A rare breast tumor: primary neuroendocrine carcinoma.

Breast cancer is the most frequently seen cancer in females but primary neuroendocrine carcinoma of the breast, which was defined as a separate entity in the 2003 World Health Organisation tumour classification, is seen extremely rarely. This entity, which is still not well-defined and has not been well-researched, demonstrates a more aggressive course than invasive ductal carcinoma. As metastatic breast neuroendocrine tumours are more widespread and the treatment strategy is different, preoperative differential diagnosis is important. The basic diagnostic method is pathological examination. If a neuroendocrine pattern is determined in microscopy, then immunohistochemical study of neuroendocrine markers should be made. It is necessary to be vigilant in terms of synchronous tumours and metachronous tumours which may develop in the postoperative period as the incidence of synchronous and metachronous cancers in patients with neuroendocrine tumours is higher compared to the general population. The case presented here is of a 73-year old patient who presented with complaints of a breast lump, which was thought to be invasive breast cancer, and as a result of the operation with pathological and immunohistochemical examination, primary neuroendocrine carcinoma of the breast was determined. With more advanced evaluations, no synchronous or metachronous tumours were determined.

Pneumatosis cystoides intestinalis: A rare cause of intraabdominal free air.

Pneumatosis cystoides intestinalis is a rarely seen disease characterized by cysts filled with multiple gases in the wall of the small or large intestine. Many factors have been suggested in the etiology and pathogenesis, including peptic ulcer, pyloric stenosis, and endoscopic trauma. Because various clinical characteristics and symptoms are observed together, diagnosis is generally difficult. It may be a cause of free air observed on direct radiographs. Treatment is directed at the cause and although there is generally a good course, it can sometimes lead to severe complications. In this paper, we present the case of a 33-year old male being prepared for surgery for pyloric stenosis due to a peptic ulcer. In the preoperative tests, because acid was determined within the abdomen and free air below the diaphragm, pneumatosis cystoides intestinalis was considered in the differential diagnosis. Definitive diagnosis was made during the operation and surgical treatment was applied.

Development of acute cholecystitis following laparoscopic partial cholecystectomy.

In cases where the dissection of Calot's triangle is difficult during laparoscopic cholecystectomy, laparoscopic partial cholecystectomy is an alternative to total cholecystectomy to prevent bile duct damage. However, recurrent symptoms and bile duct problems associated with the remaining gallbladder tissue may develop in patients over time. The case of a 45-year-old male who underwent laparoscopic partial cholecystectomy one year previously is presented here. In the postoperative period, as a result of tests for the continuing symptoms of cholecystitis, stones and surrounding abscess were detected in the remaining gallbladder tissue, so open completion cholecystectomy was applied. In acute cholecystitis, as severe inflammation of the hilar structures does not allow safe dissection, partial cholecystectomy can be applied. However, in these patients, there is a risk of recurrence of cholecystitis symptoms and the development of biliary pancreatitis and choledocolithiasis because of the remaining tissue. Therefore, it should not be forgotten that endoscopic and/or surgical intervention may be necessary at least in some patients.

A rare cause of acute abdomen: spontaneous common hepatic duct perforation.

Spontaneous extrahepatic bile duct perforation is generally seen in infants. Although rarely seen in adults, it may be seen with fatal bile peritonitis. Therefore, for a patient presenting with acute abdominal symptoms, differential diagnosis must be made with radiological imaging such as abdominal ultrasonography or computed tomography, without any loss of time. In these imaging tests, in cases of gallstone disease together with perihepatic free fluid or choledocus which can not be monitored, it should be considered in the differential diagnosis. An emergency surgical intervention should be planned to avoid serious complications. The aim of this paper was to present the rare cause of acute abdomen which developed associated with spontaneous common hepatic canal perforation in an adult.

Eyedrop-shaped, modified Limberg transposition flap in the treatment of pilonidal sinus disease.

BACKGROUND: Pilonidal sinus disease is an inflammatory disease seen in the intergluteal region, which is a commonly encountered problem in surgical practice that mostly affects young people. The aim of this study is to assess the effectiveness of the modified Limberg flap technique with eyedrop excision in the treatment of pilonidal sinus disease. PATIENTS: The study population consisted of 91 patients with pilonidal disease in the sacrococcygeal region who underwent operation between June 2010 and December 2012. All cases underwent eyedrop-shaped excision and modified Limberg flap reconstruction. RESULTS: The mean operative time was 41.2 ± 6.7 minutes. All patients were followed up for >8 months, and the mean follow-up period was 13.1 ± 3.7 months. There were three wound dehiscences because of fecal contamination and riding cycle on postoperative Day 5. Seroma and flap echimosis were observed in two and four cases, respectively. Five patients experienced recurrence in this series (4.5%). CONCLUSION: The results of the present study suggest that use of the eyedrop-shaped modified Limberg flap is associated with a lower maceration and recurrence rate when compared with the available data on the use of the Limberg flap. Flap necrosis and wound healing was better, and the routine use of drains did not affect the wound-related complications and recurrence rates.

