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

Bezoars are indigestible masses of material forming within the gastrointestinal system. Phytobezoars are the most common subtype consisting of plant matter such as fibre, skins, and seeds. Rarely they present causing small bowel obstruction (SBO) and may be difficult to distinguish from faecalization on imaging. Here we present the case of a man in his 70s who rapidly consumed an expiring bag of peanuts and subsequently developed a SBO due to formation of a peanut phytobezoar. After failing conservative management, he required emergency surgery with intentional enterotomy to milk out the bezoar. This case highlights the importance of maintaining a broad differential and thorough history taking in patients presenting with SBO. 

Peanut phytobezoar: an unusual cause for small bowel obstruction

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

A male patient in his 30s, with myotonic dystrophy (DM), presented to the emergency department with abdominal pain and vomiting. CT imaging revealed a soft tissue lesion in the terminal ileum causing small bowel obstruction (SBO). The patient underwent diagnostic laparoscopy which allowed identification and removal of the obstructing lesion. This was in the form of an intact, undigested potato, a phytobezoar. Bezoars are collections of undigested material found in the gastrointestinal (GI) tract, a phytobezoar is composed of plant material and is the most common form of bezoar. DM is a multisystem disorder characterised by skeletal muscle weakness, however it often presents with GI symptoms and the muscles of mastication are often affected. DM is a known risk factor for bezoar formation and should be considered as an important differential in DM patients presenting with SBO. 

Small bowel obstruction secondary to phytobezoar in a patient with myotonic dystrophy

Sequential Treatment of Duodenogastoliths and Pyloric Obstruction by Painless Endoscopy and Vegetable Oil in an Elderly Patient: A Case Report

Evaluation of the location, number and diameter of bezoars in patients with a history of previous gastrointestinal surgery

/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.

Lynch sendromu; kolorektal kansere donusen soliter adenomlar ve ekstra-kolonik manifestasyonlarla karakterize, otozomal dominant kalitimli bir kanser predispozan sendromdur. Sendromun tanisi klinik bulgular, patolojik ozellikler, aile oykusu ve genetik testler ile koyulabilir. Lynch Sendromu riski altinda olan bireylerde tarama calismalarina 20’ li yaslardan itibaren baslanmali, mutasyon pozitif tasiyicilarinda yillik olarak devam edilmeli ve belli sartlarin varliginda da da profilaktik cerrahi gundeme alinmalidir.

/pdf/lynch-sendromunda-profilaktik-cerrahi-ne-zaman-ve-nasil-282xopid20.pdf

Lynch sendromunda profilaktik cerrahi: Ne zaman ve nasıl?– Güncel yaklaşımlar ve literatür derlemesi

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Evaluation of the location, number and diameter of bezoars in patients with a history of previous gastrointestinal surgery

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

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

Lynch sendromunda profilaktik cerrahi: Ne zaman ve nasıl?– Güncel yaklaşımlar ve literatür derlemesi