Rahman Şenocak

The Effects of Total Colectomy on Bacterial Translocation in a Model of Acute Pancreatitis

Prevention of secondary infection is currently the main goal of treatment for acute necrotizing pancreatitis. Colon was considered as the main origin of secondary infection. Our aim was to investigate whether prophylactic total colectomy would reduce the rate of bacterial translocation and infection of pancreatic necrosis. Forty-two Sprague–Dawley rats were used. Pancreatitis was created by ductal infusion of sodium taurocholate. Rats were divided into four groups: group-1, laparotomy + pancreatic ductal infusion of saline; group-2, laparotomy + pancreatic ductal infusion of sodium taurocholate; group-3, total colectomy + pancreatic ductal infusion of saline; and group-4, total colectomy + pancreatic ductal infusion of sodium taurocholate. Forty-eight hours later, tissue and blood samples were collected for microbiological and histopathological analysis. Total colectomy caused small bowel bacterial overgrowth with gram-negative and gram-positive microorganisms. Bacterial count of gram-negative rods in the small intestine and pancreatic tissue in rats with colectomy and acute pancreatitis were significantly higher than in rats with acute pancreatitis only (group-2 versus group-4; small bowel, p = <0.001; pancreas, p = 0.002). Significant correlation was found between proximal small bowel bacterial overgrowth and pancreatic infection (r = 0,836, p = 0.001). In acute pancreatitis, prophylactic total colectomy (which can mimic colonic cleansing and reduction of colonic flora) induces small bowel bacterial overgrowth, which is associated with increased bacterial translocation to the pancreas.

Giant Epidermal Cyst Unusually Located in Perianal Region

Address for Correspondence/Yazışma Adresi: Şahin Kaymak MD Gülhane Training and Research Hospital, Clinic of General Surgery, Ankara, Turkey Phone: +90 532 333 41 14 E-mail: sahinkaymak@hotmail.com ORCID ID: orcid.org/0000-0003-4717-5791 Received/Geliş Tarihi: 23.08.2017 Accepted/Kabul Tarihi: 20.10.2017 ©Copyright 2018 by Turkish Society of Colon and Rectal Surgery Turkish Journal of Colorectal Disease published by Galenos Publishing House. DOI: 10.4274/tjcd.46362 Turk J Colorectal Dis 2018;28:40-43 CASE REPORT

Clinical and prognostic significance of preoperative and postoperative neutrophil/lymphocyte ratio and platelet/ lymphocyte ratio in patients undergoing major abdominal surgery

Aims: Acute inflammatory processes are associated with perioperative complications. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were reported to have prognostic importance in various diseases. We aimed to investigate the clinical importance of preoperative (preop) and postoperative (postop) NLR and PLR as predictors of morbidity and surgical or nonsurgical complications after major abdominal surgery. Methods: Patients who had a major abdominal surgery were retrospectively evaluated. Age, gender, American Society of Anesthesiologist (ASA) score, and the type of operation were recorded. Preop and postop days 1, 3 and 5 white blood cell (WBC), neutrophil, lymphocyte and platelet counts, duration of intensive care unit stay and hospitalization, Clavien Dindo classification, and surgical or non-surgical complications were determined. Results: The study included 462 subjects. Concerning increased need for red blood cell transfusions, NLR was significantly higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 compared to preop state. Regarding a worse ClavienDindo classification, NLR was higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 and 3 compared to baseline. In those with increased surgical complications, NLR was lower on postop day 5, and postop day 1 and 3 PLR were higher compared to baseline values. In subjects with higher non-surgical complications, NLR was higher on postop day 3 but lower on day 5 compared to preop measurements. PLR was similar across the days of follow up in terms of non-surgical complications. Conclusions: Higher NLR on postoperative day 5, and higher PLR on postoperative days 1 and 3 compared to preop values were the indicators of increased complications in this study.

Endoskopik balon dilatasyonu sonrasında gelişen pnömatozis sistoides intestinalis

Pnomotosis sistoides intestinalis (PSI), etiyolojisi tam olarak bilinmeyen, gastrointestinal sistemde subserozal ve submukozal gaz dolu kistler ile karakterize nadir gorulen bir hastaliktir. Pilor stenozu gibi bircok gastrointestinal sistem hastaligi PSI’ye eslik edebilir. Ayrica cerrahi veya endoskopik travmaya sekonder PSI olgulari da bildirilmistir. Burada pilor stenozu olan ve endoskopik dilatasyon tedavisi sonrasinda yapilan cerrahi tedavi esnasinda saptanan PSI olgusu sunulmustur.

Antikoagulasyonla başarılı bir şekilde tedavi edilen portal ve splenik trombozla kombine superior mezenterik ven trombozu

Antikoagulasyonla basarili bir sekilde tedavi edilen Portal ve Splenik trombozla kombine Superior mezenterik Ven Trombozu

Successful conservative treatment of type 3 injury (ductal injury) developing after ERCP

Although endoscopic retrograde cholangio-pancreatography (ERCP) is considered a safe procedure, it is associated with complications such as pancreatitis, bleeding and perforation of the bile duct, pancreatic duct and duodenum. In recent years, successful conservative treatment in selected patients with complications have increased. We present a case with successful conservative treatment of rare injury (type 3) developing after ERCP.

