A rarely encountered case: A neuroendocrine tumor in strangulated Littre's hernia.

Littre's hernia is a rare condition that involves Meckel's diverticulum in the hernia sac. Meckel's diverticulum is the true diverticulum of the small intestine. Neuroendocrine tumors may develop in it; however, there are very few reported cases. In this study, we present a case of neuroendocrine tumor in strangulated Littre's hernia, on which we did not find a study when we reviewed the relevant literature. A 71-year-old male patient presented to our outpatient clinic with complaints of left groin pain and swelling in the groin. Acute abdomen findings were also present in the abdominal examination of the patient. The patient was operated on immediately and it was observed during the operation that the herniated Meckel's diverticulum was perforated. Segmental small intestine resection was performed. The pathology results of the patient revealed a well-differentiated neuroendocrine tumor with mucosal and submucosal localization in Meckel's diverticulum. We believe that if Meckel's diverticulum is found in the hernia sac in incarcerated hernias, it must be completely resected as a neuroendocrine tumor may develop, even if only rarely.

Postoperative fluid management.

Postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. Management of postoperative fluid therapy should be done considering both patients' status and intraoperative events. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. The main goal of fluid resuscitation is to provide adequate tissue perfusion without harming the patient. The endothelial glycocalyx dysfunction and fluid shift to extracellular compartment should be considered wisely. Fluid management must be done based on patient's body fluid status. Patients who are responsive to fluids can benefit from fluid resuscitation, whereas patients who are not fluid responsive are more likely to suffer complications of over-hydration. Therefore, common use of central venous pressure measurement, which is proved to be inefficient to predict fluid responsiveness, should be avoided. Goal directed strategy is the most rational approach to assess the patient and maintain optimum fluid balance. However, accessible and applicable monitoring tools for determining patient's actual fluid need should be further studied and universalized. The debate around colloids and crystalloids should also be considered with goal directed therapies. Advantages and disadvantages of each solution must be evaluated with the patient's specific condition.

Experimental study on the effects of massive bowel resection on liver function and hepatocyte apoptosis.

BACKGROUND/AIMS: The effects of short-bowel syndrome on liver function and liver morphology independent of parenteral nutrition have not been thoroughly investigated. Our aim was to investigate the effects of massive bowel resection on hepatocyte apoptosis and liver function in rats. MATERIALS AND METHODS: A total of 37 female Sprague-Dawley rats were randomly assigned to five groups: Control (no procedure); Sham 1 [laparotomy (LT)/enterotomy (ET); evaluated on postoperative day (POD) 1]; Sham 2 (LT/ET; evaluated on POD7; Group 1 (80% bowel resection after LT/ET; POD1); and Group 2 (80% bowel resection; POD7). Blood samples were obtained for measuring aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels. For assessing hepatocyte apoptosis, liver tissue samples from the median lobe were obtained and used for a terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick-end labeling assay. RESULTS: Aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels showed statistically significant differences among the five groups. Apoptotic hepatocyte counts there were statistically significant differences among groups for counts made in 20 consecutive high-power fields. However, liver sinusoidal cell apoptosis rates among groups showed statistically significant differences for counts made in 20 consecutive high-power fields, particularly on POD7 in rats undergoing massive bowel resection. CONCLUSION: Parenteral nutrition is not the only factor involved in liver dysfunction after massive bowel resection. Massive bowel resection alone can cause liver abnormalities. Rats undergoing massive small intestinal resection show significant temporal increases in liver sinusoidal cell apoptosis rates.

Primary liposarcoma of the stomach.

Sarcomas represent less than 1% of adult solid malignancies and are rarely seen in the gastrointestinal tract. Here, we report a 59-year-old female with a well-differentiated liposarcoma of the stomach. This is the first case in the literature in which endoscopic ultrasound proved to be a diagnostic tool for gastric liposarcoma.

Long term efficacy of laparoscopic adjustable gastric banding--retrospective analysis.

BACKGROUND: Laparoscopic procedures have emerged over the past decade for treatment of obesity. Laparoscopic adjustable gastric banding is the easiest surgical technique for morbid obesity. OBJECTIVES: The authors analyzed the long term results of laparoscopic adjustable gastric banding in their center. MATERIAL AND METHODS: A total of 172 consecutive patients who had undergone laparoscopic adjustable gastric banding between May 2005 and February 2011 in authors clinic were contacted for evaluation. The main outcome measures were complications, secondary operations, percent excess weight loss, mortality, patient satisfaction and band removal rate. RESULTS: The follow-up rate was 62.2%. Mean age of patients was 30.6 years. Mean body mass index of patients was 48.47 +/- 7.8 kg/m2. Median follow-up interval was 36 months (min 8, max 81) and band removal rate was 19.1%. There was one mortality. Of all patients, 33 had band removal. The band was removed laparoscopically in 21 patients. The main reason for band removal was slippage followed by band erosion. After band removal, 4 patients had re-banding, 5 had Roux-en-Y gastric bypass. Overall, the mean percent excess weight loss was 50.6 +/- 7.8% (range, 5-100%). Mean percent excess weight loss for those who had band removal was 27.8 +/- 5.78% (range 12.5-34.1%). Overall satisfaction index was rated as "good" for 42% of patients. CONCLUSIONS: Despite a low satisfaction index, considerable mean percent excess weight loss and vast improvement in co-morbidities is achieved after laparoscopic adjustable gastric banding. The authors conclude that laparoscopic adjustable gastric banding can be utilized as the initial surgical procedure in morbid obesity.

