The analysis of 146 patients with difficult laparoscopic cholecystectomy.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is very commonly performed surgical intervention. Acute or chronic cholecystitis, adhesions due to previous upper abdomen surgeries, Mirrizi's syndrome and obesity are common clinical conditions that can be associated with difficult cholecystectomy. In this study, we evaluated and scored the patients with difficult surgical exploration during laparoscopic cholecystectomy. MATERIAL AND METHOD: All patients who underwent LC from 2010 to 2015 were retrospectively rewieved. According to intraoperative findings DLC cases were described and classified. Class I difficulty: Adhesion of omentum majus, transverse colon, duodenum to the fundus of the gallbladder. Class II difficulty: Adhesions in Calot's triangle and difficulty in dissection of cystic artery and cystic duct Class III difficulty: Difficulty in dissection of gallbladder bed (scleroathrophic gallbladder, hemorrhage from liver during dissection of gallbladder, chirotic liver). Class IV difficulty: Difficulty in exploration of gallbladder due to intraabdominal adhesions including technical problems. RESULTS: A total of 146 patients were operated with DLC. The most common difficulty type was Class I difficulty (88 patients/60.2%). Laparoscopic cholecystectomy was converted to laparotomy in 98 patients. Operation time was found to be related with conversion to open surgery (P<0.05). Wound infection rate was also statistically higher in conversion group (P<0.05). The opertion time was found to be longest with Class II difficulty. Conversion rate to open surgery was also highest with Class II difficulty group. CONCLUSION: Class II difficulty characterized by severe adhesions in calot's triangle is most serious problem among all DLC cases. They have longer operation time and higher conversion rate.

The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis.

BACKGROUND: The aim of this study was to establish the diagnostic value of leucocyte count and neutrophil percentage in both diagnosing simple appendicitis and predicting complicated appendicitis. METHODS: The patients who underwent appendectomy with a clinical diagnosis of acute appendicitis (AA) between January 2011 and December 2012 were studied retrospectively. The data of total WBC count, neutrophil ratio, and physical findings were analyzed. Sensitivities and specificities of leucocyte count and neutrophil ratio were calculated. RESULTS: One hundred and fifty-nine patients, diagnosed with acute appendicitis, were operated. Simple appendicitis was detected in 82.4% of the patients and complicated appendicitis in 17.6%. Leucocyte count had low sensitivity and specificity for diagnosing acute appendicitis (67.5% and 36.3%, respectively). Neutrophil ratio had a sensitivity rate of 60.1% and specificity rate of 90.9%. Complicated appendicitis was more common in male patients. Leucocyte count was statistically higher in patients with complicated appendicitis. CONCLUSION: Two inflammatory markers, leucocyte count and neutrophil ratio, were evaluated for diagnosing acute appendicitis. Neutrophil ratio had higher sensitivity and specificity for acute appendicitis. On the other hand, increased leucocyte count and male gender was found to be a risk factor for complicated appendicitis.

Clinical results of laparoscopic appendectomy in patients with complicated and uncomplicated appendicitis.

Acute appendicitis is the most common surgical emergency. The aim of this study was to evaluate the clinical results of laparoscopic appendectomy (LA) for the treatment of uncomplicated and complicated appendicitis. A retrospective analysis was performed who had undergone laparoscopic appendectomy for complicated appendicitis between January 2010 to October 2013. The diagnosis of acute appendicitis was established with physical examination, laboratory tests, and ultrasound examination. The patients were analysed for age, sex, conversion rate,operation time, postoperative infectious complications and length of hospital stay. A total of 452 patients were operated with LA. There were 362 (80.1%) uncomplicated (Group I) and 90 (19.1%) complicated Group (II) appendicitis.The intraabdominal abscess rate was 14.35% in Group I and 19.5% in Group II. The wound infection and rate of incisional hernia were also higher in Group II. The postoperative complications including intraabdominal abscess, wound infection and incisional hernia after LA in complicated appendicitis found high. LA should be performed very carefully in complicated appendicitis.

Pneumatosis cystoides intestinalis mimicking acute abdomen.

Pneumatosis cystoides intestinalis (PCI) is a rare disease. It was first described by Du Vernoy in 1793 during a cadaver dissection. Air-filled bubble-like lesions are located in the submucosa or the subserosa of the digestive tract. A 55-year-old Turkish male presented to the emergency department with complaints of recurrent abdominal pain and vomiting. Free air was detected in abdominal x-ray and abdominal computed tomography (CT). In exploration, a grape-like lesion consisting of hundreds of cysts was detected on the surface of the small intestine. Bowel resection was performed successfully. The surgical findings and pathological result confirmed the diagnosis of pneumatosis cystoides intestinalis.

Prolene mesh migration into the rectum after sacral colpopexy presented with frozen pelvis.

INTRODUCTION: Pelvic organ prolapse (POP) is a common gynecological problem. Repair with synthetic materials such as prolene mesh has become a popular approach in prolapsus surgery. Migration of synthetic materials can cause serious complications. PRESENTATION OF CASE: A 69-year-old woman was admitted to the hospital with a complaint of sensation of fullness and a feeling of a foreign material protruding during defecation. The patient underwent exploratory laparotomy. Prolene mesh was detected in sacral region but resection of the mesh could not be conducted because of dense adhesions causing frozen pelvis. The migrated prolene mesh was resected transanally. DISCUSSION: Genital prolapse or genital hernia is described as the protrusion of pelvic organs along the vagina. It is one of the common gynecological conditions that affect the quality of life in women. Mesh migration is a well-known clinical pathology. CONCLUSION: Mesh migration is a serious complication after sacral colpopexy. Surgical resection of migrated mesh can be difficult due to dense adhesions.

