Accessory Splenic Torsion is a Rare Cause of Acute Abdomen: A Case Report and Literature Review

Background: Accessory splenic torsion is an extremely rare condition. Torsion of the accessory spleen may lead to symptoms of acute abdominal pain with accompanying nausea, vomiting, and fever. Without treatment, torsion can lead to significant complications including hemorrhagic shock, peritonitis or rupture. Case Presentation: A 47-year-old female patient was admitted to our hospital with complaints of nausea, vomiting and abdominal pain. An intra-abdominal mass was detected in the imaging findings. The patient was taken into surgery. Torsioned giant accessory spleen was detected. Splenectomy was performed and the patient was discharged at the postoperative second day. Conclusion: In cases with giant accessory spleen, prophylactic splenectomy can be considered in order to avoid possible complications such as torsion, spontaneous rupture, hemorrhage, peritonitis and intestinal obstruction

Sinotomy technique versus surgical excision with primary closure technique in pilonidal sinus disease

Pilonidal disease is a common chronic disorder mainly seen in the sacrococcygeal region, especially in young males. Many surgical treatment modalities have been suggested, but an ideal and widely accepted treatment has yet to be established. The aim of this study was to compare quality of life of patients treated with the sinotomy technique with quality of life of patients treated with surgical excision plus primary closure technique by means of quality of life questionnaire. The data of patients who had been treated for pilonidal sinus in our clinic from September 2010 to June 2012 were analyzed retrospectively. Forty patients were treated with sinotomy technique and 40 patients were treated with surgical excision plus primary closure technique. Time to return to work and to time to complete wound healing were evaluated. All patients were asked to fill the questionnaire after complete healing occurred. Postoperative complications were bleeding in 2.5%, infection in 3.75% and fever in 2.5% patients. There were no significant differences between the two groups in terms of complete healing (p=0.1) and sport times (p=0.1). There were significant diffetences between the groups in terms of length of hospital stay (p <= 0.001), time off work (p <= 0.001), times to sitting on toilet and walking without pain (p=0.002 and p <= 0.001, respectively). The mean postoperative VAS scores were 5.2 +/- 3.2 and 2.8 +/- 2.2, respectively (p=0.02). The technique of sinotomy with good wound and surrounding skin care seems to be an ideal approach with high chance of cure. The patients returned to their routine in a short period of time

Hepatik Bileşkede Hiler Kolanjiokarsinomayı Taklit Eden Tip IV Mirizzi Sendromu

Mirizzi’s syndrome refers to common bile duct obstruction resulting from compression by a gallstone impacted in the cystic duct or neck of the gallbladder. Some cases can not be identified preoperatively, despite modern imaging techniques. Today, treatment of Mirizzi syndrome is surgical. The essential part of the management of patients with Mirizzi syndrome is to determine the best surgical procedure in the preoperative period. In type I patients, simple cholecystectomy is generally enough, but types IIIV require more complex surgical approach, such as cholecystectomy and bilioenteric anastomosis. Here, we presented a 48 year-old man with obstructive jaundice who diagnosed as Mirizzi’s syndrome.Mirizzi sendromu, sistik kanal ya da safra kesesi boynuna impakte taşın, koledok kanalına dıştan basısı sonucu gelişir. Modern görüntüleme tekniklerine rağmen bazı olgular ameliyat öncesi dönemde belirlenememektedir. Mirizzi sendromunun günümüzdeki tedavisi cerrahidir. Mirizzi Sendrom tanılı hastalarda tedavide en önemli noktalardan biri de preoperatif dönemde cerrahi tedavinin belirlenmesidir. Tip I olgularda basit kolesistektomi yeterli olurken, Tip II-IV MS olguları kolesistektomi ve biliyoenterik anastomoz gibi kompleks prosedürler gerektirebilir. Burada tıkanma sarılığı ile müracaat eden, Mirizzi sendromu tespit edilen 48 yaşında bir erkek hasta sunulmuştur

İnsizyonel Herni Onarımının Nadir Komplikasyonu: Gastroenterostomi Hattına Mesh Migrasyonuna Bağlı Gastrik Obstruksiyon

Hernia repair is one of the most common elective procedures in general surgery. Agreement has been achieved that tension-free hernia repair using prostheses reducesrecurrence rates significantly. Approximately 60% of prosthetic repairs of the inguinal flor are believed to use a flat mesh of some type, and 90% of incisional and ventral herniarepairs incorporate the use of a synthetic prosthesis. However, the use of prosthetic mesh for hernia repair can cause serious complicationssuch as infection, seroma formation, fistulae formation, adhesion, biomaterial-related intestinal obstructions, and other miscellaneous complications. Mesh migration is dangerous and rare complication after hernia repair. Hereby, reporting a rare case of intra-peritoneal migration of polypropylene mesh and its adhesion to stomach wall following onlay mesh repair of incisional hernia.Fıtık tamiri genel cerrahide en fazla yapılan ameliyatlardan birisidir. Protez kullanılarak yapılacak gerginliği azaltıcı tamirlerin etkinliği konusunda bir fikir birliği oluştu. Bugün, inguinal fıtıkların %60’ında flat mesh, insizyonel fıtıkların %90’ında prosthetic mesh kullanıldığı sanılmaktadır. Bununla birlikte, mesh kullanımı enfeksiyon, seroma, fistül, barsak fistülü, yapışıklık, barsak tıkanmaları ve diğer nadir görülen komplikasyonlara yol açabilir. Mesh migrasyonu tehlikeli ve nadir bir komplikasyondur. Burada, insizyonel herni nedeniyle onlay olarak uygulanan polipropilen meshin intraperitoneal olarak migrasyonu ve mide duvarına yapıştığı nadir bir vaka sunulmuştur

