First case of bilateral diaphragm eventration successfully repaired through an abdominal approach following lung transplantation.

A 61-year-old male patient with bilateral lung transplantation was admitted to the outpatient clinic with increasing respiratory distress for a month. Bilateral diaphragm eventration was observed in his examinations. Bilateral diaphragm plication was successfully performed abdominally in the patient who had a complaint despite supportive treatment. The respiratory capacity of the patient returned to normal. The abdominal approach may be a good alternative option in cases where intrathoracic surgery cannot be performed due to adhesions in patients with eventration after lung transplantation. KEY WORDS: Acquired eventration, Diaphragm, Lung transplantation.

Clinical significance of the largest histopathological metastatic lymph node size for postoperative course of patients undergoing surgery for gastric cancer.

Aim: The aim of this study was to investigate the effect of the largest metastatic lymph node (MLN) size on postoperative outcomes of patients with stage II-III gastric cancer (GC). Methods: A total of 163 patients with stage II/III GC who underwent curative surgery were included in this single-center retrospective study. The lymph nodes were counted, each lymph node was analyzed for metastatic involvement by histopathological examination, and the diameter of the largest metastatic lymph node was recorded. The severity of postoperative complications was assessed by Clavien-Dindo classification system. Two groups of 163 patients were defined according to ROC analysis with cut-off value of histopathologically maximum MLN diameter. A comparative analysis of demographic and clinicopathological characteristics of the patients and their postoperative outcomes were performed. Results: The median hospital stay was significantly longer in patients with major complications compared to patients without major complications [18 days (IQR: 13-24) vs. 8 days (IQR: 7-11); (p < 0.001)]. The median MLN size was significantly larger in deceased patients compared to survived [1.3 cm (IQR: 0.8-1.6) vs. 0.9 cm (IQR: 0.6-1.2), respectively; (p < 0.001)]. The cut-off value of MLN size predicting mortality was found as 1.05 cm. MLN size ≥1.05 cm had nearly 3.5 times more negative impact on survival. Conclusions: The largest metastatic lymph node size had a significant association with survival outcomes. Particularly, MLN size over 1.05 cm was associated with worse survival outcomes. However, the largest MLN was not shown to have any effect on major complications. Further prospective and large-scale studies are required to draw more precise conclusions.

Clinical significance of the histopathological metastatic largest lymph node size in colorectal cancer patients.

Background: The metastatic lymph nodes (MLN) are interpreted to be correlated with prognosis of the colorectal cancers (CRC). The present retrospective study aimed to investigate the clinical significance of the largest MLN size in terms of postoperative outcomes and its predictive value in the prognosis of the patients with stage III CRC. Methods: Between May 2013 and December 2018, a total of 101 patients who underwent curative resection for stage III CRC retrospectively reviewed. All patients were divided into two groups regarding cut-off value (<1.05 cm and ≥1.05 cm) of maximum MLN diameter measured histopathologically. A comparative analysis of demographic and clinicopathological characteristics of the patients and their postoperative outcomes were performed. Results: Two groups carried similar demographic data and preoperative laboratory variables except the lymphocyte count, hematocrit (HCT) ratio, hemoglobin level and mean corpuscular volume (MCV) value (p<0.05). The patients with MLN diameter ≥1.05 cm (n=46) needed more erythrocyte suspension and were hospitalized longer than the patients with a diameter <1.05 cm (n=55) (p=0.006 and 0.0294, respectively). Patients with MLN diameter < 1.05 cm had a significantly longer overall survival than patients with MLN diameter ≥ 1.05 cm (75,29 vs. 52,57 months, respectively). Regarding the histopathologic features, the patients with MLN diameter ≥1.05 cm had larger tumor size and higher number of MLN than those with diameter <1.05 cm (p=0.049 and 0.001). Conclusion: The size of MLN larger than 1.05 cm may be predictive for a poor prognosis and lower survival of stage III CRC patients. The largest MLN size may be a proper alternative factor to the number of MLNs in predicting prognosis or in staging CRC patients.

