An unusual cause of hematuria; primary epiploic appendagitis.

INTRODUCTION: Primary epiploic appendagitis (PEA) is self limiting inflammatory disease of colonic epiploic appendices. PRESENTATION OF CASE: Herein, a 40 years old patient describing abdomino-inguinal pain with clotty hematuria having PEA was presented. At first, the patient was thought to have a primary bladder pathology, but after a meticioulus examination, he found to have PEA and managed by conservative measures. DISCUSSION: Although PEA does not require surgical intervention, it may mimic other acute abdominal disorders which can be difficult to differentiate. Appendices overlying the sigmoid colon and cecum are more prone to be affected as they are more elongated and wider in size. The patient is usually admitted due to sudden onset of abdominal pain accompanied with fever, abdominal tenderness and leucocytosis. CONCLUSION: The present case demonstrated that PEA located close to the lower urinary tract especially urinary bladder might present with urinary symptoms such as hematuria. dysuria, pollakuria and inguinal pain.

The search for ideal hernia repair; mesh materials and types.

Hernia surgery continues to draw the attention of surgeons, patients, and the industry. This strong interest has driven the establishment of professional medical societies with the sole purpose of furthering the understanding of hernias and hernia repair. In the more than 100 years of development, industry has played a major role in advancing the technology to perfect the performance of hernia repair with the hope of establishing the "best" technique and its associated technology. However, with the development of newer prosthetics and approaches to hernia repair, many surgeons do not fully understand the properties of the available prosthetics. The goal of this review is to highlight the different types of meshes in an effort to clarify to surgeons what types of materials are available to them and how to select an appropriate one for a given case.

[A case of rectus sheath hematoma]. / Rektus kilifi hematomu: Olgu sunumu.

Rectus sheath hematomas are uncommon and are being caused by the injuries of the epigastric vessels and the rectus muscle. They are usually located infraumblically and often misdiagnosed as inflammatory diseases or tumours of the abdomen. We present a 70-year-old woman who had complaints of severe abdominal pain on the left side, nausea and vomiting after heavy lifting. Rectus sheath hematoma was detected by abdominal ultrasonography and computerized tomography. The patient recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment. Computerized tomography must be chosen for definitive diagnosis. Ideal treatment is conservative.

Role of TIMP-2 in fascia transversalis on development of inguinal hernias.

The exact reason for the development of inguinal hernia has not been completely determined. However, it is known that the fascia transversalis (FT) is one of the structures preventing development of hernias. In the etiology of the inguinal hernia, disorders in collagen metabolism have been proposed, and the role of metalloproteinases in remodeling the collagen has recently been of great importance. We could not encounter any study where the role of metalloproteinase inhibitors was evaluated in inguinal hernia. We obtained samples of FT from patients with direct and indirect hernia and used an immunohistochemical method to determine tissue inhibitor of metalloproteinase-2 (TIMP-2) expression. In the study group, samples of FT were taken during the operation from 45 patients, of which 35 were indirect and 10 were direct inguinal hernias. In the control group, samples of FT from various abdominal incisions were also taken from 45 patients with no hernia and operated upon for another pathology. TIMP-2 scores of a direct inguinal hernia were significantly less than those of the control group. However, no difference has been found between the TIMP-2 scores of an indirect inguinal hernia and those of the control group. Decreased TIMP-2 scores in patients with a direct inguinal hernia, compared with both the indirect inguinal hernia group and the control group, explain the reason for the increase in matrix metalloproteinase-2 (MMP-2) that has been proposed in some studies. Therefore, it can be expressed that a decreased activity of TIMP-2 plays a role in inguinal hernia development.

[Incarceration of the left hepatic lobe in incisional hernia: a case report]. / Insizyonel hernide sol karaciger lobunun inkarserasyonu.

Incisional hernias are delayed complications of abdominal surgery and occur in 0.5-13.9 % of patients according to various reported series. The causative factors of incisional hernia are related to the condition of the patient, the main disease, surgical techniques and postoperative complications. The subcutaneous herniation of the left hepatic lobe through the abdominal wall is a rare condition. In this case report, we discuss an incarcerated incisional hernia associated with medial segment of the left hepatic lobe.