Oesophageal foreign bodies caused by meat consumed during the Sacrifice Feast: Our single-centre experience.

OBJECTIVE: To compare the frequency of oesophageal foreign bodies during the month of Eid-ul-Adha with other months. METHODS: This retrospective study was conducted at YüzüncüYil University Hospital, Van, Turkey, during 2012-16, and comprised individuals who were treated for bone and/or meat fragments lodged in the oesophagus. The number of hospital admissions with diagnosis of oesophageal foreign bodies during Eid-ul-Adha episodes were extricated and compares with similar date for the other months.Minitab 13 was used for statistical computations. RESULTS: Among the 289 cases in the study, a pronounced increase in the number of patients was observed during Eid-ul-Adha, with the most frequent symptoms in 263(91%) patients being dysphagia and odynophagia. The number of patients with oesophageal foreign bodies diagnosed during Eid-ul-Adha were significantly higher than the other months (p<0.05). CONCLUSIONS: An increase in cases of oesophageal foreign bodies was found during Eid-ul-Adha.

Oesophagus obstruction due to ingestion of multiple foreign bodies.

The ingestion of a foreign body (FB) is a potentially serious condition. In children, the most common years for FB ingestion are from the age of 6 months to 6 years. FB ingestion also occurs in those with psychiatric disorders or mental retardation and among adult prisoners and alcoholics. Most ingested FBs spontaneously pass out of the body via the gastrointestinal system. An endoscopic or surgical approach is only needed if the object fails to progress through the gastrointestinal tract. All objects impacted in the oesophagus require urgent treatment. This study reports a case of multiple FB ingestion and provides a literature review.

Effect of crush and axotomy of phrenic nerves on oxidative stress in diaphragm muscle of rats.

INTRODUCTION: In this study we investigated the effect of crush and axotomy of phrenic nerves on oxidative stress and antioxidant enzyme activities in rat diaphragm muscle. METHODS: The animals in the first group were not crushed or axotomized and served as controls. Phrenic nerves of the rats in the second and third groups were crushed or axotomized in the diaphragm muscle. RESULTS: The malondialdehyde level increased in diaphragm muscles after both crush and axotomy. The antioxidant enzymes, such as superoxide dismutase, glutathione peroxidase, carbonic anhydrase, and catalase, decreased in diaphragm muscles after both crush and axotomy. CONCLUSIONS: Crushing or axotomizing the phrenic nerves may produce oxidative stress in the diaphragm muscle of the rat by increasing lipid peroxidation and decreasing antioxidant enzyme activities.

Effects of shock waves on oxidative stress and some trace element levels of rat liver and diaphragm muscles.

This study was designed to investigate whether the short-term extracorporeal shockwave lithotripsy (ESWL) exposure to kidney produces an oxidative stress and a change in some trace element levels in liver and diaphragm muscles of rats. Twelve male Wistar albino rats were divided randomly into two groups, each consisting of six rats. The animals in the first group did not receive any treatment and served as control group. The right-side kidneys of animals in group 2 were treated with two-thousand 18 kV shock waves while anesthetized with 50 mg kg(-1) ketamine. The localization of the right kidney was achieved after contrast medium injection through a tail vein under fluoroscopy control. The animals were killed 72 h after the ESWL treatment, and liver and diaphragm muscles were harvested for the determination of tissue oxidative stress and trace element levels. Although the malondialdehyde level increased, superoxide dismutase and glutathione peroxidase enzyme activities decreased in the livers and diaphragm muscles of ESWL-treated rats. Although glutathione level increased in liver, it decreased in diaphragm muscles of ESWL-treated animals. Fe, Mg and Mn levels decreased, and Cu and Pb levels increased in the livers of ESWL-treated animals. Fe and Cu levels increased, and Mg, Pb, Mn and Zn levels decreased in the diaphragm muscles of ESWL-treated animals. It also causes a decrease or increase in many mineral levels in liver and diaphragm muscles, which is an undesirable condition for the normal physiological function of tissues.

Late complications due to thoracic traumas.