Fournier Gangreni’ni Taklit Eden Massif Pelvik Sellülit: Olgu Sunumu ve Literatür Derlemesi

Introduction: Fournier’s gangrene (FG), a localized form of necrotizing fasciitis (NF), is a rapidly progressive infectious disease that particularly affects the genital area. Cellulitis, however, is a mild disease that affects the skin and extremities. Case Report: We report a case involving a 71-year-old woman with a rash, extending from her thigh to her breast, which had begun two days prior to her visit to the ER. She was referred to our clinic with an initial diagnosis of extensive pelvic cellulitis mimicking Fournier's gangrene. Following the first assessment (blood glucose >500 mg/dL, pyrexia of 38.3 °C), she was admitted to the intensive care unit, where she received antibiotics and dressings and was monitored. Showing a good recovery, she was discharged in two weeks. Discussion: In the diagnosis and treatment of Fournier's gangrene, significant advancements have been made since it was first described by Jean-Alfred Fournier in 1883. The disease’s morbidity and mortality, however, is still between 25% and 35%. Conclusion: In patients with FG, early diagnosis and aggressive treatment are highly recommended.Giriş: Fournier gangreni Nekrotizan fasiitin localize formu olup, genellikle genital bölgede görülen ve hızlı ilerleyen enfeksiyöz bir hastalıktır. Sellülit ise daha çok ekstremite ve deride görülen daha ılımlı bir hastalıktır. Olgu Sunumu: 71 yaşında bayan hasta, öyküsünde son 2 günde gelişen her iki uyluktan başlayıp memelere kadar uzanan Fournier gangrenini taklit eden geniş pelvik sellülit ile başvurdu. İlk değerlendirmeden sonra (Kan şekeri >500 mg/dl, ateş 38,3 oC) hasta yoğun bakıma alındı, hastaya antibiyotik tedavisi verildi ve sık aralıklarla pansumanlar yapıldı. Hasta iki hafta içerisinde şifa ile taburcu edildi. Tartışma: 1883 yılında Jean-Alfred Fournier tarafından tanımlanan Fournier gangreni tedavisinde, o zamandan beri önemli gelişmeler olmuştur. Ancak, morbidite ve mortalitesi hala yüksektir (%25–35). Sonuç: Fournier gangrenli veya bizim hastamızdaki gibi geniş pelvik sellülitli hastalarda, tanı erken konulmalı ve tedavi gecikmeden yapılmalıdır

Laparoskopik Kolesistektomiden Açık Ameliyata Geçme Nedenleri

Aim:To determine the number of laparoscopic cholecystectomy procedures, reasons and risk factors for conversion to open cholecystectomy, which were performed in the General Surgery Departmnent of our Hospital.Materials and Methods:568 laparoscopic cholecystectomy procedures performed between 2008-2013 were analyzed. Patients’ age andsex were noted. The causes of conversion to open cholecystectomy, the number of acute cholecytitis and chronic cholelithiasis cases, conversion rates according to the age groups were determined.Results:The sex distribution of the cases was 525 (92.4%) and 43 (7.6 %) male (F/M: 4.1). Median age was45.5 ± 12.7 years (range: 18-82), median operative time was 60.2 minutes (range: 17-200). Indications for surgery, were chronic cholecystitis in 525 (92.4 %), acute cholecystitis in 33 (4.4 %), and gall bladder polyps in 6 (1 %), a calculous cholecystitis in 2patient (% 0.35) were operated. Overall, conversion to open laparotomy was necessary in 20 patients (3.5%) Seven patients (1.2 %) required reoperation due to complications.There was no mortality. Median post operative hospital stay was1.6 days (8 hours- 28 days). Causes of conversion were determined as fibrosis in Calot’striangle (n=3), acute cholecystitis (n=33), stone in choledocus (n=2), adhesions due to previous operations (n=1), difficulty in dissection (n=2), organ injury (n=2), anatomical variation (n=1), perforation of gall bladder and seeding of Stones into abdominal cavity (n=1).Conclusion:Acute cholecystitis seems to be the main factorin creasing the ratio of conversion to open cholecystectomy. Risk factors of conversion to open cholecystectomy were determined as follows: male gender, being elderly and the diagnosis of acute cholecystitis before the operation. However, laparoscopic cholecystectomy should be the first choice for all cases with cholelithiasi