Small bowel perforation due to fish bone: A case report.

Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen.

Rare cause of oesophagus perforation.

INTRODUCTION: Oesophagus perforations, which are generally caused by iatrogenic injuries, are a serious clinical event. There are still high rates of mortality and morbidity and there is no gold standard of surgical treatment. PRESENTATION OF CASE: The case is here presented of a 54-year old female with complaints of dysphagia after having swallowed a bone in food, who was determined with oesophagus perforation on CT examination. DISCUSSION: Oesophagus perforation generally occurs secondary to interventional procedures and rarely develops associated with foreign bodies. Treatment depends on the perforation site and dimension. CONCLUSION: While conservative primary surgical repair may be chosen for cervical lesions, more aggressive approaches such as resection and delayed reconstruction are recommended for thoracic lesions. Early determination and appropriate treatment are life-saving.

Triple, double- and single-incision laparoscopic cholecystectomy: a prospective study.

PURPOSE: Advances in laparoscopic techniques have enabled complicated intra-abdominal surgical procedures to be made with less trauma and a better cosmetic appearance. The techniques have been developed by decreasing the number of incisions in conventional laparoscopic procedures in order to increase patient satisfaction. The aim of this study was to compare the results of cholecystectomies made with 3, 2 or a single incision. METHOD: A total of 95 cholecystectomy patients from Elbistan State Hospital and Suleyman Demirel University Hospital between 2011 and 2013 were prospectively evaluated. The patients were separated into 3 groups as triple incision laparoscopic cholecystectomy (TILC), double incision laparoscopic cholecystectomy (DILC) and single incision laparoscopic cholecystectomy (SILC). Patients were evaluated in respect of demographic characteristics, operation time, success rate, analgesia requirement, length of hospital stay and patient satisfaction. RESULTS: Successful procedures were completed in 40 TILC, 40 DILC and 15 SILC cases. Transfer to open cholecystectomy was not required in any case. The mean duration of operation was 71 mins (range, 55-120 mins) for SILC cases, 45 mins (range, 32-125 mins) for DILC cases and 42 mins (range, 29-96 mins) for TILC cases. The mean time for the SILC cases was statistically significantly longer than the other two groups (p < 0.000). CONCLUSIONS: At a comparable level with DILC and TILC, single incision laparosccopic cholecystectomy is a method which can be used without incurring any extra costs or requiring additional instrumentation or training and which has good cosmetic results and a low requirement for analgesia.

Minimally invasive surgery using mini anterior incision for thyroid diseases: a prospective cohort study.

AIM: Minimally invasive surgical techniques have attracted interest in all surgical specialties since 1980. The thyroidectomy technique requires meticulous surgical dissection, absolute hemostasis, en bloc tumor resection and adequate visualization of the operative field, all of which can be accomplished with minimally invasive techniques. METHODS: The study group comprised all patients undergoing MITS from its introduction in 2010 until July 2012. All data were prospectively recorded in the Elbistan Hospital and Suleyman Demirel University in Turkey. This study was designed to demonstrate our experience with mini-incision-technique in thyroidectomy. RESULTS: Over the 2-year period, 37 patients underwent bilateral MITS procedures. The procedure made with a small (2.5 cm) anterior incision made above the isthmus. The final diagnoses were benign multinodular goitre (37%), follicular adenoma (28%) incidental carcinoma (11%), Hashimoto's thyroiditis (15%), Hurtle cell adenoma (5%), subacute thyroiditis (3%), residual thyroid-non carcinoma (2%), simple cyst (1%), diffuse hyperplasia (1%) and other (1%). Of the carcinomas, 80% were papillary thyroid cancer, 13% were follicular, and the remaining 7% were Hurtle cell carcinomas. We dont need to extend our incision in any cases. Two patients had temporary recurrent laryngeal nevre paresis and one patient had temporary hypocalcemia. CONCLUSIONS: It is not easy to demonstrate the advantages of MIT over conventional and video-assisted surgery. The main complications, such as nerve injury, hypoparathyroidism, or hemorrhage, are the same as in other surgical approaches. MIT has demonstrated advantages over conventional open approaches for both hemi- and total thyroidectomy and the benefits do not depend on the open or video-assisted approach. The anterior mini-incision approach can be performed with an operative time and postoperative complication profile equivalent to conventional thyroidectomy while providing excellent cosmesis with a 2 cm scar in both total thyroidectomy and lobectomies.

Omental torsion with left-sided inguinal hernia: a rare preoperative diagnosis.

Omental torsion is a rare disease. It can be difficult to identify if it is not clinically considered in the preoperative period, and this pathology may lead to an acute abdomen. We present the characteristic computed tomography findings and clinical particulars in a 34-year-old male patient with longstanding left inguinal hernia associated with an extraordinary diagnosis.