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Öğe Acute Mesenteric Ischemia: Clinical Experience(Aves, 2009) Aslan, Ahmet; Temiz, Muhyittin; Semerci, Ersan; Ozkan, Orhan Veli; Yetim, Ibrahim; Fansa, Iyad; Beyaz, FikretBACKGROUND: Acute mesenteric ischemia (AMI) is a life threatening vascular emergency which requires prompt diagnosis and treatment. The prevention of this cause of high mortality and morbidity depends on early clinical suspicion end timely intervention. In the present study we aimed to analyze the acute mesenteric ischemia cases treated in Mustafa Kemal University Department of General Surgery between January 2004 and December 2008. MATERIAL/METHODS: The clinic records of all the patients who underwent surgical treatment for AMI between January 1, 2004, and December 2008, were retrospectively reviewed. The data from operative records, postoperative complications, mortality, and hospital stay were recorded. RESULTS: The study group included 18 patients. Mean age was 69. There was comorbidity in all patients and cardiac disease and hypertension were the most common ones. The most common laboratory abnormalities were leukocytes, hypoalbuminemia, hyperamylasemia. There was superiorly vascular necrosis in 16 patients; inferior vascular necrosis in one patient. One patient had non occlusive mesenteric ischemia. Segmentery resection was performed to 13 patients. Abdominoperineal resection was performed to the patient with inferior mesenter artery occlusion. We performed duodenotransversostomy on two patients and only laparotomy on two patients. Re-operation was required in 5 patients. Causes of death were multiorgan insufficiency in 7 cases, cardiac death in 2 cases. One patient died due to short intestine syndrome. CONCLUSION: Acute mesenteric ischemia is highly mortal emergency which should always be suspected in elderly patients with cardiac disease suffering from abdominal pain.Öğe Akut mezenter iskemi : Klinik deneyimlerimiz(2009) Aslan, Ahmet; Temiz, Muhyittin; Semerci, Ersan; Özkan, Orhan Veli; Yetim, İbrahim; Fansa, İyad; Beyaz, FikretAMAÇ: Akut mezenterik iskemi (AMİ) erken tanı ve tedavi gerektiren hayatı tehdit edici bir vasküler acildir.Günümüzde hala yüksek mortalite ve morbidite ile seyretmekte olan bu hastalığın önlenmesi erken klinik şüphe ve zamanında müdahaleye bağlıdır. Bu çalışmada Mustafa Kemal Üniversitesi Tıp Fakültesi Genel Cerrahi kliniğinde Ocak 2004- Aralık 2008 tarihleri arasında mezenter iskemi tanısıyla takip edilip opere edilen olgularımızın özelliklerini analiz etmeyi amaçladık. GEREÇ-YÖNTEM: Operasyonda AMİ tanısı konulan olgular retrospektif olarak değerlendirildi. Preoperatif, operatif ve postoperatif bulgular SPSS 16.0 programına yüklenerek istatistiki olarak incelendi. BULGULAR: Değerlendirmeye 18 olgu alındı. Yaş ortalaması 69 idi. En sık Kalp hastalıkları ve Hipertansiyon olmak üzere bütün hastalarda ek morbidite mevcuttu. Lökositoz, Hiperglisemi, Hiperamilazemi, Hipoalbüminemi ve kreatinin yüksekliği saptandı. 16 hastada Superior mezenter vasküler nekroz, 1 hastada İnferior mezenter vasküler nekroz ve 1 olguda nonoklüzif mezenter iskemi saptandı. 13 olguya segmenter rezeksiyon uygulanırken, İnferior Mezenter arter embolisi saptanan hasta abdominoperineal rezeksiyon uygulandı. 2 olguya düodenotransversostomi, 2 olguya sadece eksplorasyon uygulandı. 4 olguya tekrar iskemi gelişmesi, 1 olguda insizyonel evisserasyon nedeniyle reoperasyon uygulandı. Toplam 7 olgu postop multiorgan yetmezliğinden ve 2 olgu kardiyak patoloji nedeniyle eksitus olmuştur. SONUÇ: Mezenter iskemi erken tanının çok önemli olduğu halen yüksek mortalite oranları taşıyan, özellikle kardiyak patolojisi olan karın ağrılı hastalarda ayırıcı tanıda mutlaka düşünülmesi gerekli bir hastalıktır.Öğe Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: A case report(2009) Ozkan, Orhan Veli; Semerci, Ersan; Yetim, Ibrahim; Davran, Ramazan; Diner, Guvenc; Paltaci, IlhanEarly diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed. © 2009 Ozkan et al.; licensee Cases Network Ltd.