Makale Arama

 Meckel’s diverticulum is the most frequently seen congenital anomaly of the gastrointestinal tract. Most of the cases are asymptomatic. Generally they are found randomly during surgical procedures and autopsies. They can be seen following fulminant abdominal pain and subsequently life-threatening complications. A Meckel’s diverticulum with complications is generally diagnosed following diagnostic laparotomy procedures. In our study, we present the case of a gangrened Meckel’s diverticulum case twisted and attached to the fibrotic band, which is reported to be a rare complication in literature. The patient was taken into surgery with the pre-diagnosis of acute appendicitis and the procedure was completed laparoscopically.

Aim: Gastric cancer is one of the leading causes of cancer-related deaths. Tumor budding has been
shown to be a prognostic factor in many cancers. In this study, we aimed to evaluate the prognostic
significance of tumor budding in intestinal-type gastric adenoc arcinoma.
Patients and Methods: A total of 152 cases diagnosed as intestinal type gastric adenocarcinoma in
the Pathology Clinic between 2015 and 2021 were included in the study. Tumor budding was grouped
as low, medium and high. Hematoxylin and eosin-stained slides were re-evaluated in terms of tumor
differentiation, lymphovascular invasion (LVI), perineural invasion (PNI), lymph node involvement, depth
of invasion (pT) and tumor budding.
Results: Tumor budding was low in 30.9% (n=47) of the subjects included in the study, moderate in 37.5%
(n=57) and high in 31.4% (n=48). Statistically, as tumor budding increased, tumor size increased (p<0,05),
follow-up times were shortened, survival time (p<0,05), and tumor differentiation (p<0,05) decreased. A
statistically significant correlation was observed between tumor budding and LVI (p<0,05), PNI (p<0,05),
pT(p<0,05), lymph node involvement(p<0,05), and mortality of the cases (p<0,05). No statistically
significant correlation was observed between tumor budding and gender, age, tumor localization and
operation type (p>0.05).
Conclusions: Tumor budding is associated with poor prognostic factors. As it may be important to guide
the treatment modality and follow-up, tumor budding status may be mentioned in routine pathology reports.

  Brusellosis is a zoonotic disease which is transmitted with nonpasteurized milk and milk products. Mostly effects the gastrointestinal system and less the genitourinary system. Most common genitourinary complication of brucellosis is epididymo-orchitis.

 Here we present a case which presented with right lower quadrant pain in which physical examination lead us to the preliminary diagnosis of appendicitis after laboratuary results, cilinical findings and deepining the history the patient was diagnosed with unilateral epididimoorchit and here presented with clinical laboratuary findings. Brusellosis which is endemic in our country, should be kept in mind especially when accompanied with acute abdomen eventhoug imaging prosedures do not confirm the diagnosis. 

Chronic mesenteric ischemia is a rare disease caused by intestinal perfusion disorder. Increased abdominal pain after meals, loss of appetite, weight loss, such as the symptoms of the course. The patient was presented with intestinal ischemia, arterial dorsalis pedis obstruction, celiac artery and superior mesenteric artery involvement. The coexistence of all these lesions in a 35-year-old female patient was interesting because of its rarity. In this study, we wanted to share the surgical treatment of a young patient who was not suitable for endovascular treatment and underwent saphenous vein and aorta-hepatic bypass due to multiple lesions.

Bezoars are concretions in the gastrointestinal tract that increase in size by continuous accumulation of non-absorbable food or fibers. Most bezoars in children are trichobezoars from swallowed hair from the dolls or brushers. Trichobezoars typically cause abdominal pain and nausia, but can also present as an asymptomatic abdominal mass, progressing to intestinal obstruction and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngers. We report a case of an unusual giant trichobezoar in 8-year-old girl. It was not extracted endoscopically, because it was huge and passed into the duodenum. Attempts at dissolving the bezoar with enzymes (papain) or meat tenderizers have not been efficacious. The abdomen was explored through a supraumblical median incision, an approximately 15X3 cm trichobezoar in diameter was identified in 50 cm distance from ileocecal segment, and was removed. In addition, ischemic and rupture 10 cm jejunal segment was repaired. These two rupture segments were repaired using Heineke Mikulicz procedure.

