Current Articles

Suprapubic Transabdominal Injury by Metallic Object: Rare Penetrating Injury Managed with Multidisciplinary Approach

Abdominal injury with a metallic object is a rare condition when war zones are excluded. The foreign body penetrates the body by forming an open wound, and the damage depends on the density of the adjacent organs, the character of the metallic object and the energy of the trauma. In our article; we evaluated the management of a 72-year-old male patient with hypertension, who allegedly injured the suprapubic region with an anchor while engaged in agriculture about an hour before his admission to the emergency room. Hemodynamically stable patient was resuscitated according to the current Emergency Management of Severe Trauma (EMST) guidelines, emergency laparotomy was decided after major vascular injury was excluded by angiography. Result : The V-shaped metallic foreign body was approximately 1 meter long, 3 kg, 5 cm wide and 2 cm thick. By making an incision extending from the entrance of the foreign body to the umbilicus and providing adequate vision; The body was removed under the control of bleeding. There was no major vascular injury in the examination, and the defect in the sigmoid colon meso was repaired ;orthopedic physicians applied debridement for the crack in the pubic tubercle. The patient who received ceftiriaxone, metronidzol, gentamicin antibiotics; He was discharged uneventfully on the 17th postoperative day after the purulent flux from incision was controlled. Angiography is useful in excluding great vessel injury in hemodynamically stable patients with impalement injury and the process requires a multidisciplinary approach.

Accepted: 03.08.2023

An Anatomic Variation to be Consider in Appendectomy: Duplication of Appendix Vermiformis

Appendectomy operation is performed for appendicular pathologies that may occur with different clinical manifestations in all age groups and genders, and congenital anomalies such as duplication, diverticulum, agenesis and atypical localization that can be detected incidentally during surgery are very rarely observed. Appendix vermiformis duplication is a congenital anomaly that should be considered in cases suspected of appendicitis, and there are few case reports in the literature. In this study; a case of appendix vermiformis duplication observed in a 62-year-old male patient who was operated on with the diagnosis of acute appendicitis is presented.

Accepted: 06.06.2023

Lumbar Disc Herniation In A 15-Year-Old Pediatric Patient: Case Report

Lumbar disc herniation (LDH) is a clinical picture with complaints of low back and leg pain that occurs when the lumbar spinal root is compressed by the hernia nucleus pulposus. Although LDH is usually seen in adults, it is less frequently seen in adolescents and children. LDH can cause disruption in education and limitation in social and physical activity in the pediatric population. A 15-year-old female patient applied to our clinic because of the complaints of pain in the lower back and right leg, which started three months ago, and could not get results from the medical and physical therapy. In the examination, the straight leg lift test was evaluated at 30 degrees on the right, the plantar flexion of the right ankle was 4/5, and the right big toe extension was at the 4/5 strength level. Multilevel lumbar disc degeneration was detected in the lumbar magnetic resonance imaging (MRI) of the patient. Microdiscectomy was performed for the right paracentrally located disc herniation in the L5-S1, which was symptomatic, and the root was relieved. In the control examination of the patient, who stated that the leg pain was gone after the operation, the plantar flexion of the right ankle and the extension of the right big toe were 5/5 strength. LDH can occur at any age. In adolescent patients, LDH may occur due to many reasons such as lumbosacral stress, vertebral anomalies, and genetic factors. Recent studies suggest that spinopelvic parameters may play a role in the development of LDH. Although conservative approach is primarily considered in the treatment, if the patient has radiculopathy and motor deficit, and if there is no response to medical and physical therapy at the same time, surgical treatment is inevitable.

Accepted: 06.04.2023

Spontaneous Catheter Replacement After Venous Port Catheterization

Central venous port systems are systems that can be used frequently in patients with chronic diseases that require long-term treatment and need a long-term venous system. In our case, we aimed to present a rare and life-threatening complication due to intracardiac displacement of the port catheter. A 62-year-old female patient who was treated for breast cancer was discharged with a port catheter about 1 month ago and no pathology was detected in the post-procedure controls. After 1 month, the wound was opened in an external center due to swelling and collection in the port pocket, but the patient was referred because the port was not in place. After the examinations were performed by us, the catheter was found to be in the intracardiac region and the patient was taken into surgery. The catheter that could not be removed with minimally invasive methods, a mini-incision was made in the thorax and the pericardium right atrium was reached. The palpable catheter was released with an incision made in the right auricle, and the operation was terminated by closing it appropriately. Although central venous port catheter systems have many advantages for the patient, they can also lead to vital complications after the procedure, as in our case. For this reason, the procedures to be performed should be explained to the patient in detail and their consent should be obtained.

