This is a multi-center retrospective study of patients underwent low anterior resection for rectal cancer. Ileostomy had been done to protect low lying Colo-rectal anastomosis, closure of ileostomy had been delayed in some patients due to patient own will, surgical complications (anastomotic leak) or coarse of chemotherapy. This study aimed to find the effect of temporary ileostomy on post-operative bowel defunction which is called Low anterior resection syndrome (LARS), and include; urgency, difficulty in emptying of bowel, and incontinence for feces and flatus.  A total of 50 patients included in this study, the age ranges from the 19 to 80 years old with a mean age of 51.96 years. The total number of males was (33, %66). Majority of patients were overweight (21, 42%). The distance of tumors from the anal verge were less than 10 cm in (31,62%). The mean duration of fecal diversion was 7.17 months. Loop ileostomy were closed before six months in (27,54%). The mean duration of diversion of patients developed no LARS was 6.87 months which is shorter than those of developed LARS (7.31). Lower BMI patients are more prone to develop LARS, while Obese patients are more susceptible to develop major LARS. Nineteen cases developed LARS among those patient’s ileostomy closed before six months, and 15 cases developed LARS in those ileostomies closed after six months.  

Synovial sarcoma is a mesenchymal spindle cell tumor. Primary pancreatic sarcomas are extremely rare. the present study describes a rare case of synovial sarcoma in the head of the pancreas. a 35-year-old male presented with left upper quadrant abdominal pain. an endoscopic ultrasound examination revealed a complex solid-cystic lesion in the pancreatic head. He had undergone pancreaticoduodenectomy (Whipple procedure). a histological examination yielded negative results for aE1/aE3, CD10, S100, CD34, desmin, smooth muscle actin, β-catenin, CD117, HMB45, chromogranin and synaptophysin. However, the results were positive for tlEI and vimentin, which is consistent with synovial sarcoma. Synovial sarcoma is a soft tissue malignant tumor. Primary pancreatic sarcomas frequently present as large, high-grade tumors in the pancreatic head. Histologically, there are several types of synovial sarcoma, such as monophasic, biphasic and poorly differentiated. a histological examination is necessary for the diagnosis as the imaging findings are not specifically suggestive of synovial sarcoma. the preferred course of treatment is complete resection with wide margins, followed by adjuvant chemotherapy and/or radiotherapy. Primary mesenchymal tumors of the pancreas are extremely uncommon. as a result, a diagnosis requires careful evaluation. Surgical resection is the main modality of treatment.

Introduction and importance:The simultaneous development of Kasabach-Merritt syndrome (KMS) and focal nodular hyperplasia (FNH) in the same individual is rare. This study aims to report the coexistence of KMS and FNH in a 32-year-old female. Case presentation: A 32-year-old woman presented to the gastroenterology clinic complaining of heavy menses, fatigue, and hematuria. Physical examination revealed multiple ecchymoses on the skin. Abdominal computed tomography scan revealed a large hepatic lesion with features of atypical hemangioma. Complete blood count showed normochromic, normocytic red blood cells, and thrombocytopenia. Surgery was decided based on a clinical diagnosis of KMS resulting from a giant liver hemangioma. Histopathologic diagnosis of the resected lesion was FNH. Clinical discussion: KMS, which refers to a giant hemangioma associated with thrombocytopenia, was initially described by Kasabach and Merritt. It occurs in nearly 1% of hemangiomas and primarily affects infants. KMS is a life-threatening condition that could be fatal if adequate, timely treatment is not administered. FNH is a benign hepatocellular neoplasm with a predilection for females. Conclusion: KMS and FNH are 2 distinct conditions that can rarely co-exist in the same patient. Corticosteroids, radiotherapy, and surgical resection are the primary modalities of treatment.

Pancreatic insulinomas are rare endocrine tumors and their diagnosis needs a high index of suspicion. Several patients receive an initial misdiagnosis before the tumor is being finally detected. We report on two patients who presented with vague and bizarre personality and behavioral changes. One patient was initially diagnosed with hysteria and both eventually were diagnosed with complex partial epilepsy. They had not improved on anti-epileptic medications and their symptomatology continued to deteriorate. Their final diagnosis turned out to be pancreatic insulinoma. Because of the rarity of insulinomas as well as their diverse and non-pathognomonic symptoms, the diagnosis remains challenging and may quite well escape detection unless it is entertained. Key Words: İnsulinoma; pancreatic islet cell tumor; complex partial seizures; behavioral changes; personality disorders ÖZET Pankreatik insülinom nadir görülen endokrin tümörü olup teşhisi ciddi anlamda yüksek şüphe gerektirmektedir. Hastaların çoğuna son aşamada gözlenen tümör bulgusundan önce yanlış teşhis konulmaktadır. Bu raporda belirsiz ve şüpheli davranış gösteren iki hastayı ele aldık. Hastanın birine ilk olarak histeri teşhisi konmasına ragmen sonunda her ikisine birden karışık kısmi epilepsi tanısı kondu. Her ikisine anti-epileptik ilaçlar verilmesine rağmen iyileşme gözlenmedi ve belirtileri bu durum daha kötü hale gelene kadar devam etti. Son olarak pankreatik insülinom hastası oldukları ortaya çıktı. İnsülinomlar farklı ve patognomonik olmayan belirtilerinin yanı sıra nadir görülmelerinden dolayı oldukça zor teşhis edilmektedirler ve çok belirgin olmadıkça gözden kaçabilmektedirler. Anahtar Kelimeler: İnsülinom, pankteatik islet hücre tümörü, kompleks kısmi nöbet, davranışsal değişimler, kişilik bozuklukları.