Management of rectal foreign bodies

BACKGROUND: Entrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault. METHODS: Between 1999 and 2009, 15 patients with foreign bodies in the rectum were diagnosed and treated, at Izmir Training and Research Hospital, in Izmir. Information regarding the foreign body, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients. RESULTS: All patients were males, and their mean age was 48 years (range, 33–68 years). The objects in the rectum of these 15 patients were an impulse body spray can (4 patients), a bottle (4 patients), a dildo (2 patient), an eggplant (1 patient), a brush (1 patient), a tea glass (1 patient), a ball point pen (1 patient) and a wishbone (1 patient, after oral ingestion). Twelve objects were removed transanally by anal dilatation under general anesthesia. Three patients required laparotomy. Routine rectosigmoidoscopic examination was performed after removal. One patient had perforation of the rectosigmoid and 4 had lacerations of the mucosa. None of the patients died. CONCLUSIONS: Foreign bodies in the rectum should be managed in a well-organized manner. The diagnosis is confirmed by plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is only possible for very low-lying objects. Patients with high- lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body

Extragenital endometriosis (a case report)

Endometriozis is rarely seen on incisional scars following a hernia operation, a incisional mass is considered to be either due to inflamation or reccurence. Preoperative diagnosis is diffucult and a definite diagnosis can only be made by an operative procedure and histopathological examination.İnsizyon skarlarında endometriozis oluşumu nadir görülmektedir. Fıtık ameliyatı sonrası, ameliyat lojunda kitle tespiti öncelikle inflamasyon yada fıtık nüksünü düşündürmektedir. Preoperatif tanı güç olup kesin tanı cerrahi girişim ve histopatolojik incelemeyle konulabilmektedir

Polyps of the gallbladder: retrospective analysis of 33 cases

Amaç: Safra kesesi polipleri , safra kesesi mukozasından köken alan lezyonlardır. Bu çalısmada, klinigimizde preoperatif safra kesesi polibi tanısı alarak cerrahi girisim uygulanan olgular patolojik tanıları ile tartısılmakta ve cerrahi endikasyon koyduracak kriterlerin tanımlanması amaçlanmaktadır. Materyal-Metod: Klinigimizde Ocak 1995 ile Haziran 2003 tarihleri arasında preopeeratif safra kesesi polibi tanısı alan olgular demografik özellikleri, klinik ve abdominal ultrasonografi bulguları, yapılan cerrahi tedavi, histopatolojik tanıları, morbidite ve mortalite açısından retrospektif olarak degerlendirildi. Bulgular: Kolesistektomi yapılan 1420 olgunun otuzüçü de (%2,3) preoperatif safra kesesi polibi tanısı almıstır. Karın agrısı en sık rastlanılan semptom idi.Tüm olgulara abdominal ultrasonografi ile tanı konulmus olup görüntülemede, 3 olguda sesil, 30 olguda ise pediküllü polip bulunurken, 7 olguda ek olarak kolelithiasis saptandı. Tedavide 8 olguda laparoskopik, 25 olguda ise açık olarak kolesistektomi yapıldı. Histopatolojik incelemede ; 16 olguda sadece kolelithiasis ve kronik kolesistit, 14 olguda kolesterol polibi, 2 olguda adenomatöz polip, 1 olguda ise adenokarsinom saptandı. Sonuç: Safra kesesi poliplerinde cerrahi tedavi, tüm semptomatik, beraberinde kolelitiasis olan, polip boyutu 10 mmgeçen ve ultrasonografik olarak malignite riski tasıyan olgularda yapılmalıdır.Aim: The nature of polypoid lesions of the gallbladder is difficult to define before operation, and surgical indications still remain controversial. The aim of this study was to identfy surgical indications for polypoid lesion of the gallbladder with regarding their ultrasonographic histopathological findings and indications. Material-Methods: Between 1995 and June 2003, the patients with preoperative diagnosis of gallbladder polyp were evaluated retrospectively according to their demographic findings, clinical symptoms, abdominal ultrasonography results, surgical treatment and pathology . Results: The incidence of preoperative gallbladder polyp diagnosis was 2,3% (33/1420) in cholecystectomized patients. The most common symptom was abdominal pain. In abdominal ultrasonography used for diagnosis in all patient, the polyps were sessile in 3 cases and pedunculated in 30 cases. Also cholelithiasis was coexist with polyp in 7 cases ultrasonographically. Cholecystectomy was made laparoscopically in 8 patients and others were with open technique. In histopathological assesment, the results were as only cholelithiasis and chronic cholecystitis / 16 cases, cholesterol polyp / 14 cases, adenoma / 2 cases and adenocarcinoma / 1 case. Conclusion: Surgery is the choice of treatment in all symptomatic patients and the cases having polyps with a size of greater than 10 mm as well as the cases carrying malignant features ultrasonographically

Papillary carcinoma arising in a thyroglossal duct cyst with associated microcarcinoma of the thyroid and without cervical lymph node metastasis: a case report

<p>Abstract</p> <p>Introduction</p> <p>This is a case report of a 44-year-old woman with papillary carcinoma of a thyroglossal duct cyst.</p> <p>Case presentation</p> <p>A 44 year-old woman presented to the otolaryngology outpatient clinic with an asymptomatic anterior midline neck mass. A cervical ultrasound showed a lesion which appeared to be a thyroglossal duct cyst and surgical resection using Sistrunk's procedure was performed. The histopathologic diagnosis showed papillary carcinoma evolving from a thyroglossal duct cyst, confined to the thyroglossal cyst, with a tumor diameter of 2 cm. The patient then underwent total thyroidectomy and bilateral neck dissection. The final pathology reported an 8 mm papillary cancer in the left lobe of the thyroid without any metastasis to the cervical lymph nodes. The patient was treated with radioactive iodide and thyroid suppresion therapy was given as adjuvant treatment. The patient has been following for two years without any metastasis.</p> <p>Conclusion</p> <p>Malignancy within a thyroglossal duct cyst is very rare but should be considered in the differential diagnosis of a midline neck mass.</p

A bizarre presentation of pancreatitis with Bryant's sign

WOS: 000345023700021PubMed ID: 2541762

Ruptured hepatic artery aneurysm: A rare fatal cause of obstructive jaundice

Background: Hepatic artery aneurysms (HAA) are rare vascular lesions, often with a nonspecific clinical presentation and difficult to diagnose before rupture. We present a case of radiologically diagnosed ruptured HAA that cause obstructive jaundice. Case Report: A 56-yearold woman presented with a 2-month history of upper abdominal pain and progressive jaundice. Physical examination showed hypotension, tachycardia, icteric sclera, pale conjunctiva, epigastric tenderness, and hypoactive bowel sound. Laboratory findings were compatible with obstructive jaundice. Abdominal ultrasonography revealed a cyst-like lesion at the porta hepatis and dilated intrahepatic biliary ducts. Subsequently, contrast-enhanced CT of the upper abdomen showed a well-circumscribed lesion with a density similar to that of the contrast medium-filled abdominal aorta suggesting aneursym of the hepatic artery, and a perianeurysmal hypodensity reflecting leakage of the ruptured aneurysm. During the radiological procedure, the patient's condition deteriorated. Angiography was planned but could not be performed due to technical problems. Thereafter, emergency operation was done 5 h after admission, but the patient died intraoperatively due to massive intraabdominal bleeding. Conclusion: HAA is a rare vascular lesion that should be considered in cases of unexplained obstructive jaundice