Accepted: 06.04.2023

Reconstruction with Split Thickness Skin Graft in Local Control of Metastatic, Giant Ulcer Breast Cancer

After toilet mastectomy performed in locally advanced breast cancer cases where palliative interventions such as ulceration, necrosis and bleeding , primary non-closable mastectomy defects can be treated with local flaps or skin grafts. The aim of this article is to evaluate the results of patients who underwent reconstruction with split thickness skin grafts. Four patients underwent reconstruction with a split-thickness skin graft prepared from the thigh. There were no complications in the postoperative period. No patient required revision. Although both flap and graft methods are used to treat large chest wall defects after excision of locally advanced breast cancer, graft reconstruction can be safely performed in patients with aggressive disease.

Accepted: 06.04.2023

A Rare Cause of Gastrointestinal Bleeding, A Case of Gastric Leiomyosarcoma

Gastric leiomyosarcom is a rare cause of gastrointestinal bleeding. In this study, we presented a case who consulted with gastrointestinal bleeding symptoms.

Accepted: 06.04.2023

Right Sided Enterothroax: A Rare Long-term Complication of Donor Hepatectomy

Diaphragmatic hernias can be classified as congenital and acquired. Right-sided acquired incisional diaphragmatic hernias are extremely rare. We operated on a patient who had undergone donor hepatectomy about 3 years ago with the diagnosis of strangulated incarcerated incisional diaphragmatic hernia after evaluation in the emergency department. We primarily repaired the small diaphragmatic defect with non-absorbable suture and performed a right hemicolectomy. The patient was discharged uneventfully on the 7th postoperative day. The incidence of post-operative incisional diaphragmatic hernia is between 5-62% in different series, and the postoperative morbidity rate for liver donors is 12-26%. Strangulated diaphragmatic hernias should be kept in mind as a diagnosis in patients who have undergone liver surgery. The approach to the patient should be determined according to the clinic, imaging and the patient's condition.

Accepted: 06.04.2023

Spontaneous Pneumodiastinum, A Rare Condition in Pediatric Asthma

Spontaneous pneumomediastinium is a rare condition in pediatric patients. It may originate from the trachea, esophagus or organs that may be connected to the mediastinum in the mediastinum. We present a case of pneumomediastinium with subcutaneous emphysema at the age of 4 admitted to our emergency department. A 4-year-old male patient with known asthma was brought to the emergency department with respiratory distress. The general condition of the patient was good. Body temperature was 36.5 0 C, blood pressure was 100/60 mmHg in the right arm, pulse was 125/min, respiratory rate was 18/min, oxygen saturation value was 98. The patient's other system examinations were normal, and thoracic tomography imaging was performed due to crapitation in the neck and chest region. As a result of tomography, air densities were observed in the soft tissues in the anterior mediastinum and anterior chest wall. The patient's other system examinations were normal, and thoracic tomography imaging was performed due to crapitation in the neck and chest region. As a result of tomography, air densities were observed in the soft tissues in the anterior mediastinum and anterior chest wall. The Covid-19 polymerase chain reaction test of the patient, who did not find any abnormality in the laboratory examination, was negative. The patient was diagnosed with spontaneous pneumomediastinum due to asthma and was admitted to the intensive care unit for treatment and monitoring. Nasal oxygen support, 1 mg/kg prednol, and bronchodilator treatment were started to the patient. After 4 days of intensive care, the patient's emphysema completely regressed. The patient was discharged from the pediatric service on the 5th day. Spontaneous pneumomediastinum, a rare condition called Hamman's syndrome, is a condition that mostly affects tall, thin adolescent males. Spontaneous pneumomediastinium, which is rare in children with asthma, may also occur due to Covid -19 disease in these days when we are experiencing the pandemic period, so it should not be forgotten in the diagnosis.

Accepted: 17.11.2022

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