Orhan Veli Ozkan

Aetiology of idiopathic granulomatous mastitis

Idiopathic granulomatous mastitis is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The most common clinical presentation is an unilateral, discrete breast mass, nipple retraction and even a sinus formation often associated with an inflammation of the overlying skin. The etiology of idiopathic granulomatous mastitis is still obscure. Its treatment remains controversial. The cause may be the autoimmune process, infection, a chemical reaction associated with oral contraceptive pills, or even lactation. Various factors, including hormonal imbalance, autoimmunity, unknown microbiological agents, smoking and α 1-antitrypsin deficiency have been suggested to play a role in disease aetiology. In this review, causing factors in the aetiology of idiopathic granulomatous mastitis are reviewed in detail.

Intestinal obstruction due to phytobezoars: An update

The term bezoar refers to an intraluminal mass in the gastrointestinal system caused by the accumulation of indigestible ingested materials, such as vegetables, fruits, and hair. Bezoars are responsible for 0.4%-4% of cases of mechanical intestinal obstruction. The clinical findings of bezoar-induced ileus do not differ from those of mechanical intestinal obstruction due to other causes. The appearance and localization of bezoars can be established with various imaging methods. Treatment of choice depends on the localization of the bezoar which makes the clinical findings.

Mean platelet volume as a potential prognostic marker in patients with acute mesenteric ischemia–retrospective study

IntroductionWe investigated prognostic parameters of patients who underwent surgical intervention for acute mesenteric ischemia by evaluating demographic characteristics and laboratory data on admission.MethodsThe hospital records of 30 patients who underwent surgical interventions due to acute mesenteric ischemia between January 2008 and December 2012, were reviewed retrospectively. The records were investigated with regard to demographic data, the presence of co-morbid diseases, presenting complaints, time elapsed between symptom onset and hospital admission, laboratory findings at admission, findings at surgical exploration, surgical methods used, and treatment outcomes. The patients were divided into two groups, according to death (Group 1) or survival (Group 2), and the two groups were compared in terms of the specified parameters.ResultsOf the patients, 15 were male (50%) and 15 female (50%); their mean age was 71.4 (29–94) years. Abdominal pain was the chief complaint in all patients (100%) and mean time from pain onset to hospital admission was 21 (1–72) h. In abdominal exploration, total small bowel (SB) ischemia and necrosis was found in 6 (20%) patients and other patients had subtotal SB, segmental SB, segmental SB with colon, or isolated colon ischemia. Treatment in 15 patients (50%) ended in mortality. Mean age (p = 0.038), urea (p = 0.002), AST (p < 0.001), ALT (p < 0.001), mean platelet volume (MPV; p = 0.002), and amylase (p = 0.022) levels in Group 1 were significantly higher versus Group 2, whereas Ca (p = 0.024) and albumin (p = 0.002) levels were significantly lower.ConclusionsIn this study, unlike other parameters that have been shown to be of prognostic significance in mesenteric ischemia, MPV values at presentation were higher among non-survivors than survivors.

Rare entity: Ectopic liver tissue in the wall of the gallbladder - A case report

Ectopic liver tissue (ELT) is a rare condition, which is usually not diagnosed preoperatively, but coincidentally during abdominal surgery. While the location of ELT can vary, it is usually localized on the gallbladder wall or in close proximity. ELT is associated with various complications, a major complication being extrahepatic hepatocellular carcinoma. A 59-year-old female underwent elective surgery for chronic cholecystitis with stones. During laparoscopic exploration, a 2-cm-diameter ELT was detected in the anterior gallbladder wall and a laparoscopic cholecystectomy was performed. The case is presented due to the rare nature of ELT and as a reminder of ELT-related complications.

Gossypiboma causing mechanical intestinal obstruction: a case report.

Introduction. Gossypiboma (GP) is a term used to express the mass resulting from forgotten cotton sponge in operations. Rarely, a transmural migration may occur into the gastrointestinal lumen without creating any defect by GP. Laparotomy or endoscopic removal may be required, by the way it can be taken out of the body itself by intestinal ways. In this study, we reported a case of mechanical intestinal obstruction causing GP. Case. The fifty-one-year-old female patient admitted to the emergency department with the complaints of mechanical intestinal obstruction and had a history of open cholecystectomy 20 years ago. There were the findings of intestinal obstruction in abdominal plain radiography and computerized tomography. The sponge that obstructed the lumen completely 40 cm proximal to the ileocecal valve was identified in the laparotomy with the diagnosis of brid ileus. The small intestine was closed over double-fold after removal of sponge. Transmural migration of abdominal-remained sponge was thought to be occurred without creating a defect after cholecystectomy. Postoperatively, the patient was discharged without having any problems at 4th day of hospitalization. Conclusion. Although it is a rare situation in routine clinical practice, GP should be considered as a differential diagnosis in the patients who had a diagnosis of mechanical intestinal obstruction, and laparotomy was applied before. As GP may lead to situations which cause mortality, all precautions should be taken to prevent it.

A rare etiology of acute abdominal syndrome in adults: Gastric volvulus - Cases series.

INTRODUCTION Gastric volvulus is a rare surgical emergency with a high mortality rate that requires urgent surgical management. PRESENTATION OF CASE A 19-year-old male and 51-year-old female patient underwent emergency surgery with a prediagnosis of acute abdomen syndrome, and a 60-year-old female patient underwent elective surgery due to diaphragmatic hernia. Abdominal exploration revealed gastric volvulus together with perforation in received emergency surgery patients, and a mesenteroaxial gastric volvulus due to diaphragmatic defect in third patient. DISCUSSION Gastric volvulus is classified into four subgroups depending on the mechanism of development, and organoaxial form is the most common type of gastric volvulus. The most challenging step in diagnosing gastric volvulus is the consideration of this diagnosis. CONCLUSION Preoperative diagnosis is often difficult, and its management involves surgical correction of the pathology followed by institution of resuscitative treatment.

