A Rare Cause of Intestinal Obstruction: Paraduodenal Hernia

Internal abdominal hernias may rarely be the cause of intestinal obstruction with an incidence of less than 1% and paraduodenal hernias constitute approximately 50% of them. Those hernias emerge as a result of abnormalities in gut rotation at the embryonic stage. The clinical spectrum of a symptomatic internal hernia may range from abdominal pain to frank intestinal obstruction. Delay in the diagnosis and treatment should be avoided, since the content of paraduodenal hernia may quickly progress to strangulation and necrosis because of vascular compromise. Here, we report a case of successfully diagnosed and treated with cause of paraduodenal hernia

Roux-en-Y rekonstrüksiyonlu pankreatikoduodenektomi sonrası izole pankreatikojejunostomi pankreas fistülünü azaltabilir mi?

Amaç: Pankreatikoduodenektomi ampulla Vateri, pankreas başı, distal koledok tümörleri ve bazı kronik pankreatit olgularında yaygın kabul gören cerrahi prosedürdür. Rekonstrüksiyon sonrası pankreatik fistül halen ciddi bir problemdir. Rekonstrüksiyon yöntemleri hususunda üzerinde fikir birliği sağlanmış bir yöntem henüz yoktur.Gereç ve Yöntemler: Pankreas tümörü nedeniyle pankreatikoduodenektomi uygulanan hastalarda yapılan rekonstrüksiyon yöntemleri ve sonuçları retrospektif olarak araştırılmıştır. Tüm hastalardaki anastomoz Roux-en-Y şeklinde yapılmış olup birbirinden farkları ise şöyledir; Tip 1: Y bacağı ile sadece pankreatik anastomoz, Tip 2: Y bacağı ile pankreas ve hepatik kanal anastomozu birlikte yapılmıştır.Bulgular: Çalışmaya 31 hasta dahil edilmiştir. Hastaların 21'i erkek, 10'u kadındı. Çalışmamızda pankreatik fistül, kanama, abse, yara yeri enfeksiyonu ve akciğer enfeksiyonu postoperatif dönemde gözlenen komplikasyonlardı. Her ne kadar grup 2'de komplikasyonların sayısı grup 1'e kıyasla daha fazla gözlense de istatistiksel olarak anlamlı fark tespit edilmedi. Mortalite her iki grupta da birer hastada gelişti.Sonuç: Kaçağın sebeplerinden birinin aynı ans üzerine yapılan pankreas ve safra kanalı anastomozlarının birlikte debiyi yükseltmesi ve anastomoz basıncını arttırarak fistül oluşumuna neden olması olduğunu düşünüyoruz. Çalışmamızın dezavantajı ise hasta sayısının az olmasıdır. Pankreatik sıvı ile safranın ayrı anastomozlarla rekonstüksiyonu kronik pankreatik fistülleri azaltabilir.Objective: Pancreaticoduodenectomy is a surgical procedure which is commonly accepted in cases of ampulla of Vater, head of pancreas, distal common bile duct neoplasms and severe chronic pancreatitis. Pancreatic fistula is still a serious problem after reconstruction. Yet, there is no consensus on a single reconstruction method. Material and Methods: The reconstruction methods on patients who had pancreaticoduodenectomy due to pancreatic tumor, and results of these reconstruction methods were retrospectively analyzed. Anastomosis was performed on all patients in the form of Roux-en-Y, but they varied as follows; Type 1: Only pancreatic anastomosis to the Y limb, Type 2: Pancreas and hepatic canal anastomosis together to the Y limb.Results: 31 patients participated in the study. 21 of them were male, and 10 were female. In our study, postoperative complications included pancreatic fistula, hemorrhage, abscess, wound site infection, and pulmonary infection. Although more complications were observed in group 2 than in group 1, there was no statistically significant difference. There was one mortality in each group.Conclusion: In our opinion, one of the reasons of leakage is that anastomosis of both the biliary and pancreatic ducts to the same loop increases anastomotic pressure due to the raised output thus leading to fistula formation. A limitation of our study was the low number of patients. Reconstruction of the pancreas and bile secretions through separate anastomosis may reduce the rate of pancreatic fistulas

İnsülinoma Tanı Ve Tedavisinde Endoskopik Ve İntraoperatif Ultrasonografinin Birlikte Kullanımının Önemi

