A rare cause of acute mechanical intestinal obstruction: a strangulated obturator hernia.

Obturator hernia is a rarely-seen type of abdominopelvic hernia. It is generally seen in thinner, old, multipara patients. The most frequently seen clinical sign is intestinal obstruction associated with strangulation. Diagnosis is generally made during operation in patients brought into emergency room because of intestinal obstruction. Delay in diagnosis in older patients results in higher rates of morbidity and mortality. Herein, we present a 68-year-old multipara patient who consulted to the emergency service with clinical manifestations of intestinal obstruction, and who was operated with the preoperative diagnosis of "strangulated obturator hernia" established by means of computed-tomography.

Skin-Areola, Nipple Sparing, and Subcutaneous Mastectomy and Immediate Implant-Based Breast Reconstruction Using a Titanium-Coated Polypropylene Mesh.

Skin sparing and nipple areola complex sparing subcutaneous mastectomies are both oncologically safe surgical procedures. Although autologuous breast reconstruction has been considered as a standard means of surgical approach, excellent cosmetic results have been obtained by implant based breast reconstruction. In this report, we present the result of titanium coated polypropylene mesh (Tiloop Bra; Pfm Medical, Cologne, Germany), an ultimate support material utilized in the reconstruction of a patient with breast cancer.

A Rare Reason of Ileus in Renal Transplant Patients With Peritoneal Dialysis History: Encapsulated Peritoneal Sclerosis.

Encapsulating peritoneal sclerosis is a rare complication of long-term peritoneal dialysis ranging from moderate inflammation of peritoneal structures to severe sclerosing peritonitis and encapsulating peritoneal sclerosis. Complicated it, ileus may occur during or after peritoneal dialysis treatment or after kidney transplant. We sought to evaluate 3 posttransplant encapsulating peritoneal sclerosis through clinical presentation, radiologic findings, and outcomes. We analyzed 3 renal transplant patients with symptoms of encapsulating peritoneal sclerosis admitted posttransplant to our hospital with ileus between 2012 and 2013. Conservative treatment was applied to the patients whenever necessary to avoid surgery. One patient improved with medical therapy. Surgical treatment was delayed and we decided it as a last resort, in 2 cases with no response to conservative treatment for a long time. Finally, patients with peritoneal dialysis history should be searched carefully before renal transplant for intermittent bowel obstruction story.

Management of pilonidal sinus disease with oblique excision and bilateral gluteus maximus fascia advancing flap: result of 278 patients.

PURPOSE: Excision followed by natal cleft depth reduction should be performed, with no leftover midline scar tissue, to prevent recurrence of pilonidal sinus, which is the main problem in the treatment of this disease. We investigated the potential advantages of this advancing flap technique, which we developed. METHOD: An S-type incision together with a bilateral gluteus maximus fascia advancing flap was applied on 278 (89 percent) patients, who did not have extensive gluteal involvement, of the 312 patients who had pilonidal sinus disease, between January 1997 and January 2007. No drainage was performed on any patient. RESULTS: All patients were discharged within 24 hours. Total complication rate was 7.2 percent and recurrence rate was 0.7 percent. The mean time off from work was 12 +/- 2 days (range, 10 to 22). The mean follow-up period was 66 +/- 32 months (range, 12 to 120). CONCLUSION: We suggest that this surgical procedure may successfully be applied to a large majority of the patients. It does not lead to unnecessary excision of healthy tissue because of its significantly simpler nature compared with the full-layer flap technique and its S-type incision, it does not create a midline scar tissue, and it is able to flatten the gluteal sulcus.