ABSTRACT Peptic ulcer perforation is one of the leading causes of acute abdomen, presenting with acute abdominal pain and severe distress for the patient. In one-third of patients, the presentation is less dramatic, resulting in significant delays in diagnosis. Herein, we present a very rarest case operated on for diffuse purulent peritonitis with double perforation of the stomach in a COVID-19-positive patient, which had a depressing outcome.

Double peptic ulcer perforation in a Covid-19 patient, extremely rare entity

Acute mesenteric ischemia (AMI) is a vascular emergency resulting from decreased blood flow caused by the occlusion of the mesenteric vessels, hypoperfusion, or vasospasm. This study aimed to investigate the prognostic value of the fibrinogen-to-albumin (FAR) ratio in patients with acute mesenteric ischemia. A total of 91 patients were enrolled in the study. Patients’ demographics such as age and gender, pre- and postoperative hemoglobin, CRP, white blood cell (WBC), neutrophils, preoperative lymphocyte, alanine transaminase (ALT), aspartate transaminase (AST), thrombocytes, and postoperative D-dimer values were recorded. In addition, pre- and postoperative fibrinogen and albumin levels were recorded, and FAR was calculated. Patients were divided into two groups, survivors and non-survivors. The mean pre- and postoperative fibrinogen levels were statistically significantly higher in the non-survivor group than in the survivor group (p < 0.001). The mean pre- and postoperative albumin levels were significantly lower in the non-survivors than in the survivors (p = 0.059, p < 0.001; respectively). The mean pre- and postoperative FAR ratios were considerably higher in the non-survivor than in the survivor groups (p < 0.001). The change between pre- and postoperative fibrinogen, albumin, and FAR values was statistically significant between the non-survivors and the survivors (for all, p < 0.05). The preoperative and postoperative fibrinogen levels were significantly lower, and albumin levels were significantly higher in the survivor compared to the non-survivor patients with AMI. Furthermore, the preoperative and postoperative FAR ratio was significantly higher in the non-survivors. The FAR ratio may be a valuable prognostic biomarker for patients with AMI. 

https://link.springer.com/content/pdf/10.1007/s42399-023-01451-x.pdf

FAR Ratio as Prognostic Biomarker in AMI

/pdf/mortality-in-acute-arterial-mesenteric-ischemia-a-single-1v7yddz6qd.pdf

Mortality in Acute Arterial Mesenteric Ischemia: A Single-Center Experience

Amac COVID -19 dunya capinda saglik sistemi uzerinde muazzam ve ongorulemeyen bir yuk olusturdu. Elektif genel cerrahi uygulamalarina ek olarak, acil cerrahi vakalarina yaklasim ve hastalarin hastanelere kabulleri de bu beklenmedik sonuctan ciddi sekilde etkilenmistir. Burada, sehrimizde acil cerrahi mudahale gerektiren olgularda kayda deger azalmaya dikkati cekmeyi ve bu durumu aciklamaya calismayi amacliyoruz. Yontem Bu cok merkezli retrospektif calismada, Sakarya ilinde, pandemi oncesi (Ocak 2020- Şubat 2020) ve pandeminin akut fazi (Mart 2020 Ortasi- 2020 Ortasi) donemlerinde yapilan acil cerrahi ameliyatlar karsilastirilmistir. Bulgular Pandemi oncesi hastalarin cinsiyete gore dagilimi erkek hastalarda %53.1, kadin hastalarda %46.9, pandemi sirasinda kadinlarda % 61.6 ve kadin hastalarda %38.4 idi. Hastalarin ortalama yasi pandemi oncesi 54.72 ± 3.65 ve pandemi sirasinda 38.54 ± 2.32 idi ve acil cerrahi geciren hastalarin yas dagilimi acisindan istatistiksel olarak anlamli fark vardi (p <0.05). Pandemi oncesi iki ay boyunca, toplam 290 acil ameliyat yapilirken, akut pandemik donemde, ayni zaman araliginda 164 acil operasyon gerceklestirildi. Pandemik donemde acil cerrahi geciren hasta sayisinda pandemik olmayanlara gore istatistiksel olarak anlamli bir azalma vardi (p = 0.012). Sonuc Acil cerrahi islem gerektiren durumlarda azalmanin nedenleri kismen tanimlanabilir. Bununla birlikte, degisiklik nedenleri su anda aciklanamayan hastalik gruplarinin, gelecekte istenmeyen sonuclari ile karsilasmamak icin daha ayrintili stratejik hazirliga ihtiyac olabilir.

/pdf/the-effect-of-covid-19-on-emergency-surgical-cases-data-from-29oxvyxp0z.pdf

The effect of Covid-19 on emergency surgical cases. Data from a high-volume city.