Impact of preoperative prognostic nutritional index levels on morbidity in colorectal cancer surgery.

AIM: The prognostic nutritional index (PNI) is a valuable parameter that indicates the immunonutritional status of patients with malignant tumors. MATERIAL AND METHODS: Patients operated for colorectal cancer between January 2013 and December 2019 were analyzed retrospectively. The relationship between PNI and morbidity was investigated in the 314 patients included in the study. Based on previous studies, the PNI cutoff value was set at 45, and the patients were duly divided into two groups: PNI <45 and PNI ≥45. The demographic and clinicopathological characteristics, as well as postoperative complications in the two groups, were compared. RESULTS: There was no statistical difference in gender, localization, T stage, N stage, perineural invasion, lymphovascular invasion, stage, Ca19-9 values, and body mass index(BMI) between the two groups. In contrast, there was a statistically significant difference in age, complications, and CEA values. (p=0.008, p<0.001, p=0.043, respectively). The median age was lower in patients with high PNI scores than in the low PNI group (61 vs. 64 years). When the patients were examined for complications, 36 (37.1%) patients were observed in the high PNI group, compared to 155 (71.4%) in the low PNI group. In terms of overall survival, the mean life expectancy was 68.112 2.646 months for patients with low PNI group, compared to 84.626 2.701 months in the high-PNI group, and the difference was statistically significant (p=0.001). CONCLUSION: This study's findings suggest that the preoperative prognostic nutritional index may indicate postoperative complications and prognosis. The most significant benefit of this marker is that it can be improved preoperatively and practically. KEY WORDS: Nutritional Status, Morbidity, Colorectal Neoplasms.

Hepatic bridge and round ligament of the liver during cytoreductive surgery: a retrospective cohort.

PURPOSE: The hepatic bridge as an anatomical variation may lead to recurrence and treatment failure in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by constituting an obscure region during surgery. This report aimed to highlight the relationship between the hepatic bridge and various prognostic factors in peritoneal carcinomatosis. METHODS: Data of 101 patients who underwent CRS/HIPEC for peritoneal carcinomatosis in a single centre were retrospectively reviewed. Demographic characteristics, primary origin of peritoneal carcinomatosis, classification of hepatic bridge, Peritoneal Cancer Index (PCI) score, and completeness of cytoreduction (CC) score were analysed. RESULTS: The tumour was proven histopathologically in 18 (28.6%) of 63 patients who underwent distal round ligament (DRL) resection. The PCI score was found to be significantly higher in patients with tumour in DRL compared to the ones without tumour (p < 0.001). The median PCI score of patients with implant positive DRL was 18 (12-20) and this score was 3 (2-6) for patients with implant negative DRL (p < 0.001). The ROC curve concerning the risk of an implant penetrating the round ligament revealed the optimal cut-off value of PCI at 10 with 88.9% sensitivity and 79.3% specificity. CONCLUSION: The round ligament should be removed, regardless of the PCI score, as a standard in mucinous adenocarcinoma of the appendix and malignant peritoneal mesothelioma. DRL should be removed when PCI is equal or higher than 10 for PC due to colorectal and ovarian cancers.

Clinical importance of serum CEA and CA-19-9 levels in oesophagogastric junction adenocarcinomas.

