A New and Effective Technique in the Endoscopic Treatment of Obesity and Regulation of Diabetes: The Pyloric Revision.

AIM: This study aimed to investigate the role of the functional structure of the pylorus in obesity and diabetes and to determine the efficacy of a new method, pyloric revision (PR), in the treatment. METHODS: The pyloric structures of the patients who applied for endoscopic obesity treatment were examined, and the patients were classified as normotonic (NP), hypotonic (HP), and atonic (AP) according to their pyloric structures. PR was applied to those with pyloric structural disorders. Patients with NP were also given the preferred endoscopic treatment (balloon, botulinum toxin, Kanlioz technique). In addition, the pre-procedure fasting blood glucose (FBG) and glycated hemoglobin levels (HbA1c) of the patients were compared with the sixth-month post-procedure status. In order to compare the pyloric structure and other parameters in normal weights with the obese group, a second group of 100 normal-weight (BMI<25) individuals was formed and compared with the study group. RESULTS: In patients with HP (93 patients) and AP (61 patients), a statistically significant decrease was found between HbA1c and FBG levels before treatment and six months after treatment (p˂0.02, p<0.001, respectively). There was a statistically significant difference in favor of the endoscopic obesity treatment group (EOTG) in terms of pyloric disorder, HbA1c, and FPG levels between the EOTG and the normal weight group (NWG) (p<0.0001). CONCLUSION: We recommend using PR as an easy-to-perform, effective, minimally invasive, reproducible, and cost-effective technique that does not require hospitalization.

Comparison of 'primary repair' and 'placing a drain without repair' methods in duodenum perforations.

BACKGROUND: Duodenal ulcer perforation is a serious condition. A number of methods have been defined and used in surgical treatment. In this study, it was aimed to compare the effectiveness of 'primary repair' and 'drain placement without repair' methods in duodenal perforations using an animal model. METHODS: Three equivalent groups of ten rats each were formed. Perforation was created in the duodenum in the first (primary repair/sutured group) and the second group (drain placement without repair/sutureless drainage group). In the first group, the per-foration was repaired with sutures. In the second group, only a drain was placed in the abdomen without sutures. In the third group (control group), only laparotomy was performed. Neutrophil count, sedimentation, serum C-reactive protein (CRP), serum total an-tioxidant capacity (TAC), serum total thiol, serum native thiol, and serum myeloperoxidase (MPO) analyses were performed on animal subjects in the pre-operative period and on the post-operative 1st and 7th days. Histological and immunohistochemical (transforming growth factor-beta 1 [TGF-ß1]) analyzes were performed. Blood analysis, histological, and immunohistochemical findings obtained from the groups were compared statistically. RESULTS: There was no significant difference between the first and second groups, except for the TAC on the post-operative 7th day and MPO values on the post-operative 1st day (P>0.05). Although tissue healing was more pronounced in the second group than in the first group, there was no significant difference between the groups (P>0.05). TGF-ß1 immunoreactivity observed in the second group was found to be significantly higher than in the first group (P<0.05). CONCLUSION: We think that the sutureless drainage method is as effective as the primary repair method in the treatment of duo-denal ulcer perforation and can be safely applied as an alternative to the primary repair method. However, further studies are needed to fully determine the efficacy of the sutureless drainage method.

Total Gastrointestinal Flora Transplantation in the Treatment of Leaky Gut Syndrome and Flora Loss.

Introduction The aim of this work was to treat patients with leaky gut syndrome (LGS) and gastrointestinal flora loss in a simple, inexpensive, permanent and effective way without the need for further treatment. Methods A total gastrointestinal flora transplantation (TGFT) procedure is performed by simultaneously transferring the "flora" taken from approximately 30 different anatomical sites, from the mouth to the anus, of healthy donors to the corresponding anatomical site of the patient using the endoscopic lavage method. Results Of the patients, 25 (44.6%) were female and 31 (55.4%) were male, totaling 56 (100%). The mean age was 32.88±15.78 years. Among the 56 patients enrolled in the study, TGFT had no efficacy in one patient, five patients underwent repeat TGFT during a mean follow-up period of 23.73±16.74 months, and the treatment was permanent in 50 patients; our success rate during the follow-up period was 89.3%. Conclusion In LGS, TGFT should be the gold standard treatment.