Laparoscopy in Abdominal Trauma

Purpose of ReviewExploratory laparotomy is the traditional therapeutic approach in patients with abdominal trauma. However, due to potential associated morbidity and mortality, avoiding unnecessary laparotomies is an important issue.Recent FindingsWhile selective nonoperative management has shown good results, certain clinical situations in hemodynamically stable patients, where the need for surgery could be in doubt, call for proactive diagnosis. In these cases, laparoscopy can be used to exclude or diagnose potential injuries requiring surgery. When the surgeon has the necessary expertise, some of these injuries can be treated laparoscopically.SummaryOver the last decades, diagnostic and therapeutic applications of laparoscopy have increased, with reported reduction in nontherapeutic laparotomies. Furthermore, shorter duration of hospital stay, faster recovery, and reduced costs have been reported. However, as seen in other minimally access interventions, safe implementation of laparoscopy in trauma care requires adequate surgical training and skills as well as appropriate staffing and equipment.

Androgen Insensitivity Syndrome Diagnosed in an Elderly Patient During a Strangulated Inguinal Hernia Repair

Androgen Insensitivity Syndrome Diagnosed in an Elderly Patient during a Strangulated Inguinal Hernia Repair INTRODUCTION A strangulated inguinal hernia is a common indication for emergency surgery. In comparison, complete testicular feminization is a rare genetic disease that can present with an inguinal hernia because of ectopically positioned testicles. PRESENTATION OF CASE A 70-year-old female was admitted to the emergency service complaining of a painful swelling in the right inguinal region for 1 day. The physical examination indicated a strangulated inguinal hernia and surgery was performed. On exploring the inguinal region, a strangulated indirect inguinal hernia and hard 2 × 3-cm mass were detected. The histopathological examination of the excised mass showed testicular tissue, and complete testicular feminization (CTF) was diagnosed after further examinations. DISCUSSION Androgen insensitivity syndrome (AIS), the most frequent cause of male pseudohermaphroditism. The diagnosis of patients with AIS is usually made at the beginning of the second decade when a healthy person with a female phenotype complains of no menarche. Making a first diagnosis after the 5th decade is extremely rare. CONCLUSION While AIS can be diagnosed in early adulthood, cases might not bediagnosed until the patient is of advanced age.

Squamous Cell Carcinoma Arising in Etiology of Chronic Pilonidal Sinus Disease:A Case Report

DOI: 10.4328/JCAM.183 Received: 18.01.2010 Accepted: 25.01.2010 Printed: 01.01.2011 J Clin Anal Med 2011;2(1):31-3 Corresponding Author: Ibrahim Yetim, Mustafa Kemal Universitesi Tayfur Ata Sokmen Tip Fakultesi Genel Cerrahi A.B.D, Serinyol, Hatay ,Turkiye. Phone: +903262111900, +905325060009 E-mail: yetim54@gmail.com Ozet Pilonidal sinus hastaligi genellikle sakrokoksigeal bolgede yerlesen, skuamoz epitelle doseli, kil iceren sinuslerin olusturdugu edinsel inflamatuar bir hastaliktir. Etiyolojisi kesin bilinmemekle birlikte, patogenezinde dokulen killarin subkutanoz kistlere penetre olarak yabanci cisim reaksiyonu ve enfeksiyona sebep oldugu kabul edilir. Pilonidal sinus hastaliginin sik gorulen komplikasyonlari sellulit, apse ve fistul olusumudur. Kronik inflamasyonun bazi malignitelerin etiyolojisinde rol oynadigi bilinmektedir. Malign dejenerasyon, kronik pilonidal hastalikta cok nadir bir komplikasyondur. Burada uzun yillar tedavisiz kalmis pilonidal sinus hastaligi zemininde gelismis skuamoz hucreli karsinom tanisi ile cerrahi olarak tedavi ettigimiz bir olgumuzu sunuyoruz. Anahtar Kelimeler Pilonidal Sinus Hastaligi, Skuamoz Hucreli Karsinom. Abstract

Laparoscopic Techniques in the Repair of Large Abdominal Wall Defects

Large abdominal wall hernias are rarely primary, but frequently secondary to abdominal surgery. Depending on the indication and the extent of the operation, incisional hernias develop in up to 11% of cases after elective surgery. After emergency surgery or septic operations, up to 50% of patients will have an incisional hernia. Patients with large abdominal wall defects with primary hernias have less extensive adhesions than those with incisional or recurrent hernias. The latter have a history of several laparotomies and attempts at hernia repair with various techniques, and laparoscopic repair of such complicated hernias is often thought to be difficult, if not impossible. With improved technology and greater experience, laparoscopic repair is now feasible in most cases, even those with prior surgeries. Laparoscopic surgery has two important components: adhesiolysis and tension-free sublay coverage of the abdominal wall defect with a synthetic mesh. With an experienced team and good surgical technique in compliance with safety guidelines, patients with large abdominal wall defects can by all means benefit from the advantages of laparoscopic surgery. The adhesiolysis and the tension-free closure share the advantages of considerably fewer postoperative adhesions and significantly reduced recurrence rate. Further, the structures in the abdominal wall damaged by previous surgery are spared, as meshes and sutures from previous operations are left in place. Postoperative morbidity is low, and the patient has all the advantages of laparoscopic surgery.