INTRODUCTION: In recent years, the incidence of gastroesophageal junction tumors has increased rapidly in worldwide. AIM: To evaluate pretreatment serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 in oesophagogastric junction (OGJ) adenocarcinomas regarding clinicopathologic characteristics and overall survival. MATERIAL AND METHODS: Patients undergoing curative surgery diagnosed with OGJ adenocarcinoma in the gastrointestinal surgery clinic between 2007 and 2019 were included in the study retrospectively. Kaplan Meier and Log Rank tests were performed in survival analyses. Logistic regression analysis was performed to state the independent variables affecting survival. RESULTS: The mean age of the 70 patients included in the study was 59.78 ±10.49 (31-76) years. Serum CEA and CA 19-9 were high in 19 (27.1%) patients. CEA ≥ 5 ng/ml was found to be statistically significant in patients receiving neoadjuvant chemotherapy (NAC) and in patients with a high number of positive lymph nodes (N +) (p = 0.041 and p = 0.042, respectively). CA 19-9 positivity was statistically higher in patients with lymphovascular invasion (LVI) and diabetes mellitus (DM) (p = 0.042 and p = 0.012, respectively). The age and N+ findings of the patients in the CA 19-9-positive group were statistically significant compared to the patients in the CA 19-9-negative group (p = 0.039 and p = 0.007, respectively). Overall survival rates of 1-3 and 5 years were statistically significantly lower in patients who were CA 19-9 positive (p = 0.016). For patients in whom both tumour markers were positive, the N+ mean value was statistically significantly higher (p = 0.001). CONCLUSIONS: In our study, a significant relationship was found in terms of overall survival and serum CA 19-9 in OGJ adenocarcinoma, and it was associated with both tumour markers being positive and the mean N+ value.

Prognostic effect of perineural invasion in successive years in patients with locally advanced gastric cancer.

AIM: The present study evaluates the prognostic significance of perineural invasion (PNI) on 2-year, 5-year, and overall survival in patients undergoing gastrectomy and D2 lymphadenectomy due to locally advanced gastric cancer. MATERIALS AND METHODS: Included in the study were 231 patients who underwent surgery between November 2006 and October 2018 due to stage 1B and over locally advanced gastric cancer, whose records were reviewed retrospectively. STATISTICAL ANALYSIS: The variables in the presence or absence of PNI were compared between the two groups with a Chi-square test, a Fisher's exact test, a likelihood ratio, and a Mann-Whitney U test. Overall survival data were evaluated with a Kaplan-Meier test. Prognostic factors were evaluated with a stepwise Cox regression analysis. RESULTS: PNI was identified in 167 (72.3%) of the patients. The 2-year, 5-year, and overall survival rates at the end of the follow-up period were 85.9%, 70.3%, and 64.1% in those without PNI, and 52.7%, 38.3%, and 36.5% in those with PNI, respectively. In a multivariate analysis, PNI appeared to be a significant prognostic factor for 2-year survival (P = 0.04) but had no effect on 5-year and overall survival. CONCLUSIONS: Survival was shorter in patients with PNI than in patients without PNI, and PNI had no effect on overall survival, although it was found to be of prognostic significance for 2-year survival.

The risk factors of intraoperative hyperlactatemia in patients undergoing laparoscopic colorectal surgery.

AIM: The aim of this study is to determine the incidence of intraoperative hyperlactatemia and its risk factors in patients undergoing laparoscopic colorectal surgery. MATERIAL AND METHODS: We retrospectively enrolled 75 patients who underwent laparoscopic resection for colorectal cancer. Initial lactate levels were determined from blood gas analysis before the incision. The end lactate values were recorded after the termination of the pneumoperitoneum. Hyperlactatemia defined as lactate levels between 2 mmol/L and 5 mmol/L without evidence of acidosis. The patients were divided into two groups as normolactatemia and hyperlactatemia according to lactate values at the end of the surgery. RESULTS: Of the 75 patients, 45 (60.0%) had higher lactate levels than normal at the end of the surgery. The median age of the study population was 62 (24-84) years. Forty (53.3%) of the patients were male. Most of the patients in the study had colon cancer origin [56 cases (74.7%)]. Univariate logistic regression analysis for a possible independent risk factor in terms of hyperlactatemia showed that Charlson comorbidity index (CCI) ≥ 3, body mass index (BMI) ≥ 30 kg/m2, the operative time, and the tumor size were significant (p < 0.05). Multivariate analysis found that only BMI ≥ 30 kg/m2 and the operative time were significant (p = 0.004, and p < 0.001, respectively). CONCLUSION: According to our work, obesity (BMI ≥ 30 kg/m2) and the operative time in laparoscopic colorectal surgery were independent risk factors for intraoperative hyperlactatemia at the end of the operation. Therefore, clinicians should be vigilant about the inevitable consequences of surgery by making appropriate preparation. KEY WORDS: Colorectal cancer, Lactate, Hyperlactatemia, Laparoscopy.

