What should we expect when colon wall thickening is detected on abdominal CT scan in the era of artificial intelligence?

AIM: Except for emergencies, endoscopic findings were investigated in patients with increased thickness of the colon wall on abdominal CT. MATERIAL AND METHODS: Patients who underwent colonoscopy due to the detection of thickening of the colon wall in the abdominal CT performed for non-emergency reasons in the General Surgery Clinic of Health Sciences University Haseki Training and Research Hospital between January 2018 and December 2020 were evaluated retrospectively. Data were obtained by scanning the hospital database. RESULTS: Fifty-four patients who underwent colonoscopy after incidentally detected increased colonic wall thickening determined from the hospital database. Endoscopic examinations revealed tumors in 30 patients (55.6%), inflammatory bowel disease (IBD) in 9 patients (16,6%), nonspesific colitis in 1 patient (1,9%), polyps in 3 patients (5,6%), and diverticula in 2 patients (3.7%). No pathology was detected in 9 patients (16.6%). Patients were aged between 21 and 87 (mean 59,04 years, SD ± 18,54). DISCUSSION: Tumor is the primary endoscopy finding in cases where an increase in colon wall thickness is detected incidentally on abdominal CT, except in emergencies. We performed this preliminary study in the near future to determine the diagnostic algorithm with the use of artificial intelligence in radiology and thus avoid unnecessary investigations. CONCLUSION: In our study, the main reason for the incidentally detected increase in colon wall thickness is the tumor. A diagnostic algorithm can be created with machine learning, a subcomponent of artificial intelligence. KEY WORDS: Artificial intelligence, Bowel wall thickening, Colonoscopy, Computed tomography.

The role of serum nesfatin-1 in a rat model of acute pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a disease that can still be fatal despite rapid advances in medicine. The relationship between serum nesfatin-1 levels and AP is still to be fully resolved. OBJECTIVES: To investigate the utility of serum nesfatin-1 levels in the diagnosis of AP. MATERIAL AND METHODS: Twenty-four male Sprague Dawley rats were divided into control, mild pancreatitis and severe pancreatitis groups (n = 8/group). Acute pancreatitis was induced by cerulein injection and the control group received saline injections. Then, the serum nesfatin-1, amylase, lipase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were determined. A pathologist blinded to the study scored the severity of pancreatitis. RESULTS: There was a considerable decrease in serum nesfatin-1 levels in parallel to the severity of pancreatitis, though there was no statistically significant relationship observed between pancreatitis and nesfatin-1. In addition, there was no significant difference in AST or ALT levels among the groups. However, a strong positive correlation between amylase and lipase levels was observed (p < 0.05). The severe pancreatitis group (group 3) had a higher lipase level and pathology score than mild pancreatitis group (group 2), and this difference was statistically significant. CONCLUSIONS: Serum nesfatin-1 may be used as a diagnostic and severity marker in pancreatitis in the future.

Reliability of Hem-o-Lok clip in laparoscopic appendectomy is an uncharted territory.

AIM: Laparoscopic appendectomy is increasingly used in the treatment of acute appendicitis. We aimed in the present report to evaluate the reliability of the Hem-o-Lok clip used in appendix stump capping for occluding orifice . MATERIAL AND METHODS: In this study, sequential laparoscopic appendectomy cases, in whom Hem-o-Lok clips was employed, in a single center between January 2017 and June 2020 because of acute appendicitis were retrospectively analyzed. RESULTS: The study was completed with a total of 305 cases who underwent laparoscopic appendectomy with hem-o-lok clips within the specified date range. There were no intraoperative complications in any of the cases. The number of women was 94 (30.8%) and the number of men was 211 (69.2%). The average age was 32.7 years. There were 275 (90.2%) patients without appendix perforations and 30 (9.8%) patients with perforations.Postoperative complications occurred in 13 patients. Surgical site infection in five patients, mechanical intestinal in two patients, intraabdominal abscess in five patients, and hematoma at the trocar entry site in one patient were observed. There were no intraoperative complications in any of the patients. CONCLUSIONS: Hem-o-Lok clip can be applied safely in laparoscopic appendectomy for the capping of the appendix stump, with its easy-to-use and low-cost features. KEY WORDS: Acute appendicitis, Laparoscopic appendectomy, Hem-o-lok clip.