A comparison of crystal phenol treatment, midline primary closure and Limberg flap reconstruction methods in female patients with primary pilonidal sinus disease.

Pilonidal sinus disease (PSD) is a chronic problem often occurs in healthy hirsute men, however, women may also be affected. A range of conservative techniques to surgical flaps have been used to treat this condition. Currently, midline primary closure (MPC) is considered the standard of therapy; however, no statistically significant difference has been noted between primary versus secondary (Karydakis flap or Limberg flap) closure. Recently, flap reconstruction methods have been applied and superiority of these methods have been shown. Treatment methods should be employed to the individual, taking into account recurrence and complication rates of the method, recovery time, patients' preference and surgeon's skill. KEY WORDS: Crystal Phenol Treatment, Female Patient, Pilonidal Sinus, Limberg Flap Reconstruction, Primary Midline Closure.

Pilonidal Sinus Disease: An Analysis of the Factors Affecting Recurrence.

OBJECTIVE: To assess the success of treatment methods at reducing recurrence, the most important problem in pilonidal sinus disease (PSD), along with factors affecting the occurrence of PSD and posttreatment recurrence. METHODS: The researchers retrospectively analyzed files of patients treated for PSD between 2003 and 2018. Three study groups were created: G1, G2, and G3. G1 included all PSDs with recurrence, and a comparable number of cases without recurrence were selected randomly for the G2 group. The control group, G3, included healthy individuals without PSD. In all groups, the following were recorded: body mass index, skin color and oiliness, family history of PSD, hair overgrowth, smoking habit, time spent sitting per day, and number of baths per week. The following were additionally recorded for G1 and G2: treatment methods, follow-up periods, pretreatment abscess(es), and time of onset of complaints before treatment. The number of recurrences and the period between last treatment and recurrence were also recorded for G1. RESULTS: G1 comprised 234 patients; G2, 247 patients; and G3, 128 healthy individuals. The significant factors causing recurrence included body mass index, family history, bathing habits, hair overgrowth, skin color and oiliness, time spent sitting per day, smoking habit, abscess(es), and duration of symptom(s) (P < .05). Limberg flap repair was the most successful treatment method. Sixty-three (27%), 135 (58%), and 185 (79%) recurrences occurred in the first 6 months, in the first year, and in the first 2 years, respectively. CONCLUSIONS: The researchers recommend Limberg flap repair for treatment. It is possible to reduce recurrence by taking preventable factors into consideration.

Efficacy of Intragastric Balloon Placement and Botulinum Toxin Injection in Bariatric Endoscopy.

BACKGROUND: To evaluate the results obtained from the combination of intragastric botulinum toxin A (IGBTA), intragastric balloon (IGB), and IGBTA(+)IGB in the treatment of obesity. MATERIALS AND METHODS: Three separate treatment groups were set up. IGBTA, IGB, and IGBTA(+)IGB were administered to Group 1, 2, and 3, respectively. The body mass indexes (BMI) of patients were measured before and 6 months after the treatment. The intragroup and intergroup treatment results have been evaluated. P<0.05 was considered significant. RESULTS: The mean BMI decreased by 1.6 kg/m in 40 patients who received IGBTA in group 1 (P<0.001), 3.95 kg/m in 42 patients who received IGB in group 2 (P<0.001), and 4.9 kg/m in 39 patients who received IGBTA and IGB in group 3 (P<0.001) after 6 months of treatment. The intolerance because of the application was the highest in group 3, followed by group 2. CONCLUSION: The treatment was most successful in group 3 followed by group 2 and group 1, respectively. The authors recommend the group 3 treatment, provided that nausea, vomiting, and flatulence have a high index of probability in such a treatment. However, when deciding between group 1 and group 2 treatments, the authors recommend opting for group 2 treatment that shows to be more efficient.

