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Öğe Gallstone ileus as an unexpected complication of cholelithiasis: Diagnostic difficulties and treatment [Kolelitiazisin beklenmedik komplikasyonu, safra taşi ileusu: Tani zorluklari ve tedavi](Turkish Association of Trauma and Emergency Surgery, 2010) Yakan S.; Engin O.; Tekeli T.; Çalik B.; Deneçli A.G.; Çoker A.; Harman M.BACKGROUND Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature. METHODS Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied. RESULTS There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine - required for decubital necrosis from the gallstone - was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were two (16.6%) perioperative mortalities. CONCLUSION Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Gallstone ileus should be suspected in all cases admitted to the emergency service with acute intestinal obstruction with a history of cholelithiasis, especially in the elderly and females.Öğe Gossypiboma mimicking a uistal pancreatic mass: Report of a case(2010) Yakan S.; Oztürk S.; Harman M.; Tekesin O.; Coker A.Gossypiboma (retained surgical sponge) is a pseudotumor within the body that is composed of non-absorbable surgical material with a cotton matrix. Because the symptoms of gossypiboma usually are nonspecific and may appear years after surgery, the diagnosis of gossypiboma may be difficult because the condition may mimic a benign or malignant soft-tissue tumour in the abdomen and pelvis. A 61-year-old woman with a one-year history of left upper-quadrant pain and weight loss was referred to our center. She had undergone peptic ulcer perforation 23 year ago. Physical examination revealed dullness and palpable mass In the left upper abdomen. On examination by computed tomography (CT), a hypodense mass of 12 cm in diameter between the greater curvature of the stomach, pancreas, and splenic hilus was detected. Upon exploration, a mass lesion of 10 cm in diameter was detected between the greater curvature of the stomach and splenic hilus, which caused dense adhesions not In communication with the pancreas. It was excised and a splenectomy was performed. After a macroscopic examination, the mass lesion was diagnosed as gossypiboma. Although ultrasonography (US), CT, angiography, and magnetic resonance imaging (MRI) may be used to diagnose gossypiboma, definitive diagnosis is possibile only upon surgery or histopathological examination. As a result, when an abdominal mass Is observed, surgeons should carefully investigate the patient's past surgical history while taking the possibility of gossypiboma into consideration. © Versita Warsaw and Springer-Verlag Berlin Heidelberg.Öğe Isolated late recurrence of renal cell carcinoma in the inferior vena cava(2010) Kazimi M.; Uguz A.; Yakan S.; Nart D.; Murat Z.; Goker E.; Coker A.Renal cell carcinoma is an urologic malignancy with poor prognosis. Local invasion and distant metastasis determine the prognosis of the disease. Dissemination to inferior vena cava via renal vein is seen in 4-10% of the patients. The role of radiotherapy and chemotherapy is limited, surgery is the only curative treatment option and patients with liver metastasis also benefit from surgery. In patients with vena cava trombosis, cavotomy and trombectomy should be done to prolong survival, if nodal or visseral metastasis is not present. Surgical procedure differs according to location of trombus in inferior vena cava. In our case report, a patient treated with right nephrectomy due to renal cell carcinoma 3 years ago who was re-operated for vena caval trombus is mentioned. Operation was done without using Pringle technique (clamping of hepatic pedicle) by mobilization of the liver with piggy back technique, and after cavotomy and trombus excision, defect in vena cava was reconstructed with PTFE prosthetic graft. Here, we report this case and discuss it in the light of current literature.Öğe Non-operative management of high grade blunt liver trauma: Case report [Yüksek dereceli kunt karaciger travmasina nonoperatif yaklaşim: Olgu sunumu](2010) Kazimi M.; Yakan S.; Farajov R.; Kiliç M.in spite of its well-preserved anatomical position, liver is the most frequently damaged intraabdominal organ in a blunt abdominal trauma. Blunt liver trauma can be an important cause of morbidity and mortality. Recently, with the progress in the imaging techniques for solid organ traumas and the intensive care units, treatment choices have changed direction from surgical to nonsurgical treatments in hemodynamically stable patients with a blunt liver trauma. in this paper, we report a case admitted to the General Surgery intensive Care Unit with high grade (Grade 4) liver trauma due to falling from a high place who was treated conservatively and discuss the case in the light of the current literature.Öğe A rare cause of intestinal hemorrhage: Stromal tumor of duodenum(2004) Yildirim M.; Yakan S.; Doganavşargil B.; Akalin T.Stromal tumor of the duodenum is rarely seen among the gastrointestinal stromal tumors. In this paper, a patient presented with obscure gastrointestinal bleeding and the small bowel endoscopy revealed a bleeding ulcer at the second part of duodenum. The patient underwent segmental duodenectomy. The histopathology of the mass confirmed the diagnosis of duodenal stromal tumor.
