Remzi Adnan Akdogan

A giant abdominal mass: fecaloma.

r t a d p w t f i o a a t p h s A man was admitted to our hospital for 2-month constipation, nausea, and abdominal pain. Abominal distention had been added to his list of complaints for bout 2 weeks. He was not able to pass stool but did have ischarge of gas. The patient had no history of serious illness, ospitalization, or major surgery, but he had been smoking igarettes and cannabis and using various kinds of laxatives for any years. On initial evaluation, he had a temperature of 7.8°C, a heart rate of 106 beats per minute, respiratory rate of 6 breaths per minute, and blood pressure of 95/60 mm Hg. He as found to be in an agitated condition; on physical examiation, his skin was wet and the patient seemed anxious. Bowel ounds were hypoactive, especially in the left quadrant. Palpaion revealed a hard, nonmobile, tender abdominal mass filling he mid and left abdominal quadrants (Figure A). Digital rectal xamination revealed hard stool impaction. Blood tests reealed: hemoglobin, 15 g/dL; hematocrit, 42; white blood cells, 6.800/mL; sedimentation rate, 61 mm per hour; blood glucose, 48 mg/dL; urea, 58; creatinine, 0.6; Na, 135; protein, 5.5; and lbumin, 3.1 g/dL. Carcino-embryonic antigen, CA 19 –9, and lpha-fetoprotein levels were normal. Abdominal tomography howed a giant fecaloma in the pelvis and left side of the bdomen causing displacement of visceral structures to the ight side (Figure B; b, bladder; f, fecaloma). A hard mass of feces hat could not be fragmented was noted on sigmoidoscopic exmination. Repeated enemas and laxatives were used to stimulate efecation, but they were all unsuccessful. It was decided that the atient required abdominal surgery. Laparotomy was performed ith a midline incision. During the exploration, we discovered that he descending and sigmoid colons were filled with a giant ecaloma. To extract the colon from the abdomen, a midline ncision was made, extending from the xiphoid process to the level f the pubic symphysis. The diameter of the sigmoid colon was pproximately 20 cm (Figure C). Resection of the descending nd sigmoid colons, manual extraction of the remainder of he fecalomas from the rectum, and terminal colostomy were erformed following Hartmann’s technique (Figure D). The istopathologic study revealed atrophy of the mucosa and ubmucosa (Figure E), and pigmented macrophages in the

Comparison of Levofloxacin- and Moxifloxacin-Based Triple Therapies with Standard Treatment in Eradication of Helicobacter Pylori as First-Line Therapy

Aim: It is recommended that treatments that include clarithromycin should be avoided in eradication of Helicobacter pylori (HP) in cases where clarithromycin resistance is higher than 20%. We aimed to compare levofloxacin- and moxifloxacin-based triple therapies with standard treatment and with each other in eradication of helicobacter pylori as first-line therapy. Materials and Methods: Patients were randomized prospectively as three groups. There were 102 patients in the levofloxacin group, 101 patients in the moxifloxacin group, and 103 patients in the standard treatment group. The patients received levofloxacin 500 mg daily, amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. for ten days (LAL) in the levofloxacin group; moxifloxacin 400 mg daily, amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. (MAL) in the moxifloxacin group; and clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d. and lansoprazole 30 mg b.i.d. (CAL) in the standard treatment group. At post-treatment week 6, HP was checked by using stool antigen test. Results: In the eradication of Helicobacter pylori, the success rate as determined by per protocol (PP) analysis was 92% in the LAL group, 91.8% in the MAL group, and 82.4% in the CAL group. A statistically significant difference was found in the LAL and MAL groups compared to the CAL group (p < 0.05). There was no difference between the LAL and MAL groups. Conclusions: It was determined that levofloxacin- and moxifloxacin-based triple therapies were more effective than the standard treatment in first-line setting in the eradication of Helicobacter pylori. In addition, no difference was found between levofloxacin- and moxifloxacin-based triple therapies. Currently observed high efficacy may be evaluated in treatment. Although quinolon resistance is not considered a major problem, it appears to be a factor that may reduce treatment success over a period of time.