Relation between Sarcopenia and Surgical Site Infection in Patients Undergoing Gastric Cancer Surgery.

Background: Sarcopenia is a syndrome that can have negative consequences after gastric cancer (GC) surgery. This study aims to determine the effect of sarcopenia on surgical site infection (SSI) that develops after open GC surgery. Patients and Methods: In this retrospective design study, data were collected for patients who underwent GC surgery between January 2013 and August 2019. The diagnosis of sarcopenia was made according to the skeletal muscle index (SMI) calculated from pre-operative computed tomography images. Patients with sarcopenia and those without sarcopenia were compared in terms of SSIs; the risk factors for SSI were also analyzed. Results: One hundred forty-nine patients were included in the study and had a mean age of 59.3 years. Post-operative complications developed in 59 patients (39.6%) and SSIs in 28 patients (18.7%). Sarcopenia was detected in 57 (38.3%) patients; the mean age was 59.9 years in the sarcopenic group (SG) and 58.9 years in the non-sarcopenic group (NSG; p = 0.55). The mean SMI was 382.5 mm2/m2 and 646.2 mm2/m2 in the SG and NSG, respectively (p < 0.001). A relation between SSIs and sarcopenia was detected; 17 patients in the SG (29.8%) versus 11 patients in the NSG (11.9%; p = 0.007). Surgical site infection was not found to be statistically significantly related to obesity, hypoalbuminemia, intra-operative blood loss, or duration of operation, although the sarcopenic obesity patients were found to have the highest SSI rate (40%). Conclusion: The present study identified a relation between sarcopenia and SSIs occurring after GC surgery. The authors believe that studies seeking to reduce the incidence of SSIs, which are a leading cause of morbidity after GC surgery, should be supported.

Prognostic Factors in Operated T3-T4 Gastric Cancer.

OBJECTIVE: To investigate the prognostic factors affecting survival in patients with a deep gastric wall invasion of T3-T4 advanced gastric cancer. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Gastroenterological Surgery, Kartal Kosuyolu High Specialty Training and Research Hospital, between November 2006 and December 2018. METHODOLOGY: A retrospective review was made of 252 patients; and the clinicopathological characteristics and survival status in the presence of T1-T2 and T3-T4 patients were investigated. The cumulative survival of the two groups was analysed with a Kaplan-Meier test, and the differences were analysed with a log-rank test. The prognostic factors for T3-T4 patients were established through a stepwise Cox regression analysis. RESULTS: Of the total, 52 (20.6%) patients had T1-T2 and 200 (79.4%) had T3-T4 gastric wall invasion. Statistical differences were noted in the Lauren classification as gender, tumor size, presence of lymph node involvement, presence of vascular and perineural invasion, and overall survival (p <0.001). A univariate analysis of the prognostic factors affecting survival in T3-T4 patients revealed a difference in the tumor localisation, tumor size, the presence of involved lymph nodes, perineural invasion, and vascular invasion. A multivariate analysis of the prognostic factors affecting survival identified differences in tumor size, the presence of involved lymph nodes and perineural invasion. CONCLUSION: The most significant prognostic factor affecting survival in patients with T3-T4 gastric cancer, based on the depth of gastric wall invasion, was the tumor size, lymph node involvement and perineural invasion. Key Words: Advanced gastric cancer, Prognostic factor, Survival.

