Is sporadic colorectal cancer more aggressive in young people and should the age of colonoscopy screening be reduced?

OBJECTIVES: The present study aims to report the incidence of colorectal cancer patients under 50 years of age and to compare its aggressiveness with colorectal cancer patients over 50 years of age. BACKGROUND: Recently, the incidence of colorectal cancer at younger ages has increased, and colorectal cancers in young people have a more aggressive course due to late screening programs. METHOD: The files of patients who were operated for colorectal cancer were reviewed retrospectively. Information on the patients such as gender, age, BMI, type and duration of symptoms, location of the tumor, TNM staging, pathology results, operative procedure, morbidity and mortality rates were recorded. Admission complaints, symptom onset time, tumor locations, pathological findings and tumor stages were compared between patients under and over the age of 50. RESULTS: The incidence of colorectal cancer under 50 was 21 % (56/267). The age group of 40‒49 was found to be the most common age range under the age of 50, with a colorectal cancer rate of 68%. In patients under the age of 50, higher invasion of the tumor to the serosa, low differentiation of the tumor in terms of histological findings in a higher number of patients and higher mucin component of the tumors and higher N2 lymph node involvement ratio and the tumor was located more in the lower rectum were statistically significant when compared to patients over the age of 50 (p=0.026, p=0.018, p=0.002, p=0.042, p=0.006; respectively). CONCLUSION: The incidence of colorectal cancer has increased at younger ages and has a more aggressive course. Screening programs should be modified (Tab. 4, Fig. 2, Ref. 45).

Emergency surgery of the abdominal wall hernias: risk factors that increase morbidity and mortality-a single-center experience.

PURPOSE: Morbidity and mortality are higher in urgently operated abdominal hernia cases compared to elective surgeries. The present study aims to investigate the factors that cause increased morbidity and mortality in emergency surgical operations. METHODS: The files of a total of 426 patients who were operated for non-reducible abdominal hernia between 2015 and 2020 were reviewed retrospectively. Patients' ages, genders, comorbidities, Charlson Comorbidity Index (CCI), ASA score, BMI, hernia types, duration of symptom, laboratory values, intestinal strangulations or necroses, whether intestinal resection was performed, whether mesh was preferred for hernia repair, and rates of morbidity and mortality were recorded. Factors affecting morbidity and mortality rates were analyzed. RESULTS: Factors such as gender, BMI (> 30), duration of symptom (> 24 h), presence of bowel necrosis and resection, type of hernia and prolonged operation time were found to cause an increase in morbidity. In the multivariate analysis, however, gender, duration of symptom and BMI (> 30) were statistically significant factors causing increased morbidity (p = 0.009, p < 0.001, p = 0.032, respectively). Advanced age, high ASA scores, CCI and duration of symptom were determined as factors affecting the increase in mortality. In the multivariate analysis, the effect of high ASA scores and advanced age on high mortality rate was statistically significant (p < 0.023, p = 0.039, respectively). CONCLUSIONS: The mortality rate is higher, especially in elderly patients with high comorbidity. Therefore, we argue that the cases of abdominal wall hernia should be operated under elective conditions even if they do not give any clinical findings to prevent problems in older ages.

Intermammary pilonidal sinus in women. Diagnosis and treatment.

BACKGROUND: Globally, the term pilonidal sinus disease (PSD) is most frequently used for lesions in the sacrococcygeal region. The inter-mammary sulcus is a rare location for pilonidal sinus abscesses. Our study examined the causes of inter-mammary PSD (IMPSD), which is rarely seen in the literature and our treatment approach. MATERIAL: We retrospectively analyzed patients referred to our hospital's general surgery clinic between 2012 and 2018. Twelve patients were operated on for IMPSD during these six years. An excision, including all sinus openings, was planned, and a D-shaped incision was performed. Sinus openings and tracts underlying the skin were excised in toto. Subcutaneous flaps were created to shift the incision from the midline plane to reduce the recurrence rate. The minimum duration for the follow-up was 24 months. Eight patients were suffering from polycystic ovary syndrome. Progesterone and testosterone levels of the patients were normal. Prior studies evaluating PSD and hormone levels of female patients showed no correlation. CONCLUSIONS: IMPSD is a disease that should be kept in mind if induration and abscess in the inter-mammary region are present. The risk of recurrence is high if no proper excision is planned. A D-shaped incision including all sinus tract openings and a midline shift prevented our series' possible recurrences. HIPPOKRATIA 2020, 24(2): 84-87.

Acutely incarcerated abdominal wall hernia: what if it is a consequence?

PURPOSE: The aim of this study was to emphasize the importance of differential diagnosis in patients with acutely incarcerated abdominal wall hernia (AWH). METHODS: The medical records of patients who underwent emergency surgery with preoperative diagnosis of acutely incarcerated AWH and in whom acutely incarcerated AWH was the consequence of increased intraabdominal pressure due to other abdominal emergencies were reviewed. The following data were collected: demographics, the duration between the onset of symptoms and admission, clinical findings, biochemical test results that were abnormal, radiological findings, preoperative and intraoperative diagnosis, operative findings, surgical procedure, different diagnosis made in the postoperative period, reoperation, morbidity, mortality, and the length of hospital stay. RESULTS: Ten patients were included to the study. The primary pathology was found to be perforated peptic ulcer disease in three, bowel obstruction due to neoplastic mass in three, complicated appendicitis in two, acute mesenteric ischemia in one, and acute diverticulitis in one. The correct diagnosis was made during emergency surgery for hernia repair, whereas the primary pathology was identified postoperatively in two patients. CONCLUSIONS: Patients who are diagnosed to have acutely incarcerated AWH preoperatively should undergo further diagnostic workup, if any level of clinical suspicion for differential diagnosis is present. Moreover, the surgeon should consider general abdominal exploration if contradictory findings are encountered during the exploration of the hernia sac, even if preoperative diagnostic studies reveal no gross pathology or non-specific findings.