Diverticular Disease

Diverticulosis is a common problem, especially in industrialized countries. The main risk factors for the development of diverticular disease are physical inactivity and consumption of a low-fiber diet. Among the population with diverticulosis, only 10–25% of the patients develop diverticulitis. Computed tomography (CT) scans are very helpful for diagnosis and deciding the treatment strategy. Patients with acute diverticulitis usually have a good response to conservative therapy. However, some of the patients present with complications such as perforation, fistula, abscess, stricture, and obstruction. Depending on disease severity, they commonly require surgical or radiologic intervention. Despite lots of contradictory results on treatment approaches, recent guidelines tend to be less invasive than the ones in the past. As a result, less invasive treatment protocols, including nonsurgical follow-up, percutaneous drainage, minimally invasive surgery and resection with primary anastomosis, are more commonly used than the more invasive Hartmann procedure. In this chapter, we discuss the clinical characteristics, diagnostic workup and different treatment approaches in the management of diverticular diseases

Colon Cancer

Colorectal cancers (CRCs) are commonly diagnosed malignancy in both men and women. Although it is a common disease, mortality rates decrease with widespread use of screening methods and novel developments in surgery. Physical examination, abdomen and pelvic computerized tomography, and chest imaging are necessary for preoperative staging and surgical planning of a newly diagnosed colon cancer. CRCs usually develop from adenomatous polyps. Although curative treatment of localized colon cancer is surgery, endoscopic polypectomy is sufficient when severe dysplasia or carcinoma in situ is detected on a polyp surface. Total mesorectal excision and neoadjuvant chemoradiotherapy in rectum cancers resulted in significant reductions in morbidity, mortality, and recurrence rates. Recently, complete mesocolic excision and central vascular ligation method has been described in the surgical treatment of colon cancer to achieve similar results. Unfortunately, metastatic colon cancer rate at presentation is approximately 20%. Surgery is a potentially curative option in selected patients with liver and lung metastasis. Pathologic stage of the tumor at presentation is the most important prognostic factor after resection. Therefore, early diagnosis of colon cancer by screening methods and new surgical techniques will lead to better results in survival rates

Parastomal Hernia

Parastomal hernia (PSH) is a type of incisional hernia defined as a protrusion of abdominal contents through a weakness in the abdominal wall. PSH is the most common and significant complication following enterostomy construction, with an incidence of 30–50%. The risk is higher in colostomies than in ileostomies. Diagnosis of PSH is based on clinical examination or imaging. Most patients with PSH are usually asymptomatic. On the other hand, PSHs may affect an individual’s physical function and decrease their quality of life. Surgical repair is indicated in 10–30% of patients with PSH. For repair, no single technique is superior to another. Therefore, several surgical methods have been developed and attempted, including primary repair, stoma relocation, and repair with different types of mesh either via the open or laparoscopic approach. However, high recurrence rates have been reported after repair. Because this is a difficult and problematic entity, the prevention of PSH occurrence is clearly the most appropriate management approach

Aggressive Angiomyxoma: A Rare Tumor of Male Pelvic Cavity

Aggressive angiomyxoma is an uncommon, benign, slow-growing, and locally infiltrative soft tissue neoplasm which is located primarily in the genital region and pelviperineal interstitial tissue of female patient in the fourth decade of life. Its occurrence in male patients is even more unusual and commonly appears at a later age. The mainstay of treatment typically involves surgical excision with tumor-free margins, and despite complete resection, local recurrences are common. Here, an unusual case of aggressive angiomyxoma occurring in the pelvic region of a 55-year-old man and its treatment is discussed due to its rarity

Is local resection sufficient for parathyroid carcinoma?

OBJECTIVES: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients. RESULTS: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma. CONCLUSION: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy

Intestinal Tuberculosis: A Rare Disease with Diagnostic Difficulty

Tuberculosis is an important cause of mortality and morbidity in Turkey with steadily increasing incidence. By effecting the same part of gastrointestinal tract and causing ulserative lessions, symptoms and examination findings, intestinal tuberculosis and Crohn's disease are clinically indistinguishable. In this case, we present a successfully treated case of 31 year old woman with intestinal tuberculosis, despite the diagnostic difficulties. Patients who have only abdominal symptoms may face the risk of getting treated like inflammatory bowel diseases with antiinflammatory and immunomodulator agents which might cause a progression in the disease. Diagnosis of intestinal tuberculosis should be studied carefully. [Cukurova Med J 2015; 40(1.000): 178-183

Thyroid Gland Metastasis from Cancer of the Uterine Cervix: An Extremely Rare Case Report

The thyroid gland is a relatively uncommon site for a metastatic disease, although it is richly supplied with blood. The metastases may originate from various primary sites, mainly kidney, lung, head and neck, and breast. Thyroid metastasis from cervical carcinomas is extremely rare; and only a few cases have been previously reported in the literature. In patient with thyroid nodules and an oncological history, the possibility of thyroid metastasis should be seriously considered. Despite the rarity of the metastasis of cervical carcinoma to the thyroid, it is difficult to say appropriate treatment approach for these lesions. When managing such patients, decision-making should balance the possibility of gaining long-term survival against estimation of the aggressiveness of the disease and its possible complications. Here, a case of thyroid metastasis from a squamous cell carcinoma of the uterine cervix presenting with cervical mass and difficulty in swallowing and its treatment is reported