Makale Arama

Objective: The aim of this study is to evaluate the perioperative and postoperative follow-up results of patients operated for a parotid mass.

Materials and Methods: A total of 66 patients who were operated between 2000 and 2011, were evaluated retrospectively.

Results: The mean age of the patients was 48,6. On the basis of post-operative histopathologic assessement, 61 of the cases were found to be primary benign, 3 of the cases  primary malignant and 2 of the cases secondary malignant. Pleomorphic adenoma was the most common in primary benign tumors group with 29 cases, Warthin tumors were in the second place with 14 cases. Adenoid cystic carcinoma, adenocarcinoma and expleomorphic adenoma were observed as primary malignant tumors. Both of the seconder malignant tumors were metastasis of squamous cell carcinoma. Sensitivity and specifity of the preoperative fine needle aspiration biopsy in the benign-malignant differentiation were found as 60 % and 96 %, respectively. Superfacial parotidectomy, total parotidectomy and radical parotidectomy were used as surgical procedures. In addition to this procedure, neck dissection was performed in several cases. The most frequent complication was temporary facial nerve paresis.

Conclusion: Fine needle aspiration biopsy is an effective diagnostic procedure for the benign-malignant differentiation of the parotid tumors. Superfacial parotidectomy is an adequate and efficient surgical procedure for the benign parotid tumors and complication risk is considerably low when applied carefully. For malignant tumors, superfacial, total or radical parotidectomy should be performed and when necessary, neck dissection and postoperative radiotherapy should be added to the treatment.

 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.

 Primary Epiploic Appendagitis is a self-limited condition without need any surgery. It can be conservatively treated after diagnosis with Computerized Tomography. We discuss a healthy 36-year-old man who admitted to our emergency clinic with sudden onset abdominal pain.

Aim: The aim of this study was to evaluate the demographic characteristics, emergency care needs and prognosis of patients aged 65 years and older who presented to our Emergency Medicine Clinic with abdominal pain for a period of one year.

Patients and Methods: In this single-center, retrospective, observational study included patients aged 65 years and older who presented to the emergency department with abdominal pain between June 15, 2015 and June 14, 2016. The related variables were recorded from the patients' electronic and written files. The general patient population and the differences of variables in the 65-74 age group, 75-84 age group and ≥85 age group were investigated.

Results: A total of 1330 patients were included in the study. The mean age of the patients was 75.2 ± 7.2 years and 582 (43.8%) were male. While 58.8% of the patients were discharged from the emergency department, the most common hospitalization wards were General Surgery (14.1%) and Gastroenterology (11.4%). The ICU admission rate increased with age (p<0.001; 3.3% - 5.8% - 11.6%). The mean length of stay in hospital was 5.9 ± 7.1 days and the in-hospital mortality rate was 3.4%. While 50.1% of the patients in the 65-74 age group were discharged from the emergency department without consultation, this rate decreased to 36.6% in the ≥85 age group and the difference was statistically significant (p<0.001). Abdominal ultrasound was performed in 34.1%, abdominal tomography in 20.0% and both of them in 7.5% of the patients.

Conclusion: The patients aged 85 years and older with abdominal pain are more likely to be characterized by more examination needs, more consultation needs, more hospitalization rates and higher mortality rates. Taking these differences into consideration during the management of the elderly patients with abdominal pain in emergency department will help to reduce morbidity and mortality rates while improving patient care quality.

 Many of the colorectal cancers originales from polips.We wanted to discuss a case accompanied with literature who has a complicated giant rectal polip which presented with an unusual clinic and confusion in diagnosis. 36 years old male patient.He has cramp like stomache and changing in volonic habits for about a year.During colonoscopy a malign mass in caecum and a giant villous adenoma in rectum is identified.The mass in caecum is excised via laparoscopic surgery.The mass in rectum received polipectomy via local excision.Altough a cancer has seen in the polip the surgery is considered opprepriote because of the surgical frontier and acceptable histologic properties. Colorectal polips are lesions which has the risk to turn into cancers thus, detoiled histopatologic examination and gently decission of surgery is needed.

Abstract

Objective

There is still no consensus on nonoperative management (NOM) for the treatment of patients with liver injury due to multiple trauma. In this study, we aimed to present our experience in patients who underwent NOM in our hospital due to liver injury resulting from blunt trauma.

Material & Methods

In this study, a total of 104 patients who presented to our hospital with liver injury due to multiple trauma were retrospectively evaluated. Patients with successful NOM and those who underwent laparotomy due to failure of NOM were grouped.

Results

All of the 104 patients had solid organ injury due to blunt abdominal trauma, and 58 of these had thorax trauma. NOM was successfully performed in 94 patients with liver injury due to blunt abdominal trauma. The treatment was converted to surgery in 10 patients during conservative follow-up. According to injury grades; 35 patients were graded as Grade 1, 23 patients as Grade 2, 24 patients as Grade 3, and 12 patients as Grade 4. Data of 10 patients with liver trauma and NOM failed were compared with those of the NOM group.