BACKGROUND: A total of 412 patients who applied to our clinic after a thoracic trauma between March 2010 and December 2019 were examined retrospectively In this study, late complications that developed as a result of blunt and penetrating thoracic traumas were evaluated and it was aimed to present a prediction for the management of these complications to physicians who are dealing with trauma. METHODS: Among the 412 thoracic trauma cases, 62 cases (15.04%) who developed late-term complications which constituted the main theme of this study were evaluated in terms of age, gender, the type of trauma, the cause of trauma, thorax, and concomitant organ pathologies that developed when the trauma first occurred, the late-term complications, and the treatment methods for them while considering mortality. RESULTS: Of 62 patients with late complications due to thoracic trauma, 47 (75.80%) were male, 15 (24.20%) were female, and the average age was 56.98±21.22. When the trauma type of the patients who developed posttraumatic late-term complications was evaluated, blunt traumas were seen in 90.33% (n=56) of the cases, whereas penetrating traumas were seen in 9.47% (n=6). Traffic accidents were the most common cause in blunt trauma cases (66.07%), whereas pointed and sharp-edged weapon injuries were the most common in penetrating traumas (83.33%). The most common thorax pathology is pulmonary contusion (75%) in blunt traumas and hemopneumothorax in penetrating traumas (66.66%). When the groups were analyzed separately, the most common late-term complication for penetrating traumas was retained hemothorax (66.66%), while pneumonia was the most common (41.07%) in blunt trauma cases. Video-assisted thoracoscopic surgery was performed in seventeen patients with retained post-traumatic hemothorax and thoracotomy was performed in eight cases. Seven patients with post-traumatic empyema underwent thoracoscopy, and four patients underwent decortication with thoracotomy. Six of the patients who developed late-term complications died. The mortality rate is 9.67%. Pneumonia was detected as a late complication type in 83.33% of cases with mortality. CONCLUSION: It will be appropriate for the physicians who are interested in trauma to determine the treatment modalities of the patients by considering many factors such as the age of the patient and the trauma type in terms of the late complications that they will not be able to detect at first glance.

[Should videothorascopic surgery be the first choice in isolated traumatic hemothorax? A prospective randomized controlled study]. / Izole travmatik hemotoraksin tedavisinde videotorakoskopik cerrahi ilk tercih olmali mi? Prospektif randomize kontrolü çalisma.

BACKGROUND: In this study, patients with hemothorax due to blunt or penetrating thorax trauma and treated by tube thoracostomy were compared with the patients treated by videothoracoscopic surgery (VATS) in order to determine whether VATS can be the first choice in treatment. METHODS: Sixty patients with hemothorax due to trauma were examined prospectively. Thirty patients with isolated hemothorax and treated by tube thoracostomy were classified as Group I (50%), and 30 patients treated by VATS were classified as Group II (50%). Patients were compared according to healing duration, tube thoracostomy duration, hospitalization duration, success rate of treatment, morbidity, and mortality. RESULTS: When Group I and II were compared according to the duration of tube thoracostomy and hospitalization, Group I was found to have longer duration statistically (p=0.001). When the two groups were compared according to morbidity, statistical morbidity was found higher in Group I (p=0.030). CONCLUSION: VATS seems to be better in the treatment of hemothorax when compared with traditional drainage method because of its advantage of direct diagnosis and hemostasis by diagnostic thoracoscopy. If clotted blood is evacuated, empyema and fibrothorax are preventable. In these cases, chest tube duration and hospital length of stay are shorter. Therefore, these patients can be discharged early.

Rib resection using a Gigli saw under thoracoscopic guidance.

INTRODUCTION: Despite the advantages and expanded indications of video-assisted thoracoscopic surgery, the open surgical approach is commonly preferred for the surgical treatment of rib lesions. Such an approach could lead to disadvantageous results such as increased postoperative pain and prolonged hospital stay. Despite all these handicaps, thoracoscopic resection of isolated rib resection has been reported in a small number of publications. AIM: To compare the clinical outcomes of patients with isolated benign rib pathologies treated with either minimally invasive or open surgery. MATERIAL AND METHODS: The medical records of 22 patients undergoing surgery for isolated benign rib pathologies between 2013 and 2017 were reviewed. Variables statistically compared between the two groups were age, gender, symptoms, lesion size, duration of the surgery, amount of intraoperative bleeding, conversion to open surgery, volume and duration of the drainage, postoperative complications, length of hospital stay, pathological diagnosis, follow-up period, recurrence, duration of narcotic analgesic usage and pain according to visual analog scale evaluation. RESULTS: The thoracoscopic approach was superior to conventional surgery in terms of drainage volume, time to drain removal, morbidity, hospital stay, narcotic analgesic treatment duration and postoperative pain scores. All thoracoscopic procedures were concluded successfully, and conversion to open surgery was not required. During the mean 14-month follow-up period, no recurrence was encountered in either group. CONCLUSIONS: This technique is a safe option for isolated benign lesions of the ribs. It is more effective in patient recovery in the postoperative period and in the management of surgical pain.