The safety of upper gastrointestinal endoscopic biopsy in patients receiving antithrombic drugs. A single-centre prospective observational study.

INTRODUCTION: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines on gastroenterological endoscopy in patients undergoing antithrombotic therapy, although the safety of endoscopic procedures in patients receiving antithrombotic drugs has yet to be sufficiently studied. AIM: This study evaluates the safety of upper gastroenterological endoscopic biopsy in patients receiving antithrombotic drugs. We evaluated the prospective observational safety of endoscopic biopsy performed in the endoscopy unit of our patients using antithrombotic drugs. MATERIAL AND METHODS: Oesophagogastroduodenoscopies (OGD) and biopsies performed at a single endoscopy unit between July 2018 and February 2019 were examined in this prospective observational study. Patients receiving antithrombotic drugs due to cardiovascular and neurological reasons, who underwent an endoscopic mucosal biopsy for diagnostic purposes, were included in the study. RESULTS: The study was completed with 166 patients who underwent an endoscopic biopsy, from whom a total of 327 biopsies taken. The patients were examined in two groups: those "receiving antithrombotic drugs" and those who had "stopped taking antithrombotic drugs". There was no statistically significant difference between the two groups with respect to bleeding. CONCLUSIONS: This prospective observational study showed that performing an endoscopic biopsy without the cessation of antithrombotic drugs does not increase bleeding risk. Low-risk procedures, such as endoscopic mucosal biopsies, can be performed confidently by experienced endoscopists.

The impact of sarcopenia on pathologic complete response following neoadjuvant chemoradiation in rectal cancer.

PURPOSE: The role of sarcopenia in pathologic complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in non-metastatic locally advanced rectal cancer is currently unknown. The present study investigates the association between sarcopenia and post-nCRT pCR. METHODS: The data of patients operated on following nCRT between January 2013 and January 2020 were collected retrospectively. Sarcopenia was diagnosed based on the calculation of the skeletal muscle index (SMI) from computed tomography carried out at the time of the initial diagnosis. A statistical analysis was then conducted for predictors of pCR. RESULTS: The study included 61 patients with an average age of 57.3 years, 28 of whom formed the non-sarcopenic group (NSG) and 33 the sarcopenic group (SG). Of the patients, 32.7% were at clinical stage 2, and 67.3% were at clinical stage 3. Pathologic data following a mesorectal excision revealed a pCR rate of 21.4% in the NSG compared with 3% in the SG, which was a statistically significant difference (p = 0.025). The TNM downstaging rate was higher in the NSG than in the SG, although the difference was not statistically significant (50% vs. 33.3%, p = 0.28). A univariate analysis revealed the factors affecting pCR to be non-sarcopenia (p = 0.025), age < 61 years (p = 0.004), interval to surgery ≥ 8 weeks (p = 0.029), and serum CEA < 2.5 ng/ml (p = 0.035). CONCLUSION: Sarcopenia was found to be a negative marker of pCR following nCRT in non-metastatic locally advanced rectal cancer.

The prognostic value of different lymph node classification systems in stage III colorectal cancer patients.

