A rare case of perforated Meckel's diverticulum presenting as a gatrointestinal stromal tumor

Meckel's diverticulum is located on the antimesentric border of the ileum, approximately 45 to 60 cm proximal to the ileocecal valve, and results from incomplete closure of the omphalomesentric or viteline duct. Common complications presenting in adults include bleeding, obstruction, diverticulitis, and perforation. Tumors within Meckel's diverticulum are a rare, but recognized complication. A 62 year-old woman presented with peri-umbilical pain that had localized to the right iliac fossa. On examination, she was tender in the right iliac fossa, with localized peritonism. At surgery,a perforated Meckel's diverticulum was found that was associated with free intra-abdominal fluid and hemorrhage. A 25 mm nodule was found at the apex of Meckel's diverticulum. We resected 100 mm of the small bowel and a primary anastamosis was performed. Histopathological examination of the resected lesion revealed a mesenchymal tumor categorized as a gastrointestinal stromal tumor (GISTs). GISTs arising from Meckel's diverticulum are an extremely rare, but recognized complication. Surgery is considered the standard treatment for non-metastatic GISTs with enbloc resection and clear margins.

Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history

Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. Although a consensus has been built on its etiology and pathogenesis, the same course has not progressed for treatment modality. This review is a short article about the process of pilonidal sinus disease from past to present. Some important points were mentioned between the years 1833, which is accepted as the milestone for the awareness of the disease, in which it was first reported until the year of 1880, in which it was given its name. Although its name has been the same for about two centuries, some other names such as "Jeep Disease" have also been used depending on the population affected by the disease. At present, it is indisputable that the disease is acquired. Large series were presented about the treatment in the last two decades. Some surgical methods were even named after the ones who first described them and they have many supporters. However, since the treatment modalities have some advantages and disadvantages and they do not have marked superiority over others, debates still continue. We hope that pilonidal sinus disease will not lose its significance and be underrated in parallel with the developments in technology and specialization in medicine.

Ileus due to Meckel's diverticulum: case reports

Meckel's diverticulum is the most common congenital anomaly of the small intestine, with an estimated incidence of approximately 1-3% in the general population. Intestinal obstruction is the most common complication in adult patients. Since accurate diagnosis before the operation is difficult, decision for surgery is delayed, and serious problems may be encountered. Here in, we present the diagnosis and management of our patients with intestinal obstruction due to Meckel's diverticulum.

Effect of bariatric surgery on humoral control of metabolic derangements in obese patients with type 2 diabetes mellitus: How it works

Obesity and diabetes is a co-pandemic and a major health concern that is expanding. It has many psychosocial and economic consequences due to morbidity and mortality of this disease combination. The pathophysiology of obesity and related diabetes is complex and multifactorial. One arm of this disease process is the genetic susceptibility. Other arm is dependent on the intricate neuro-humoral factors that converge in the central nerve system. Gut hormones and the adipose tissue derived factors plays an important role in this delicate network. Bariatric surgery provides the only durable option for treatment of obesity and furthermore it provides a remission in the concomitant diseases that accompany obesity. This review provides a brief insight to all these mechanisms and tries to deduce the possible reasons of remission of type 2 diabetes after bariatric surgery.

Intestinal malrotation in an adult: case report

Intestinal malrotation is a developmental anomaly of the midgut in which the normal fetal rotation of intestines around the superior mesenteric artery and their fixation in the peritoneal cavity fail. Rotational anomalies of the midgut are rare in adults. Operative intervention is required generally when they are symptomatic. While difficult to diagnose, prompt recognition and surgical treatment usually lead to a successful outcome. Intestinal malrotation is rarely asymptomatic and generally diagnosed incidentally in adults. In the present report, a case of incidental intestinal malrotation with clinical findings of small bowel obstruction is discussed with a literature review.