Clinical analysis of pneumonectomy for destroyed lung: a retrospective study of 32 patients.

OBJECTIVE: Destroyed lung is whole lung destruction secondary to chronic or recurrent lung infections. This clinical condition can result in irreversible changes in the lung parenchyma. In this study, we aimed to evaluate patients undergoing pneumonectomy with a diagnosis of lung destruction in terms of surgical technique, post-operative morbidity and mortality, and long-term outcomes. METHODS: A total of 32 patients that underwent pneumonectomy due to a destroyed lung between 2005 and 2017 were retrospectively reviewed. Age, gender, presenting symptoms, etiologies, localization of the destruction, pre-operative medical history, pre- and post-operative respiratory function tests, intraoperative complications and bleeding volume, morbidity and mortality, length of hospital stay, and long-term follow-up outcomes were reviewed for each patient. RESULTS: The study included 32 patients with a mean age of 31.7 ± 10.8 years. All the patients presented with persistent cough, whereas sputum production was presented by 25, hemoptysis by 18, and chest pain by 11 patients. The underlying primary diseases included nonspecific bronchiectasis in 20 (62.5%), tuberculosis in 9 (28.1%), left pulmonary hypoplasia accompanied by Bochdalek hernia in 2 (6.2%), and aspiration of a foreign body lodged in the left main bronchus in 1 (3.1%) patient. Mean operative time was 220.6 ± 40.2 min and mean perioperative bleeding was 450.9 ± 225.7 ml. Post-operative complications occurred in 14.2% of the patients, most commonly including atelectasis associated with stasis of secretions and wound site infection. Mean post-operative hospital stay was 11.8 ± 2.8 days and mean follow-up period was 35.5 ± 28.3 months. A significant clinical improvement was observed in 81.2% of the patients post-operatively. CONCLUSIONS: Favorable long-term outcomes were obtained in our patients through careful patient selection and appropriate pre-operative work-up and surgical technique.

Serum prolidase activity, total oxidant/antioxidant, and nitric oxide levels in patients with esophageal squamous cell carcinoma.

BACKGROUND: This study aims to assess the prolidase activity, nitric oxide levels, and oxidative status in patients with esophageal squamous cell carcinoma. METHODS: The study included 30 patients with esophageal squamous cell carcinoma (11 males, 19 females; mean age 61±3 years; range, 28 to 77 years) and 30 healthy controls (10 males, 20 females; mean age 58±5 years; range, 31 to 73 years). Serum prolidase activity, total antioxidant capacity, total oxidant status, and nitric oxide levels were measured. In addition, the oxidative stress index was calculated. RESULTS: Prominently elevated serum prolidase activity, oxidative stress index values, total oxidant status, and nitric oxide levels were detected in the patient group (p<0.05). Lower total antioxidant capacity levels were observed in the patient group (p<0.05). CONCLUSION: Increased oxidant status with increased nitric oxide levels and prolidase activity were found in esophageal squamous cell carcinoma patients. Impairment of antioxidant mechanism with increased prolidase activity and nitric oxide levels may have a crucial role in the etiopathogenesis of esophageal squamous cell carcinoma.

Uniportal Thoracoscopic Approach For Pulmonary Hydatid Cyst: Preliminary Results.

