients (p<0.001). In 5 (38.4%) of the 13 surviving patients, primary repair was applied to the abdomen, and in the remaining 8 patients abdominal wall repair was performed using dual mesh. Conclusions In patients in whom a Bogota bag was used, which is a cheap and easy method for temporary closure of the abdomen, the high mortality rates seen are related to diagnosis, Apache II score, age, and organ failure.

A rare cause of acute abdomen: spontaneous common hepatic duct perforation.

Spontaneous extrahepatic bile duct perforation is generally seen in infants. Although rarely seen in adults, it may be seen with fatal bile peritonitis. Therefore, for a patient presenting with acute abdominal symptoms, differential diagnosis must be made with radiological imaging such as abdominal ultrasonography or computed tomography, without any loss of time. In these imaging tests, in cases of gallstone disease together with perihepatic free fluid or choledocus which can not be monitored, it should be considered in the differential diagnosis. An emergency surgical intervention should be planned to avoid serious complications. The aim of this paper was to present the rare cause of acute abdomen which developed associated with spontaneous common hepatic canal perforation in an adult.

Rare cause of oesophagus perforation.

Highlights • Oesophagus perforation is a very serious clinical event.• Mortality rates increase because inexperienced physicians cannot make a diagnosis.• Although there is no consensus in literature on surgical treatment choices.

Pneumatosis cystoides intestinalis: A rare cause of intraabdominal free air

Pneumatosis cystoides intestinalis is a rarely seen disease characterized by cysts filled with multiple gases in the wall of the small or large intestine. Many factors have been suggested in the etiology and pathogenesis, including peptic ulcer, pyloric stenosis, and endoscopic trauma. Because various clinical characteristics and symptoms are observed together, diagnosis is generally difficult. It may be a cause of free air observed on direct radiographs. Treatment is directed at the cause and although there is generally a good course, it can sometimes lead to severe complications. In this paper, we present the case of a 33-year old male being prepared for surgery for pyloric stenosis due to a peptic ulcer. In the preoperative tests, because acid was determined within the abdomen and free air below the diaphragm, pneumatosis cystoides intestinalis was considered in the differential diagnosis. Definitive diagnosis was made during the operation and surgical treatment was applied.

Development of acute cholecystitis following laparoscopic partial cholecystectomy

In cases where the dissection of Calots triangle is difficult during laparoscopic cholecystectomy, laparoscopic partial cholecystectomy is an alternative to total cholecystectomy to prevent bile duct damage. However, recurrent symptoms and bile duct problems associated with the remaining gallbladder tissue may develop in patients over time. The case of a 45-year-old male who underwent laparoscopic partial cholecystectomy one year previously is presented here. In the postoperative period, as a result of tests for the continuing symptoms of cholecystitis, stones and surrounding abscess were detected in the remaining gallbladder tissue, so open completion cholecystectomy was applied. In acute cholecystitis, as severe inflammation of the hilar structures does not allow safe dissection, partial cholecystectomy can be applied. However, in these patients, there is a risk of recurrence of cholecystitis symptoms and the development of biliary pancreatitis and choledocolithiasis because of the remaining tissue. Therefore, it should not be forgotten that endoscopic and/or surgical intervention may be necessary at least in some patients.

A rare breast tumors: Primary neuroendocrin carcinoma

Breast cancer is the most frequently seen cancer in females but primary neuroendocrine carcinoma of the breast, which was defined as a separate entity in the 2003 World Health Organisation tumour classification, is seen extremely rarely. This entity, which is still not well-defined and has not been well-researched, demonstrates a more aggressive course than invasive ductal carcinoma. As metastatic breast neuroendocrine tumours are more widespread and the treatment strategy is different, preoperative differential diagnosis is important. The basic diagnostic method is pathological examination. If a neuroendocrine pattern is determined in microscopy, then immunohistochemical study of neuroendocrine markers should be made. It is necessary to be vigilant in terms of synchronous tumours and metachronous tumours which may develop in the postoperative period as the incidence of synchronous and metachronous cancers in patients with neuroendocrine tumours is higher compared to the general population. The case presented here is of a 73-year old patient who presented with complaints of a breast lump, which was thought to be invasive breast cancer, and as a result of the operation with pathological and immunohistochemical examination, primary neuroendocrine carcinoma of the breast was determined. With more advanced evaluations, no synchronous or metachronous tumours were determined.

Memenin Paget Hastalığı Deneyimimiz

Objective: Pagets disease of the breast is a rare disease, is just 1-4.3% of all breast cancer patient and causing characteristic eczematous changes at the nipple. In this study, we aimed to present clinicopathological findings and treatment approach of the patients were treated surgically in the diagnosis of Pagets disease of thebreast. MaterialsandMethods: Thirteen patients medical records, which were treated for Pagets disease of the breast in our clinic between 2006 - 2013, were analyzed retrospectively. Results: 3.15% of patients admitted to our clinic with breast cancer has been diagnosed as Pagets disease of the breast. The median age of patients was 54 (29-87) years. It was found that the use of topical treatment of patients with lesion in the nipple causes delay in diagnosing. The other complaint of the patients was the breast mass. All patients were performed modified radical mastectomy procedure. Patients were followed up for an average of 27 (3-52) months. Radiologic examinations has shown there may be false-negative results. Ultrasonography showed no benefit, especially in patients with DCIS. There has been a patient with multiple bone metastases during follow-up. There was no recurrence or metastasis on the other patients. Conclusion: Pagets disease is primarily a clinical diagnosis. Topical treatments and diagnosing only based on radiological findings may cause delay in diagnosis. In consideration of occurrence of relapses, mastectomy is the Standard treatment. However, breast-conserving surgery can also be done in selected patients.