Ingested bone fragment in the bowel: Two cases and a review of the literature

Generally, ingested foreign bodies are excreted from the digestive tract without any complications or morbidity. In adults, ingestion of foreign bodies frequently occurs in alcoholics and elderly individuals with dentures. The most commonly ingested foreign bodies are food stuffs or their parts, such as fish bones or fragments of bone and phytobezoars. Sharp foreign bodies like fish and chicken bones can lead to intestinal perforation and peritonitis. We report herein two cases, one of bowel perforation and another of anal impaction, both caused by ingested bone fragments. Complications due to ingested bone fragments are not common and preoperative diagnosis remains a challenge and therefore it must be considered in susceptible cases.

Prevention of bacterial translocation using glutamine and melatonin in small bowel ischemia and reperfusion in rats

BACKGROUND

Ischemia/reperfusion (IR) injury of the intestine is a major problem in abdominal pathological condition and is associated with a high morbidity and mortality. The purpose of the study is to determine whether glutamine and melatonin can prevent BT of small intestinal IR injury in rats.

METHODS

Forty Wistar-albino rats with a weight of 200 to 250 g were used in the study. They were randomly divided into four groups (n=10 for each group): sham operated group (Group I), IR group (Group II), IR+ glutamine treatment group (Group III) and IR+ melatonin treatment group (Group IV). All animals were given 10(10) E. Coli by orogastric intubation 12 hours before sampling. Seventy-two hours after the first operation, mesenteric lymph node and blood samples were obtained and cultured Two cc blood samples were obtained for a Polymerase chain reaction study. A piece of terminal ileum was also sampled for histopathologic examination.

RESULTS

Mesenteric lymph node and blood cultures of all control animals were positive for microbiological growth, and polymerase chain reaction results were positive in seven of the eight rats. Histopathologically, edema, vasodilatation and inflammatory cell infiltration were found to be less in the other groups in comparison to the control group. The incidence of bacterial translocation was decreased in all treatment groups as compared to the control group.

CONCLUSIONS

Glutamine and Melatonin reduced the incidence of BT in intestinal I/R. rats. These results suggest that glutamine and melatonin would be clinically useful in the treatment of intestinal I/R injury.

[Primary omental torsion as a cause of acute abdomen: case report]

Torsion of the omentum is a rare pathology that was described 100 years ago. The characteristic appearance of omental torsion and a review of the literature are presented with respect to a case of primary omental torsion that was causing acute abdomen. Excision of the ischemic omentum is the proper treatment for omental torsion.

[Evaluation of an acute mechanic intestinal obstruction case secondary to diaphragm rupture due to a blunt trauma]

Rupture of the diaphragm after blunt trauma is uncommon. In this report, a 24-year-old male with intestinal obstruction who underwent laparotomy is presented; he had been involved in a traffic accident three years prior to presentation to our emergency service. We conclude that diaphragma ruptures may cause herniation of abdominal organs and intestinal obstruction, and thus should be repaired when diagnosed.

Are postoperative drains necessary with the Karydakis flap for treatment of pilonidal sinus? (Can fibrin glue be replaced to drains?) A prospective randomized trial

PURPOSE

Different surgical techniques for pilonidal disease have been described in the literature. In this study, our aim was to evaluate the influence of routine cavity drainage in the Karydakis flap technique.

METHODS

As much as 50 male patients with pilonidal sinus who underwent the Karydakis flap operation were evaluated prospectively.The patients were assigned randomly into two groups (Group 1 with suction drain; Group 2 fibrin glue).

RESULTS

Fluid collection was encountered in 8 out of 50 patients (6.25%): 6 in Group 2 (24%) of which 4 experienced superficial, healed with simple dressing, the other 2 with substantial dehiscence healed with wound dressing; 2 in Group 1 (8%) were treated with wound punctures.There has been no recurrence in any of the patients during the follow-up period.The Karydakis flap operations can be performed with a near zero recurrence rate with the use of drains.

CONCLUSION

We recommend the use of fibrin sealant with Karydakis flap procedure, but further studies are needed to confirm this conclusion.