Multidetector CT findings in gastrointestinal tract perforation that can help prediction of perforation site accurately.

AIM: To assess the accuracy, sensitivity, and specificity of multidetector computed tomography (MDCT) findings by comparing the locations of free air in the abdomen and imaging findings with the site of gastrointestinal perforation. MATERIALS AND METHODS: Ninety-three patients with acute abdominal pain who visited the emergency department between January 2015 and October 2018 were included in the study. There were 59 male and 34 female patients with a mean age of 50.5 years. The site of perforation was based on surgical findings in all cases. RESULTS: Among specific air distributions, periportal free air and subphrenic free air were statistically significant in differentiating upper gastrointestinal tract perforation. Whereas free air in the minor pelvis, right lower quadrant free air, left lower quadrant free air, and air in the mesentery were statistically significant in differentiation of lower gastrointestinal tract perforation. CONCLUSION: Multidetector findings may help to predict the site of gastrointestinal perforation, which would change the treatment plan.

Role of obesity and abdominal shape morphometric features to predict postoperative complications and quality of lymph node dissection of gastrectomy for gastric cancer.

Obesity and abdominal shape morphometric features have been thought to be independent risk factors for surgical outcomes after gastrectomy.A total of 113 patients undergoing surgery for primary gastric adenocarcinoma from June 2011 to January 2015 were retrospectively included. Body mass index, visceral fatty area, anterior-posterior abdominal and transverse diameters and depth ratio at levels of the umbilicus, the gastroesophageal junction and the root of the celiac artery were measured or calculated. Patients were grouped according to body mass index (<25.0 kg/m2or ≥25.0 kg/m2) or median value of these parameters. Surgical outcomes including postoperative complications, total and metastatic lymph node numbers and their ratio were compared.There was a significant association between body mass index and abdominal shape indexes. Body mass index and abdominal shape indexes showed no statistical significance on development of complications. But, lymph node numbers and their ratio were negatively affected by depth ratio at the root of the celiac artery.Our findings showed that gastrectomy with curative intent can be performed safely in patients with higher body mass index and abdominal shape indexes. Therefore, there is no need to perform any change in surgical strategy according to these measurements and calculations.

WHAT SHOULD BE THE APPROACH TO MODERATE HYPOCALCAEMIA IN THE EARLY PERIOD FOLLOWING TOTAL THYROIDECTOMY?

CONTEXT: It is unclear whether treatment is necessary for transient moderate hypocalcaemia occurring after total thyroidectomy; if it is present, it is unclear which treatment modality should be preferred. OBJECTIVE: To investigate both the necessity and effectiveness of different treatment approaches of oral and/or intravenous calcium treatment in patients with transient, postoperative, moderate hypocalcaemia. DESIGN: This is a case control study made between June 2014 and June 2015. SUBJECTS AND METHODS: Forty-five patients who had serum calcium levels 6 hours after total thyroidectomy between 7.5-8 mg/dL were divided into three equal groups: an oral calcium administration group, an intravenous calcium administration group and a no-treatment group. Serum calcium and parathyroid hormone levels were measured preoperatively and on postoperative days 1, 2, 5 and 10. RESULTS: For post-thyroidectomy patients with serum calcium 7.5-8 mg/dL in the early postoperative period, no significant difference in serum calcium or parathyroid hormone was detected between groups. CONCLUSIONS: Follow-up without treatment seems to be the most effective approach for moderate hypocalcaemia occurring in the early period following total thyroidectomy; this suggests that intravenous treatment should be avoided.