 Today an increasing prevalence of obesity, which is one of major health problems is associated with many chronic diseases such as diabetes, cardiovascular disease, stroke, cancer, asthma obstructive sleep apnea syndrome. Therefore, treatment of obesity contribute to  prevention of many chronic diseases risk. Recent years, it has started to consider on effects on the gastrointestinal system in treatment of obesity as well as adequate and balanced diet, increasing  physical activity and lifestyle changes. Especially it was seen that gut microbiota has been associated with obesity. Many studies showed that gut microbiota may be vary with eating habits and obesity. It is discussed changed microbiota might be associated with obesity and many obesity-related diseases. It is thought that long term-controlled studies in this area   will create a new approach to the treatment of obesity and come into prominence in the fight against obesity. In this review,it was aimed to evaluate the relationship between body weight and the gut microbiota.
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Aim: In this study, we aimed to discuss our experience and results of non-operating room anesthesia.

Materials and Methods: Anesthesia records of patients older than 18 years who underwent sedo-analgesia outside the operating room for diagnosis and treatment between May 2017 and December 2017 were retrospectively screened. The records were examined in terms of demographic data, applied procedure, duration of the procedure, sedation grade, medications used, developing minor and major complications, chronic obstructive pulmonary disease story and intensive care need. Relationships between complications with demographic data and categorical variables were analyzed.

Results: Totally 2562 patients underwent sedo-analgesia. 1428 (55.7%) of these cases were female and 1134 (44.3%) of them were male. The average age of patients was 53.08±16.55. 268 (10.5%) of the cases were ASA I, 1683 (65.7%) were ASA II, 598 (23.3%) were ASA III and 13 (0.5%) were ASA IV. 519 (20.3%) patients were minimally sedated, 1541 (60.1%) were moderate sedated and 502 (19.6%) deep sedated. The longest procedure time in endoscopic retrograde cholangiopancreatography was 28.7 ± 16.3 min, and the shortest procedure time in endoscopy was 10.3 ± 3.1 min. The most commonly performed procedure was colonoscopy with 31%. The most commonly used drug combination was midazolam + propofol + fentanyl applied to 1231 patients (48%). 148 (5.76%) patients had minor complication, and 10 (0.37%) patients had major complication. A total of 15 (0.58%) patients underwent intensive care after the procedure. Desaturation was statistically significantly higher in patients with ASA III and above, in procedures take longer than 15 minutes, in patients older than 65 years, and in the presence of chronic obstructive pulmonary disease. The intensive care need after the procedure was also significantly higher in these patient groups.

Conclusion: The incidence of non-operating room anesthesia is increasing steadily. The risks associated with these practices are similar to the anesthesia in the operating room. In order to increase patient safety and reduce complications, it is important to carry out a thorough evaluation before the procedure, to provide proper monitored anesthesia care in appropriate physical conditions, and to establish healthy communication between the teams.

Purpose:

Primary and metastatic digestive system malignant melanomas are extremely rare. In our study, we aimed to compare lymph node metastasis with clinical and pathological parameters in gallbladder, stomach, small intestine and anorectal region malignant melanomas.

Materials and methods:

This retrospective study included 20 cases diagnosed with malignant melanoma in the gastrointestinal tract organs between January 2010 and January 2020 at XXXXXXXXXXXX. In our study, we wanted to evaluate the relationship between regional lymph node metastasis and age, gender, tumor localization, tumor size, extraintestinal melanoma history, melanin pigment, neutrophil-lymphocyte ratio and post-diagnosis life span in primary and metastatic malignant melanoma cases. We also reviewed the origin and literature of the cells from which melanoma originates in the digestive system.

