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    Epiploic Appendagitis: Is There Need for Surgery to Confirm Diagnosis in Spite of Clinical and Radiological Findings?
    (SPRINGER, 2012) Hasbahceci, Mustafa; Erol, Cengiz; Seker, Mehmet
    The present retrospective study was conducted to review the authors' experience and describe clinical and radiologic features of epiploic appendagitis (EA), which is an uncommon, self-limiting clinical entity mimicking acute appendicitis and diverticulitis. Awareness of the features of EA would allow a correct diagnosis and avoid unnecessary surgical interventions. Patients diagnosed as EA in one regional medical center between June 2006 and June 2010 were included. Clinical, laboratory, and imaging features of EA were studied, with particular attention to its unique radiologic appearances. Twenty patients (13 men and 7 women; average age 43.2 years) diagnosed with EA were included in the study. Localized abdominal pain without nausea, vomiting, and fever were the major presenting symptoms for all patients. Laboratory blood tests were normal, except in one patient with leukocytosis and two patients with increased serum C-reactive protein (CRP) levels. A noncompressible hyperechoic ovoid mass with hypoechoic border and without central blood flow on Doppler ultrasound (US) was detected in five of six patients. In all patients, the computed tomography (CT) scans revealed an ovoid fatty mass with hyperattenuating rim and disproportionate adjacent fat stranding. Central dot sign, concomitant old infarct, and lobulation were present in 75%, 20%, and 10% of the patients, respectively. All of the patients were treated conservatively. No recurrences occurred during the follow-up period (average: 24.8 months) in 18 (90%) of the patients. In patients with localized abdominal pain without other symptoms, diagnosis of EA should be considered. Recognizing the US and CT features of EA may allow an accurate diagnosis and avoid unnecessary surgery.
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    Internal Pancreatic Stent Causing Irreversible Dilatation of Pancreatic Duct
    (SPRINGER INDIA, 2014) Hasbahceci, Mustafa; Erol, Cengiz
    A 28-year-old woman underwent a pylorus preserving Whipple procedure for pancreatic serous cystadenoma located on the head of the pancreas. During the operation, an internal stent (7F silastic catheter, 9 cm in length) was placed within the pancreatic duct in the area of pancreaticojejunal end-to-end Dunking type anastomosis to prevent development of fistula. The stent was positioned so that one third of its length would lie into the pancreatic duct, and it was anchored to the periductal pancreatic tissue with only one rapidly absorbable chromic suture. Leakage from the anastomosis was not observed, and she was discharged without any complaint. Early postoperative abdominal CT examination revealed that the stent was retained within the normal caliber pancreatic duct (Fig. 1a). Six months after the operation, she began to complain to epigastric pain triggered by the meals. The laboratory analysis was normal, particularly liver biochemical tests and serum amylase. The internal pancreatic stent within the dilated pancreatic duct was detected by an additional CT examination (Fig. 1b). The stent was removed endoscopically at the third attempt. The pain was resolved after its removal. Control CT examination which was taken at the 18th month after removal of the stent showed dilatation of the pancreatic duct (Fig. 2a). The patient remained free of any complaint, although regressed pancreatic duct dilatation has persisted over 4 years of follow-up (Fig. 2b).
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    Laparoscopic Cholecystectomy in a Single, Non-Teaching Hospital: An Analysis of 1557 Patients
    (Mary Ann Liebert, Inc, 2012) Hasbahceci, Mustafa; Uludağ, Murat; Erol, Cengiz; Özdemir, Arif
    Background: Laparoscopic cholecystectomy may lead to serious complications, although it is the gold standard treatment for gallstones. In this article, the aim was to review our experience with laparoscopic cholecystectomies. Subjects and Methods: All laparoscopic cholecystectomies were performed in a single, non-teaching hospital between January 2000 and October 2010 and were reviewed retrospectively to analyze the effect of preoperative risk factors on outcome and the associated major complications. Results: This study included 1557 laparoscopic cholecystectomies, and the mean age of the patients was 54.1 +/- 12.3 years. The mean duration of the operation and the mean length of stay were 43.4 minutes and 1.2 days, respectively. Conversion to an open cholecystectomy was necessary in 39 patients, and thus the conversion rate was 2.5%. In total, 57 (3.7%) complications occurred in 51 patients. Serious common bile duct injury was seen in 4 (0.27%) cases. The other common complications included bile leakage in 10 (0.64%) and postoperative bleeding in 7 (0.45%) patients. The mortality rate was 0.13%. Risk factors for conversion to open surgery were male gender, age >55 years, emergency admission due to acute cholecystitis, and a history of previous acute cholecystitis attacks. Factors that increased the morbidity rate were male gender, an American Society of Anesthesiologists score of III, emergency admission due to acute cholecystitis, and a history of previous acute cholecystitis attacks. Conclusions: Our results may serve as a baseline for comparison with future studies done at single, non-teaching hospitals where surgical teams perform laparoscopic cholecystectomies over a long period of time.