Current Articles

A Rare Cause of Colon Perforation: Foramen of Winslow Herniation

Foramen Winslow herniation is an infrequent herniation type among internal hernias. Clinical signs can be various ranging from minimal digestive disorders to the acute abdomen. A sixty-eight-year-old female patient was applied to the Emergency Department with abdominal pain which started almost a week ago. She was diagnosed with intestinal perforation after clinical evaluation,and emergancy surgery was planned. Hepatic flexure and the distal part of the ascending colon were observed herniated under the hepatoduodenal ligament through the foramen Winslow, and ischemic, and perforated at the exploration. Due to the absence of typical clinical findings, and the rarity of this entity, it might be not easy to diagnose the Foramen of Winslow herniation. Delayed diagnosis may result in herniated bowel loops tissue ischemia, and even perforation. There is not any consensus for treatment modality for foramen Winslow herniation. The decision on the treatment could be considered during the operation.

Accepted: 16.07.2024

Clinical Outcome After Debulking Surgery and Systemic Treatment for Peritoneal Carcinomatosis in A Recurrent Breast Cancer Patient: Case Report

It is currently known that metastatic breast cancer (BC) has a poor prognosis. The patients usually undergo palliative surgical procedures and are treated symptomatically. Even if the current guidelines do not recommend surgery in the treatment of abdominal metastases derived from breast cancer, some centers suggest surgical treatment, especially in patients with solitary metastases. Here, we described a unique case of a recurrent breast cancer patient with peritoneal carcinomatosis and irresectable big mass in the right lower quadrant of the abdomen who had complete remission after systemic treatment.

Accepted: 27.05.2024

Bilateral Thalamic and Right Mesencephalon Infarct Following General Anesthesia for Rectum Cancer With Laparoscopic Low Anterior Surgery: An Extreme Case of Perioperative Stroke

Introduction: Bilateral thalamic and right mesencephalon infarct (BTMI) due to perioperative stroke is a rare and undesirable complication following surgery. Many risk factors cause perioperative stroke in clinical practice. We present the successful management of perioperative stroke following laparoscopic abdominal surgery in a patient with rectum cancer. Case report: A 55-year-old female patient was admitted for rectum cancer. She had hypertension in her history. After evaluating the clinical and radiological findings, the patient underwent laparoscopic low anterior resection as total mesorectal excision with a loop ileostomy. The laparoscopic surgery was uneventful, and there was no intraoperative complication. The patient was taken to an intensive care unit and monitored. A lack of cooperation and mild disturbance of consciousness was observed on postoperative one day. A brain computed tomography, magnetic-resonance imaging, ultrasound, and echocardiography showed postoperative cerebrovascular stroke, including bilateral thalamic, right mesencephalon infarct, and nervous abducens injury after a postoperative follow-up. The neurology suggested low-molecular-weight heparin, clopidogrel, and duloxetine. She recovered slightly after medical treatment and was discharged on postoperative fourteen days. The patient is now in the postoperative 10th month with no neurological sequelae. Discussion: A bilateral thalamic and right mesencephalon infarct due to perfusion is a significant complication. After general anesthesia in laparoscopic cancer surgery, cerebrovascular disease can occur. Early diagnosis and treatment of perfusion stroke can reduce morbidity. Conclusion: A multidisciplinary approach is essential to manage bilateral thalamic infarct following general anesthesia in laparoscopic low anterior resection for rectum cancer.

Accepted: 09.01.2024

Petrous Apex Cholesterol Granuloma

Cholesterol granuloma is a granulomatous inflammation in reaction to the cholesterol. It can develop in air cells of the temporal bone. This condition can occur in middle ear cavity, mastoid cells and petrous apex. It is described as one of the most common benign lesion of the petrous apex. Herein, we report a case of cholesterol granuloma in petrous apex with the clinical and radiological findings.

Accepted: 03.11.2023

Metronidazole Induced Encephalopathy and Sudden Hearing Loss – A Case Report

After using medication, patients can apply to the emergency department with neurological symptoms. In this case, we aimed to present a patient with sudden hearing loss, imbalance and speech disorder after metronidazole use. The reason for presenting this case is that unlike other cases in the literature, this is the first case showing that MRI findings regressed with clinical improvement of the patient. A 65-year-old male patient was admitted to the emergency service with sudden hearing loss three days after metronidazole use, followed by speech and balance disorders. Diffusion restriction was observed in the corpus callosum in the magnetic resonance images (MRI), and a hyperintense signal change was observed at this level in the fluid-attenuated inversion recovery (FLAIR) series. Shortly after metronidazole was discontinued, the patient's clinical condition started to improve. The patient, whose previous findings regressed on the subsequent control MRI, was discharged. Drug induced toxicity should be kept in mind in patients presenting with neurological symptoms.

Accepted: 03.11.2023

A Case of Digoxin Toxicity with Hypokalemia

Digoxin is an antiarrhythmic drug that has long been preferred as a treatment modality in patients with heart failure and atrial fibrillation. Hypokalemia and renal failure may increase the serum digoxin levels with several physiological mechanisms. In this case we report an elderly female patient who presented to the emergency department with symptoms of weakness and anorexia. The patient was diagnosed with digoxin toxicity and hypokalemia and renal failure was likely the contributing factors for toxicity. The patient received intravenous potassium replacement and symptoms resolved rapidly. This case focuses on the effects of chronic diseases on serum digoxin levels in patients receiving digoxin therapy and the importance of regular monitoring of serum potassium levels.

Accepted: 03.11.2023

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

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