Results:

There was a statistical relationship between tumor diameter and regional lymph node metastasis (p =0.000). As the tumor diameter increased, the lymph node metastasis rate increased. There was a relationship between survival and gender, tumor localization, distant metastasis, primary and metastatic digestive system melanoma (all p <0.05). Most of the men and those who did not metastasize away from the digestive system were alive. All patients with melanoma metastases to the digestive system and all patients with gallbladder and small intestine localization were alive. Our 70 year old patient with gallbladder primary malignant melanoma was the oldest patient we could identify in the literature.

Conclusions:

Regardless of cutaneous or origin, all melanomas originate from melanocytes, cells derived from embryological nerve crest. Malignant melanoma can be primary in every region, more frequently in the anorectal region in the gastrointestinal tract. The most common metastasis is to the small intestine. Accurate diagnosis is vital in places where it is rarely seen, such as the digestive system. Recently, in metastatic melanoma, immuno-oncological agents are used in adjuvant therapy to help prevent metastatic spread of the disease. Thanks to these treatments, it is reported that more than half of patients with melanoma who have the risk of metastasis after surgical resection provide recurrence-free survival. Although it is very rare, it should be kept in mind that there may be primary or metastatic malignant melanoma in the evaluation of digestive system biopsies.

Aim: Mesenchymal tumors of the gastrointestinal tract other than gastrointestinal stromal tumors are rare and most of them are benign. The aim of this study to reveal the clinical and pathological features of non-gastrointestinal stromal tumor mesenchymal tumors of the gastrointestinal tract.

Materials and Methods: All gastrointestinal endoscopic and surgical resection materials, between 2008-2018, were retrospectively reviewed. Cases diagnosed with mesenchymal tumor other than gastrointestinal stromal tumors were included.

Results: Twenty four lipomas, 14 inflammatory fibroid polyps, six leiomyomas, four lymphangiomas, four hemangiomas, four schwannomas, two neuromas, two malignant melanomas, one leiomyosarcoma, one granular cell tumor and one Kaposi sarcoma were detected. The median ages of the cases were 61 years (29-87), the median tumor size was 1.5 cm (0.2-14). Thirty seven (58.7%) cases were female and 26 (41.3%) were male. They caused nonspecific symptoms. No recurrence or metastasis was detected after excision in benign tumors regardless of the pathological diagnosis.

Conclusion: Non-gastrointestinal stromal tumor mesenchymal tumors of the gastrointestinal tract are mostly small and benign tumors that can be seen at any age and are frequently seen in women. The most common ones are lipomas and inflammatory fibroid polyps. Most gastric tumors cause dyspeptic complaints and intestinal tumors cause abdominal pain, nausea or vomiting, as well as some of the intestinal tumors lead to serious, even fatal clinical situations such as acute and chronic bleeding, obstruction, perforation, volvulus or intussusception. For benign tumors’ treatment, excision is sufficient, they do not exhibit recurrence or metastasis.

The most common therapeutic method for early stage distal esophageal cancers and proximal stomach
cancer is surgery. One of the challenges in esophageal surgery is to maintain gastrointestinal continuity.
The neoesophagus is transferred from the posterior, mediastinal, or retrosternal areas to the cervical
region. A 61-year-old male patient with esophageal cancer had received transhiatal total gastrectomy,
distal esophagectomy, and Roux-en-Y esophagojejunostomy. Right thoracotomy had been performed due
to anastomotic leak with the esophageal stump left behind. Left thoracotomy and metastasectomy were
also performed due to lung metastasis. The left colon was transpositioned from the presternal area to
the cervical region for reconstructive purposes. Physicians should bear in mind that the conduit can be
advanced in the presternal area as the last resort for its localization in esophageal surgery. The aim of this
study was to present, along with literature review, the case of a patient with distal esophageal cancer for
whom presternal colonic transposition was performed with the es ophageal stump left behind.