Duodenal Duplication Cyst with Recurrent Acute Pancreatitis: Report of a Case

Introduction:Duplication cyst can be occurred in any level of GI tract but the duodenal cysts are extremely rare. Most of the duplication cysts are detected in children. Duodenum duplication cysts are difficult to diagnose, as the presenting symptoms are nonspecific and are closely related to the type, size and location of the lesion. Both CT imaging and MRI can adequately identify a duodenal duplication cyst.Presentation of the case: We report an adult with recurrent episodes of acute pancreatitis who was diagnosed with ERCP. With the diagnosis of duodenal duplication cyst, we planned to perform surgical resection of the cyst.Conclusions: The surgical intervention for duodenal duplication cyst includes complete or partial surgical resection of the cyst. The location of the cysts in relation to the duodenum, especially to the ampulla, is important to determine the treatment strategy. Alternatively, duodenum duplication can be safely and effectively treated by different endoscopic interventions

Apandisit ile komplike gebeliklerin cerrahi tedavisi ve gebelik sonuçları: obstetrisyen görüşü

Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy. Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients’ pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergency department and operation, mean operative time, pregnancy outcome and pathologic results of the appendix. Results: Thirty-nine patients were included in the study. Sixteen of 39 patients were in the first, 15 of them in the second and 8 of them were in the third trimester of the pregnancy. Three patients underwent laparoscopic appendectomy and the rest underwent laparotomy. In pathologic evaluation of the appendix, seven patients (17%) had normal appendix, 4 patients had perforated appendix, one patient had neuro-endocrine tumor and rest of the patients had appendicitis. Two missed abortion occurred after operation, rest of the patients had live birth. Six of them were preterm and 31 had term birth. Twelve patients delivered through vaginal birth and the rest via caesarean section. Twenty patients were in the first half of the pregnancy (group 1) and 19 patients were in the second half of the pregnancy (group 2). There were no significant differences between the groups in operation time and mean time interval between emergency administration and operation. Conclusion: Delayed operation and negative appendectomy can cause adverse pregnancy outcomes. Expectant management in suspected cases may decrease negative appendectomy rates but can also lead to perforation. Computed tomography and MRI ought to be considered if ultrasonography is inconclusive. Tocolytic regimens can be administered to prevent threatened preterm labor. Obstetric indications were valid for delivery mode.Amaç: Gebeliğinde apendektomi yapılan hastaların gebelik sonuçlarının değerlendirilmesi. Gereç ve Yöntemler: 2010-2014 yılları arasında apendektomi yapılan hastalar retrospektif olarak incelendi. Tüm hastaların gebelik sonuçları üniversite kayıt sistemi ve telefon görüşmeleri ile takip edildi. Hastalar yaş, gebelik yaşı, klinik ve laboratuvar muayeneleri, görüntüleme çalışmaları, acil servis ve operasyon arasındaki ortalama zaman, ortalama operasyon süresi, gebelik sonucu ve apandiksin patoloji sonucuna göre değerlendirildi. Bulgular: Otuz dokuz hasta çalışmaya dahil edildi. Otuz dokuz hastanın 16’sı ilk, 15’i ikinci ve 8’i gebeliğin üçüncü trimesterindeydi. Üç hastaya laparoskopik apendektomi kalanlarına laparatomi yapıldı. Apendiksin patolojik değerlendirilmesinde, yedi hasta (17%) normal apendiks, dört hasta perfore apendiks, bir hasta nöro-endokrin tümor ve kalanları apandisit saptandı. Operasyon sonrası iki missed abortus meydana gelirken kalanları canlı doğum yaptı. Bunlardan altısı preterm ve otuz biri term doğum yaptı. On iki hasta vajinal yolla ve kalanları sezaryen yoluyla doğurtuldu. Yirmi hasta gebeliğin birinci yarısında (grup 1) ve 19 hasta gebeliğin ikinci yarısındaydı (grup 2). Gruplar arasında operasyon zamanı ve acile kabul ile operasyon arasındaki ortalama zaman aralığı açısıdan anlamlı farklılık yoktu. Sonuç: Gecikmiş operasyon ve negatif apendektomi olumsuz gebelik sonuçlarına neden olabilir. Şüpheli olgulardaki izlem tedavisi negatif apendektomi oranlarını düşürebilir; ancak aynı zamanda perforasyona neden olabilir. Bilgisayarlı tomografi ve manyetik rezonans görüntüleme, ultrasonografinin net olmadığı zaman düşünülmelidir. Erken doğum tehditini önlemek için tokolitik rejimler uygulanabilir. Doğum şekli için obstetrik endikasyonlar geçerlidir

Meckel’s Diverticulum Perforation Due to Strangulated Inguinal Hernia (Littre’s Hernia): A Rare Case

Meckel's diverticulum is remnant of omphalomesenteric ductus and it is the most frequent congenital malformation of the gastrointestinal tract. Rarely, any hernia sac contains it and named as a Littre hernia. A 59-year-old male patient with Meckel's diverticulum perforation due to strangulated inguinal hernia, was successfully treated with diverticullectomy using linear GIA stapler and performing graft-free hernia repair. Littre’s hernia may also be present in abdominal wall hernias requiring urgent surgical intervention due to incarceration. For this reason, it is important to have information about treatment management of this clinical entity

Have General Surgery Practices Decreased During the COVID-19 Pandemic?