AIM: Prognostic significance assessment of different lymph node classification systems in stage III colorectal cancer patients. MATERIAL AND METHODS: A total of 85 stage III colorectal cancer patients, who had undergone surgery between January 2013 and December 2018, were divided into 3 different groups comprising of lymph node ratios (LNR) and log odds of positive lymph nodes (LODDS) as per the cutoff values of 25 and 75 percentile threshold values. They were accordingly classified as: LNR1 <0.069, LNR2 0.069-0.24, LNR3 >0.24 and LODDS1 <-0.99; -0.99≥ LODDS2 <-0.47; LODDS3 ≥-0.47. Further the LNR was assessed according to the cutoff values proposed by Berger et al. The pN statuses of all patients were also categorized as pN1 and pN2 in line with the AJCC 8th Edition. The Kaplan-Meier test and Cox regression analysis were performed to analyze the relationship among the LNR, LODDS, pN and overall survival. RESULTS: While 55 patients included in the study had tumors in their colons, the localization of the tumors of 30 patients was the rectum. The means for survival time was 63.3 months +/- 3.6 [95% CI(56.2-70.4)]. When univariate analyses were conducted for the factors affecting 3 and 5-year survival of the patients, it was ascertained that there was a significant relationship only between perineural invasion (PNI) and survival. Accordingly, the 3-year survival of those with PNI was found to be 31.4% in comparison to 56% of those without PNI (p=0.025), while the figure was 5.7% for the 5-year survival of the former group and 22% for the latter (p=0.040). When the relation between the survival time of the patients and the LNR classification conducted according to the staging system developed by Berger et al. was studied, no significant relationship could be found (p>0.05). Similarly, and 0.321 respectively. CONCLUSION: Although numerous studies have shown that there was a significant relationship between high LNR and increased survival, as opposed to the results of our study, the greatest obstacle before LNR's survival prediction is the absence of a consensus for standard cutoff values. KEY WORDS: Colorectal cancer, Lymph node classification systems, Lymph node ratio.

Spontaneous splenic rupture related to anticoagulant and antiaggregant treatment.

INTRODUCTION: Trauma is the most frequent cause of splenic rupture. In contrast to traumatic rupture of the spleen, spontaneous splenic rupture (SSR) is a rare and life-threatening condition. AIM: To present the cases of patients with SSR, who had no history of trauma, and who had been receiving anticoagulant and/or antiaggregant treatment while hospitalised for cardiac reasons. MATERIAL AND METHODS: The cases of 6 patients with SSR at Gastroenterological Surgery Department, Kartal Kosuyolu High Speciality and Training Hospital were retrospectively evaluated. The clinicodemographic factors and the diagnostic and therapeutic methods utilised for these patients with SSR while hospitalised were investigated as well. RESULTS: Five (83.3%) of the patients were male and 1 (16.6%) was female. The median age of the patients was 71 (61-73) years. Three of the patients had only been receiving antiaggregant treatment, while 2 had only been receiving anticoagulant treatment; only 1 patient had been receiving both anticoagulant and antiaggregant treatments. The decrease in haematocrit (HCT) levels ascertained on the day of SSR diagnosis and the HCT levels ascertained on the day of hospitalisation were statistically significant. All the patients received a blood transfusion. While 5 (83.33%) of the 6 patients had splenectomy, 1 (16.66%) patient received conservative treatment. Mortality was seen in 4 (66.6%) patients. CONCLUSIONS: Spontaneous splenic rupture is a condition that should be taken into consideration in the differential diagnosis of patients hospitalised for cardiac reasons, who are receiving anticoagulant and/or antiaggregant treatment in cases of newly developed abdominal pain and low HCT levels.

Endoscopic and histopathological features of the upper gastrointestinal system polyps: evaluation of 12.563 procedures.

OBJECTIVES: With the widespread use of esophagogastroduodenoscopy (EGD) in recent years, upper gastrointestinal system polyps have started to be encountered more often. Although most patients with gastric polyps are asymptomatic, these are important due to their malign potential, and gastric cancer may develop if left untreated. MATERIAL AND METHODS: Records of 12.563 patients who underwent EGD at Kartal Kosuyolu High Specialization Health Application and Research Center for any reason between January 2013 and June 2016 were reviewed retrospectively. Patients with at least 1 histopathologically proven polyp were included in this study. RESULTS: A total of 12.563 endoscopic procedures of the upper gastrointestinal system were investigated and 353 (2.8%) polypoid lesions were detected. Mean age of these patients was 56.3 years and 241 (68.3%) of the patients were female. Gastric polyps were found most commonly in the antrum (50.1%) and of all gastric polyps, 245 (69.5%) were less than 1 cm. Histopathological evaluation showed that hyperplastic polyp (HP) (n= 151, 42.8%) was the most common polyp type, followed by fundic gastric polyp (FGP) (n= 51, 14.4%). Non-polyp gastric mucosa evaluation of 298 patients revealed that 34.9% of the cases were Helicobacter pylori positive, 19.4% had intestinal metaplasia, and 11.4% had atrophic gastritis. CONCLUSION: Polyps of the upper gastrointestinal system are generally detected coincidentally as they have no specific symptoms. Polypectomy is required for gastric polyps because of their potential for malign transformation according to medical evidence.

