Colonic perforation after short-term use of nonsteroidal antiinflammatory drugs: report of two cases.

Nonsteroidal antiinflammatory drugs are widely used for acute and chronic pain, but they may have serious side effects such as impairment of renal function, asthma, erosions of the mucosa in the gastrointestinal tract, colonic and intestinal strictures, and gastrointestinal tract bleeding. Although the upper gastrointestinal tract disturbances caused by nonsteroidal antiinflammatory drugs are well known, their side effects in the lower gastrointestinal tract are not clearly defined. There are a limited number of articles and case reports about the latter in the literature. We report two cases of colonic perforation due to short-term use of nonsteroidal antiinflammatory drugs in this study. Colonic perforation should be considered as one of the possible diagnoses in patients with acute abdominal pain and nonsteroidal antiinflammatory drug use should be considered as a possible cause of colonic perforation if other possibilities are excluded.

Videoanoscope-assisted stapled haemorrhoidopexy: analysis of 18 patients.

An optimal stapled haemorrhoidopexy requires the purse-string suture to be placed circumferentially at a constant distance from the dentate line and to pass through an appropriate thickness of rectal mucosa. An unsuitable purse-string suture may increase the risk of postoperative complications. We developed a new anoscope (the videoanoscope) to prevent the difficulties during application of the purse-string suture, and we used the videoanoscope in 18 stapled haemorrhoidopexy procedures. The videoanoscope is made up of three pieces. The front part is in the form of an open half-cylinder. The second piece is a sliding lid that covers the front piece. The rear part of the anoscope includes a hollow handle in which a scope can be inserted, and the whole procedure can be transmitted to a monitor via this scope. The opening on the anoscope can be adjusted by sliding the lid. A purse-string suture is placed on the rectal mucosa protruding through this adjustable opening. The anoscope is rotated to apply the subsequent suture bites and when the starting point is reached again the purse-string is completed. Then the stapled haemorrhoidopexy procedure is continued in the usual fashion. Videoanoscope-assisted stapled haemorrhoidopexy was easily performed in 18 patients (12 men, 6 women; mean age 48.9 years). The mean operative time was 32.8 minutes. The excised rectal mucosal rings were complete in all of the patients. Optimal purse-string depth was reflected in the presence of only mucosa and submucosa in all specimens, without incorporation of muscle cells. Postoperative complications were urinary retention in one patient and bleeding in five patients, one of whom requiring sutures for haemostasis. Further studies are required to assess the potential advantages of this technique.

Fournier's gangrene: evaluation of 68 patients and analysis of prognostic variables.

CONTEXT: Fournier's gangrene (FG) is a rapidly progressing acute gangrenous infection of the anorectal and urogenital area. AIMS: The objectives of this study were to investigate patients with FG and to determine risk factors that affect mortality. SETTINGS AND DESIGN: Retrospective clinical study. MATERIALS AND METHODS: Clinical presentations and outcomes of surgical treatments were evaluated in 68 patients with FG. STATISTICAL ANALYSIS USED: Chi-square, Student's t -test, and logistic regression test. RESULTS: Mean age of patients was 54 and female-to-male ratio was 9:59. Among the predisposing factors, diabetes mellitus (DM) was the most common ( n =24, 35.3%), and sepsis on admission was detected in 31 (45.6%) and 15 (22.1%) patients, respectively. Seven (10.3%) patients died. Using logistic regression test, Fournier's Gangrene Severity Index (FGSI)> 9, DM and sepsis on admission were found as prognostic factors. CONCLUSIONS: FG has a high mortality rate, especially in patients with DM and sepsis. An FGSI value> 9 indicates high mortality rate.