PURPOSE: Pulmonary hydatid cyst is a preventable parasitary disease with high prevalence in low-medium income countries. Thoracoscopic approach is seen in the literature as small-case groups and multiple-port incisions are observed in these studies. Unlike other thoracoscopic approaches for the surgical treatment, we describe the single-port technique for the first time in our study. We attempt to compare the clinical outcomes and preliminary results of patients with pulmonary hydatid cyst treated with either minimally invasive or thoracotomy. METHODS: The medical records of 66 patients undergoing surgery for pulmonary hydatid cyst disease between January 2013 and July 2017 were reviewed. The number of patients who underwent thoracotomy was 48, whereas 18 were managed by single-port video-assisted thoracoscopic surgery. Variables statistically compared between the 2 groups were age, diameter of the cystic, operation time, volume and duration of the drainage, postoperative complications, length of stay, duration of narcotic analgesic usage, and pain score. RESULTS: Thoracoscopic approach was superior to conventional thoracotomy in terms of operation time, drainage volume, time to drain removal, hospital stay, narcotic analgesic treatment duration, and postoperative pain scores. All thoracoscopic procedures were concluded successfully, and conversion to open surgery was not required. No postoperative mortality was seen in either group. During the follow-up period, no recurrence was encountered in either group. CONCLUSIONS: Uniportal thoracoscopic approach is a safe option for the treatment of hydatid cyst disease. It can be used as an alternative to thoracotomy, depending on the size and location of the lesion.

Pediatric pleural tuberculosis.

Background: Pleural tuberculosis (TB) diagnosis is sometimes controversial because the microbiologic confirmation ratio is very low in pleural fluid. There are few pediatric pleural TB case series in the literature. Methods: We retrospectively evaluated our TB cases below 18 years of age and extracted pleural TB cases. Results: Seven cases with pleural TB were identified. About 42.9% of the patients had isolated pleural TB whereas 57.1% of the patients had accompanying pulmonary TB. Lymphocytic pleural effusion and increased adenosine deaminase (ADA) (>40 U/L) level are found in 85.7% of the patients. Six patients had uncomplicated effusion (transudate) according to Light's criteria and one had complicated effusion (exudate). Lung decortication was needed in three patients. All patients were given 6 months anti-TB medication and recovered completely. Conclusion: In the lymphocyte-predominant pleural effusion, an increased ADA level highly supported TB disease. The complicated effusion (exudate) in pleural TB is not rule; uncomplicated effusion (transudate) could be seen.

A novel approach for preventing recurrence of malign pleural effusion: early phase pleurodesis.

INTRODUCTION: The effective control of malignant pleural effusion (MPE) is of paramount importance in the treatment of patients with disseminated cancer. In this study, we compared two different approaches (early pleurodesis versus late pleurodesis) to MPE. MATERIAL AND METHODS: Patients (188 cases) whose primary tumor type was known and who were confirmed to have MPE, were included in the study and were separated into two groups. One group consisted of patients who were asymptomatic and who underwent early phase pleurodesis (group I, n = 79). The other group (group II, n = 109) was composed of patients who were symptomatic and whose pleurodesis was performed later. In all cases, pleural effusion was evaluated by means of direct radiography. Computed tomography was performed with the goal of confirming the parenchymal or mediastinal lesions accompanying the pleural fluid. RESULTS: The rate of complete success in group I cases was observed to be higher, while the rate of recurrence was lower (p = 0.001 and p = 0.002, respectively) than group II. In multiple logistic regression analysis, co-morbidities and the group that patient belong were found to be significant in terms of pleurodesis success (p = 0.02 and p = 0.03). There was a significant difference in survival time between group I and group II, with group I exhibiting longer average survival time (log rank test p < 0.001). CONCLUSIONS: We observed that the success rate was lower and the rate of recurrence higher in the late pleurodesis group, whose members already had greater volumes of pleural effusion.

Are Serum Mac 2-Binding Protein Levels Elevated in Esophageal Cancer? A Control Study of Esophageal Squamous Cell Carcinoma Patients.

OBJECTIVE: Elevated serum Mac 2-binding protein (M2BP) levels have been observed in some cancers. As far as we know, its importance has not been investigated in esophageal squamous cell carcinoma (ESCC). The investigated problem of this study was to evaluate whether there was a difference between ESCC patients and the control group in terms of M2BP. Also, we evaluated the diagnostic performance of serum M2BP alone or in combination with the CEA for patients with ESCC. MATERIAL AND METHODS: Blood serum samples were collected from 50 healthy donors and 150 patients with ESCC. M2BP levels of all 200 samples were quantified by ELISA (enzyme-linked immunosorbent assay). Patients who had been diagnosed with ESCC and did not have any other malignancies were enrolled to study. RESULTS: The two groups did not significantly differ in terms of age (p > 0.05). In the control group, the mean serum M2BP level was 14.97 ± 3.46 ng/mL. The mean serum M2BP level of the ESCC patients was 176.65 ± 22.14 ng/mL. The serum M2BP level was significantly higher in patients with ESCC than in the control group (p < 0.001). Gender was also comparable in both groups (p = 0.695). CONCLUSIONS: Our analysis demonstrated that this marker may be associated with the mechanism of the disease. Despite that serum M2BP is not a specific marker for ESCC, it can be used as an adjuvant biomarker for the diagnosis of ESCC.