Background As the coronavirus disease 2019 (COVID-19) pandemic started, some restrictions were imposed throughout the country. The pandemic caused disruption, reduction, and even a halt in health services worldwide. During this period, the number of procedures performed in surgical clinics decreased due to the interruption of services and the restriction in patient admissions. Methodology In this study, we aimed to evaluate the effect of the pandemic on the number of surgeries performed in our clinic during the pre- and post-pandemic period by evaluating the following elective surgeries conducted between September 2018 and September 2021: upper gastrointestinal system, abdominal wall hernia, gallbladder surgeries, and kidney transplantation. Results A significant decrease was observed in the number of operations before and after the pandemic in our clinic. Conclusions In our opinion, both the Ministry of Health and healthcare institutions should increase the necessary precautions, organize the planning and programming in hospitals, and increase efforts in protecting healthcare workers and patients by increasing surgical practices and ensuring that the healthcare services we provide reach the numbers noted during the pre-pandemic period

Tension-free inguinal hernia repair with transversus abdominis plane (TAP) block in elderly high-risk patients

Background Inguinal hernia repair is still being studied today because it is one of the most commonly performed surgical procedures in the world and is used in people of all ages. Although many centers use spinal anesthetic to treat inguinal hernias, complications such as hypotension from peripheral vasodilation, delayed mobilization from paralysis, urine retention and post-spinal headache might occur. Regional blocks are a significant component of multimodal anaesthesia that promotes postoperative recovery. Transversus abdominis plane (TAP) block is a regional anesthetic block technique that is effective on the parietal peritoneum, skin, and anterior abdominal wall. Methods This study aimed to show that TAP block administration may be done safely without the use of an extra anesthetic treatment, especially in older patients who may experience complications from general or spinal anesthesia. Without either general, spinal or epidural anesthetic, we conducted a tension-free - Lichtenstein - inguinal hernia repair operation with only TAP block application. This retrospective case-control study received ethics committee approval (decision number 21-5T/108). Between September and December 2019, patients who underwent elective Lichtenstein hernia repair in our clinic were evaluated retrospectively. Results We think that inguinal hernia repair can be safely performed with only TAP block and that TAP block application has fewer anaesthesia-related complications such as postspinal headache and urinary retention compared with spinal anaesthesia, and that it can be used as an alternative to spinal anaesthesia in patients who cannot tolerate general anaesthesia. Conclusion Even hernia surgery can be very challenging in patients with advanced age and comorbidities. We wanted to show the feasibility of the TAP block method as an alternative to anaesthesia in such patients

MALNUTRITION VIA GLIM CRITERIA IN GENERAL SURGERY PATIENTS

Purpose: The purposes are to determine malnutrition in elective general surgery patients via GLIM criteria, and to determine the effect of malnutrition on Length of Stay (LoS).Material and Methods: : In this cross-sectional study malnutrition was detected by GLIM after a pre -assessment via NRS2002. Reduced muscle mass in GLIM, was assessed using different anthropometric measurements and cut-off points and a handgrip. Length of hospital (LoS) and intensive care unit (ICU) stay were the outcomes. Data were collected within 48 hours of admission. Association between malnutrition and outcomes were determine by t-test. Logistic regression models were established to present the effect of malnutrition on long LoS. p0.05 was deemed significant.Results: Among participants (n=224) risk of malnutrition was 45.5% via NRS2002, malnutrition was 44-45 % via GLIM. The ones who are under risk of malnutrition and malnourished has significantly longer ICU stay and LoS. After controlling for confounding variables, being in malnutrition via GLIM, significantly increased long LoS 3.9-fold (p0.001).Conclusion: Malnutrition increased LoS. NRS2002 and GLIM yield similar results. Measured by a non-elastic tape, circumference measurements can be preferred to define reduced muscle mass in GLIM. Broader studies should be conducted to determine which anthropometric measurement would better define reduced muscle mass for GLIM

Pregnancy Outcomes and Surgical Management of Pregnancy Complicated By Appendicitis: Obstetrician View

Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy. Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients’ pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergency department and operation, mean operative time, pregnancy outcome and pathologic results of the appendix. Results: Thirty-nine patients were included in the study. Sixteen of 39 patients were in the first, 15 of them in the second and 8 of them were in the third trimester of the pregnancy. Three patients underwent laparoscopic appendectomy and the rest underwent laparotomy. In pathologic evaluation of the appendix, seven patients (17%) had normal appendix, 4 patients had perforated appendix, one patient had neuro-endocrine tumor and rest of the patients had appendicitis. Two missed abortion occurred after operation, rest of the patients had live birth. Six of them were preterm and 31 had term birth. Twelve patients delivered through vaginal birth and the rest via caesarean section. Twenty patients were in the first half of the pregnancy (group 1) and 19 patients were in the second half of the pregnancy (group 2). There were no significant differences between the groups in operation time and mean time interval between emergency administration and operation. Conclusion: Delayed operation and negative appendectomy can cause adverse pregnancy outcomes. Expectant management in suspected cases may decrease negative appendectomy rates but can also lead to perforation. Computed tomography and MRI ought to be considered if ultrasonography is inconclusive. Tocolytic regimens can be administered to prevent threatened preterm labor. Obstetric indications were valid for delivery mode