Importance of routine histopathological examination of a gallbladder surgical specimen: Unexpected gallbladder cancer.

INTRODUCTION: Cholecystectomy performed for benign diseases of the gallbladder is important for the diagnosis of gallbladder cancer. This is done by pathological examination of the removed specimens for patients with no detected or suspected complications before surgery. Although some centers undertake selective approaches for histopathological examination of gallbladder specimens, many centers perform this examination routinely. In our study, we investigated results of pathological examinations carried out on cholecystectomy specimens, in respect to unexpected cases of gallbladder cancer. METHODS: We reviewed cholecystectomy cases performed for benign diseases of gallbladder from January 2012 to February 2016 by investigating pathological specimens from the gallbladder. We evaluated demographical properties and their association with the pathological diagnosis and frequency of unexpected gallbladder cancer cases. We reported additional treatment and survival information of the malignancy cases after surgery. RESULTS: We reviewed 1294 cases of cholecystectomy, and the mean patient age was 47.5 ± 14.3 years. The most frequent diagnosis was chronic cholecystitis (92.3%), and it was more prevalent among younger patients and female sex (P < 0.0001). Five patients (0.4%) were determined to have gallbladder cancer, and the mean age of these cases was 65.6 ± 18.2 years. Two cases were Stage 2, two cases were Stage 3B, and one case was Stage 3A. There was no T1 or Tis tumor. CONCLUSION: Routine histopathological examination of gallbladder is significant with respect to the determination of additional interventions at the postoperative period required for cancer cases coincidentally diagnosed.

Incidental Findings in Routine Histopathological Examination of Appendectomy Specimens; Retrospective Analysis of 1970 Patients.

Diseases and tumors of the appendix vermiformis are very rare, except for acute appendicitis. This study aimed to examine rare findings in the histopathologic examinations of specimens of patients undergoing appendectomy due to the diagnosis of acute appendicitis. The files of 1970 patients undergoing appendectomy due to the diagnosis of acute appendicitis between March 2012 and March 2016 were retrospectively investigated. Rare findings were found in 59 (3 %) patients, and these were evaluated in detail. Patients' age, gender, pathology reports, and postoperation follow-ups were recorded. The rare histopathological findings of 59 patients were examined. Of these, 31 were female (52.5 %) and 28 were male (47.5 %). The average age was 33.1 ± 18.2 years. The unusual findings were as follows: 16 fibrous obliteration, 11 Enterobius vermicularis, 2 schistosomiasis, 3 appendiceal neuroma, 2 granulomatous appendicitis, 1 Crohn's disease, 3 chronic appendicitis, 1 endometriosis, 2 hyperplastic polyps, 9 mucinous cystadenoma (+mucocele), 8 carcinoid tumors, and 1 lymphoma. All of the malignant tumors were localized in the distal end of the appendix, and all of the patients were treated with appendectomy. Patients with parasitic diseases also underwent anthelmintic treatment, while chemotherapy was administered to the patient with lymphoma. All of the patients diagnosed with malignancy were alive reported no problems at their follow-ups. Although all of the appendectomy samples were normal macroscopically, data from this study suggest that all specimens should be sent for routine investigation.

Acute gastric dilatation due to binge eating may be fatal.

Acute gastric dilatation was first described by Duplay in 1833. Since the stomach has rich blood circulation, necrosis and perforation due to dilatation are rarely seen. Clinically, more than 90% of cases have complaints of vomiting. The most useful method to determine diagnosis and etiology is computerized tomography (CT). Medical treatment is suitable for cases that have no necrosis or peritonitis findings. Delay in surgical treatment increases the risk of mortality. The present case is that of a diagnosis of gastric perforation due to acute gastric dilatation in a 24-year-old female patient.

Unexpected findings in the routine histopathological examinations of appendectomy specimens A retrospective analysis of 1,970 patients.