Gastric cancer with situs inversus totalis: does it really create difficulties for surgeons?

INTRODUCTION: Situs inversus totalis (SIT) is a very rare condition that is seen at a rate of one in about 6000-8000 births. AIM: To offer a general view on the coexistence of SIT and gastric cancer, accompanied by a literature review. MATERIAL AND METHODS: Within the scope of this study, the case of a patient with gastric adenocarcinoma and SIT has been presented. Previous research on gastric cancer cases with SIT was reviewed through a comprehensive search of the PubMed, Medline, and Google Scholar databases. The keywords used to conduct this research were "situs inversus totalis and gastric cancer," "situs inversus totalis and gastric malignant," and "situs inversus totalis and gastric resection." The database search covered English studies published between 2000 and 2016. RESULTS: The results of our literature review revealed 20 studies of patients with gastric cancer and SIT, and 21 related cases. Overall, 12 of the patients were male, 9 were female, and their mean age was 61.8 ±10.97 years. The vascular assessment data showed that three out of the 13 mentioned cases had vascular anomalies. Eleven of the patients had laparoscopic resections, and one of the patients that had a surgical procedure exhibiting a postoperative mechanical obstruction. CONCLUSIONS: The coexistence of SIT and gastric cancer is a very rare condition, and a careful preoperative radiological assessment should be conducted because there can be accompanying vascular anomalies. Laparoscopies and robotic surgeries can be performed for suitable patients at experienced centres, consistent with oncological principles.

Ischemic colitis following infrarenal abdominal aortic aneurysm treatment: Results from a tertiary medical center.

OBJECTIVE: The aim of this study was to investigate the effects of ruptured aneurysm on morbidity and mortality in patients with ischemic colitis (IC) and resection following infrarenal abdominal aortic aneurysms (AAA) surgery. METHODS: Between January 2012 and December 2016, patients who underwent resection for ischemic colitis in our clinic were retrospectively reviewed. Data on the ruptured condition of the aneurysm, the emergency or elective form of aneurysm surgery, treatment method for the aneurysm (EVAR-open) were obtained. The patients were compared and divided into two groups as those with ruptured aneurysm and those without. RESULTS: A total of 275 infrarenal AAA cases were treated by the cardiovascular surgery clinic between January 2012 and December 2016. Fourteen patients (5%) developed ischemic colitis requiring resection. Four (1.8%) patients with EVAR and 10 (17.5%) patients with open surgery were operated because of IC. No statistically significant difference was observed between the two groups in terms of demographic data and surgical procedures. The intergroup comparison did not reveal any statistically significant difference among gastrointestinal (GIS) symptoms, the time period until surgery, the involved colon segment, and the surgical procedures performed. The mortality rate in ruptured AAA group was 83.3%, while it was 62.5% in the non-ruptured AAA group. In spite of the fact that the mortality rate was high in the ruptured group, it was not statistically significant (p=0.393). CONCLUSION: IC is a complication of AAA surgery with a high mortality rate. Rupture in abdominal aortic aneurysm increasing mortality in IC patients. This complication with a high mortality rate following open AAA surgery should be noted by surgeons and we believe that the liberal utilization of laparotomy and early intervention in suspected cases will decrease mortality rates.