Multivisceral resections for locally advanced rectal cancer.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of en bloc multivisceral resection of organs involved by locally advanced rectal carcinoma. METHOD: A total of 312 patients with primary rectal cancer underwent surgery between January 1994 and April 2005. Of these, 57 patients (18.3%) had macroscopically direct invasion of an adjacent organ or structure, and underwent multivisceral resection with curative intent. Survival analyses were made by the Kaplan-Meier and the Cox proportional hazards regression model. RESULTS: The postoperative mortality was 3.5%. The overall survival rate at 1, 3 and 5 years was 96.4%, 81.6% and 49.0%. Age (> or = 65 years), depth of tumour invasion (pT3 stage), lymph node status (pN0), tumour stage (III A-B), grading (G1), vascular and neural invasion (not extensive), type of adhesion (inflammatory) and type of resection (R0) were significant factors favouring survival in the univariate analysis. Only two factors, lymph node status pN0 (P = 0.007) and R0 resection (P = 0.005) were independently significant factors in the multivariate analysis. CONCLUSION: R0 resection and pN0 status influence overall survival for locally advanced rectal carcinoma.

Laparoscopic cholecystectomy accompanied by simultaneous umbilical hernia repair: a retrospective study.

BACKGROUND: Umbilical defects may cause technical problems for general surgeons in patients during laparoscopic cholecystectomy (LC) operations and may increase the incidence of incisional hernia. AIM: The objectives of this study were to determine the optimal repair method for umbilical hernias that already exist or are encountered incidentally and to present data regarding potential problems that may occur during LC. SETTINGS AND DESIGN: Medical records of patients who had received simultaneous umbilical hernia repair (UHR) with LC were investigated retrospectively. MATERIALS AND METHODS: Cholelithiasis was accompanied by umbilical hernia in 64 (8.6%) out of 745 patients who underwent LC and UHR simultaneously in our hospital between 2000 and 2004. STATISTICAL ANALYSIS USED: The Mann-Whitney U, Chi-square, One-Way Anova, Kaplan-Meier survival analysis, the log-rank test and t test were used for statistical analyses. RESULTS: LC was followed by UHR using primary suture (Group 1), Mayo repair (Group 2) and flat mesh-based repair (Group 3) in 32 (50%), 18 (28.1%) and 14 (21.9%) patients, respectively. Mean body mass indexes (BMI) of patients were 26.6 kg/m 2, 29.2 kg/m 2 and 39.9 kg/m 2 in Groups 1, 2 and 3, respectively. Recurrence rates were 9.4%, 5.6% and none (0%) in Groups 1, 2 and 3, respectively. Recurrence was observed in three (7.0%) out of 43(67.2%) patients with BMI > or = 30 kg/m 2 while umbilical hernia recurred in one (4.8%) out of 21 (32.8%) patients with BMI < 30 kg/m 2. Overall morbidity and mortality rates were 14.1% and 0%, respectively. CONCLUSIONS: The outcomes of the UHR with mesh after laparoscopic surgeries appear to be better for either obese or non-obese patients than primary suture techniques in recurrence rates.

Factors affecting morbidity and mortality in incarcerated abdominal wall hernias.

BACKGROUND: Incarcerated abdominal wall hernia cases may necessitate emergency interventions, but under such circumstances morbidity and mortality rates may increase. The aim of this study was to investigate the factors that affect morbidity and mortality in patients with incarcerated abdominal wall hernias who underwent emergency surgery. METHODS: Urgent surgical interventions due to incarcerated abdominal wall hernias were performed in 182 patients in our clinics between January 1998 and January 2006. Factors that affect morbidity and mortality in incarcerated abdominal wall hernias were investigated retrospectively by browsing the archives. Logistic regression analysis was used to evaluate parameters that affect morbidity and mortality. RESULTS: Morbidity and mortality occurred in 43 (23.6%) and 9 (4.9%) patients, respectively. A symptomatic period of longer than 8 h, presence of accompanying disease, high American Society of Anesthesiology (ASA) score, general anesthesia, presence of strangulation, and necrosis were found to affect morbidity significantly by univariate analysis. Necrosis was the sole factor affecting morbidity significantly by multivariate analysis. Advanced age, presence of accompanying disease, high ASA score, presence of strangulation, necrosis, and hernia repair with graft were found to affect mortality significantly by univariate analysis; however, necrosis was the sole factor affecting mortality significantly by multivariate analysis. CONCLUSIONS: Intestinal necrosis, which was followed by bowel resection, was the sole factor affecting morbidity and mortality using multivariate logistic regression analysis. Emergency surgery is required for incarcerated abdominal wall hernias before intestinal necrosis develops.

