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BACKGROUND: Appendiceal diverticular disease (ADD) is a rare pathology which is associated with an increased mortality risk due to rapid perforation and high rates of neoplasm. In our study, we aimed to evaluate the clinical and histopathological characteristics of ADD with differences from acute appendicitis (AA) diagnosis and to determine the association with neoformative processes. METHODS: The 4279 patients who underwent appendectomy were evaluated retrospectively. ADD patients histopathologically classified into four groups. Patients' demographic characteristics, imaging and preoperative laboratory findings, additionally postoperative histopathology results were compared between groups. RESULTS: The prevalence of ADD was 2.29% (n = 98). In addition, the male/female ratio was 2.37 in ADD patients who were found to be significantly older than those with AA patients. Type III was the most frequently (62.2%) identified sub-group of ADD. The incidence of neoplasms, plastrone, and Littre's hernia was found statistically higher in ADD group than AA group. Mucinous adenomas (10.2%) was the most common neoplasm while the carcinoid tumor (1%) and precancerous serrated adenomas (4.1%) were also reported. CONCLUSIONS: As a result, high neoplasm in ADD patients can be shown with incidence of perforation and plastron, and in order to avoid possible neoplasm or major complications, it is necessary to carry out new studies for the right diagnosis of ADD whether the diagnosis is done preoperatively or intraoperatively. We recommend surgical resection of the ADD, which may even be incidentally detected during any surgical procedure, due to its high risk of neoplasm and rapid perforation.
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Neoplasias do Apêndice/patologia , Apendicite/patologia , Apêndice/patologia , Doenças Diverticulares/patologia , Lesões Pré-Cancerosas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Neoplasias do Apêndice/diagnóstico por imagem , Neoplasias do Apêndice/epidemiologia , Neoplasias do Apêndice/cirurgia , Apendicite/diagnóstico por imagem , Apendicite/epidemiologia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Criança , Diagnóstico Diferencial , Doenças Diverticulares/diagnóstico por imagem , Doenças Diverticulares/epidemiologia , Doenças Diverticulares/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/cirurgia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Turquia/epidemiologia , Adulto JovemRESUMO
PURPOSE: The study was conducted to investigate the effect of preoperative oral carbohydrate loading on the preoperative discomforts and postoperative complications of patients undergoing elective thyroidectomy. DESIGN: A randomized controlled clinical trial. METHODS: Ninety patients scheduled for thyroidectomy were divided into three groups: (1) those receiving a carbohydrate-rich drink (CHD), (2) those receiving an overnight 5% glucose intravenous infusion, and (3) those fasting from midnight. The preoperative discomforts and postoperative complications of patients were evaluated using the Visual Analog Scale (VAS). The patients' vital signs and blood glucose levels were measured perioperatively. FINDINGS: In the preoperative assessment, hunger, thirst, mouth dryness, chill, and headache adjusted for age, gender, body mass index, and duration of the operation were all found to be significantly higher in the glucose and fasting groups than the CHD group (P < .01). In the postoperative period, the fasting group experienced more vomiting and pain compared with the CHD group (P < .05). A significant difference was found between the groups in terms of diastolic blood pressure and pulse rate in the preoperative and intraoperative periods (P < .05). CONCLUSIONS: The CHD treatment before thyroidectomy increases patient comfort by reducing preoperative discomfort (such as hunger, thirst, dry mouth, fatigue and headache) and early postoperative complications (vomiting and pain).
