A Clinical Experience: Endoscopic and Surgical Management of Bezoars

Objective:This study aims to evaluate the cases treated for gastrointestinal obstruction due to bezoar in terms of clinical-radiological-endoscopic features and treatment methods.Method:Among the patients treated for acute mechanical intestinal obstruction (AMIO) in our hospital between January 2014 and December 2019, 33 patients with bezoar-related AMIO were included in the study. The cases were examined in terms of the presence of comorbidity, tomography and endoscopy features, and treatment modalities.Results:A history of intraabdominal surgery was found in 82% of patients (n=27) and a history of upper gastrointestinal surgery in 60% (n=20). DM accompanied in 27% of the patients (n=9) and psychiatric disorder in 18% (n=6). With computered tomography, gastric dilatation was observed in 9 patients, jejunal in 9 patients, jejunoileal in 9 patients, and dilatation in all bowel segments in 6 patients. Endoscopy was performed in 12 patients; 9 had peptic ulcers, 3 were normal. Seventeen cases were treated with laparotomy, 9 cases with a laparoscopic enterotomy, and 3 cases with endoscopic procedures. 4 cases were treated with a Coca-Cola injection from a nasogastric catheter, which was successful.Conclusion:It is difficult to diagnose bezoar-related AMIO with clinical findings. Radiological and endoscopic methods are important in diagnosis. Although endoscopic methods are also used successfully for therapeutic purposes, surgical methods are used in distal locations and complicated cases

The 33-year Retrospective Analysis of Esophageal Carcinomas: Cerrahpaşa Experience

Aim:Esophageal cancer is a fatal disease where the majority of patients are diagnosed at an advanced stage. In this study, we aimed to present the demographic and clinicopathological characteristics of patients who were operated for esophageal cancer.Materials and Methods:A total of 847 patients who underwent surgery, chemoradiotherapy, or palliative procedures for esophageal pathology between the years of 1985 and 2018 were retrospectively analyzed. Age, gender, tumor location, histopathology, surgical technique, and chemoradiotherapy history of patients were analyzed.Results:In the study, 488 patients were male (60.5%) and 319 were female (39.5%). The ratio of males and females was 1.52. The average age was 58.6 years, and 80.1% were older than 50 years. The most common pathological material obtained was squamous cell carcinoma (67.5%), followed by adenocarcinoma (27.7%). Total esophagectomy was performed in 435 patients; distal esophagectomy was performed in 38 patients. Transhiatal esophagectomy (n=271, 62.2%) was the most common procedure that was performed.Conclusion:Esophagectomy is the primary treatment modality for esophageal cancers. When determining the optimal treatment, appropriate patient selection, staging, and risk assessment should be made. Patient-specific treatment should be planned with a multidisciplinary approach

Incidental appendiceal neoplasias: ten years' experience with 1,642 patients

Background: Acute appendicitis is the most common surgical emergency. In this study, we investigated the rate of neoplasia among patients who underwent an appendectomy in our center, a large Tertiary Care Teaching Hospital. Methods: We retrospectively reviewed 1,642 cases of appendectomies performed between 2007 and 2017. In this study, the data included demographic data, operative and pathological findings, and additional procedures following the appendectomy. Results: Of the 1,642 appendectomies, 1,294 were laparoscopic, and 348 were open procedures. Appendiceal neoplasia was encountered in the examination of appendix specimens taken from 20 patients. Sessile serrated adenoma (SSRA) was found in seven patients, neuroendocrine tumor (NET) in six patients, low-grade mucinous neoplasia (LGMN) in four patients, mucinous cystadenoma (MCA) in two patients, and diffuse adenoma (DA) in one patient. Two patients underwent right hemicolectomy due to positive surgical margins from previous surgeries. Colonoscopy and computed tomography (CT) control were performed on all neoplasia patients during the postoperative period, and no additional pathology was seen. Conclusions: Although the probability of neoplasia after appendectomy is low, it should be considered. Adenomas and neuroendocrine tumors seem to be the most common neoplasias that are incidentally encountered in appendectomy specimens

Appendico-Ileal Fistula: A Rare Image

We present a rare image where an acutely inflammed appendix entered and perforated the terminal ileum. This became a presentable rare image after we converted a laparoscopic attempt to do appendisectomy in this patient in an open surgery. The patient was managed by simple appendisectomy without burying the stump and closing the ileal perforation after freshening the margins in two layers using 3-0 Polyglactin

Reversal of Hartmann's procedure is still a high-morbid surgery?