How Taking into Account the Pyloric Tonus Contributes to Treatment Success While Administering Gastric "Botulinum Toxin A" for Weight Loss.

PURPOSE: To analyze how considering the structure of normotonic pylorus (NP) or hypotonic pylorus (HP) contributes to treatment success in patients administered gastric botulinum toxin A for weight loss. MATERIALS AND METHODS: We measured body mass indexes (BMIs) of the patients who applied for gastric botulinum toxin A (BTA) for weight loss, before and 6 months after the procedure. The patients' pylori were classified as normotonic pylorus (NP) if, during endoscopy, they had a normal peristaltic motion and was closing completely, and as hypotonic pylorus if they were not closing properly or were aperistaltic. We compared the patients' mean pre-operative and 6-month post-operative BMIs. The groups were compared using the chi-square test where a p Ë‚ 0.05 was considered significant. RESULTS: The study included 178 patients administered gastric BTA. In the assessment made without considering the pyloric structure, the mean BMI decreased from 34.76 ± 7.65 to 33.09 ± 7.80 kg/m2, while the difference was not statistically significant (p Ë‚ 0.06). Conversely, in the analysis performed considering the structure of pylorus, the mean pre-operative BMI of the 45 patients with HP structure was 35.16 ± 7.07 kg/m2 which decreased to 35.11 ± 7.03 kg/m2 6 months after the procedure; hence, the difference was not statistically significant (p Ë‚ 0.7). The mean pre-operative BMI of the 133 patients with NP structure, 34.63 ± 7.84 kg/m2, decreased to 32.40 ± 8.05 kg/m2 6 months after the procedure and the difference was statistically significant (p Ë‚ 0.05)*. CONCLUSION: We advise to be selective in BTA administration and to administer BTA to the patients who, endoscopically, have a NP structure.

Reliability and Educational Features of YouTube Videos About Hernia Operations Performed Using Laparoscopic TEP Method.

PURPOSE: The purpose of this study was to assess the reliability, educational features, and popularity of YouTube videos on inguinal hernia operations using the laparoscopic total extraperitoneal (TEP) method on the basis of objective scoring criteria. MATERIALS AND METHODS: We reviewed the first 50 videos on TEP. To assess the reliability and educational features of the videos, we used the DISCERN questionnaire score (DISCERN), Journal of the American Medical Association Benchmark criteria (JAMAS), and Global Quality Scores (GQS). We then used Video Power Index (VPI) to assess the videos' power on YouTube, and total extraperitoneal scoring (TEPS) to assess their conformity with the medical technique and also the accuracy, quantity, and quality of the information contained therein. RESULTS: In the analysis of the source and contents of videos, the VPI, DISCERN, JAMAS, GQS, and TEPS values of all videos were found to be low. A positive correlation-at a level of 0.988-was found to exist between their number of views and VPI values (r: 0.988, P<0.001). Furthermore, we also observed a positive correlation-at a level of 0.811-between the video's likes and DISCERN scores (r: 0.811, P: 0.004). There was no other statistically significant relationship between other scores and the quantitative features of videos. A positive correlation-at a level of 0.709-was found between the videos' GQS and TEPS (r: 0.709, P: 0.022). No correlation was found among other scores. CONCLUSION: Depending on the scoring criteria, the lower scores obtained by those videos show that they do not provide a sufficient level of reliability and quality information.

Analysis of the Relapse Rates of the Primary Closure and Limberg Flap Techniques in Pilonidal Sinus Surgery.