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Carboidratos da Dieta/administração & dosagem , Satisfação do Paciente , Administração Oral , Adulto , Feminino , Glucose/administração & dosagem , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , TireoidectomiaRESUMO
BACKGROUND: Early diagnosis of postoperative pancreatic fistula (POPF) is important for proper interventions. The preoperative, intraoperative and early postoperative biochemical markers have predictive value of POPF. The present study was to evaluate several simple biochemical parameters in the prediction of POPF. METHODS: Patients who underwent pancreaticoduodenectomy in our center between 2006 and 2015 were reviewed retrospectively. Preoperative and early postoperative biochemical parameters were evaluated. Additionally, the relationship between POPF and pH and lactate level at the end of surgery were analyzed, and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width-to-platelet ratio (RPR) were calculated for postoperative days (PODs) 1 and 3. Diagnosis and grading of POPF were performed according to the standards of the International Study Group on Pancreatic Fistula. The patients were divided into two groups: Group 1 with no fistula or grade-A fistula; group 2 with grade-B or -C fistula. These simple biochemical markers were then compared between the two groups. RESULTS: Serum amylase level was significantly higher at POD3, and pH level was significantly lower at the end of operation in group 2 compared with those in group 1. However, the serum amylase was below the upper limit of normal serum level and therefore, the difference was not significant in clinical practice. Receiver operating charecteristic curve analysis showed that pH level was a reliable predictor of POPF (area under the curve: 0.713; 95% CI: 0.573-0.853). CONCLUSIONS: A low pH level at the end of pancreaticoduodenectomy was a risk factor of POPF. NLR, PLR, and RPR had no predictive value of POPF after pancreaticoduodenectomy.
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Acidose Láctica/etiologia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Acidose Láctica/sangue , Acidose Láctica/diagnóstico , Idoso , Amilases/sangue , Área Sob a Curva , Biomarcadores/sangue , Diagnóstico Precoce , Índices de Eritrócitos , Feminino , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico/sangue , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/sangue , Fístula Pancreática/diagnóstico , Contagem de Plaquetas , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , TurquiaRESUMO
OBJECTIVE: Colonic mucosal pseudolipomatosis is rare, and its pathogenesis is controversial. A number of mechanisms, including mechanical injury during an endoscopic procedure or chemical injury by disinfectant, seem to contribute to its pathogenesis. MATERIAL AND METHODS: This retrospective study examined the colonic biopsies of 1370 patients. These biopsies were preserved at the Department of Pathology of Istanbul Training and Research Hospital between January 2012 and June 2013. RESULTS: We found pseudolipomatosis in 14 of 1370 colonoscopy cases (1.02%). Of these 14 patients, 8 were male and 6 were female. The male patients were between 24 and 66 years, with a mean of 39; the female patients were between 26 and 58 years, with a mean of 42. CONCLUSION: Many endoscopists are unaware of the lesion, and the diagnosis is generally possible only after pathological assessment of multiple biopsies taken from suspect lesions. Here we report and discuss colonic pseudolipomatosis incidentally found in a series of patients undergoing routine colonoscopy, and we underline the endoscopic pattern and diagnostic difficulties.
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OBJECTIVE: Isolated cecal necrosis is a rare cause of ischemic colitis. Ischemic colitis is further divided into two groups: occlusive mesenteric ischemia and non-occlusive mesenteric ischemia. The aim of this study was to investigate the cause of isolated cecal necrosis. MATERIAL AND METHODS: We operated on 3 male and 3 female patients with a mean age of 60.3±18.7 (38-85) years with a preliminary diagnosis of acute appendicitis between 2007 and 2012. Four of these patients were on hemodialysis, 1 patient had an aortofemoral bypass, and 1 patient had coronary artery disease with atrial fibrillation. RESULTS: The diagnosis was made intraoperatively in all cases. Five patients died postoperatively. One patient survived. CONCLUSION: In the case of right lower quadrant pain, the possibility of isolated cecal necrosis should be kept in mind, especially in patients on hemodialysis, elderly patients with diabetes, and heart disease; surgical strategies should be planned accordingly, and it should be understood that a high mortality rate will be inevitable.
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INTRODUCTION: Although laparoscopic repair of inguinal hernia is associated with reduced postoperative pain, it is not entirely painless. In addition to reducing the need for analgesic medication, postoperative complications, and hospitalization, postoperative pain control enables early return to normal activity. AIM: To evaluate the efficacy of bupivacaine instilled into the pre-peritoneal space and trocar incisions of patients undergoing laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia. MATERIAL AND METHODS: Bupivacaine was instilled into the pre-peritoneal space and trocar incisions of the patients in group I (n = 23), whereas it was infiltrated only into the trocar incisions of the patients in group II (n = 21). No local anesthetic was administered to the patients in group III (n = 21). Postoperative pain was assessed using the Visual Analog Scale (VAS) at 4 and 24 h, and the dosage of analgesic medication was noted. RESULTS: No significant difference regarding age, gender, body mass index, ASA class, history of abdominal surgery, or smoking was noted between the three groups (p > 0.05). VAS score at 4 h was significantly higher in group III than in groups I and II (p < 0.05). The dosage of analgesic medication was significantly higher in group III than in groups I and II (p < 0.05), with no significant difference between groups I and II (p > 0.05). CONCLUSIONS: Infiltration of long-acting local anesthetic into the pre-peritoneal space and trocar incisions of patients undergoing laparoscopic TEP repair of inguinal hernia reduces the need for analgesic medication by reducing early postoperative pain.