The Effects of Infliximab on Laminin, NFκB, and Anti-TNF Expression through Its Effect on Ischemic Liver Tissue

The aim of this study was to investigate the possible protective effects of infliximab on expression of laminin, anti-TNF, and NFκB in the rat hepatic cells after ischemia/reperfusion (I/R). A total of 30 male Wistar albino rats were divided into three groups: Control (C), sham I/R (ISC), and I/R+ infliximab (ISC inf); each group comprised 10 animals. C group animals underwent laparotomy without I/R injury. In ISC groups after undergoing laparotomy, 1 hour of superior mesenteric artery ligation was done, which was followed by 1 hour of reperfusion. In the ISC inf group, 3 days before I/R, infliximab (3 mg/kg) was administered intravenously. All animals were killed at the end of reperfusion and hepatic tissue samples were obtained for histopathological and histochemical investigations in all groups. Laminin, anti-TNF, and NFκB immunoreactivity were performed for all groups. ISC caused severe histopathological injury including mucosal erosions, inflammatory cell infiltration, necrosis, hemorrhage, and villous congestion. Infliximab treatment significantly attenuated the severity of intestinal I/R injury and it is shown by laminin, anti-TNF, and NFκB immunoreactivity. Because of its anti-inflammatory and antioxidant effects, infliximab pretreatment may have protective effects on hepatic cells in the experimental intestinal I/R model of rats.

A novel model approach for esophageal burns in rats: A comparison of three methods

Background: Corrosive esophageal injury causes serious clinical problems. We aimed to create a new experimental esophageal burn model using a single catheter without a surgical procedure. Materials and methods: We conducted the study with two groups of 12 male rats that fasted for 12 h before application. A modified Foley balloon catheter was inserted into the esophageal lumen. The control group was given 0.9% sodium chloride, while the experimental group was given 37.5% sodium hydroxide with the other part of the catheter. After 60s, esophagus was washed with distilled water. The killed rats were examined using histopathological methods after 28 days. Results: In comparison with the histopathological changes experienced by the study groups, the control groups were observed to have no pathological changes. Basal cell degeneration, dermal edema, and a slight increase in the keratin layer and collagen density of submucosa due to stenosis were all observed in the group subjected to esophageal corrosion. Conclusion: A new burn model can thus, we believe, be created without the involvement of invasive laparoscopic surgery and general anesthesia. The burn in our experiment was formed in both the distal and proximal esophagus, as in other models; it can also be formed optionally in the entire esophagus.

F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Isolated Gastric Tuberculosis mimicking Gastric Cancer and Lymphoma

Introduction Tuberculosis (TB) infection is still a challenging health issue, especially in developing countries. Diagnosing extrapulmonary infections, especially isolated organ involvement, is difficult in most cases even with the radiological, endoscopic, and histopathological examinations done for accurate diagnosis. Here we describe a case of isolated gastric TB with specific F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings mimicking gastric cancer/ lymphoma. Case report A 20-year-old male patient was admitted to our hospital with abdominal pain in the epigastric region, weight loss, and fever especially at nights for 2 months. Physical examination was normal. Hemoglobin was 9.6 gm/dL; the patient had iron deficiency anemia. Upper gastrointestinal (GI) endoscopy was suggestive of gastric ulcer mimicking malignancy. F-18 FDG PET/CT revealed multiple hypermetabolic malignant lymphadenopathies in the abdomen and diffuse gastric wall thickening as linitis plastica and multiple hypermetabolic peritoneal implants in the omentum. Exploratory laparotomy was done for tissue diagnosis and exploration of the peritoneum for TB infection, lymphoma, and Crohn’s disease to make differential diagnosis. Histopathology revealed granulomatous lymphadenitis with granulomas including giant cells, suspecting TB. Patient was put on antituberculosis treatment (ATT). After treatment, the complaints resolved, and he gained weight. Fusion PET/CT exhibited a complete response to ATT with no residual disease. Conclusion According to our knowledge, this is the first report about F-18 FDG PET/CT findings in the diagnosis of isolated gastric TB. F-18 FDG PET/CT may provide help in the diagnosis and follow-up of isolated gastric TB in challenging cases. How to cite this article: Akdogan RA, Rakici H, Güngör S, Bedir R, Akdogan E. F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Isolated Gastric Tuberculosis mimicking Gastric Cancer and Lymphoma. Euroasian J Hepato-Gastroenterol 2018;8(1):93-96.

