Acute pancreatitis can have a variable presentation and diagnosis is based on clinical presentation, serum amylase and lipase levels and computed tomography. Negative predictive value of serum lipase in diagnosing acute pancreatitis is approximately to 100 percent and a normal blood lipase level in acute pancreatitis is an extremely rare condition. Here we reported two cases with normal serum amylase and lipase levels.

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Objectives: Hepatitis B infection is an important problem in immune suppressed patients. Anti HbcAb is an important marker that shows past exposure to virus. In this study, we retrospectively searched HBV serology among the patients who had Bone Marrow Transplantation (BMT) or chemotherapies (CT) at Medicalpark Izmir Hospital Bone Marrow Transplantation Unit; changes in viral parameters throughout therapy; and tried to find the efficiency of antiviral prophylaxis . Methods: We retrospectively evaluated the viral parameters; HbsAg, Anti HbsAb, Anti Hbc IgG, HbeAg, Anti Hbe Ab, HBV DNA, HCV RNA which were carried out before BMT and CT. We grouped the patients as latent HBV infection and inactive carriers .Started antiviral treatment as prophylaxis, monitored the changes in serological parameters and defined HBV related situations. Results: A total of 584 patients were evaluated retrospectively. Twenty patients were having latent HBV infection. Ten patients were inactive carriers of HBV. In post-transplant period, the patients were screened for 11 months (1-38 months). None of the patients experienced HBV activation during follow period. Conclusion: The best approach in HbcAb positive patients with planned immunosuppressive treatment is the use of anti-viralagents before immune suppression and close monitoring of the patients HBV-related markers . Keywords: Hepatitis B; Hematologic Malignancy; stem cell transplantation.

ercutaneous endoscopic gastrostomy (PEG) is a broadly accepted procedure of enteral feeding for patients with inadequate oral intake. The side effects and complications of PEG are becoming more evident with its increasing use. Buried bumper syndrome (BBS) is one of the rare complications of PEG and occurs when internal bumper of the PEG tube becomes lodged anywhere between the gastric wall and the skin along the PEG tract. It is considered to be a late complication and becomes apparent months to years after PEG placement.1 Here, we report an unusual case of BBS with a gastric perforation at the internal gastrostomy site and peritonitis that occurred on the third day of placement. The contributing factors, preventive measures and treatment recommendations are also reviewed briefly. A AB BS ST TR RA AC CT T Percutaneous endoscopic gastrostomy (PEG) is a broadly accepted procedure of enteral feeding for patients with inadequate oral intake. The side effects and complications of PEG are becoming more evident with its increasing use. Here, we report a case of buried bumper syndrome, gastric perforation and peritonitis after PEG. In our case, perforated area was closed endoscopically by using hemoclips. The patient was treated with intravenous broad spectrum antibiotics for 10 days and fed by parenteral nutrition. The patient responded well to medical treatment therefore there was not any need for a surgical exploration. Follow up endoscopy was performed 15 days later which showed closure of the perforation area. A new PEG tube was inserted 1 month later.K Ke ey y W Wo or rd ds s: : Peritonitis; endoscopy, gastrointestinal Ö ÖZ ZE ET T Perkütan endoskopik gastrostomi (PEG) ağızdan gıda alımı yetersiz olan hastalarda geniş kabul görmüş bir işlemdir. Artan kullanımla birlikte PEG'in yan etkileri ve komplikasyonları da daha belirgin hale gelmektedir. Burada PEG'den sonra gelişen gömülmüş tampon sendromu, mide perforasyonu ve peritonit olgusunu sunuyoruz. Olgumuzda perfore alan hemoklipler kullanarak endoskopik olarak kapatıldı. Hasta 10 gün boyunca intravenöz geniş spektrumlu antibiyotiklerle tedavi edildi ve parenteral beslendi. Hasta medikal tedaviye iyi yanıt verdi, böylece cerrahi eksplorasyona gerek kalmadı. Onbeş gün sonra takip endoskopisi yapıldı ve perforasyon alanının kapandığı görüldü. Bir ay sonra yeni bir PEG tüpü yerleştirildi.A An na ah ht ta ar r K Ke el li im me el le er r: : Peritonit; endoskopi, gastrointestinal T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 12 2; ;3 32 2( (6 6) ): :1 17 79 91 1--5 5

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