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BACKGROUND: Biliary fistula is one of the most common complications of liver and biliary tract surgeries. Endoscopic retrograde cholangiopancreatography (ERCP) is used for the diagnosis and treatment of biliary fistulas. In this study, we aimed to analyze the contribution of ERCP in this regard. METHODS: Patients who underwent ERCP for biliary fistulas following liver and biliary tract surgery between January 2012 and December 2017 were included in this study. The demographic characteristics of the patient, surgical procedure, localization of the biliary fistula, classification of biliary duct injury, and success of ERCP were retrospectively evaluated. RESULTS: In total, 90 patients (37 male and 53 female) with a diagnosis of biliary fistula underwent ERCP. Common biliary duct (CBD) cannulation was achieved in 87 patients using ERCP. In five patients, the proximal part of the biliary tract was not visualized, and complete injury of CBD was considered. In ERCP, contrast extravasation was detected in the cystic duct in 44 patients: CBD, eight patients; liver bed, four patients; hepatic duct bifurcation, two patients; the right hepatic canal, seven patients; and the left hepatic canal, two patients. CONCLUSION: ERCP is an effective method for the diagnosis and treatment of biliary diseases. The diagnosis and treatment of postoperative biliary fistulas with ERCP reduces surgery cost, morbidity, and mortality.
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Fístula Biliar/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Complicações Pós-Operatórias/cirurgia , Humanos , Estudos RetrospectivosRESUMO
Objective: Prognostic effect of KRAS mutation and side of tumor in colorectal cancer is a highly controversial subject. Therefore, we evaluated the association between FDG uptake pattern in 18F-fluoro-2-deoxy-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging and KRAS mutation and tumor localization in patients with a diagnosis of colon cancer and assessed the effects of these three factors on prognosis and survival. Methods: Eighty-three patients with colorectal cancer were retrospectively included in this study. 18F-FDG PET/CT study was performed for pretreatment staging. The maximum standardized uptake value (SUVmax) of the primary tumor and survival data of patients were compared between groups. KRAS mutations were detected with the help of real-time Polymerase Chain Reaction technique through genomic DNA extracted from paraffin-embedded tumor tissue blocks. Tumor lesions with potential KRAS mutations were classified as mutant KRAS and wild type. Results: Twenty five patients were female while 58 were male. The mean age of the patients was 59.8±11.3 years. Mean follow-up was 35.5±18.9 months. Primary tumor was localized in the left colon in 83.1% of patients and in the right colon in 16.9%. KRAS mutation was detected in 54.2% (n=45) of patients. Mean SUVmax of patients with primary tumor was estimated to be 21.1±9.1 (range= 6.0-47.5). Mean tumor SUVmax of patients with a KRAS mutation (24.0±9.0) was found to be significantly higher than those without KRAS mutation (17.7±8.2) (p=0.001). Mean survival was significantly shorter in patients with locoregional nodal metastasis than in patients without locoregional nodal metastasis as well as in patients with distant nodal metastasis than in patients without distant nodal metastasis and in patients with organ metastasis in initial PET/CT than in patients without organ metastasis. Also, mean survival was nearly statistically-significantly shorter in patients with tumors located in left colon (34.2±19.4) than in right colon (43.2±14.6) (p=0.059). However, we found no significant impact of KRAS mutation on survival. Conclusion: In our study, we found that tumor localization had no significant effect on prognosis in patients with colon cancer. On the other hand, FDG uptake was observed to be higher in the presence of KRAS mutation and it was concluded that coexistence of KRAS mutation with higher SUVmax is a negative prognostic factor.
