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