The hemostatic effect of calcium alginate in experimental splenic injury model.

BACKGROUND: We evaluated the effect of calcium alginate as a hemostatic agent in a splenic injury model. METHODS: Experimental rats (Wistar albino) were divided into four groups. Group I: Laparotomy was not performed. Group II: After laparotomy, the abdomen was closed without any splenic injury. Group III: After laparotomy, splenic injury about 0.5 cm in depth and 0.3 cm in length was created by standard Rochester pean forceps. Physiological serum treated gauze dressing, about 2x2 cm in size, was applied to the injured splenic tissue for 3 minutes. Group IV: After laparotomy, standard splenic injury about 0.5 cm in length and 0.3 cm in depth was created. Calcium alginate wound dressing, 1x1 cm in size, was applied to the splenic wound. In all groups, blood samples for bleeding time and hemogram were taken. Peroperative blood loss, pre- and post-operative hemoglobin and hematocrit values were calculated. RESULTS: Comparing hematocrit values and peroperative bleeding in Groups III and IV, Group IV had a lower decline in hematocrit values and lower peroperative bleeding. CONCLUSION: Calcium alginate has hemostatic capacity. It may be used in splenic injuries, especially for Grades I and II.

The diagnostic value of D-dimer, procalcitonin and CRP in acute appendicitis.

BACKGROUND: The early diagnosis of acute abdomen is of great importance. To date, several inflammatory markers have been used for the diagnosis of acute abdominal conditions, including acute appendicitis. The aim of this study was to evaluate the diagnostic utility of D-dimer, Procalcitonin (PCT) and C-reactive protein (CRP) measurements in the acute appendicitis. METHODS: This prospective study was conducted between March 1(st), 2010 and July 1(st), 2011. In this period, seventy-eight patients were operated with the diagnosis of acute appendicitis, and D-dimer, PCT and CRP levels of the patients were measured. The patients were grouped as phlegmonous appendicitis (Group 1), gangrenous appendicitis (Group 2), perforated appendicitis (Group 3) and negative appendectomy (Group 4) according to the surgical findings and histopathological results. RESULTS: Of 78 patients, 54 (69.2 %) were male and 24 (30.8 %) were female, and the mean age was 25.4 ± 11.1 years (range, 18 to 69 years). 66 (84.6 %) patients had increased leukocyte count (white blood cell count). The PCT values were higher than the upper normal limit in 20 (25.6%) patients, followed by D-dimer in 22 (28.2 %) patients and CRP in 54 (69.2 %) patients. The diagnostic value of leukocyte count and CRP in acute appendicitis was higher than that of the other markers, whereas leukocyte count showed very low specificity. CRP values were higher in perforated appendicitis when compared with the phlegmonous appendicitis (p < 0.05). However, PCT and D-dimer showed lower diagnostic values (26% and 31%, respectively). CONCLUSION: An increase in CRP levels alone is not sufficient to make the diagnosis of acute appendicitis. However, CRP levels may differentiate between phlegmonous appendicitis and perforated appendicitis. Due to their low sensitivity and diagnostic value, PCT and D-dimer are not better markers than CRP for the diagnosis of acute appendicitis.

Steroid-induced sigmoid diverticular perforation in a patient with temporal arteritis: a rare clinical pathology.

Corticosteroids are used in the treatment of many rheumatological diseases including temporal arteritis. The gastrointestinal perforation during corticosteroid treatment is a serious complication. Colon perforation after steroid use was first reported by Beck et al in 1950.1 Although the pathophysiological mechanism is not understood clearly, it is claimed that steroids probably by disturbing the intestinal mucosal barrier, facilitate the intestinal perforation. The long term treatment with corticosteroids increases the risk of colon perforation. We are presenting a patient who was taking corticosteroid due to temporal arteritis for two years and operated with sigmoid diverticular perforation.

Prolonged venous bleeding due to traditional treatment with leech bite: a case report.

INTRODUCTION: The medicinal leech, Hirudo medicinalis, has been used in the treatment of many diseases for thousands of years. In Turkey, it is used most commonly in the management of venous diseases of lower extremities. CASE PRESENTATION: A 25-year-old Turkish woman presented to our emergency room with bleeding from her left leg. She had been treated for varicose veins in her lower extremities with leeches about 24 hours before admission to the emergency room. The bleeding was controlled by applying pressure with sterile gauze upon the wound, and she was discharged. She returned after four hours having started bleeding again. Hemostasis was achieved by vein ligation under local anesthesia. CONCLUSIONS: Leech bite should be evaluated as a special injury. Prolonged bleeding can be seen after leech bites. In such cases, hemostasis either with local pressure or ligation of the bleeding vessel is mandatory.

'The intraabdominal bleeding with an inguinal defect that mimicking a femoral vein aneurysm'. A case report.

Inguinal hernia repair is commonly performed operation in surgical practice. Thirty-five years old female patient was operated with the diagnosis of inguinal hernia. The inguinal defect was misdiagnosed as femoral vein aneurysm in surgical exploration. The postoperative diagnostic imaging revealed that the inguinal defect had been confused as femoral vein aneurysm due to intra-abdominal hemorrhogical fluid after an ovarian cyst rupture.