Rectus sheath hematoma as a revisited and rare cause of abdominal pain?

OBJECTIVES: Rectus sheath hematoma is the accumulation of blood within rectus abdominis muscle. The aim of this study was to investigate the clinical presentation, diagnostic methods, treatment strategy, and outcomes of patients diagnosed with rectus sheath hematoma. METHODS: Patients diagnosed and treated for spontaneous rectus sheath hematoma between January 2014 and December 2019 were included in the study. RESULTS: A total of 11 patients were diagnosed as spontaneous rectus sheath hematoma, with a median age of 63.5 ± IQR (55.5-73.25). 8 patients were treated by transfusion and medical therapy, while two patients underwent surgery and drainage. One patient was treated with arterial embolization. No mortality was encountered. CONCLUSION: Anticoagulant therapy was a major risk factor. Treatment is mostly based on supportive care to maintain hemodynamic stability. KEY WORDS: Abdominal pain, Hematoma, Interventional radiology, Rectus sheath.

The effects on bacterial translocation and tissue damage of selenium treatment in an experimental intestina ischaemia-reperfusion model.

BACKGROUND: The free oxygen radicals formed with reperfusion following intestinal ischaemia are extremely toxic for the cells. Glutathione peroxidase, an important enzyme that prevents the formation of reactive oxygen species, requires selenium as a co-factor. This study aims to demonstrate the effects of selenium administration on reducing ischaemia-reperfusion damage. METHODS: In this study, 28 male Wistar rats were separated into four groups. To Groups 3 and 4, sodium selenite at the dose of 10 µg/kg/day was administered intraperitoneally for five days. In Groups 1 and 3, laparotomy was applied, and in Groups 2 and 4, following laparotomy, ischaemia was created by clamping the superior mesenteric artery for 45 mins, then reperfusion was provided for 90 mins. Blood, liver and ileum samples were taken from all the animals for examination of malondialdehyde. For examination of bacterial translocation, liver, spleen and mesenteric lymph node tissue samples were taken. A sample taken from the ileum was examined histopathologically. RESULTS: There was determined to be significantly more bacterial translocation in the mesenteric lymph nodes of the ischaemia-reperfusion group (p<0.05). In the histopathological evaluation, the score in the ischaemia-reperfusion group was significantly higher than the scores in the other groups (p<0.05). Elevated serum, liver and ileum malondialdehyde levels in the ischaemia-reperfusion group were significantly higher than those in the other groups (p<0.05). CONCLUSION: Selenium was seen to have decreased serum and tissue malondialdehyde levels and increased the histopathological damage developing in the intestines with ischaemia-reperfusion and thereby increased bacterial translocation.

[Clinical follow-up of patients who ingested narcotic filled bags as a rare cause of mechanical bowel obstruction: case report]. / Mekanik barsak obstrüksiyonunun nadir bir nedeni olrak uyusturucu posetleri yutan iki hastanin klinik takibi: olgu sununu.

Two patients were admitted to the emergency service of Haseki Education and Research Hospital due to ingestion of narcotic filled bags. Incomplete mechanical bowel obstruction developed in one of them. Both patients were treated conservatively with cleansing enema and were discharged from the hospital without any complication. We present clinical follow-up of these patients with literature review.

[Dieulafoy's disease as a cause of massive upper gastrointestinal hemorrhage]. / Masif üst gastrointestinal sistem kanamasina neden olan dieulafoy hastaligi.

Dieulafoy's disease is a rare cause of gastrointestinal hemorrhage. The cause of this disorder is not known exactly but it is generally characterized with massive hemorrhage from the abnormal submucosal vessels. Although abnormal submucosal vessels are mostly seen in stomach, they can also be seen in duedonum, jejunum or colon. In this report we presented a patient who developed massive gastrointestinal hemorrhage due to Dieulafoy disease.