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

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

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

The Evaluation of Routine Parathyroid Autotransplantation During Thyroidectomy

Hypoparathyroidism, which is a significant morbidity cause, is one of the major complications of thyroidectomy surgery. Generally, a rigorous and careful dissection and parathyroid autotransplantation, if required,are used to reduce the incidence of hypoparathyroidism. The incidence of hypoparathyroidisim reported in the literature and in centres using the said strategyis around % 1. When the literature is reviewed, there are studies advocating that autotransplantation of at least one gland, along with protecting the parathryoid glands, would reduce the incidence of hypoparathyroidism. Routin autotransplantation may have advantages especially in patients undergoing central dissection; however, there are not sufficient number of studies on this subject. Total thyroidectomy surgeries require a more comprehensive study. The aim of the present study was to evaluate the studies on routine parathyroid autotransplantation during thyroidectomy

Gastric Diverticula: Report of Two Cases

Gastric diverticula are rare and uncommon conditions. Most gastric diverticula are asymptomatic. When symptoms arise, they are most commonly upper abdominal pain, nausea and emesis, while dyspepsia and vomiting are less common. Occasionally, patients with gastric diverticula can have dramatic presentations related to massive bleeding or perforation. The diagnosis may be difficult, as symptoms can be caused by more common gastrointestinal pathologies and only aggravated by diverticula. The appropriate management of diverticula depends mainly on the symptom pattern and as well as diverticulum size. There is no specific therapeutic strategy for an asymptomatic diverticulum. Surgical resection is the mainstay of treatment when the diverticulum is large, symptomatic or complicated by bleeding, perforation or malignancy

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

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 (