No abstract

Rupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. Computed tomography scan, in addition to clinical presentation, is essential for diagnosis. Emergency surgery is the main treatment for acute ruptured hydatid cysts. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.

Background: Since the first introduction of tumour markers, their usefulness for diagnosis has been a challenging question. The aim of the present prospective study was to investigate, in colorectal cancer patients, the relationship between preoperative tumour marker concentrations and various clinical variables. Methods: The study prospectively enrolled 131 consecutive patients with a confirmed diagnosis of colorectal carcinoma and 131 age- and sex-matched control subjects with no malignancy. The relationships of the tumour markers carcinoembryonic antigen (cea) and carbohydrate antigen (ca) 19-9 with disease stage, tumour differentiation (grade), mucus production, liver function tests, T stage, N stage, M stage were investigated. Results: Serum concentrations of cea were significantly higher in the patient group than in the control group (p = 0.001); they were also significantly higher in stage iii (p = 0.018) and iv disease (p = 0.001) than in stage i. Serum concentrations of cea were significantly elevated in the presence of spread to lymph nodes (p = 0.005) in the patient group. Levels of both tumour markers were significantly elevated in the presence of distant metastasis in the patient group (p = 0.005 for cea; p = 0.004 for ca 19-9). Conclusions: Preoperative levels of cea and ca 19-9 might provide an estimate of lymph node invasion and distant metastasis in colorectal cancer patients.

Gossypiboma is the term used to describe a retained non-absorbable surgical material that is composed of cotton matrix which leads to serious surgical complications for both patient and surgeon. Its incidence is not precisely known probably due to medico-legal importance of this potential complication. The condition may manifest either as asymptomatic or severe gastrointestinal complications. The increasing number of recent reports in the literature implies that this issue still remains as an important problem to be solved after intraabdominal surgery. In this report, we aimed to emphasize this potential complication by presenting the clinical outcomes of our 14 patients who underwent different surgical interventions for gossypiboma. Between February 2009 and October 2014, a total of 14 patients who underwent surgery for gossypiboma were reviewed retrospectively. The patients were analyzed with regard to demographic characteristics, initial diagnosisprior surgery, clinical presentation, the interval period from the first operation to last definite operation, diagnostic methods, gossypiboma location, definite surgery, and postoperative outcomes. A total of 14 patients including 6 (42.9 %) male and 8 (57.1 %) female with a median age of 41.4± 12 years (22-61 years) enrolled in this study. The prior surgery of 10 (71.4 %) patients was performed by general surgeons, while 4 (28.6 %) patients were operated by gynecologists. The interval period from prior surgery to definite surgery ranged from 14 days to 113 months. Three (21.4 %) patients were asymptomatic, whereas the vast of the patients were complicated (fistula, ileus, wound infection). Gossypiboma was removed by open surgery, laparoscopic surgery, and endoscopic intervention in 10, 2, and 1 patient, respectively. Removal was performed from perineal wound side in one patient. Removal was enough for definitive treatment in 10 (71.4 %) patients whereas bowel resection and primary repair was performed in 4 (28.6 %) patients due to fistula or perforation. One patient died from intra-abdominal sepsis on postoperative 13th day. Gossypiboma should strongly be considered in differential diagnosis of any postoperative patient with mild gastrointestinal symptom or with persistent wound infection. Adequate surgical intervention should be planned as soon as possible either to prevent further complications or to overcome medico-legal problems, when gossypiboma is detected.

Right diaphragmatic hernia is a rare injury (0.25-1%) following blunt abdominal trauma. The diagnosis may be delayed and achieved years after the trauma during laparotomies for other reasons. A 75-year-old male fell 6 years before, and was symptom-free since then. He was admitted to the hospital for abdominal pain, and chest X-rays revealed intestinal gas in the lower right thoracal region. Abdominal ultrasonography showed agenesis of the gallbladder, and computed tomography demonstrated that the right upper abdominal viscera were located in the vicinity of the heart. The patient underwent a laparotomy for right diaphragmatic hernia, and the right hepatic lobe and the medial segment of the left lobe, the gall bladder, the proximal part of the transverse colon, the omentum and some segments of the intestine were dislocated into the thoracal cavity by a tear in the right diaphragm. The organs were returned to the abdominal cavity uneventfully and the defect in the diaphragm, measuring 10 x 5 cm, was repaired by unabsorbable sutures. The diagnosis, surgical treatment and postoperative course of the right diaphragmatic hernia is discussed with a review of the literature.