The Effects of Phrenic Nerve Degeneration by Axotomy and Crush on the Electrical Activities of Diaphragm Muscles of Rats.

The aim of this study was to investigate the effect of axotomy and crush-related degeneration on the electrical activities of diaphragm muscle strips of experimental rats. In the present study, twenty-one male Wistar-albino rats were used and divided into three groups. The animals in the first group were not crushed or axotomized and served as controls. Phrenic nerves of the rats in the second and third groups were crushed or axotomized in the diaphragm muscle. Resting membrane potential (RMP) was decreased significantly in both crush and axotomy of diaphragm muscle strips of experimental rats (p < 0.05). Depolarization time (T DEP) and half-repolarization (1/2 RT) time were significantly prolonged in crush and axotomy rats (p < 0.05). Crushing or axotomizing the phrenic nerves may produce electrical activities in the diaphragm muscle of the rat by depolarization time and half-repolarization time prolonged in crush and axotomy rats.

A 3-cm Single-port Video-assisted Thoracoscopic Lobectomy for Lung Cancer.

Video-assisted thoracoscopic surgery is advantageous over traditional surgical practices, because of a faster postoperative recovery period, less pain, and a shorter hospital length of stay. There is no single standard technique in the video-assisted thoracoscopic surgery approach. Although these "minimally invasive" resections are habitually performed through 3-port or 4-port incision, we performed a left lower lobectomy in a 54-year-old male patient for lung cancer, through a 3-cm single-port incision.

Diagnostic Dilemma in Hydatid Cysts: Tumor-Mimicking Hydatid Cysts.

OBJECTIVES: Hydatid cysts are sometimes confused with different pathologies, and problems arise in their diagnosis and treatment. In this study, cases that are followed up with a diagnosis of lung malignancy and that are detected to have hydatid cysts were retrospectively examined. MATERIAL AND METHODS: Seven patients with hydatid cysts whose clinical and radiological features were consistent with lung malignancy were retrospectively examined between 2010 and 2014 regarding sex, age, symptoms, diagnostic methods, surgical procedures performed, and postoperative complications. In the diagnosis of the patients, radiological diagnostic methods such as chest radiography, thoracic computed tomography (TCT), and positron emission tomography+computed tomography (PET-CT) as well as invasive diagnostic methods such as bronchoscopy, fine-needle aspiration biopsy, thoracentesis, and video-assisted thoracoscopic surgery were used. RESULTS: The average diameter of the lesions was determined as 4.14±1.57 cm in TCT. Maximum standardized uptake value (SUV max) was measured as 8.77±3.41 (5.4-15.1) in the PET-CT analysis. Bronchoscopy, fine-needle aspiration biopsy, and thoracentesis yielded no results. Definitive diagnosis was established by performing thoracotomy and video-assisted thoracoscopic surgery. CONCLUSION: Pulmonary hydatid cysts can appear as malignant diseases such as lung cancer as well as infectious pathologies such as tuberculosis or benign pathologies. Radiologically, it should be kept in mind that pulmonary hydatid cysts can mimic many pulmonary pathologies, particularly malignancies. Necessary examinations towards its differential diagnosis must be performed in the preoperative period.

Primitive neuroectodermal tumor/ewing sarcoma presenting with pulmonary nodular lesions.

Primitive neuroectodermal tumors (PNETs) and Ewing sarcoma (EWS) belong to the same family of malignant, small, round cell neoplasms of soft tissue or bone origin. EWS-PNETs that arise in the lung parenchyma involvement are extremely rare in adults. A case of a 32-year-old male presenting with chest pain and diffuse pulmonary nodules on chest X-ray and diagnosed with Ewing sarcoma-PNETs will be presented here.

Serum paraoxonase-1 enzyme activities and oxidative stress levels in patients with esophageal squamous cell carcinoma.