Conclusion

The development of complications increases in patients with high-grade injury or those accompanied by thorax trauma. The rate of complications is high in patients who receive NOM in Grade 4 injury.

Postburn contractures in the upper extremities limit the function of the hand and arm. A 25-year-old female patient was admitted to our outpatient clinic for contracture of the left wrist since the age of three. On examination, the patient had an extension contracture of approximately 120 degrees in the left wrist. The patient's contracture was opened with an incision and the defect was closed with an abdominal flap. We think that abdominal flap is a good alternative for the treatment of postburn contractures.

A rare cause of acute abdomen; appendiceal neuroma. Case report

ABSTRACT

    Acute abdomen refers to nontraumatic pathologies of abdominal origin which are characterized by sudden-onset abdominal pain. In most cases the cause of pain is a pathological condition requiring urgent surgical intervention. Acute appendicitis is the most common indication for surgical intervention in patients presenting to emergency department with acute abdomen. Obstruction of appendiceal lumen has been widely accepted as the precipitating factor in the pathophysiology of acute appendicitis. It usually develops as a result of food or feces particles entering into and obstructing appendiceal lumen, leading to inflammation and swelling of regional lymph nodes. Luminal obstruction results in overproduction of bacteria, excessive mucus secretion, and increased intraluminal pressure. Some studies in recent years have suggested a neural component in the pathophysiology of this condition. Such cases may present with various diagnoses such as obliterated appendix, fibrous obliteration, appendiceal neuroma, and neurogenic appendicitis. In this paper we present a case operated with the initial diagnosis of appendicitis and histopathologically diagnosed with appendiceal neuroma, a rare cause of acute abdomen.

Aim: The aim of the study was to evaluate the clinical features and consultation process of the patients who
were consulted from the pediatric emergency department to the surgical departments during the pandemic
period, and to compare the findings with the data before the pa ndemic.
Patients and Methods: The research was conducted between 11.03.2020-11.03.2021 in the pediatric
emergency department of our hospital. The enrolled patients at 0-18 years of age were retrospectively
evaluated in terms of gender, age, diagnosis, consultation result, consultation response time. Our study was
compared with the prepandemic data between 01.01.2019 and 31.12 .2019.
Results: Of the patients; 42,4% were female and 57,6% were male. The mean age was 6,9±4,9 years. It
was determined that 27,3% of our patients were consulted to one of the surgical clinics with the diagnosis of
foreign body, 22,2% acute abdomen, 10.6% foreign body aspiration. It was found that 38,5% of the patients
were consulted to the pediatric surgery department, 33,9% to the otolaryngology department and 11,4% to the
thoracic surgery department. The mean consultation response time was 72,2±48,8 minutes. The distribution
of diagnoses, consultation response time, consulted surgical departments, consultation results by age groups,
and distribution of the consultation response times by surgical departments during the pandemic were found
to be statistically significant compared to the pre-pandemic pe riod (p<0,05).
Conclusion: In our study, it was found that the number of patients admitted to the pediatric emergency
department decreased during the pandemic period, the number of hospitalizations increased, the diagnoses
associated with trauma and close physical contact decreased, and the diagnosis of epididymorchitis increased.
In addition consultation response times were observed to be con siderably longer.

\r\n Tubal torsion is a very rare case, especially in pregnancy. We present a case of a patient of 24 weeks gestation that was admitted to our clinic with acute abdomen. Radiological and biochemical investigations did not reveal the cause of abdominal pain which resulted in laparatomic exploration. During the operation, the Morgagni cyst, previously explored by ultrasonographic examination, and the right fallopian tube were found twisted among themselves. Cystectomy and detorsion was performed of the Morgagni cyst and the fallopian tube, respectively.  

\r\n  

Aim: It was aimed to compare with healthy volunteers the changes in heat shock protein (HSP) 90 alpha and vitamin levels during exacerbation and remission periods in our patients with familial Mediterranean fever (FMF), to research whether these molecules will benefit in control of FMF exacerbation and prevention of amyloid accumulation, and also to investigate the relationship of these molecules with FMF gene mutations.

Patients and Methods: HSP 90 alpha, vitamin A, vitamin B 12, vitamin D, vitamin E and folic acid levels were studied in 30 patients with AAA diagnosed in our hospital's pediatric nephrology department during the exacerbation and remission periods and 30 healthy volunteers. The results were compared statistically.

Results: In our series, 19 (63.3%) of the patients were male, 11 (36.7%) were female, with a mean age of 11 years. The most common presenting complaint was abdominal pain (n=19; 63.3%) after fever and only high fever was found to be present in five (16.7%) patients. The most common genetic mutation was M694V (n=14; 46.7%), whereas no mutation was detected in five (16.7%) patients. Although HSP 90 alpha was the highest in the exacerbation group and the lowest in the remission group, there was no significant difference between the groups. Vitamin B12 was significantly different between the groups and the highest value was in the control group. Vitamin D was significantly different between the exacerbation and the remission groups and the highest value was in the exacerbation group. In addition, vitamin D levels were significantly higher in boys. There was no significant difference between vitamin A, vitamin E and folic acid levels. FMF gene mutations did not affect HSP 90 alpha and vitamin levels.