BACKGROUND: This study evaluated the outcome of the reversal of Hartmann's procedure based on preoperative and intraoperative risk factors

Analysis of General Surgical Consultations Requested from the Emergency Department in the Period of Pandemic and Non-Pandemic

Objective: To investigate the emergency department admissions, the general surgery consultation request, and the necessity of immediate treatment of patients even though the society did not leave the house unless necessary during the pandemic period

Analysis of General Surgical Consultations Requested From The Emergency Department in the Period of Pandemic and Non-Pandemic

Objective: To investigate the emergency department admissions, the general surgery consultation request, and the necessity of immediate treatment of patients even though the society did not leave the house unless necessary during the pandemic period

Systemic Inflammatory Biomarkers as Surrogate Markers for Stage in Colon Cancer

Background This study aimed to investigate whether the systemic inflammatory parameters currently in use in staging the disease can be used as biomarker tests operated colon cancer patients. Neutrophil, lymphocyte, monocyte, platelet, neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), platelet/lymphocyte ratio (PLR), neutrophil/monocyte ratio (NMR), CRP, albumin, lymphocyte/CRP ratio, CRP/albumin ratio, and neutrophil/albumin ratio as systemic inflammatory biomarkers and prognostic nutritional index (PNI) were evaluated. Methods This retrospective study included 592 patients. Patients with colon cancer in the cohort were divided into 2 subgroups: Tumor, nodes, metastases (TNM) stage 0, TNM stage 1, and TNM stage 2; early stage (n: 332) and TNM stage 3 and TNM stage 4; late stage (n: 260) colon cancer patients. Results LDH (P < .001), NLR (P < .001), PLR (P < .05), CRP/albumin (P < .01), and neutrophil/albumin (P < .01) were significantly higher, while monocyte count (P < .05) and PNI (P < .01) were found to be significantly lower in late stage colon cancer patients than in early stage colon cancer patients. Moderate negative correlation was found between the PNI and the neutrophil/albumin ratio in late stage colon cancer patients (r: -.568, P < .001). Conclusions Our data suggest that high serum LDH, NLR, PLR, CRP/albumin, and neutrophil/albumin may be useful predictive markers for advanced stage in colon cancer. According to the receiver operating characteristic analysis results, CRP/albumin ratio can be used to discriminate early from late stage. Preoperative low monocyte count and PNI are associated with postoperative staging patients with colon cancer

Clinicopathological features and management of colonic lipomas Case reports

Introduction: Colonic lipomas are benign tumors of adipose tissue that are often asymptomatic, but they may present with rectal bleeding or obstructive symptoms. These tumors are unique in that they are rarely encountered within the gastrointestinal system and can mimic malignant tumors in appearance. Surgical resection and endoscopic removal of tumors have been shown to be successful in their management. Patient concerns: In this report, we present 3 cases of colonic lipomas, 2 of which are located in the cecum and the other within the sigmoid colon. The presenting symptoms of the patients included abdominal pain, constipation, and dyspepsia. Diagnosis: Patients typically presented with anemia and an elevated C-reactive protein count. Colonoscopic and computerized tomography findings were used for diagnosis. Interventions: Hemicolectomy was performed, depending on the localization, and the pathologic specimens were consistent with lipoma. Outcomes: Surgical resection was curative in all patients. The postoperative period was uneventful in all patients and all patients are symptom-free and alive at 3 years follow-up. Conclusion: Colonic lipomas are benign mesenchymal tumors of the gastrointestinal system with a male predominance and are observed within the fourth to sixth decades of life. Various genetic abnormalities have been reported and they have been linked to the formation of intussusception. The squeeze sign on radiological imaging, cushion sign and tenting sign in colonoscopy, and naked fat sign during pathologic examination is helpful towards reaching a diagnosis. Surgical resection is the treatment of choice but minimally invasive endoscopic approaches have also been shown to be successful

Outcomes after combined right hemicolectomy and pancreaticoduodenectomy for locally advanced right-sided colon cancer: a case series

Background: Although right colon cancers mostly grow intraluminally, they may rarely invade neighboring organs without distant organ metastasis. En bloc resection is required for R0 resection in pancreas and duodenum-invasive right colon tumors. Despite the high mortality and morbidity rates, the en bloc right hemicolectomy and pancreaticoduodenectomy (RHPD) procedure can be safely performed in centers experienced in colorectal and hepatobiliary surgery. Objective: In this study, we aimed to share the results of our patients who underwent en bloc pancreaticoduodenectomy in addition to right hemicolectomy for cases with locally advanced right colon cancer. Materials and Methods: Patients who were operated on the right colon cancer between January 2010 and March 2018 were retrospectively screened. Patients who underwent RHPD due to locally advanced colon cancer invading the duodenum and pancreas were included in this study. RHPD was performed in cases where radical resection was deemed appropriate, and R0 resection could be performed. Demographic information, intraoperative and postoperative findings, and long-term follow-up data of the patients were recorded. Results: Six cases underwent RHPD. All of the cases were male, and the mean age was 67 +/- 6. Proximal PD was performed in five cases, and total PD was performed in one case. SMV reconstruction was performed in one case with an SMV invasion. One case died due to pneumonia and anastomotic leak in the postoperative period. The other five patients had a mean disease-free survival of 29.2 +/- 14.7 months. The 1 and 2-year survival rate was 66.6% and 66.6%, respectively. Conclusion: RHPD is a surgical operation that can be performed safely in experienced centers with acceptable mortality and morbidity rates in cases suitable for R0 resection