OBJECTIVES: Oxidative stress is well recognized to play a role in the pathogenesis of many diseases, including cancers. Paraoxonase-1 (PON1) is implicated in the elimination of carcinogenic lipid-soluble radicals produced by lipid peroxidation. Reports on PON1 activities in patients with cancer are conflicting. The aim of this study was to investigate serum antioxidant enzyme activities and oxidative stress levels in patients with esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS: Thirty-two patients with ESCC and 33 healthy controls were enrolled. Serum malondialdehyde (MDA) levels and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione reductase (GR), paraoxonase, and arylesterase activities were measured spectrophotometrically. RESULTS: Serum paraoxonase, arylesterase, SOD, activities, GSH-Px, and GR activities were significantly lower in patients with ESCC than in controls (all, P < 0.05), whereas serum MDA levels were significantly higher (P < 0.05). Serum MDA levels were significantly correlated with paraoxonase (r = -0.572, P < 0.001) and arylesterase activities (r = -0.597, P < 0.001) in patients with ESCC. CONCLUSIONS: This study indicated that ESCC is associated with increased oxidative stress and decreased antioxidant enzyme activities. Decreased serum PON1 enzyme activities may play a role in the progression and/or development of ESCC. Further studies are required to clarify these results.

Effects of crush and axotomy on oxidative stress and some trace element levels in phrenic nerve of rats.

This study was designed to investigate the effect of crush and axotomy on oxidative stress and some trace element levels in phrenic nerve of rats. Eighteen male Wistar-albino rats were divided randomly into three groups, each consisting of 6 rats. The animals in the first group were not crushed or axotomized and served as control. Phrenic nerves of the animals in the second and third groups were crushed and axotomized, respectively. Animals in all groups were sacrificed one week after the crush or axotomy, and degenerated phrenic nerves were harvested for the determination of tissue oxidative stress and trace element levels. Lipid peroxidation product malondialdehyde and antioxidant glutathione levels increased in both crushed and axotomized phrenic nerves. The activities of antioxidant enzymes such as superoxide dismutase, catalase and glutathione peroxidase were lower in crushed and axotomized phrenic nerves than in controls. The levels of Fe, Pb, Mn, Cd and Co increased, and Mg and Cu levels decreased in crushed phrenic nerves. The levels of Fe and Mg decreased, Pb and Co levels increased in axotomized phrenic nerves. It was concluded that crushing or axotomizing the phrenic nerves may produce oxidative stress by increasing lipid peroxidation and decreasing antioxidant enzyme activities. It was also concluded that while crush to phrenic nerves causes accumulation of minerals, axotomizing phrenic nerves causes depletion of minerals in the tissues.

Surgical treatment of pulmonary hydatid cysts, which perforated to the pleura.

OBJECTIVE: Hydatid cyst disease, endemic in Eastern region of Turkey, is a significant parasitic public health problem. In this study, pleural complications of hydatid cysts were presented in 76 cases. MATERIALS AND METHODS: In our study, of the 412 pulmonary hydatid cyst cases operated on between 2003 and 2011, 76 cases had ruptured into the pleura for various reasons, and the different clinicoradiological presentations were evaluated retrospectively. The age distribution of the cases was between 7 and 56 years, and the mean age was 26.20±13.04. RESULTS: The most frequent symptom due to pleural rupture in patients was dyspnea (44 cases, 57.8%). Etiologically, iatrogenic perforation was detected in four cases and thoracic trauma in nine cases (six car accidents and three falls from a height). An anthelmintic drug use history was found in three cases of ruptured pleura. Spontaneous perforation was detected in the other 60 (78.9%) cases. Two cases that were admitted to the emergency unit and were immediately administered a tube thoracostomy developed tension pneumothorax. In addition, 21 cases had hydropneumothorax, 17 had pneumothorax, and 36 had pleurisy. Morbidity was observed in 30 cases (39.4%). Atelectasis was the most frequent cause of morbidity in these patients (10 cases). The mean duration of hospitalization was determined to be 12.26±2.90 days. CONCLUSION: This disease can progress asymptomatically for a long time and can sometimes lead to life-threatening emergency situations, such as tension pneumothorax. The delayed admission of a patient to a physician causes the disease to become more complicated and to increase the morbidity and mortality rates. Treatment of the disease is in the form of surgery. Possible parenchymal protection should be applied in surgical treatment, and anatomic resection should not be performed unless necessary.