Evaluation of colonoscopy requests in an open-access endoscopy unit

Aim: Improper colonoscopy requests from different medical fields, especially like in an open access endoscopy unit, increases workload of the unit and healthcare expenses. For standardize these requests, eligibility criterias emerged. The aim of this study was to evaluate the appropriateness of colonoscopy requests performed in an open-access endoscopy unit of a university hospital and determine possible causes of the improper requests by patient characteristics, colonoscopy indications and results. Material and Methods: Between January 2009 and January 2015, 3259 patients who were referred for colonoscopy in an open-access endoscopy unit of a university hospital were enrolled into study. Post-procedure colonoscopy reports, along with their diagnoses, were recorded. All records were then evaluated retrospectively and the patient’s indications and patients’ results were compared and reasons for improper requests were discussed. Results: The mean age of the patients who underwent colonoscopy was 56.68 year, and 56.2% of the patients were males. When the requests were placed in order of frequency, the first three cases were rectal bleeding, anemia, and abdominal pain. Most of the patients did not have any pathology on colonoscopy (37.8%, n = 1238). The other most common diagnoses were hemorrhoids and colon polyps. Malignancy detection rate by colonoscopy was 5.3%. Associations between requests and results were detailed. Conclusion: Eligibility criterias should be used to minimize inappropriate requests and training should be provided for experts about colonoscopy these criterias, or a gastroenterologist should be consulted before colonoscopy procedure, especially for open-access endoscopy units.

A case of rectal neuroendocrine tumor presenting as polyp.

Highlights • Pointing out the rarely seen rectal neuroendocrine tumors (NETs).• Rectal neuroendocrine tumors (NETs) can be presented as polypes.• Emphasizing the importance of classification.• Classifying the variety of treatments.

Is There Any Advantage of Treating Partners in Helicobacter pylori Eradication

Aim. We designed this trial to find answers to the following questions. (1) Does the success rate decrease in a country where HP prevalence is high? (2) Can we provide benefit by simultaneously treating the partners of infected patients? Materials and Methods. The first group consisted of 102 HP-positive patients, and both the patients and their HP-positive partners were treated. The second group consisted of 104 HP-positive patients whose partners were HP-positive but only the patients were treated. The participants in both groups were treated with levofloxacin 500 mg daily, amoxicillin 1 g b.i.d, and lansoprazole 30 mg b.i.d (LAL) for ten days. Results. In the per-protocol analysis, the eradication success rate was found to be 92.2% (94/8) in the first group and 90.4% (94/10) in the second group. No statistically significant difference was found between the two groups (P > 0.05). Conclusions. With regard to the HP eradication rate, no difference was found between treating the HP-positive partners of HP-positive patients simultaneously and not treating them simultaneously. According to these results, we can say that reinfections between partners do not significantly contribute to the failure of eradication.

Jejunogastric intussusception: a rare cause of gastric outlet obstruction.