Central hepatectomy: A valuable option to avoid posthepatectomy liver insufficiency in patients requiring extensive liver resection

Despite being uncommon, posthepatectomy liver failure (PLF) is a dreadful complication following extended hepatectomy or liver trisectionectomy. It has been reported that liver insufficiency may occur in as high as 12% of posthepatectomy patients, especially in those who have a concomitant chronic liver disease, hepatosteatosis or history of receiving long-course (>6 cycles) chemotherapy (1). Central hepatectomy or mesohepatectomy, defined as en-bloc anatomical resection of liver segments 4-5 and 8, is a valuable option in patients with central large or multiple liver lesions to minimize PLF caused by the loss of a considerable portion of functional liver parenchyma following extensive resections (2). The purpose of this video-based article is to share key procedural components to be adhered to when performing central hepatectomy.

Can Human Recombinant Epidermal Growth Factor Improve Ischemia and Induce Healing of Anastomosis in an Experimental Study in a Rabbit Model

ABSTRACT Purpose: Anastomotic leaks following intestinal operations may cause devastating effects on patients. Ischemia may also occur at the intestinal walls in the presence of strangulations. In this study, we examined the effects of human recombinant (Hr)-epidermal growth factor (EGF) given at a single intramural dose into the intestinal walls and daily intraperitoneal cavity on ischemia and the healing process of anastomosis. Materials and Methods: Sixteen male New Zeland white rabbits were randomly divided into four groups (n = 4 in each group). In Group 1, two different segments of ileum were identified and, then, transected and the free ends were sutured each other. In the other groups, ischemia was induced by ligating the mesenteric vascular arcade. After the ischemic induction, Group 2 received intramural injections of %0.9 saline, Group 3 received intramural injections of a single dose of EGF, and Group 4 received intramural and intraperitoneal injections of EGF. Bursting pressures and tissue hydroxyproline levels were analyzed. Necrosis, fibroblastic activity, collagen deposition and neovascularization were also studied. Results: The mean levels of bursting pressures in Group 4 (148.6 ± 25.3 mmHg) were higher than Group 2 (70 ± 21.5 mmHg) (p = 0.001). The mean level of bursting pressures was not statistically significant between Group 1 (170.1 ± 35 mmHg) and Group 4 (p = 0.073). Hydroxyproline levels in Group 2 were lower than Groups 3 and 4. There was a statistically significant difference in the mucosal ischemia, mucosal healing and degree of adhesion, but not in the mural anastomotic healing among the groups. Conclusions: Intramural injection with daily intraperitoneal administration of low-dose EGF enhances the bursting pressure and collagen accumulation in ischemic anastomosis, improving many histological variables associated with ischemic intestinal anastomosis.

The Role of the Ultrasonography of Abdomen Performed by a General Surgeon on Diagnosis of Acute Appendicitis

Aim: In this study, we aimed to investigate whether abdominal ultrasonography (USG) performed by a general surgeon provides significant contribution to himself in diagnosing acute appendicitis. Method: This study was performed at two different hospitals where referral of patients to another hospital is not possible due to geographical reasons. Two hundred fifteen patients with suspicious diagnosis of acute appendicitis were included into the study among 2140 patients with abdominal pain at three different periods during 12 months. Data of the patients were evaluated retrospectively and patients were divided into three groups. Group 1 and 2 include patients followed and treated in the same hospital. Group 1 patients were followed and treated by general surgeon using conventional methods without abdominal USG. Group 2 patients were followed and treated by same general surgeon using both conventional methods and abdominal USG. Group 3 patients were followed and treated by a different general surgeon in a different hospital using conventional methods and abdominal USG performed by a radiologist. Results: Of patients, 200 male and 15 were female, and mean age was 23. A total of 66 patients from all groups underwent appendectomy. When the groups were compared with according to the pathological results which were consistent with acute appendicitis; there was not statistically significant difference among groups (p=0.362). Conservative treatment were applied to the patients with sonographically negative for appendicitis and with negative findings for physical examination and laboratory tests in their follow-up. When the groups were compared in terms of correctly identification of nonacute appendicitis and avoidance of negative appendectomy (laparotomy); statistically significant difference in favor of group 2 (p=0.002) was found. Conclusion: According to the results of the study; when surgeons use USG as an adjunctive method, the rate of negative appendectomy decreases.

Diverticulitis of appendix vermiformis: a distinct case from acute appendicitis

Apendiks divertikülitinin (AD) görülme sıklığı % 0,004 – % 2,1 arasında değişiklik göstermektedir1. Cerrah ve patologlar AD tanısını kolaylıkla atlayabilmektedirler. Bu nedenle tanı genellikle cerrahi sonrası dönemde konabilmektedir. Her iki hastalıkta da klinik bulgular benzerlik gösterir. Ancak, tanıda gecikme ve divertikülün anatomik özellikleri AD’li hastalarda daha fazla perforasyon gelişimine neden olmaktadır. Ayrıca AD’li hastaların büyük çoğunluğu daha ileri yaşlarda görülmektedir2. Dolayısıyla AD apandisitten farklı bir hastalık olarak görülmektedir3,4. Biz, sağ alt karın ağrısı nedeniyle apendektomi yaptığımız ama postoperatif dönemde histopatolojik olarak apendiks divertiküliti tespit edilen bir olguyu sunduk.