Öğe Kronik sakrokoksigeal pilonidal sinüs zemininde gelişen skuamöz hücreli karsinom : Bir olgu sunumu(2011) Yetim, İbrahim; Semerci, Ersan; Özkan, Orhan Veli; Paltacı, İlhan; Diner, GüvençPilonidal sinüs hastalığı genellikle sakrokoksigeal bölgede yerleşen, skuamöz epitelle döşeli, kıl içeren sinüslerin oluşturduğu edinsel inflamatuar bir hastalıktır. Etiyolojisi kesin bilinmemekle birlikte, patogenezinde dökülen kılların subkutanöz kistlere penetre olarak yabancı cisim reaksiyonu ve enfeksiyona sebep olduğu kabul edilir. Pilonidal sinus hastalığının sık görülen komplikasyonları sellülit, apse ve fistül oluşumudur. Kronik inflamasyonun bazı malignitelerin etiyolojisinde rol oynadığı bilinmektedir. Malign dejenerasyon, kronik pilonidal hastalıkta çok nadir bir komplikasyondur. Burada uzun yıllar tedavisiz kalmış pilonidal sinüs hastalığı zemininde gelişmiş skuamöz hücreli karsinom tanısı ile cerrahi olarak tedavi ettiğimiz bir olgumuzu sunuyoruz.Öğe Malign kitleyi taklit eden insizyonel endometrioma : İki olgu sunumu(2010) Özkan, Orhan Veli; Semerci, Ersan; Aslan, Erdoğan; Davran, Ramazan; Gökçe, Cumali; Hakverdi, Sibel; Beyaz, Fikret; Akansu, BülentIncisional Endometriozis doğurganlık çağındaki kadınlarda sık görülen klinik bir problemdir. İnsizyon yerleşimli endometriomaya ise nadir rastlanır. Hastalarda genellikle sezaryen veya histerektomi gibi ameliyat öyküsü vardır. Endometriomayı oluşturan dokudan malignite gelişebildiği bildirilmiştir. Jinekolojik bir patoloji olmasına rağmen insizyonel herni ya da karın duvarı tümörleri gibi bulgu verebilmekte ve bu nedenle hastalar genellikle genel cerrahi polikliniklerine başvurmaktadırlar. Biz bu çalışmada doğurganlık çağında olan ve daha önce sezaryen ameliyatı öyküsü bulunan, klinik ve laboratuar olarak malignite şüphesi taşıyan iki olguyu sunduk. Tedavide sezaryen skarındaki kitlelere geniş eksizyon yapıldı ve oluşan fasya defekti primer onarıldı. Patolojik inceleme sonucu kitlelerin endometrium dokusuna sahip endometrioma olduğu saptandı.Endometrioma Mimicking a Malignant Mass: Report of Two CasesÖğe Prognostic Value of Preoperative CEA, CA 19-9, CA 72-4, and AFP Levels in Gastric Cancer(Springer, 2008) Ucar, Edip; Semerci, Ersan; Ustun, Hasan; Yetim, Tugba; Huzmeli, Can; Gullu, MuratIntroduction: Recent research has suggested that serum tumor markers can give valuable prognostic information in gastric cancer. In this study, we examined the relationship between preoperative serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, CA 72-4, and alfa fetoprotein (AFP) levels on clinicopathologic significance in gastric cancer patients. Methods: Preoperative plasma levels of CEA, CA 19-9, CA 72-4, and AFP were retrospectively examined in 95 patients who underwent surgical resection for gastric cancer, and the prognostic value of the tumour markers were estimated. Results: The percentage of CA 19-9, CA 72-4, CEA, and AFP-positive cases were 41%, 32.6%, 24.2%, and 8.4%, respectively. CEA was more frequently positive in the patients with liver metastases (P=0.02). CA 19-9 was more frequently positive in patients with lymph node (P=0.005), peritoneal (P=0.01), and serosal (P=0.03) involvement. CA 72-4 was more frequently positive in patients with lymph node (P=0.01), peritoneal (P=0.03), and liver (P=0.01) involvement. Low 3-year cumulative survival was associated significantly with elevated serum levels of CEA (P=0.001), CA 19-9 (P=0.001), CA 72-4 (P=0.001), and AFP (P=0.01). In multivariate analysis, age, tumor stage, and CA 72-4 were the only independent prognostic factors. Being positive for CA 72-4 was associated with a 3.8-fold higher risk of death (95% confidence intervals: 1.3, 10.9). Conclusion: Our results suggest that high preoperative serum levels of CA 72-4 in gastric cancer patients are associated with a higher risk of death due to gastric cancer.Öğe Rare cause of intestinal obstruction, Ascaris lumbricoides infestation: Two case reports(2009) Yetim, Ibrahim; Ozkan, Orhan Veli; Semerci, Ersan; Abanoz, RecepAscaris lumbricoides is common resident of intestine especially low socioeconomic areas in the world. Complication of Ascaris lumbricoides has been reported include obstruction of the small intestine, intestinal volvulus and intussusception. We report two children with severe sequelae of intestinal obstruction. © 2009 Yetim et al; licensee Cases Network Ltd.