The comparison of short-term results of marsupialization method in operated patients with acute pilonidal abscess and chronic pilonidal sinus.

Objectives: This study aimed to compare the short term results of the marsupialization method for the treatment of patients with acute pilonidal abscess and chronic pilonidal sinus disease treated in single step and to investigate the feasibility of final pilonidal sinus treatment in single step in patients with pilonidal abscess. Material and Methods: A total of 58 patients who were operated on using the marsupialization method were included in this study. Patients with acute pilonidal abscess were included in Group 1 (23 patients) and those with chronic pilonidal sinus disease were included in Group 2 (35 patients). Pilonidal sinus was excised as a whole by a vertical elliptic incision, with some surrounding intact tissue. After excision, the wound edges were sutured to the postsacral fascia. Daily dressings were performed by relatives at home. The patients were instructed to visit the hospital for follow-up 1-2 times a week. Student's t-test was used to compare the parameters between the groups. Results: The mean wound length was 73.4 and 61.7 mm in Group 1 and Group 2, respectively. The mean duration of wound closure was 59.3 and 54.1 days in Group 1 and Group 2, respectively. There was no significant difference between the groups in terms of age, operation time, hospital stay, and duration of wound closure; however, wound length was significantly shorter in Group 2 than in Group 1. Conclusion: The definitive treatment of acute pilonidal abscess can be achieved in single step by using marsupialization method as well as in patients with chronic pilonidal disease.

Ozone Treatment for Chronic Anal Fistula: It Is Not Promising.

The aim of this study is to assess the effect of ozone gas in the treatment of anorectal fistulae. The tip of a 20 G intravenous cannula was inserted from the fistula orifice. Medical ozone was introduced into the fistula. A total of 10 sessions of ozone gas insufflation was performed on alternate days. Treatment was considered to be successful if fistula discharge ceased and the outer fistula orifice closed; however, if discharge was continued or outer fistula orifice was open, the treatment considered to be failed. A total of 12 adult patients were included in the study. The fistula was closed in three patients (25 %), in nine patients (75 %) without closure. In one patient who had fistula closure, the fistula recurred after 2 months. Patients did not express any discomfort during ozone insufflation. There were no side effects or complications due to ozone insufflation. The success rate of ozone insufflation in anorectal fistulae closure is low.

The Role of Doctors and Patients in Appendicitis Perforation.

In this study, we aimed to determine factors that cause appendix perforations and to identify the role of physicians and patients in contributing to the cause of these perforations. This study was conducted between April 2010 and May 2015 and included 64 patients with perforated appendicitis. Patients' medical records were examined for factors that might have contributed to perforation, and the roles of patients and physicians in perforation appendicitis were evaluated. The perforation rate of patients with appendicitis was 16.0 per cent. The average duration from symptom onset to hospital admission was 4.4 days (29 patients were admitted to hospital within two days, 35 were admitted later). In total, 38 patients had visited a different hospital before admission. Furthermore, six out of 26 patients who had not visited any other hospital had consumed analgesics. Factors contributing to appendix perforation included misdiagnosis at the patient's initial visit (56.0%), delayed admission to hospital (11.0%), and use of analgesics (9.0%). The cause of perforation was mostly physician-related in children and adults, and patient-related in older adults.

The comparison of the effectiveness of tomography and Alvarado scoring system in patients who underwent surgery with the diagnosis of appendicitis.

OBJECTIVE: The aim of this study is to compare the effectiveness of computed tomography and Alvarado scoring system in the diagnosis of acute appendicitis in patients who underwent appendectomy with the preliminary diagnosis of acute appendicitis. MATERIAL AND METHODS: One hundred and one patients who underwent appendectomy with the diagnosis of acute appendicitis between January and December 2011 were included in the study. Alvarado scores were calculated, and abdominal tomography scans were obtained for each patient before surgery. Patients with Alvarado score ≥7 were considered to have appendicitis while patients with a score <7 were considered not to have appendicitis. Patients were classified into two groups based on the presence of appendicitis findings on abdominal tomography. Histopathological examination of the appendices was performed following appendectomy. All patients were classified into groups according to pathology results, Alvarado score and tomography findings. The effectiveness of Alvarado score and tomography were compared using the McNemar test. RESULTS: Sixty patients (59.4%) were male and 41 (40.6%) were female, with a mean age of 32 years (5-85 years). The rate of negative appendectomy was 3.9%. In 78 patients (77.3%) the Alvarado score was ≥7, while 23 patients (22.7%) had Alvarado scores <7. The presence of appendicitis was determined by histopathology in 22 out of 23 patients whose Alvarado score was <7. Tomography indicated appendicitis in 97 patients (95.9%) whereas four patients (4.1%) exhibited no signs of appendicitis by tomography. However, histopathological evaluation indicated the presence of appendicitis in those four patients as well. CONCLUSION: The study results imply that tomography is a more effective means of diagnosing acute appendicitis as compared to the Alvarado scoring system.

