MTHFR C677T mutasyonunun neden olduğu süperior mezenterik ven trombozu

Amaç: Akut süperior mezenterik ven trombozu, tüm mezenterik iskemik olayların yaklaşık % 5 -15’ini oluşturan nadir görülen bir intestinal iskemi nedenidir. Bu yazıda süperior mezenterik ven trombozu gelişen kalıtsal trombofilili 2 hastanın sunulması amaçlanmıştır. Olgu sunumu: Otuz bir ve 51 yaşında iki hastaya akut batın, mezenter iskemi nedeni ile laparotomi ve ince barsak rezeksiyonu yapıldı. Genetik incelemede her iki hastada homozigot MTHFR C677-T mutasyonu saptandı. Ameliyat sonrası dönem sorunsuz geçen hastalar 10. ve 12. günde taburcu edildi. Sonuç: Akut süperior mezenterik ven trombozu mortalitesi yüksek olan ciddi bir sağlık problemidir. Doğru tanı koyabilmek için hastalıktan şüphelenmek oldukça önemlidir. Nekroz varlığında acil eksplorasyon ve nekrotik dokuların rezeksiyonu gerekmektedir. Trombofilili hastalar tanınmalı ve uzun dönem antikoagülan kullanımı planı yapılmalıdı

Penetrating anterior abdominal stab injury

AMAÇ: Acil cerrahi servislerinde sık karşılaşılan karına penetre delici kesici alet yaralanmalarında (DKAY) tedavi yaklaşımı, zaman içinde rutin eksploratis laparotomiden selektif konservatif yaklaşıma doğru değişim göstermiştir. Konservatif yaklaşımda fizik muayene, laboratuar ve görüntüleme sonuçlarına göre laparotomi kararı verilir. Çalışmamızın amacı karın anterior bölgesine penetre DKAY'lı hastalarımızın takip ve tedavi sonuçlarının irdelenmesidir. YÖNTEMLER: Nisan 2009 - Kasım 2011 tarihleri arasında karın anterior bölgesine penetre DKAY' sı olan ve acil cerrahi ünitesine başvuran hastalar prospektif olarak incelendi. Hemodinamisi stabil, akut karın bulguları olmayan hastalar konservatif tedaviye alınırken, hemodinamisi instabil ve/veya akut karın bulguları olan hastalara acil laparotomi yapıldı. Yaralanmanın lokalizasyonu, zamanlaması (acil,erken,geç), laparotomi bulguları (terapötik,nonterapötik,negatif) ve tedavi sonuçları değerlendirildi. BULGULAR: Toplam 85 hasta çalışmaya dahil edildi. İlk değerlendirme sonucunda hemodinamisi stabil olan ve peritonit bulguları olmayan 80 hasta konservatif tedaviye (grup 1) alınırken, 5 hastaya acil laparotomi (grup 2) uygulandı. Grup 1'de 11 hastaya erken, 5 hastaya geç dönemde laparotomi yapıldı. Bu grupda ki hastaların 13'ünde laparotomi terapötik, 2'sinde nonterapötik ve 1'inde negatif idi. Grup 2'de laparotomi endikasyonları; 3 hastada akut batın, 1 hastada hemodinamik instabilite ve 1 hastada organ eviserasyonu idi. Bu grup da 4 terapötik, 1 negatif laparotomi yapılırken bir hasta peroperatif exitus oldu. SONUÇ: Bu çalışmada 64 hastaya (% 75) konservatif tedavi, 21 hastaya (% 25) laparotomi uygulandı. Laparotomilerin; 17'si (% 80) terapötik, 2'si (%10) nonterapötik ve 2'si (%10) negatif idi. Klinik takip ve tanı metodlarının birlikte kullanımı gereksiz laparotomi oranlarını azaltmaktadır. OBJECTIVE: Penetrating anterior abdominal stab injuries (PAASI), frequently encountered in Emergency Unit and traditionally managed with mandatory laparotomy, are nowadays managed conservatively. The decision of laparotomy is based on physical examination, laboratory and imaging results during follow-up. The purpose of this study was to analyze the outcome of patients with PAASI. METHODS: From April 2009 to November 2011, patients with diagnosis of PAASI admitted in Emergency Unit were prospectively included in the study. While hemodinamically stable patients without signs of peritonitis were managed conservatively, unstable and/or patients with signs of peritonitis underwent emergency laparotomy. Location of the injury, type of management (emergency, early, late), laparotomy findings (therapeutic, non-therapeutic, negative), and treatment results were analyzed. RESULTS: Totally 85 patients were included in the study. Hemodynamically stable 80 patients without signs of peritonitis were treated conservatively (group 1), while emergency laparotomy was performed in 5 patients (group 2). In group 1, early laparotomy was performed in 11 patients and late laparotomy in 5 patients. Totally 13 therapeutic, 2 nontherapeutic and 1 negative laparotomy were performed. In Group 2, the indications for laparotomy were acute abdomen (n=3), hemodynamic instability (n=1), and organ evisceration (n=1). Group 2 included 4 therapeutic, 1 negative laparotomy and in this group 1 patient died intraoperatively. CONCLUSION: In this study, 64 patients (75%) were managed conservatively, whereas 21 patients (25%) underwent laparotomy, including 17 therapeutic (80%), 2 nontherapeutic (% 10) and 2 negative (10%). Clinical follow-up and use of diagnostic methods decrease the rate of unnecessary laparotomy