A 55-year-old male patient was admitted to the emergency department with complaints of severe colicky epigastric pain, bilious vomiting and haematemesis over the previous 2 days. The patient’s medical history indicated that gastrojejunostomy (Billroth II reconstruction) surgery was performed about 15 years before to correct a duodenal ulcer, and he admitted that he had not experienced any serious dyspeptic complaints thereafter. Abdominal examination revealed a painful mass in the epigastric region with palpation. The patient’s blood pressure was 120/70 mmHg and his pulse was 88 bpm. Laboratory investigations revealed that the haemoglobin (8.2 g/dL), white blood cell count (14.000/μL), and coagulation tests were within normal range. A solid mass covered with blood, fibrin, and food residues was observed during gastroscopy, and occupied a large part of the stomach (Fig. 1). Initially, haemorrhagic gastric tumor was considered. Contrast-enhanced abdominal tomography showed a heterogeneous mass consisting of loops of the small bowel inside the enlarged stomach (Fig. 2). Laparotomy was performed to confirm a diagnosis of jejunogastric intussusception (JGI). During laparotomy, we saw that part of the afferent loop ranging from 5-cm distal to the Traitz ligament to the gastrum and part of the efferent limb of the jejunum were nutritionally impaired. We also observed that parts of both of the afferent and efferent loops were intussuscepted into the stomach (type 3). Following gastrotomy from the anterior face near the large curvature, intussuscepted gangrenous jejunal limbs forming a mass in the gastric lumen were observed. We resected the intussuscepted bowel segment, nutritionally impaired segment of the afferent loop, and part of the gastrum containing the intussuscepted segments, and performed a Rouxand-Y gastrojejunostomy (Fig. 3). No pathologic finding, apart from necrosis, was observed on pathologic examination of the invaginated segment. The patient was discharged on the 8th postoperative day without complication. JGI is a rare complication of partial gastrectomy or gastrojejunostomy (0.15%). Early diagnosis and urgent surgical intervention is essential, because a delay in treatment of more than 48 h, following onset of severe symptoms in these cases is associated with a rise of mortality rate from 10% to 50%. JGI has been described in two clinical forms, acute and chronic. In the acute form, strangulation and incarceration are encountered more frequently. The most notable complaints are severe epigastric pain, vomiting and haematemesis. In the chronic form, spontaneous reductions are seen. Therefore, complaints are not severe and accurate diagnosis is quite difficult. Gastroscopy may help in diagnosis, however, in the presence of blood, the appearance of the intussuscepted bowel loops may resemble a bleeding gastric tumour. In the acute form of the disease and also during the symptomatic period of the chronic form of the disease, the contrastenhanced abdominal tomography may show a dilated stomach with intragastric filling by bowel loops. Three anatomic types of JGI have been described: intussusception of the afferent loop (type 1), efferent loop (type 2) and both loops

The effect of irritable bowel syndrome on carotid intima-media thickness, pulse wave velocity, and heart rate variability

OBJECTIVE Irritable bowel syndrome (IBS), a subgroup of functional somatic disorders, may be associated with autonomic dysfunction (AD). Heart rate variability (HRV), a measure of autonomic dysfunction, may predict survival. The aim of this study was to investigate the effect of IBS on HRV parameters, carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) as surrogates of AD, subclinical atherosclerosis and arterial stiffness, respectively. METHODS Our study was cross-sectional and observational. Thirty consecutive patients with IBS and 30 control participants underwent 24-hour Holter monitoring, cf-PWV assessment and CIMT measurement. The diagnosis of IBS was based on Rome III criteria. There were 24 patients with IBS-Constipation (80%), 4 patients with IBS-Diarrhea (13.3%), and 2 patients with IBS-Mixed (6.7%) in IBS group. Student t-test and χ2 test were utilized in order to compare continuous and categorical variables between two groups, respectively. RESULTS Biochemical parameters did not differ between groups except for slightly increased creatinine in patients with IBS. cf-PWV and CIMT values were similar between groups. SDNN index and RMSSD were significantly impaired in patients with IBS compared to controls. Frequency analyses revealed lower LF, HF, and VLF in subjects with IBS. CONCLUSION We demonstrated decreased parasympathetic modulation in patients with constipation predominant IBS. However, we could not demonstrate any changes in vascular structure and functions measured by carotid intima-media thickness and pulse wave velocity. Our results do not support accelerated atherosclerosis in IBS population.