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AIM: The patients who underwent endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for mucosal and submucosal lesions of the esophagus, stomach, and duodenum and the advantages of the double endoscope method we used for traction during ESD were evaluated. MATERIAL AND METHODS: The patients who underwent ESD and EMR due to upper gastrointestinal lesions were evaluated retrospectively between January 2014 and April 2018 in our endoscopy unit. RESULT: The mean age of 10 patients with esophageal lesions was 53 years. ESD was performed for 7 lesions and EMR for 3 lesions. The most common lesion was leiomyoma and the median size of the lesions was 1.4 cm (range, 0.6-2.5 cm).The median age of 26 patients with gastric lesions was 61 years. EMR were performed for 11 lesions and ESD for 15 lesions. Double endoscope was used in 6 patients. One patient had intramucosal carcinoma, while the other lesions were benign and dysplasia was the most common lesion. The median size of lesions was 1.8 cm (range, 1-3 cm).All lesions were evaluated with endoscopic ultrasonography. Bleeding was seen in 4 patients and perforation in 1 patient during ESD and defect was closed with endoscopic clips. CONCLUSION: The advantages of endoscopic resections; short hospitalization, low complication rates, patient comfort, and doesn't require the general anesthesia. For endoscopic resection, we think that the second endoscope shortens the duration of the procedure, reduces the complication rate, and increases the comfort of the endoscopist.
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Dissecação/métodos , Endoscópios , Ressecção Endoscópica de Mucosa/métodos , Gastroenteropatias/cirurgia , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to analyze the predictive value of preoperative laboratory findings in acute appendicitis in geriatric patients aged >65 years. METHODS: We enrolled a total of 4121 patients. A retrospective evaluation of the demographic features was made using preoperative laboratory values such as the white blood cell (WBC), neutrophil, and lymphocyte counts; platelet counts; the mean platelet volume and bilirubin values; and postoperative pathological data of the patients from the electronic file system. The neutrophil-to-WBC and neutrophil-to-lymphocyte ratios were calculated. Patients were divided into two groups, as geriatric (≥65 years old, n=140) and non-geriatric (<65 years old, n=3981). RESULTS: The white blood cell and lymphocyte counts, and the neutrophil-to-WBC ratio, were significantly higher in the non-geriatric group (p<0.001, p=0.013, and p=0.021, respectively). The neutrophil and platelet counts were higher in the non-geriatric group, but this difference was not statistically significant (p=0.073 and p=0.072, respectively). A higher neutrophil-to-lymphocyte ratio was determined in the geriatric group, but the difference was not significant (p=0.176). According to the optimumal cutoff value of 12.11×103/µL for WBC, specificity and sensitivity values of 65.4% and 57.9% were calculated, respectively; the AUC value was 0.632±0.024 (p<0.001). A receiver operating characteristic (ROC) analysis was used to calculate the optimum cutoff values of neutrophil-to-WBC ratio, lymphocyte, and the mean platelet volume, but the diagnostic accuracy of these tests was inadequate with an AUC of <0.6. CONCLUSION: WBC values >12.11×103/µL were predictive of acute appendicitis in geriatric patients. The other parameters were not predictive, and further studies are required.
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BACKGROUND: Esophageal perforation (EP) is a lethal surgical emergency that needs to be diagnosed and treated immediately. Diagnosis and treatment options for EP are limited due to its lower incidence. There are scoring systems proposed for this purpose; however, they cannot be applied to every patient. The recent trend in the treatment of EP is toward the non-operative approach over the surgical treatment methods. The purpose of the present study was to evaluate our treatment methods and outcomes in patients with EP. METHODS: Thirteen patients with EP treated in our clinic between 2013 and 2017 were retrospectively reviewed. The Pittsburgh Perforation Severity Score (PSS), systemic condition status, and Clavien-Dindo Classification (CDC) score were assessed, and treatment methods were reviewed. Their effects on morbidity and mortality were examined using Fisher's exact test and biserial correlation test. RESULTS: A total of 13 patients (six males and seven females; median age 64 years) were included in the study. Ten patients were managed non-operative, and three were treated surgically. Of the 10 patients, two had additional surgery after non-operative management. The PSS, systemic condition status, CDC score, duration of stay in the hospital, time to diagnosis, presence of hypotension, and being in shock were strongly correlated with mortality (p<0.05). The PSS, CDC score, and stay in the intensive care unit were strongly correlated with morbidity (p<0.05). The comparison between the non-operative and operative groups did not yield a statistically significant difference in mortality and morbidity. CONCLUSION: Even if the scoring systems help to understand the severity of the condition, they are inadequate to determine the treatment option. Early diagnosis and treatment are the most important steps in management. Operative and non-operative treatment options are not superior to each other, but their complementary use will be more beneficial for the patients.
