Objective: This study aimed to evaluate gallstone formation, prophylactic and selective cholecystectomy and the effectiveness of ursodeoxycholic acid treatment following laparoscopic Roux-en -Y gastric bypass (LRYGB) in morbid obese patients. Results: Fifty-three (88.3%) patients were female and seven (11.7%) were male. Eight of the 60 patients (13.3%) had previously undergone cholecystectomy. Six patients (11.5%) underwent cholecystectomy in addition to LRYGB due to preoperatively detected gallstones by ultrasonography. The remaining 46 patients were followed up for a mean duration of 28.57 months (5-56 months). In 10 (21.7%) of these patients, gallstones were detected and five patients with symptomatic gallstones underwent cholecystectomy. Patients who did and did not develop gallstones after LRYGB did not show a significant difference regarding age, gender and the new body mass index (BMI). Three patients were started on ursodeoxycholic acid and the treatment was continued for six months. Gallstones were not detected in these patients. Conclusion:In light of these data, since only a very small portion of patients develops symptomatic gallstones after LRYGB, we recommend cholecystectomy in patients with symptomatic gallstones or the use of ursodeoxycholic acid rather than a prophylactic approach. Prospective randomized controlled studies in larger series are required to support these results.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst formation in various organs. The liver is the most commonly involved organ. Hydatid disease is endemic in many parts of the world and its prevalence is also high in the Mediterranean region including Turkey. Uncomplicated liver cysts may stay asymptomatic for a long time. Hydatid cysts can rupture either spontaneously or following trauma. Anaphylaxis is an acute, life-threatening medical emergency with many potential triggers. The rupture of hydatid cysts caused by sports trauma is very rare and can lead to anaphylactic reactions and fatal anaphylaxis. We described a patient who was previously unknown to have hydatid disease being treated in the emergency setting following a sports trauma.

ÖZETBu makalede penetran toraks travması geçiren ve 9 ay sonra travmatik diyafragma hernisi tanısı konan 29 yaşında bir erkek hasta sunulmuştur. Dokuz ay önce konservatif olarak tedavi edilen ve barsak tıkanıklığı yakınmalarıyla acile gelen hastada Bilgisayarlı Tomografide sol hemitoraksta abdominal organların oluşturduğu hava-sıvı seviyesi görüldü. Abdominal eksplorasyonda, sol diyafragmada 10 cm'lik iki ayrı diyafragma defekti vardı. Midenin; medyal defekten, transvers kolon, omentum ve dalağın; lateral diyafragma defektinden fıtıklaştığı görüldü. Bu olgu sunumun künt veya penetran karın ve toraks travması geçirmiş hastalarda diyafragma yaralanması olasılığını hatırlatacağına inanıyoruz.Anahtar Sözcükler: fıtık, diyafragma, toraks travması, ileus SUMMARY A 29 year old male patient who experienced penetrating thoracic trauma and had diagnosis of traumatic diaphragmatic hernia nearly 9 months later is presented here. Nine months before the patient was managed conservatively. The patient was referred to our emergency room complaining of intestinal obstruction symptoms. Computed tomography scan revealed fluid level formed by the abdominal organs in the left hemi-thorax. During abdominal exploration, two different 10cm of diaphragmatic defects located in left diaphragm were seen. Stomach was found to be herniated through the medial defect and transverse colon, omentum and spleen were herniated through the lateral diaphragmatic defect. We believe that this case report serves a useful reminder suspicion for diaphragmatic injuries in patients with a history of blunt or penetrating thoracic trauma.

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