Introduction: Insulinoma is a usually benign tumor of pancreas. It is seen rarely and incidence of insulinoma is 1 in 250,000 patient-years. We present a rare case with insulinoma which well diagnosed and treated with aid of endoscopic and intraoperative ultrasonography. Case Report: A patient involving a 39-year-old woman with complaints of cold sweats, weakness, syncope attacks, palpitations was evaluated in polyclinic. She was hospitalized with the diagnosis of pancreatic insulinoma after abdominal computer tomography(CT), magnetic resonance imaging(MRI) endoscopic ultrasonography(EUS), and biochemical parameters. The patient was well treated with enucleation and after imaging aid of endoscopic and intraoperative ultrasound(IOUS). Discussion: In patients with insulinoma, preoperative localization of tumor is most important for diagnosis and treatment. Therefore; CT scanning, MRI, EUS and SPECT / CT are used for diagnosis of insulinoma. Together use of endoscopic and intraoperatively ultrasonography are increasing recently. Enucleation is a curative treatment approach in insulinoma. Conclusion: Together using of preoperative endoscopic and intraoperative ultrasound is quite helpful in the diagnosis and treatment of insulinoma.Giriş: İnsülinoma pankreasın genellikle benign tümörüdür. Yıllık insidansı 250.000’de 1’dir ve nadir görülmektedir. Tanı ve lokalizasyon amaçlı olarak endoskopik ve intraoperatif ultrasonografinin kullanıldığı ve başarılı bir şekilde tedavi edilen insülinomalı hasta sunuldu. Olgu Sunumu: 39 yaşında bayan hasta uzun süre aç kalması sonucu artan, soğuk terleme, halsizlik, bayılma ve çarpıntı şikâyetleriyle poliklinikte değerlendirildi. Batın bilgisayarlı tomografi(BT), manyetik rezonans görüntüleme(MRG), endoskopik ultrasonografi(EUS) ve biyokimyasal parametrelerden sonra hasta insülinoma tanısıyla yatırıldı. Hastaya EUS ve intraoperatifUSG(IOUS) yardımıyla enüklüasyon yapıldı. Tartışma: İnsülinomalı hastalarda ameliyat öncesi kitlenin lokalizasyonu çok önemlidir. Bu yüzden BT tarama, MRG, EUS ve SPECT/BT tanı amaçlı olarak kullanılmaktadır. Son zamanlarda EUS ve IOUS’un birlikte kullanımı artmaktadır. Insülinomada küratif tedavi yöntemi enükleasyondur. Sonuç: İnsülinoma’nın tanı ve tedavisinde, endoskopik ve intraoperatif ultrasonografinin birlikte kullanımı oldukça yararlıdır

The effects of vardenafil and pentoxifylline administration in an animal model of ischemic colitis

OBJECTIVES: Vardenafil enhances dilatation of vascular smooth muscle and inhibits platelet aggregation. The purpose of this study was to evaluate the clinical effects of vardenafil and pentoxifylline administration in an experimental model of ischemic colitis. METHODS: Forty female Wistar albino rats weighing 250-300 g were randomized into five experimental groups (each with n = 8) as follows:1) a sham group subjected to a sham surgical procedure and administered only tap water; 2) a control group subjected to a standardized surgical procedure to induce ischemic colitis and administered only tap water; 3) and 4) treatment groups subjected to surgical induction of ischemic colitis followed by the postoperative administration of 5 mg/kg or 10 mg/kg vardenafil, respectively; and 5) a treatment group subjected to surgical induction of ischemic colitis followed by postoperative administration of pentoxifylline at 50 mg/kg/day per day as a single dose for a 3-day period. All animals were sacrificed at 72 h post-surgery and subjected to relaparotomy. We scored the macroscopically visible damage, measured the ischemic area and scored histopathology to determine the severity of ischemia. Tissue malondialdehyde levels were also quantified. RESULTS: The mean Gomella ischemic areas were 63.3 mm2 in the control group; 3.4 and 9.6 mm2 in the vardenafil 5 and vardenafil 10 groups, respectively; and 3.4 mm2 in the pentoxifylline group (p = 0.0001). The mean malondialdehyde values were 63.7 nmol/g in the control group; 25.3 and 25.6 nmol/g in the vardenafil 5 and vardenafil 10 groups, respectively; and 22.8 nmol/g in the pentoxifylline group (p = 0.0001). CONCLUSION: Our findings indicate that vardenafil and pentoxifylline are effective treatment options in an animal model of ischemic colitis. The positive clinical effects produced by these drugs are likely due to their influence on the hemodynamics associated with vascular smooth muscle and platelet functions