Background This study aimed to assess the relapse rates at the long-term follow-up of the Limberg flap repair (LFR) and primary closure (PC) methods in the surgical treatment of pilonidal sinus disease (PSD). Methods The records of primary PSDs who underwent LFR and PC due to PSD were retrospectively examined. The study included patients whose surgical intervention was performed at least two years ago. The patients were contacted by phone to obtain information. They were asked whether they had a relapse or not, and their answers were recorded. The recording and analysis were ensured using the SPSS statistical program (IBM Corp, Armonk, NY, US). The groups were compared using the chi-square test. p˂0.05 was considered significant. Results The patients' mean age was 23.68 ± 8.21 years, and their median age was 22 years. The overall follow-up period was 4.38 ± 2.12 years. LFR-treated patients numbered 292; 38 (13.01%) females and 254 (86.99%) males. Of the LFR-treated patients, 23 (7.87%) had a relapse, including five (13.15%) females and 18 (7.08%) males (p˂0.03). PC-treated patients numbered 184; 58 (31.52%) females and 126 (68.48%) males. Of PC-treated patients, 39 (21.19%) had a relapse, including 15 (25.86%) females and 24 (19.04%) males (p˂0.04). The relapse was more than three times higher in PC when compared to LFR (p˂0.01). Conclusion LFR clearly takes precedence over PC. In both methods, the relapse rate is higher in females. We believe that this is due to our tendency to be more limited in resection in women.

Analysis of Incidental Gallbladder Cancer in Cholecystectomies.

OBJECTIVE: To study incidental gallbladder cancer (IGBC) incidence in patients who underwent cholecystectomy. METHODS: The records of patients who underwent cholecystectomy between 2004-2019 were retrospectively reviewed. The demographic information, preoperative radiological findings of the patients diagnosed with gallbladder cancer (GBC), as a result of routine histopathological examination and operation records, were reviewed and findings were recorded. The preoperative radiological records of the patients with GBC and, if any, findings of GBC suspected during surgery were recorded. RESULTS: Between 2004-2019, a total of 6314 patients underwent cholecystectomy. Of the patients, 5404 (85.59%) were female and 910 (14.41%) were male. The median age was 47 years (min:19, max:94) and the mean age was 47.28±14.60 years. Nine out of 6314 patients (0.14%) were diagnosed with GBC by postoperative histopathological examination. All patients with GBC were female and their mean age was 64.33±11.08 years. Two out of nine GBC cases were prediagnosed with GBC in preoperative radiological findings; the remaining seven (0.11%) had IGBC without any preoperative findings. CONCLUSION: Asian populations are reported to have a higher incidence of GBC. Turkey is located in the transition zone between Asia and Europe. However, the GBC rates in our study remain far below the rates reported in Asian publications. We believe that our results may be affected by the predominantly Mediterranean-type diet and the relatively higher socioeconomic level of the region where we conducted our study. Consequently, we recommend routine histopathological examination after cholecystectomies in regions with a high incidence of GBC.

Complications During the Recovery Period After Pilonidal Sinus Surgery.

Introduction The current study aims to identify the complications that occur during the postoperative three-week period, which is considered the period of recovery in patients who undergo pilonidal sinus surgery. This identification of complications will help reduce morbidity and treatment costs and improve return to work. Methods This study included a total of 196 patients who underwent pilonidal sinus surgery by a combination of the resection and Limberg flap techniques under spinal anesthesia between the years 2012 and 2016. The postoperative three-week period was examined as the hospital stay period and the post-discharge period. The complications were classified into two groups: surgical and anesthesia. Results were recorded and analyzed using the SPSS statistical software (IBM Corp., Armonk, NY, US). p˂0.05 was considered significant. Results The female-to-male ratio of the patients was 1:4, whereas their average age was 24.15 years, the median age was 22 years, and the average body mass index was 24.79 kg/m². The average lengths of hospital stay in the postoperative period were 1.10, 2.15, and 3.95 days in patients without complications, all of the patients studied, and patients with complications, respectively. The difference between the groups was found statistically significant (p˂0.001). Conclusion Anesthesia-related and surgical complications were prominent in the postoperative hospital stay and post-discharge periods, respectively. The average length of hospital stay in patients with complications during hospital stay was found to be 3.59 times higher than those without complications. The difference between these two categories was statistically significant (p˂0.001).