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Perfuração Esofágica , Idoso , Perfuração Esofágica/epidemiologia , Perfuração Esofágica/mortalidade , Perfuração Esofágica/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
INTRODUCTION: Stent treatment can be applied to avoid surgery in surgically risky patients or to turn a high-risk emergency operation into a lower-risk elective operation and save time. AIM: In this study, the techniques, clinical efficacy, safety and complications of endoscopic stents applied in emergency conditions were evaluated in patients with acute mechanical intestinal obstruction (AMIO) due to colorectal cancer. MATERIAL AND METHODS: Between 2013 and 2015, 23 patients with an average age of 69.5 ±13.5 years who presented with AMIO and anastomosis stenosis secondarily to cancer to the emergency department were subjected to stent treatment under emergency conditions. RESULTS: Thirteen (56.5%) patients were diagnosed with colon cancer, 5 (21.7%) with rectal cancer, and 5 (21.7%) with stenosis in the previous anastomosis line. Fourteen (60.9%) patients were diagnosed with stage 4 cancer, 7 (30.4%) with stage 3 cancer and 2 (8.7%) with stage 2 cancer. The stents were applied to the sigmoid colon in 10 (43.5%) patients, to the recto-sigmoid area in 9 (39.1%) patients and to the rectum area in 4 (17.4%) patients. While 14 (60.9%) patients had local or locally advanced disease, 9 (39.1%) patients had metastases in different parts of their bodies, particularly in their livers. CONCLUSIONS: The study demonstrates that stents offer a favorable therapeutic alternative to emergency surgery and are associated with promising short-term outcomes as well as an acceptable safety profile for AMIO.
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INTRODUCTION: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are commonly used for the minimally invasive treatment of submucosal lesions of the gastrointestinal tract. AIM: To evaluate the safety, efficacy, outcome and recurrence rate of EMR and ESD for mucosal and submucosal lesions in the colon and rectum. MATERIAL AND METHODS: Records of 26 patients who underwent ESD and EMR for mucosal and submucosal lesions in the colon and rectum between January 2013 and March 2018 in our endoscopy unit were retrospectively reviewed. RESULTS: A total of 26 patients (6 female and 20 male) were evaluated. The mean age of the patients was 58.03 ±15.19 (21-80). Fifteen patients underwent ESD and EMR for rectal lesions. Tubular adenomas were found in 3 of these patients, tubulo-villous adenomas in 2, inflammatory polyps in 1, neuroendocrine tumors in 2 and carcinomas in 7 (intramucosal, in-situ and invasive). Eleven patients underwent ESD and EMR for colonic lesions. Villous adenomas were found in 2 of these patients, tubular adenoma showing dysplasia in 2, tubulo-villous adenomas showing dysplasia in 1 and carcinoma (in-situ, invasive and intramucosal) in 6. Two lesions were resected with secondary transanal local excision to obtain free margins. The follow-up period was 3 to 48 months and no recurrence was observed. CONCLUSIONS: The EMR and ESD are reliable minimally invasive techniques with a low rate of complications and short hospital stay in the treatment of colon and rectal lesions, including early stage carcinomas of different size and morphology.
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Intussusception, which is seen rarely in adults, is defined as the pulling or invagination of a part of the intestine into another segment of the intestine. In this case report we present chronic retrograde jejunojejunal intussusception following gastric surgery with Braun's anastomosis in adult with video presentation. A 66-year-old woman, who had undergone gastric surgery 39 years ago and cholecystectomy 20 years ago, was admitted to our clinic with the complaints about weight loss, abdominal pain, nausea, and vomiting. Upper gastrointestinal endoscopy (UGISE) was applied, and patient was treated with surgery. This case report indicates that intussusception should be considered in the presence of clinical complaints following gastric surgery, as well as importance of endoscopy in diagnosis.