Amac: Akut apandisit acil cerrahide sik gorulen patolojilerdendir. Genellikle genc yasta gorulen bir hastaliktir. Ortalama yasam suresinin uzamasi ile yasli hasta popu-lasyonunda akut apandisit gorulme oranlari giderek artmaktadir. Bu calismanin amaci, 65 yas ustu akut apandisit nedeni ile cerrahi olarak tedavi edilen hastalarda laparos-kopik ve acik cerrahi yontemlerin sonuclarini karsilastirmaktir. Gerec ve Yontemler: 2011-2018 yillari arasinda Sakarya Universitesi Tip Fakultesi Egitim ve Arastirma Has-tanesi’nde akut apandisit nedeni ile cerrahi tedavi uygulanan 65 yas ustundeki olgular calismaya dahil edildi. Olgular uygulanan cerrahi yonteme gore laparaskopik veya acik apendektomi ve komplike veya nonkomplike apandisit olarak degerlendirilerek siniflandirildi. Tum gruplar yas ortalamasi, cinsiyet, beyaz kure (WBC) duzeyleri, ko-morbid hastalik varligi, ASA skoru, operasyon suresi, oral alimin baslama zamani, hastanede kalis suresi, postoperatif yogun bakim gereksinimi, komplikasyon varligi ve mortalite acisindan degerlendirildi Bulgular: 65 yas ustu apendektomi yapilan 161 olgunun 98’i erkek (% 60,80), 63’u kadindi (% 39,20). Olgularin 109’una (% 67,70) acik apendektomi, 52’sine (% 32,29) laparoskopik apendektomi uygulandigi belirlendi. Acik operasyon uygulanan 109 olgunun 61’inin (% 55,91), laparoskopik apendektomi uygulanan 52 olgunun 22’sinin (% 42,32) komplike akut apandisit oldugu saptandi. Opere edilen olgularin 24’unde (% 14,94), kom-plikasyon gelistigi gozlendi. Komplikasyonlar acisindan laparoskopik opere edilen gruplarla acik apendektomi gruplari arasinda anlamli farklilik saptanmadi (P=0,873). Gruplar yas, cinsiyet, yandas hastalik, ASA skoru ve preoperatif laboratuvar degerleri acisindan benzer ozellikler gostermekteydi Sonuc: Laparoskopik apendektomi yasli ve komorbiditesi yuksek hasta populasyonunda guvenle uygulanabilir bir yontemdir.

/pdf/laparoscopy-versus-open-appendectomy-for-elderly-patients-a-2te6ztk867.pdf

Laparoscopy Versus Open Appendectomy for Elderly Patients: A Single-Center Experience

Objective: Laparoscopic appendectomy is now becoming the gold standard for the treatment of acute appendicitis. Besides, high-cost devices used during the process, the reliability, availability, and cost of the materials used in closing the appendix stump are also important. In this study, we aim to prove that the appendix stump can be secured reasonably and effectively by the guidance of the Karman cannula with a hand-prepared knot. Materials and Methods: In our descriptive study, the Karman cannula used as a knot pusher which can be easily found in every operating room in laparoscopic appendectomies performed between March 2018 and September 2018 in our clinic. Results: 157 males (64,9%) and 85 females (35,1%) included in the study. All patients underwent laparoscopic appendectomy, and the mean operation time was 31.9 ± 10 minutes. All patients discharged on the first postoperative day. Surgical site infection observed in five (2%) patients. Conclusion: The Karman cannula can be used as a safe and inexpensive knot pusher in laparoscopic appendectomies

/pdf/a-new-knot-pusher-used-in-laparoscopic-appendectomy-karman-38aj959vzk.pdf

A New Knot Pusher Used in Laparoscopic Appendectomy; Karman Cannula

Amac: Akut mekanik bagirsak tikanikligi (AMBT) yaygin bir cerrahi acil durumdur. Geriatrik has-talarda AMBO acil vakalarin yaklasik% 12-15'ini olusturur ve% 50'si acil operasyon gerektirir. Bu calismanin amaci AMBO icin ameliyat edilen yaslilarin etiyolojik faktorlerini, tedavi seceneklerini ve sonuclarini gozden gecirmektir. Materyal ve metod: Ocak 2015 - Aralik 2019 tarihleri arasinda AMBT nedeniyle ameliyat edilen 65 yas ustu hastalarin dosyalari geriye donuk olarak incelendi. AMBT'nin etyolojik faktorleri yas, cinsiyet, tikanikligin lokalizasyonu, onceki ameliyatlar, cerrahi prosedur, histopatolojik bulgular ve sagkalim acisindan gozden gecirilmistir. Sonuclar: AMBT olan 281 hastanin yas ortalamasi 73.4 ± 13,69 saptandi. Hastalarin % 53.3'u (n = 150) erkek,% 46.7'si (n = 131) kadindi. Akut mekanik ince barsak tikanikligi (AMIBT) vakalarin % 54.09’nu ve akut mekanik kalin barsak tikanikligi (AMKBT) olgularin % 45.91’u olusturmaktaydi . Kadinlarda AMBO'nun en yaygin nedeni % 14.9 ile fitik iken, erkeklerde% 26.6 ile tumoral neden-lerdi. Tum AMBT olgularinda % 39.5 ile tumorler en sik nedendi. Tumoral nedenler % 44.4 ile en sik mortalite nedeni olarak saptandi. Takiben % 22.2 ile herniler ikinci en sik mortalite nedeni olarak bulundu. Toplam olum orani% 9.6 (n = 27) idi. Mortalite saptanan hastalarin % 66.6'sinda (n = 18) tani AMIBT’ idi. Tartisma: Bu calismada, literaturle uyumlu olarak yasli hasta populasyonunda AMBT’nin en sik gorulen nedenleri tumoral nedenler ve fitiklar olarak saptanmistir; ancak endemik bolgelerde sik gorulen diger nedenler de - bezoarlar gibi- yasli hastalarda AMBT acisindan akilda tutulmalidir.

A Common Surgical Emergency In Elderly: Acute Mechanical Bowel Obstruction

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