Transmural Migration of a Retained Sponge Through the Rectum: A Case Report

Retained surgical sponge in the abdomen following abdominal and pelvic surgery is an uncommon condition. Here we present a case of retained surgical sponge with unusual presenting symptoms. A 27-year old female patient presented to our department with a foreign body localized in the anal region. She had a past history of a myomectomy 1 year earlier. Clinical examination and radiographic workout revealaed a sponge migrating towards the rectum. The sponge was removed under visual guidance of rectoscopy without laparotomy. The patient was discharged without complications

Comparison of common surgical procedures in non-complicated pilonidal sinus disease, a 7-year follow-up trial

Background: Pilonidal disease is a common problem in primary health care which may require immediate surgical referral. Although various management options have been proposed, so far there is no gold standard treatment. The aim of the present study was to determine which of the following techniques was superior as regards postoperative complications and recurrence, midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. Methods: A randomized clinical trial was conducted in the Department of General Surgery. Patients with non-complicated pilonidal sinus were enrolled in the study from April 2009 to January 2012. All patients were randomized the day of surgery at the coordinating center by means of a computer program. Patients were randomized to receive midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. All procedures were performed under local anesthesia and patients were discharged 6 h after surgery. Demographic characteristics, skin color, body hair type, family history, preoperative complaints and duration of symptoms, cyst size, intraoperative iatrogenic cyst rupture, the presence of a tuft of hairs in the cyst, surgical techniques, duration of drainage, length of hospital stay, postoperative complications and recurrence were evaluated. Results: One hundred and ninety-two patients with non-complicated pilonidal sinus were enrolled. Seventy-two patients were randomized to midline unshifted adipofascial turn-over flap, 67 patients to midline shifted adipofascial turn-over flap and 53 patients to Karydakis flap. The mean age was 25.66 ± 7.67 years. At 76-month follow-up, the overall complications and recurrence rates were not significantly different between groups (p > 0.05). Conclusion: In cases of non-complicated pilonidal sinus, we recommend surgical management using local anesthesia, outpatient surgery and the surgical approach with which the surgeon is most familiar

Factors predicting severity level, progression and recurrence risk of acute left colonic diverticulitis in Turkey: A multicenter study

BACKGROUND: Acute left colonic diverticulitis (ALCD) ranges from localized diverticulitis to perforation and fecal peritonitis, and treatment varies from conservative management to emergency surgery. The risk factors for recurrence following nonoperative management of ALCD is still controversial. We aimed to define the factors predicting severity level, progression and recurrence risk of ALCD to timely select patients requiring surgery