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OBJECTIVE: Iatrogenic colonic perforation is a well-known complication that can increase mortality and morbidity in patients undergoing colonoscopy. Closer follow-up and a well-planned treatment strategy are required when perforation arises as a complication. The aims of this study are to (1) report our experience with a large colonoscopy series; (2) evaluate the underlying mechanisms of iatrogenic colonic perforation; (3) discuss the ideal period between onset and treatment; and (4) review the current literature regarding the management of iatrogenic colonic perforations. MATERIAL AND METHODS: Patients who underwent colonoscopy between January 2005 and May 2015 at a single center were reviewed retrospectively. Procedures during which colonic perforations occurred were documented and analyzed. RESULTS: Between January 2005 and May 2015, 31,655 patients underwent colonoscopy and 5,214 patients underwent recto-sigmoidoscopy at our center. Thirteen of these procedures were associated with perforation. The perforation rate was found to be 0.041%. The most frequent locations of perforation were (a) the rectosigmoid junction, (b) the proximal rectum, and (c) the sigmoid colon. Management included surgical treatment in 11 patients and conservative management in 2 patients. Twelve patients (92.31%) were discharged uneventfully, and death occurred in one (7.69%) patient. CONCLUSION: Although they are rarely encountered, colonic perforations are serious complications of colonoscopy. A high index of clinical suspicion is required for early diagnosis and appropriate treatment. Age, co-morbidities, the location and size of the perforation, and the time interval between onset and diagnosis should be evaluated, and the treatment approach should be planned accordingly.
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BACKGROUND AND OBJECTIVES: The self-expandable metal stent (SEMS) is an alternative for several possible surgical and palliative treatments of upper gastrointestinal obstructions that occur in several disease states. The present study was performed to describe a single-center experience with upper gastrointestinal stents. METHODS: All patients at a single center who had an SEMS placed for the treatment of obstruction over a 3-year period were retrospectively evaluated. Pre- and postoperative dysphagia scoring was calculated and used to evaluate postprocedure improvement in quality of life. Procedural success and early and late complication rates were investigated. RESULTS: A total of 171 endoscopic procedures were performed in 73 patients. Procedural success was 95.8% (n = 69) and dilatation was performed in 80 patients. The rate of perioperative complication was 26% (n = 19). After 1 month, stents were patent in all patients (n = 73). Stent obstruction was noted in 6 patients: 2 each at 2, 7, and 10 months. CONCLUSION: SEMS usage for palliative and curative purposes in benign or malignant upper gastrointestinal system obstructions is an efficient and reliable treatment method with advantages, such as shortening hospital stay, decreased pain, cost-effectiveness, and low mortality-morbidity rates when compared to surgical procedures, and a high rate of clinical success.
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Transtornos de Deglutição/cirurgia , Estenose Esofágica/cirurgia , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is the first step treatment modality of choledocholithiasis. In spite of an extended sphincterotomy, 10-15% of complex choledochal stones (larger than 15 mm and/or more than 3 stones) cannot be removed and recurrent ERCP procedures may be needed. AIM: To evaluate the role and efficiency of multiple biliary stent application in the treatment of large and multiple choledochal stones. MATERIAL AND METHODS: Patients with complex choledochal stones and patients with inadequate choledochal clearance during ERCP were included in the study. The study group was divided into 2 groups as the placement of single (n = 27 patients) or multiple stents (n = 58 patients). After a mean time interval of 21 days (10-28), the ERCP procedure was tried for the second time and a stent was placed in case of recurrence. RESULTS: Successful biliary drainage was provided in both groups. The decrease in the longitudinal or transverse size of the stones after stent placement was found to be statistically significant in both groups (p = 0.001). Cholestatic enzymes (alkaline phosphatase (ALP), γ-glutamyltransferase (GGT)) and bilirubin levels decreased significantly in both groups following stenting (p = 0.001). Additionally, multiple stents functioned as a bridge starting from the first ERCP to full clearance in patients with large and multiple stones which could not be removed at once and saved them from the possible morbidities of an invasive operation. CONCLUSIONS: Endoscopic multiple biliary stent placement should be preferred in the treatment of patients with complex choledochal stones and high rates of co-morbidity, as a safe alternative to surgery.