Conclusion: Our findings showed that serum HSP 90 alpha, vitamin D, vitamin E and folic acid levels were normal in AAA, but vitamin B12 and vitamin A levels were low during exacerbation and remission. However, we think that prospective studies including larger series should be performed about the subject.

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.

 Fourty one years old female and 64 years old man were admitted to our clinic  because of abdominal pain. In investigating the liver was reported with a giant hemangioma. It was symptomatic and look like malignancy for each cases so they were operated. In operation it was not a liver mass , one of them observed right giant adrenal adenoma and the second one is renal cell carsinoma.  Resection was performed for each cases. Adrenal mass could be noted that mixed hemangiomas.

Abstract

INTRODUCTION

Acute mesenteric ischemia (AMI) is an acute abdominal disease which is age-related with possible bad prognosis; and while its morbidity and mortality rate is 10% in early diagnosis and treatment it may progress with 100% mortality when diagnosis and treatment are delayed.The aim of this study was to unearth the efficiency of neutrophil-to-lymphocyte ratio (NLR) which has recently been started to be utilized in the prediction of AMI prognosis and used as a prognostic factor in many diseases.

MATERIALS and METHODS:

The data of a total of 111 patients, who had undergone surgical procedures and diagnosed with mesenteric ischemia intraoperatively at Necmettin Erbakan University Meram Medical School’s General Surgery Clinic between 2005 and 2013 and whose diagnoses had later on been confirmed pathologically, were retrospectively evaluated within the scope of the study.

The demographic data of all patients (age, sex) were recorded. The hemogram results of the patients, analyzed with peripheral blood, were reviewed for preoperative evaluation. The surgical procedure performed, the part and length of the resected bowel based on pathology results, the duration of hospitalization, survey, presence of comorbidity, white blood cell count, creatinine values, and NLR of the patients were determined. The data were statistically analyzed.

RESULTS:

The patients who did not survive had a mean NLR of 24.77 ±10.38, while the same ratio was found to be 17.6±10.65 for survivors. The NLO value was found to be high in cases with mortality.

CONCLUSION:

AMI still proves to have high mortality in spite of the developments in imaging techniques and laboratory analyses. There is no specific laboratory analysis for early diagnosis. High preoperative NLR in patients suspected to have AMI may indicate bad prognosis.

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.

Aim: We aimed to retrospectively analyze and present the findings of patients diagnosed with esophageal
cancer and staged using 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed
Tomography (PET/CT) imaging.
Patients and Methods: Thirty-seven patients diagnosed with esophagus who were staged with 18F-FDG
PET/CT in our hospital between February 2015 and February 2020 were included in this study. Patients'
age, gender, localization of the primary tumor and 18F-FDG PET/CT maximum standardized uptake value
(SUVmax), findings of metastases to mediastinal, abdominal and cervical lymph nodes, lung, liver, bone and
other areas were retrospectively evaluated as.
Results: The meanage of the patients was 66,97 ± 14,54 years. 20 patients (54%) were male, 17 patients
(46%) were female. 10 patients (27%) had upper esophagus tumors, 23 patients (62%) had lower esophagus
tumors, 4 patients had middle esophageal tumors (11%). The pathological diagnosis of 23 patients was
squamous cell ca, 14 patients were adeno ca. The mean of primary tumor SUV max was measured as 14,09
± 6,36 in all patients. The mean primary tumor SUVmax of the patients diagnosed with squamous ca was
14,51 ± 6,63, and the mean of primary tumor SUV max of the patients diagnosed with adeno ca was found to
be 13,40 ± 6,03. Progression was observed in 7 of 9 patients whose treatment and follow-ups were continued
in our hospital, and regression was observed in 2 of them.
Conclusion: In the initial staging of patients diagnosed with esophageal ca, 18F-FDG PET/CT is an
increasingly useful imaging method. Our study supports this.

Acute pancreatitis is an important cause of acute abdominal pain in children and requires prompt treatment because it may become life-threatening. The incidence of acute pediatric pancreatitis is increasing. Although epidemiology of acute pancreatitis, clinical manifestations and acute pancreatitis course in children are generally different than in adults, information about etiology, management and results are obtained on the basis of adult studies. In most cases, inflammation may limit itself, but in some cases acute pancreatitis, acute recurrent pancreatitis or chronic pancreatitis may progress. It is necessary to provide optimal management in the acute period of pancreatitis in children, as this may prevent secondary conplications. In this review we summarise the epidemiology of acute pancreatitis, role of imaging and imaging findings in the diagnosis of acute pancreatitis, treatment methods and management and complications of acute pancreatitis.