Dislocation of three segments of the liver due to hernia of the right diaphragm: report of a case and review of the literature.

Right diaphragmatic hernia is a rare injury (0.25-1%) following blunt abdominal trauma. The diagnosis may be delayed and achieved years after the trauma during laparotomies for other reasons. A 75-year-old male fell 6 years before, and was symptom-free since then. He was admitted to the hospital for abdominal pain, and chest X-rays revealed intestinal gas in the lower right thoracal region. Abdominal ultrasonography showed agenesis of the gallbladder, and computed tomography demonstrated that the right upper abdominal viscera were located in the vicinity of the heart. The patient underwent a laparotomy for right diaphragmatic hernia, and the right hepatic lobe and the medial segment of the left lobe, the gall bladder, the proximal part of the transverse colon, the omentum and some segments of the intestine were dislocated into the thoracal cavity by a tear in the right diaphragm. The organs were returned to the abdominal cavity uneventfully and the defect in the diaphragm, measuring 10 x 5 cm, was repaired by unabsorbable sutures. The diagnosis, surgical treatment and postoperative course of the right diaphragmatic hernia is discussed with a review of the literature.

[Traumatic intra-abdominal major vascular injuries]. / Travmatik karin içi büyük damar yaralanmalari.

The records of 47 patients who underwent surgery with traumatic intraabdominal vascular injury at 2. and 3. Surgical Clinics of Izmir Atatürk Training and Research Hospital between January 1990 and December 1999 were studied. The aim of this study was to investigate the prognostic factors affecting the mortality. Hemoglobin (p < 0.05), hematocrit (p < 0.05), Glasgow Coma Score (p = 0.01), blood pressure (p < 0.05), Revised Trauma Score (p = 0.01), prehospital time (p = 0.01) and associated organ injury (p < 0.05) were the significant factors affecting the mortality. Our overall mortality was 46.8% and morbidity 41%.

The effect of preoperative 5-fluorouracil on colonic healing: an experimental study.

BACKGROUND/AIMS: After curative resection for colorectal carcinoma there is a high recurrence rate and neoadjuvant chemotherapy may be useful in some patients. Very little is known about the effect of preoperative 5-fluorouracil on the healing of colon anastomosis. The aim of this study was to evaluate the effect of 5-fluorouracil on colonic healing when the time interval between the last injection and operation was shortened to 24 hours. METHODOLOGY: Thirty-six male Wistar rats with a median weight of 185 g (range: 165-200 g) were divided into three groups: 1) control group (n = 12); 2) sham group (n = 12) which received saline intraperitoneally, and 3) study group (n = 12) which received 5-fluorouracil intraperitoneally (20 mg/kg-1). All injections were given intraperitoneally for 5 days and the last dose was injected 24 hours before operation. RESULTS: The mortality rate (22.7%) and anastomotic complications (29.4%) were increased in the 5-fluorouracil group, compared with the control or saline groups (P < 0.05). The anastomotic bursting pressure in rats having 5-fluorouracil treatment (27 mm Hg) was significantly lower from both the control (55 mm Hg) and saline (84 mm Hg) groups on postoperative day 3 (P < 0.05). Both myeloperoxidase and hydroxyproline contents were also significantly lower than the other groups (P < 0.05). CONCLUSIONS: Colonic healing was impaired and mortality rate was increased when intraperitoneal 5-fluorouracil treatment was repeated until 24 hours before operation.