Öğe A right sliding indirect inguinal hernia containing paraovarian cyst, fallopian tube, and ovary: a case report(Springer Heidelberg, 2009) Ozkan, Orhan Veli; Semerci, Ersan; Aslan, Erdogan; Ozkan, Sebiha; Dolapcioglu, Kenan; Besirov, ElmirAlbeit very uncommon, the hernia sac may contain unusual structures such as vermiform appendix, acute appendicitis, ovary, fallopian tube and, urinary bladder. Most of the cases of hernia containing ovary and fallopian tubes were reported to be found in children and, often accompanied with other congenital anomalies of genital tract. We present the first case of sliding inguinal hernia containing right ovary and fallopian tube and a right paraovarian cyst in 80-year-old, multiparous patient without any associated genital anomaly. The hernia was repaired with plication darn, while the paraovarian cyst was excised and adnexa were preserved. It is of utmost importance to keep in mind that the hernia sac may contain almost any abdominal organ, and surgical dissection should be carried out accordingly. Pathophysiologically, the ovary might be simply pulled along with a sliding paraovarian cyst or the paraovarian cyst might be accompanying the maldescended ovary. There seems to be a need for clinical and experimental studies to further explain the mechanisms that apply to the pathogenesis of sliding inguinal hernias.Öğe Squamous Cell Carcinoma Arising in Etiology of Chronic Pilonidal Sinus Disease: A Case Report(Derman Medical Publ, 2011) Yetim, Ibrahim; Semerci, Ersan; Ozkan, Orhan Veli; Paltaci, Ilhan; Diner, GuvencPilonidal sinus disease is usually placed in sakrokoksigeal area. The etiology is unknown exactly. The pathogenesis is assumed to deciduous hair penetration into the subcutaneous tissues and a foreign body-type reaction may then lead to formation of an abscess. Cellulitis, abscesses, fistulas are common complications in pilonidal sinus disease. Chronic inflammation may be factors in the development of some malignancies. Malignant degeneration is very rare complication in chronic pilonidal disease. We reported in this case, a squamous cell carcinoma in caused by untreated chronic pilonidal sinus.Öğe Successful localization and removal of two ingested sewing needles: One migrated into the liver and the other stuck in the ascenden colon(Professional Medical Publications, 2011) Aydogan, Akin; Ozkan, Orhan Veli; Yetim, Ibrahim; Semerci, Ersan; Bayramoglu, Elmir; Aslan, Ahmet; Temiz, MuhyittinIngested foreign bodies are mostly spontaneously passed out in the feces. However sharp, long, solid foreign bodies such as sewing needles could cause life-threatening complications. We report a 34 years old female patient with history of two sewing needle ingestion eight years ago. Radio logic images revealed that one of the needles had immigrated to the liver, one impacted the ascenden colon. They were removed via laparotomy with a successful preoperative localization. Foreign bodies which can't be self-extruded and unremoved via laparoendoscopy should be removed with laparotomy after proper localization since they could cause life-threatening complications.Öğe Warfarin dozaşımına bağlı intramural ince barsak hematomu (olgu sunumu)(2011) Yetim, İbrahim; Semerci, Ersan; Özkan, Orhan Veli; Temiz, Muhyittin; Aslan, AhmetAntikoagülanların kontrolsüz kullanımı kanamalara neden olabilmektedir. Warfarine bağlı spontan ince barsak duvarı hematomu nadiren görülen bir komplikasyondur. Warfarin kullanan karın ağrısı olan hastalarda intestinal intramural hematom ayırıcı tanıda düşünülmeli ve bu hastalarda medikal tedavi ön planda uygulanırken seçilmiş olgularda cerrahi tedaviye gereksinim olacağı da akılda tutulmalıdır. Burada spontan intestinal intramural hematom nedeni ile cerrahi olarak tedavi edilen bir olguyu sunarak nadir görülen bu durumu hatırlatmayı amaçladık.Öğe Warfarin Overdose Induced Intramural Small-Bowel Hematoma (Case Report)(Derman Medical Publ, 2011) Yetim, Ibrahim; Semerci, Ersan; Ozkan, Orhan Veli; Temiz, Muhittin; Aslan, AhmetUncontrolled use of anticoagulants may cause bleeding. Warfarin-dependent spontaneous intramural hematoma of the small intestine is a rare complication. Although warfarin using patients with abdominal pain were usually treated medically, surgical interventions should be considered in selected cases with intestinal intramural hematoma. Here we present a patient who was treated surgically to bring to mind this rare condition.