Perkütan endoskopik gastrostomi sırasında kateterizasyon noktasının önemi

Amaç: Perkütan endoskopik gastrostomi (PEG) sırasında komplikasyonları minimize etmek esastır. Kateterizasyon noktası ile PEG'in minör komplikasyonlar arasındaki ilişki çok önemlidir. Bu çalışmamızda cerrahi endoskopi ünitemizde uygulanan PEG sonuçlarının değerlendirilmesini amaçladık. Yöntem: Yenikent devlet hastanesi endoskopi ünitesinde 2008- 2011 yılları arasında 76 hastaya PEG girişiminde bulunuldu. PEG uygulanan hasta sonuçları retrospektif olarak değerlendirildi. Kateter yerleştirme alanına gore hastalar iki gruba ayrıldı. Sonuçlar istatistiksel değerlendirilmesi SPSS, Windows 21.0 ile gerçekleştirildi ve p<0.05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Hastaların 48 (63%) erkek, 28 (37%) kadın ve yaş ortalaması 57.74 idi. Majör komplikasyon gözlenmedi. Minor komplikasyonlar birinci grupta 3(%7.89), ikinci grupta 10(%26,31) ve tüm hastaların 13(%17.10) 'ünde meydana geldi. Istatis tiksel olarak iki grup arasında anlamlı fark bulunmuştur(p <0.05). Sonuç: PEG güvenli, etkili ve hızlı bir yöntemdir. Minor komplikasyonlar özellikle kateterizas yonun yanlış noktada yapılmış hastalarda meydana gelmektedir. Kataterizasyon sol arkus castalis ile umblikus arasındaki doğrunun ¾ veya 2/3 lük alanda yapılır ise mimör komplikasyonları azaltır.Objective: it is essential to minimize complications during percutaneous endoscopic gastrostomy(PEG). The relationship between catheter insertion point and minor complications of percutaneous endoscopic gastrostomy is very important. The aim of this study is to evaluate the PEG results in our surgical endoscopy unit. Method: This study included retrospective review of 76 patients who underwent percutaneous endoscopic gastrostomy in the endoscopy unit of Yenikent state hosp ital between 2008 and 2011. PEG catheter insertion point evaluated retrospectively. The patients were divided into two groups according to PEG catheter insertion point. The results were processed with SPSS&reg; ver. 21.0 (Chicago IL) p&lt;0.05 was accepted to be statistically significant. Results: There were 48 (63%) men and 28 (37%) women. The median age of the patients was 57.74 years. There was no major complication. Minor complications were occurred in 3 (%7.89) of patients from group I, 10(%26,31) of patients from group II and 13(%17.10) all patients. Statistically significant differences were found between in group I and group II (p&lt;0.005). Conclusions: PEG is a very efficient, safe and fast method. Minor complications are occurred mainly among patients with inappropriate PEG insertion point, which is a technique -related factor. If catheter insertion is made appropriate point where is two-thirds or three-quarters of the distance from the umbilicus to the midpoint of the left costal magrin , it is seem to reduction of minor complications

Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease

OBJECTIVE: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus. MATERIALS AND METHODS: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935. RESULTS: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (

The Importance of Hospital Choice in Burn Patients: Retrospective Evaluation of 22 Cases

Amaç: Çeşitli nedenler ile yanmış 22 hastanın tedavi yeri ve şeklinin değerlendirilmesi amaçlanmıştır. Materyal ve metod: Temmuz 2008 - Eylül 2014 tarihleri arasında yanık nedeniyle yanık odasında tedavi edilen 22 hastanın verileri retrospektif olarak değerlendirildi. Bulgular: Yanık nedeni; olguların %50(11)'ınde sıcak su, %36,4(8)'ınde yanıcı madde ile temas, ve %13,6(3)'ınde tandıra düşmedir. Tüm olgulara antibiyotik ve açık pansuman uygulandı. Sonuç: Genel cerrahi yanık odası; her türlü genişlikteki birinci derece yanık, komorbiditesi olmayan %10 altı ikinci derece yanık ve % 3'ün altı 3 derece yanık olguların tedavisinde yeterli bir ünitedir.Objective: We aimed to evaluate the location and depth of the burn injury of 22 patients treated in local burn unit. Materials and Methods : Data of 22 patients who were treated in the burn unit between July 2008 and September 2014, were reviewed retrospectively. Results: Half of the injuries of the patients studied were due to hot water, %36.4 were due to direct contact with the burning material, %13.5 were due to fall into a heated natural cousine. All cases were treated by antibiotics and open dressing.Conclusion: We found that this burn unit facilities can help to treat 1st degree burn injury of every kind, lower than %10 amount of 2nd degree burn injury treatment and less than %3 3th degree burn injury without transporting the patient to a big burn center