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BACKGROUND: The aim of the present study was to examine the efficacy of simple laboratory parameters including neutrophil-to-lymphocyte ratio (NLR), platelet count (PLT), mean platelet volume (MPV), and serum bilirubin level in the diagnosis of acute appendicitis and recognition of perforated appendicitis. METHODS: Records of 3392 patients who underwent appendectomy in a 10-year period were reviewed retrospectively. Patients were divided into 2 groups according to histopathological examination results: Group 1 had normal appendix, Group 2 had acute appendicitis. Patients with acute appendicitis were divided into subgroups: Group 2A had simple acute appendicitis, while Group 2B had perforated appendicitis. Efficacy of the aforementioned laboratory parameters was evaluated in the diagnosis of acute appendicitis and recognition of perforated appendicitis. Independent variables were determined by univariate analysis and multivariate analysis was performed. Receiver operating characteristic (ROC) curve analysis was used to identify significant parameters in multivariate analysis. Cut-off values, sensitivity, specificity, and accuracy calculations performed for parameters with area under curve (AUC) >0.600 were accepted as "significant parameters." RESULTS: White cell count (WCC), bilirubin, and NLR were significant parameters for the diagnosis of acute appendicitis. Cut-off values were 11900/mm3 for WCC (sensitivity: 71.2%; specificity: 67.2%; OR: 5.13), 1.0 mg/dl for bilirubin (sensitivity: 19.1%; specificity: 92.4%; OR: 2.96), and 3.0 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 4.27). Serum bilirubin and NLR were independent variables for the diagnosis of perforated appendicitis. Cut-off values were 1.0 mg/dl for bilirubin (sensitivity: 78.4%; specificity: 41.7%; OR: 2.6) and 4.8 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 2.6). CONCLUSION: Presence of at least 1 of the following findings in a patient suspected of having acute appendicitis was significantly associated with a definite diagnosis: WCC >11.900 mm3, serum bilirubin >1.0 mg/dl, NLR >3.0. In patients with acute appendicitis, serum bilirubin >1.0 mg/dl or NLR >4.8 were significantly associated with the presence of perforation. While WCC is a significant parameter for diagnosis of acute appendicitis, no significant association with perforated appendicitis was found. PLT and MPV were not useful parameters when diagnosing acute appendicitis.
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Apendicite/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/sangue , Apendicite/epidemiologia , Bilirrubina/sangue , Proteína C-Reativa/metabolismo , Feminino , Humanos , Contagem de Leucócitos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neutrófilos/patologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Turquia/epidemiologia , Adulto JovemRESUMO
Addiction to synthetic cannabinoids (SCs) is a growing social and health problem worldwide. Chronic use of SCs may cause adverse effects in the gastrointestinal system. We describe a very rare case of acute gastric dilatation (AGD) and hepatic portal venous gas (HPVG), with findings of acute abdomen resulting from chronic use of a SC, Bonzai. AGD and HPVG were detected by computerized tomography examination. Patchy mucosal ischemia was seen in endoscopic examination. Despite the findings of an acute abdomen, a non-surgical approach with nasogastric decompression, antibiotic therapy, and close radiologic and endoscopic follow-up was preferred in the presented case. Clinical and radiologic findings decreased dramatically on the first day, and endoscopic findings gradually disappeared over 7 d. In conclusion, this case shows that chronic use of a SC may cause AGD and accompanying HPVG, which can be managed non-surgically despite the findings of acute abdomen.
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Canabinoides/efeitos adversos , Embolia Aérea/etiologia , Dilatação Gástrica/induzido quimicamente , Fígado/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Transtornos Relacionados ao Uso de Substâncias , Abdome Agudo/etiologia , Adulto , Antibacterianos/uso terapêutico , Gasometria , Endoscopia , Gases , Mucosa Gástrica/patologia , Humanos , Isquemia/patologia , Fígado/efeitos dos fármacos , Masculino , Radiografia Abdominal , Tomografia Computadorizada por Raios XRESUMO
Mesenteric ischemia is one of the most mortal diseases of the gastrointestinal system causing acute abdomen. In most of the patients, the etiological factor is the obstructive embolism or thrombosis of superior mesenteric artery. In the literature, there have been reports regarding also celiac trunk occlusion in rare situations. The gold standard treatment relies on early diagnosis. The originality of our report relies on the concurrent obstruction of both vascular structures.