Preoperative and postoperative risk factors in laparoscopic cholecystectomy converted to open surgery.

BACKGROUND: Laparoscopic cholecystectomy (LC) is nowadays the gold standard in the surgical treatment of cholelithiasis and gallbladder diseases. But sometimes it may be inevitable to convert it to open surgery to safely end the procedure. OBJECTIVES: In this study, we aimed to investigate the risk factors for conversion to open surgery from LC. MATERIAL AND METHODS: The records of patients that underwent LC in Malatya State Hospital (Malatya, Turkey) between January 2013 and May 2014 were prospectively examined. One hundred and forty-five patients were involved in this study. The patients were divided into 2 groups: LC patients and patients converted to open surgery. For the patients in both groups, the preoperative age, gender, body mass index (BMI), disease history, previous abdominal operations, and preoperative laboratory findings were recorded, as well as the fact if the abdominal ultrasonography (US) and endoscopic retrograde cholangiopancreatography (ERCP) were performed. RESULTS: Of 145 patients involved in this study, 127 (87.5%) were female and 18 (12.5%) were male; their mean age was 46.54 years. Nineteen of the patients were operated on after ERCP due to acute cholecystitis and 6 patients were operated on after ERCP due to choledocholithiasis. In 134 of the patients (92.4%), the operations were completed laparoscopically, while the process was converted to open surgery in 11 cases (7.6%). Male gender, chronic disease history, normal BMI level, increased thickness of the gallbladder wall, increased preoperative blood glucose level, leukocytosis, preoperative ERCP history, grade 3 or 4 (Blauer scoring system) adhesions determined during the operation, and multiple stone presence in the bladder were found to be statistically significant risk factors for conversion to open surgery. CONCLUSIONS: Patients in the risk group should be informed by experienced laparoscopic surgeons about the potential conversion to open surgery and decision on such conversion should be made when necessary.

A comparative analysis of four different surgical methods for treatment of sacrococcygeal pilonidal sinus.

OBJECTIVES: Although many surgical methods have been described for sacrococcygeal pilonidal sinus treatment, the best option is still controversial. We aimed to compare postoperative outcomes of these different methods in terms of advantages and disadvantages. METHODS: The records of 320 patients undergone surgery for primary or recurrent pilonidal sinus between May 2013 and May 2017 were retrospectively analyzed. Demographical data, pre operative stories, wound site infection, seroma development, wound dehiscence, time of healing, duration of return to work, and if there is any recurrence of 303 patients included in the study were recorded. Upon wide local excision, the first surgeon performed marsupialisation and the lay open technique, second surgeon performed vertical excision and primary closure, third surgeon performed Limberg flap transposition and fourth surgeon performed Karydakis' flap transposition. RESULTS: There was no significant difference between the patients in terms of demographical characteristics. The duration of surgery was statistically significantly higher in primary closure method (p = 0.001). The mean duration of return-to-work was statistically significantly lower in primary closure method (p = 0.002). In primary closure method, the recurrence rate was found to be statistically significantly higher than the other methods (p = 0.009). CONCLUSION: We do not suggest the use of primary closure method in treatment of pilonidal sinus. Because of lower rates of recurrence and shorter durations of return to work, the Karydakis and Limberg methods are seen as safer methods when compared to lay-open and marsupialization method.

The Relationship of Perforated Appendicitis with Total and Direct Bilirubin.