Comparison of early and late changes in immunoglobulins and acute phase reactants after laparoscopic adjustable gastric banding in patients with morbid obesity.

BACKGROUND: There are differences in the levels of inflammation mediators, lipids, and formed elements of the blood in morbidly obese patients compared with individuals of normal weight. In the current study, the change in these parameters was determined in patients who achieved weight loss by undergoing laparoscopic adjustable gastric banding (LAGB) by comparing preoperative, and early (3 months) and late (12 months) postoperative values. METHODS: The body mass index (BMI), weight, blood pressure, and waist circumference of 72 patients treated by LAGB procedures between September 2006 and February 2009 were measured and recorded. Pre- and postoperative 3- and 12-month C-reactive protein (CRP), immunoglobulin (Ig) G, IgA, IgM, fibrinogen (Fbg), complement components C3 and C4, total cholesterol, triglycerides, low-density lipoprotein-C and high-density lipoprotein-C levels, and leukocyte, neutrophil, lymphocyte, and platelet counts were also measured. Results were presented as mean +/- SD. The preoperative values were compared with the 3- and 12-month values. A p value < 0.05 was considered statistically significant. RESULTS: BMI, weight, blood pressure, and waist circumference measurements were reduced at 3 and 12 months postoperatively compared with preoperative values (p < 0.05). Among the inflammatory mediators, IgG, IgM, and Fbg were reduced to near-normal values, beginning in the early postoperative period (p < 0.05). There was no significant reduction parallel to weight loss with respect to CRP, C3, C4, and IgA values at 3 months postoperatively (p > 0.05). However, the 12-month values of these parameters were significantly reduced (p < 0.05). CONCLUSIONS: Morbid obesity leads to significant changes in the levels of inflammation mediators. While there is a significant reduction in some of these mediators accompanying slight weight loss in the early period following an LAGB procedure, significant changes occur in other mediators in the late period when there is a larger amount of weight loss.

Evaluation of the presence of Helicobacter species in the biliary system of Turkish patients with cholelithiasis.

BACKGROUND/AIMS: Helicobacter genus and bile-resistant Helicobacter pylori are suggested to have a role in gallstone formation and epithelial cell proliferation in the gallbladder. The aim of this study was to evaluate the presence of Helicobacter species in the gallbladder tissue, bile and gallstones of Turkish patients with cholelithiasis. METHODS: Forty-seven patients with calculous cholecystitis and 3 controls were evaluated for the presence of Helicobacter spp. by culture, polymerase chain reaction, and histological and immunohistochemistry methods. RESULTS: Escherichia coli (10.6%), Enterobacter amnigenus (6.3%), Klebsiella planticola (2.1%), and Klebsiella ozaenae (2.1%) were isolated from the sample cultures of 8 patients. No other microorganisms, including H. pylori and other Helicobacter spp., were detected. Polymerase chain reaction was negative for Helicobacter spp. and H. pylori. No microorganisms resembling Helicobacter spp. were seen on the histological sections. The association between the presence of bacteria and epithelial cell proliferation index was not statistically significant (p=0.48). CONCLUSIONS: There was no association between the presence of Helicobacter spp. and development of cholelithiasis in our study group. The microorganisms found in the samples did not reveal any significant association with the underlying disease.

Frantz's tumor (solid pseudopapillary tumor) of the pancreas. A case report.

CONTEXT: A solid pseudopapillary tumor of the pancreas is a rare neoplasm which, for the most part, affects young women and has a relatively favorable prognosis with a low malignant potential. These tumors usually have unclear clinical features and may form very large masses before being diagnosed. CASE REPORT: We report the case of a 29-year-old woman who underwent complete resection of the tumor using a distal pancreatectomy and splenectomy procedure. The patient is being followed-up and in good condition. A review of the relevant literature is also presented. CONCLUSIONS: A solid pseudopapillary tumor of the pancreas is a rare condition with a low potential for malignancy and favorable prognosis; surgical resection is generally curative.

Development of two cancers in the same patient after ileorectal and ileal pouch anal anastomosis for familial adenomatous polyposis.

OBJECTIVE: To report a case of a patient with familial adenomatous polyposis. CLINICAL PRESENTATION AND INTERVENTION: A 36-year-old male patient who suffered from rectal bleeding was treated with colectomy and ileorectal anastomosis for familial adenomatous polyposis (FAP) in 1974. After 19 years, in situ adenocarcinoma was detected in the rectal stump. Completion proctectomy, mucosectomy, and hand-sewn ileal pouch anal anastomosis with protective ileostomy were performed. In 2002, a metachronous cancer was detected at the anastomosis and abdominoperineal resection of the pouch and end ileostomy were performed. Later on, the perineum was excised locally because of cancer recurrence. CONCLUSION: This case shows that lifetime surveillance of the FAP patients after surgery is crucial.