INTRODUCTION: Diseases and tumors of the appendix vermiformis are very rare, except for acute appendicitis. This study aimed to examine rare findings in the histopathologic examinations of specimens of patients undergoing appendectomy due to the diagnosis of acute appendicitis. METHODS: The files of 1,970 patients undergoing appendectomy due to the diagnosis of acute appendicitis between March 2012 and March 2016 were retrospectively investigated. Rare findings were found in 59 (3%) patients, and these were evaluated in detail. Patients' age, gender, pathology reports, and post-operation follow-ups were recorded. RESULTS: The rare histopathological findings of 59 patients were examined. Of these, 31 were female (52.5%) and 28 were male (47.5%). The average age was 33.1±18.2 years. The unusual findings were as follows: 16 Fibrous obliteration, 11 Enterobius vermicularis, 2 Schistosomiasis, 3 Appendiceal neuroma, 2 Granulomatous appendicitis, 1 Crohn's disease, 3 Chronic appendicitis, 1 Endometriosis, 2 Hyperplastic polyps, 9 Mucinous cystadenoma (+mucocele), 8 Carcinoid tumors and 1 Lymphoma. All of the malignant tumors were localized in the distal end of the appendix and all of the patients were treated with appendectomy. Patients with parasitic diseases also underwent anthelmintic treatment, while chemotherapy was administered to the patient with lymphoma. All of the patients diagnosed with malignancy were alive reported no problems at their follow-ups. CONCLUSION: Although all of the appendectomy samples were normal macroscopically, data from this study suggest that all specimens should be sent for routine investigation. KEY WORDS: Appendicitis, Appendectomy, Carcinoid, Mucocele, Endometriosis.

Causes of asymptomatic trocar site hernia: How can it be prevented?

OBJECTIVE: The aim of this study is to evalute risk factors which trigger the development of trocar site hernia after elective laparoscopic cholecystectomy operation and to discuss what needs to be done to prevent it. METHODS: Patients operated with laparoscopic cholecystectomy between 2011 and 2013 were evaluated. Patients were called back for follow-up visit at 12 month after operation. Physical and ultrasonographic examinations were performed at follow-up. Factors that facilitate development of trocar site hernia were investigated. RESULTS: One hundred and ninty patients were operated during the study period. One hundred and thirty-two patients who had been examined at follow-up period were included in the study. Mean age of the patients was 50.64±11.86 (18-76) years and female/male ratio was five. Trocar site hernia was detected in four patients at umblical trocar site. One of these patients had chronic obstructive lung disease, two of them had diabetes and three of them had obesity. Advanced age and obesity were found to be statistically significant in patients having trocar site hernia (p value: 0.007, and 0.008, respectively). CONCLUSION: Development of trocar site hernia after laparoscopic surgery may be prevented by repair of trocar site in patients taken into consideration risk factors such as advanced age and obesity.

Polypropylene mesh covered colonic anastomosis. Results of a new anastomosis technique.

BACKGROUND: The morbidity and mortality rates of anastomosis leakage of the gastrointestinal system, are high. In this study we covered the colonic anastomosis with polypropylene mesh on the safety of the anastomosis was investigated. METHODS: Twenty female albino rabbits were divided into two groups. First of all, a segmental colon resection was performed in both the groups and a single layer of anastomosis was made. In addition, a polypropylene mesh as long as the circumference of the anastomosis in the study group. All the rabbits were sacrificed on the 10th postoperative day and the explosion pressure of the anastomosis, histopathological investigation of the anastomotic contour, and peritoneal adhesion were compared. RESULTS: The anastomoses of all the subjects in the control group had exploded and the average explosion pressure was 149 +/- 16 mmHg. However, in the study group, the anastomoses did not explode in nine (90%) of the subjects, whereas it exploded in only one (10%) with a pressure of 260 mmHg. The average explosion pressure in the study group was 315 +/- 30 mmHg (p < 0.0001). No significant difference was established between the groups according to the histopathological classification of the anastomotic contour performed according to the Ehrlich-Hunt model (p > 0.05). Peritoneal adhesions of the groups is not statistically different (p > 0.05). CONCLUSION: During the short follow-up period, this new technique significantly increased the safety of the anastomosis, moreover it did not cause any increase in peritoneal adhesions. This success has most probably occurred as a result of the external mechanical support to the anastomosis.