Introduction Very different results have been reported regarding the relationship between bilirubin and perforated appendicitis. We observed this relationship with our own studies. Methods The patients, who underwent appendectomy, were retrospectively categorized as perforated and non-perforated based on their files. Those with a total bilirubin (TB) 1.20 mg/dL or less were considered normal whereas those with a 1.21 mg/dL or higher were considered having a high. Those with a direct bilirubin (DB) 0.50 mg/dL or less were considered normal whereas those with a 0.51 mg/dL or higher were considered having a high. The patients were assessed under two groups. Perforated appendicitis (PA) and non-perforated appendicitis (NPA) were analyzed according to the TB in Group 1 and the DB in Group 2. Results Group 1 included 269 patients whose TB were measured. Of those, 218 had NPA and 51 had PA. The rate of patients with high TB among the patients with PA was 1.37 times higher than those with NPA (p ˂ 0.01). Group 2 included 258 patients whose DB values were measured. Of those, 208 had NPA and 50 had PA. The rate of patients with high TB among the patients with PA was 1.71 times higher than those with NPA (p ˂ 0.001). Conclusion In the diagnosis of PA, both TB and DB show low diagnostic values. In the diagnosis, they can only be considered as a supportive factor to other parameters. However, in the case of a differential diagnosis, we recommend using DB since it has a higher sensitivity and specificity.

The Correlation Between Delayed Surgical Therapy After the Diagnosis of Pilonidal Sinus Disease and Relapse, Labor Loss, and Costs.

Introduction There has been no detailed study of the relationship between recurrence and symptom duration in pilonidal sinus disease. The aim of this study was to explore the correlation between delayed surgical therapy after symptoms appear in sacrococcygeal pilonidal sinus disease (SPSD) and relapse, labor loss and costs. Methods Patients diagnosed with SPSD were split into two groups according to symptom duration before surgery: 30 days or less (G1) and more than 30 days (G2). Patients included those who underwent Limberg flap reconstruction (LFR) for primary SPSD. The length of hospitalization during surgery, postoperative follow-up period, and, if any, relapse periods were obtained from patients' files. Of the patients with incomplete information, only those whose information was confirmed by phone were also covered by the study. Results G1 included 153 patients, including 37 (24.18%) females and 116 (75.82%) males. The median age in G1 was 22 years and the mean age was 23.08±8.72 years. G2 included 214 patients, including 51 (23.83%) females and 163 (76.17%) males. The median age in G2 was 22 years and the mean age was 22.64±9.06 years. The mean lengths of hospitalization in G1 and G2 were 2.14±0.86 and 2.98±1.04 days, respectively, and the difference between them was significant (p<0.03). The follow-up periods in G1 and G2 were 61.52±29.84 (12-108) and 64.0±31.24 (12-113) months, respectively. Relapse occurred in nine patients (5.8%) in G1 and 19 patients (8.8%) in G2, and the difference between them was significant (p<0.02). The mean relapse period was 3.44±6.01 and 11.23±7.62 months in G1 and G2, respectively, and the difference between them was significant (p<0.04). Conclusion Delayed surgery should be avoided to minimize the costs and the probability of relapse in SPSD.

Ultrasonography in diagnosis of acute appendicitis.

PURPOSE: Acute appendicitis is the most common surgical abdominal emergency. In the early diagnosis of acute appendicitis, the fact that there is no a sign which could be a reliable indicator in most of the patients increases the complications. In this study we aimed to search the relation between Ultrasonography(US) findings in patients with diagnosis of acute appendicitis and postoperative histopathologic investigation on remoced appendix.. MATERIALS AND METHODS: The files of 174 patients who came in our emergency department with lower right abdominal pain were studied retrospectively from January 2013 to May 2014. Of them, 26 patients were excluded, because these patients were not studied with US. US findings and histopathology reports of 148 patients with suspected acute appendicitis and studies preoperatively with abdominal US were enrolled. Greater than 6-mm diameter of the appendix under compression was accepted as positive sign of appandicitis in US. The demographic characteristics of the patients, US findings (acut appendicitis or not) and the pathology results were recorded on the standard proform. RESULTS: Of these 148 patients, 100 were acute appendicitis in preoperative US, and of these 100 patients, 93 histopathologic reports were acute appendicitis, 7 were normal appendices. The sensitivity of US was 75.6 % and specificity was 72 %. Positive predictive value (PPV) was 93 %, negative predictive value (NPV) was 14.6 % and the accuracy of US value was 81.7%. As a result, although US in diagnosis of acute appendicitis is a reliable technique, negative result doesn't mean no acute appendicitis. In order to determine an accurate diagnosis of acute appendicitis clinical and laboratoary findings should be assessed together. KEY WORDS: Abdominal pain, Acute appendicitis, Ultrasonography.

Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients.

The objective of this study was to analyze the clinical benefit of histopathologic analysis of appendectomy specimens from patients with an initial diagnosis of acute appendicitis. We retrospectively analyzed the demographic and histopathologic data of 1255 patients (712 males, 543 females; age range, 17-85 years) who underwent appendectomy to treat an initial diagnosis of acute appendicitis. Patients who underwent incidental appendectomy during other surgeries were excluded from the study. Histopathologic findings of the appendectomy specimens were used to confirm the initial diagnosis. Ninety-four percent of the appendectomy specimens were positive for appendicitis. Of those, 880 were phlegmonous appendicitis, 148 were gangrenous appendicitis with perforation, and the remaining 88 showed unusual histopathologic findings. In the 88 specimens with unusual pathology, fibrous obliteration was observed in 57 specimens, carcinoid tumor in 11, Encheliophis vermicularis parasite infection in 8, granulatomous inflammation in 6, appendiceal endometriosis in 2, and 1 specimen each showed mucocele, eosinophilic infiltration, Taenia saginata parasite infection, and appendicular diverticulitis. All carcinoid tumors were located in the distal appendix. Six of the 11 carcinoid tumors were defined by histopathology as involving tubular cells, and the other 5 as involving enterochromaffin cells. Six patients had muscularis propria invasion, 2 patients had submucosa invasion, 2 patients had mesoappendix invasion, and 1 patient had serosal invasion. All patients with tumors remained disease free during the follow-up (range, 1-27 months). We conclude that when the ratio of unusual pathologic findings for appendectomy specimens is considered, it is evident that all surgical specimens should be subjected to careful histologic examination.

Double Meckel's diverticulum presenting as acute appendicitis: a case report and literature review.

BACKGROUND: Meckel's diverticulum is the most common developmental anomaly of the gastrointestinal tract, affecting 1-3% of the general population. This anomaly is caused by incomplete obliteration of the omphalomesenteric duct during the 7th week of gestation and is located in the last meter of the ileum in 90% of patients. Meckel's diverticulum is often an incidental finding during a laparotomy for other causes, such as acute appendicitis, and occasional complications are bleeding, obstruction, diverticulitis, and perforation. OBJECTIVE: Primary aim of this study was to present and share an extremely rare case of double Meckel's diverticulum. METHODS: A 20-year-old woman who was admitted due to symptoms of right lower quadrant pain, nausea, and vomiting. A laparotomy with a McBurney's incision was performed because of a presumed diagnosis of acute appendicitis. The surgical exploration revealed a double Meckel's diverticulum localized 50 cm proximal to the ileocecal valve, but no acute appendicitis. The operation was finished after a diverticulectomy and appendectomy. No complications occurred during the postoperative follow-up. CONCLUSIONS: We conducted a literature review of studies published in the English language on double Meckel's diverticulum, accessed via PubMed, Medline, and the Google Scholar databases. We found only five case reports of such a Meckel's diverticulum variant.

Breast hydatid cyst mimicking fibroadenoma and malignancy: A case report.

Echinococcus granulosis is known as the cause of hydatid cyst disease. It is often seen in many regions of the world, and can cause serious health problems. This parasite can invade tissues in all parts of the body and produce hydatid cysts, although it has been mainly observed in the liver and the lungs. Breast hydatid cysts are encountered rarely. After physical examination, radiological and serological tests are performed on patients with breast hydatid disease. These examinations are helpful for an early diagnosis, but they are insufficient to make a definitive diagnosis, which can only be made according to the results of histopathological examinations. We had a primary diagnosis of either fibroadenoma or malignancy in the breast during the preoperative period of the present case. A precise diagnosis could only be made by histopathological examinations in the postoperative period.