Importance of Together Use of Endoscopic and Intraoperative Ultrasonography In The Diagnosis and Treatment of Insulinoma

Introduction:Insulinoma is a usually benign tumor of pancreas. It is seen rarely and incidence of insulinoma is 1 in 250,000 patient-years. We present a rare case with insulinoma which well diagnosed and treated with aid of endoscopic and intraoperative ultrasonography.Case Report:A patient involving a 39-year-old woman with complaints of cold sweats, weakness, syncope attacks, palpitations was evaluated in polyclinic. She was hospitalized with the diagnosis of pancreatic insulinoma after abdominal computer tomography(CT), magnetic resonance imaging(MRI) endoscopic ultrasonography(EUS), and biochemical parameters. The patient was well treated with enucleation and after imaging aid of endoscopic and intraoperative ultrasound(IOUS).Discussion:In patients with insulinoma, preoperative localization of tumor is most important for diagnosis and treatment. Therefore; CT scanning, MRI, EUS and SPECT / CT are used for diagnosis of insulinoma. Together use of endoscopic and intraoperatively ultrasonography are increasing recently. Enucleation is a curative treatment approach in insulinoma.Conclusion:Together using of preoperative endoscopic and intraoperative ultrasound is quite helpful in the diagnosis and treatment of insulinoma

Nadir Bir İleus Nedeni: Paraduodenal Herni

Internal abdominal hernias may rarely be the cause of intestinal obstruction with an incidence of less than 1% and paraduodenal hernias constitute approximately 50% of them. Those hernias emerge as a result of abnormalities in gut rotation at the embryonic stage. The clinical spectrum of a symptomatic internal hernia may range from abdominal pain to frank intestinal obstruction. Delay in the diagnosis and treatment should be avoided, since the content of paraduodenal hernia may quickly progress to strangulation and necrosis because of vascular compromise. Here, we report a case of successfully diagnosed and treated with cause of paraduodenal hernia.İnternal abdominal herniler incebağırsak obstrüksiyonunun nadir görülen bir nedeni olup insidansı %1’den az olarak bildirilmiştir. Paraduodenal herni (PDH) ise, internal hernilerin yaklaşık % 50’ sini oluşturmaktadır. Bu herniler bağırsağın rotasyonundaki değişimler nedeniyle oluşmaktadır. Tekrarlayıcı karın ağrılarından, akut bağırsak tıkanıklığına kadar değişebilen klinik spektrumu mevcuttur. PDH’ de içeriğin, strangülasyon ve nekrozuna kadar giden dolaşım bozukluğu riski nedeniyle tanı ve tedavi geciktirilmemelidir. Biz burada, ince bağırsak tıkanıklığı nedeniyle ameliyata alınan ve başarılı bir şekilde PDH onarımı yapılan hastayı sunduk

The potential efficacy of Survanta (R) and Seprafilm (R) on preventing intra-abdominal adhesions in rats

WOS: 000380361700005PubMed ID: 27355746PURPOSE: To investigate the potential efficacy of beractant (Survanta (R)) and Seprafilm (R) on the prevention of postoperative adhesions. METHODS: Forty Wistar-albino female rats were used. The rats were randomly allocated into four groups of 10 rats each as control group (CG), beractant group (BG), Seprafilm (R) group (SG), and combined group (COG). All rats underwent cecal abrasion via midline laparotomy. Before abdominal closure, isotonic saline, beractant, Seprafilm, and combined agents were intraperitoneally administered. Adhesions were classified macroscopically with Canbaz Scoring System on postoperative day 10. Ceacum was resected for histopathological assessment. RESULTS: Macroscopic adhesion scores were significantly lower in BG, SG, and COG than CG (p<0.05); (45%, 15%, 25%, and 15%; respectively). Histopathological assessment revealed a reduced inflammation and fibrosis score in the study groups than CG (p<0.05). In BG, adhesion development, inflammation and fibrosis scores were lower than SG; however, it was not statistically significant. CONCLUSIONS: Intra-abdominal application of beractant is significantly effective for the prevention of adhesion formation with no adverse effect by covering the whole peritoneal mesothelium with excellent gliding properties in a rat model. The combination of both agents is also effective in reducing adhesion formation, however, not superior to single beractant application