Scar Endometrioma: An Uncommon Yet Easily Treated Condition.

OBJECTIVE: To illustrate and emphasize the need for keeping scar endometrioma in mind in order to facilitate an early diagnosis in cases of a mass detected on the abdominal wall in women who have undergone a cesarean section. STUDY DESIGN: Records of 21 patients were reviewed retrospectively. All the patients complained of a mass on the abdominal wall and had undergone cesarean section in the past. Endometrioma was confirmed histopathologically for each patient. Information about the characteristics of the patients are retrieved from the patient records and analyzed. RESULTS: The average age of patients was 31 years. The average duration before onset of the complaints in the postcesarean section period was 32.9 months, and the average duration of the complaints was 25.3 months. In most cases (62%) the scar endometrioma was located at the right end of the Pfannenstiel incision. The average size of the endometrioma masses was 30 mm. Recurrence was not observed in any of the patients during an average follow-up of 31.3 months after total excision. CONCLUSION: Scar endometrioma is a rare disease which can be treated easily. If a mass on a cesarean section scar which becomes sensitive during menstruation is detected in a patient with history of cesarean section, the diagnosis of scar endometrioma should be suspected.

A Rare Parasitic Infection: Primary Intradural Extramedullary Hydatid Cyst.

Echinococcus granulosus infrequently induces spinal hydatid cysts, and intradural hydatid cysts are extremely rare among these spinal hydatid cysts. We report a 30-year-old man with a history of progressive back pain caused by a previous back injury. Magnetic resonance imaging revealed a spinal intradural cystic lesion. After surgical removal, histopathological diagnosis was a hydatid cyst. The patient had no other symptoms of systemic hydatid cyst disease. Diagnosis of hydatid cyst should be considered prior to surgery, especially in young patients with spinal intradural cystic lesions, as leakage of the hydatid cyst's fluid during surgery is a frequent case of recurrence.

A Case of Duodenal Obstruction and Pancreatitis Due to Intragastric Balloon.

BACKGROUND: Intragastric balloons have several advantages such as easy placement and low complication rates over other bariatric procedures. It is very rare for intragastric balloons to dislodge and give rise to pancreatitis. In this article, we present a case of duodenal obstruction caused by a gastric balloon leading to pancreatitis. CASE REPORT: A 38-year-old obese female patient had undergone intragastric implantation one month before admission. The patient was admitted to our hospital because of sudden onset of abdominal pain. On the abdominal ultrasonography and tomography, edematous pancreatitis and cholelithiasis were observed. The patient was given medical treatment for pancreatitis. Abdominal ultrasonography was repeated on the next day, and a distended gallbladder was revealed. Thus, the patient was operated on with the pre-diagnosis of acute cholecystitis and biliary pancreatitis. Laparoscopic cholecystectomy was performed. During the operation, a hard and trapped object was determined in the second part of the duodenal lumen. The patient was reevaluated on the second postoperative day as her pain had increased. On direct abdominal X-ray and computed tomography scan, the tubular part of the gastric balloon was found to be stuck in the duodenum. A gastroscopy was performed, but the balloon could not be removed. Therefore, an immediate laparotomy was performed, and the balloon was removed via gastrotomy. CONCLUSION: Although intragastric balloons are designed to reduce the risk of displacement, all unexpected patient complaints should lead to a thorough examination of the position and status of the balloon.

A prolapsed intraductal papilloma: a case report.

Intraductal papillomas (IP) are benign papillary lesions caused by proliferation of mammary ductal epithelium. IP occurs in the breast tissue. Prolapse of IP from nipple can be rarely seen. IPs are generally treated with total excision. A 31-year-old female patient was admitted to our clinic because of a protruded lesion from the nipple of her right breast. On her breast examination, an 8 mm- prolapsed mass was seen on the areola of her right breast. Breast ultrasonography showed no other lesions in the breast. The patient was operated with initial diagnosis of IP. The prolapsed mass, the overlying nipple skin and related ductus were totally excised under local anesthesia. Histopathological examination of the specimen revealed intraductal papilloma without atypical dysplasia. Herein, we are presenting a rarely encountered case of IP prolapsed from the nipple of a female patient.