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Mide divertikülü çok nadir görülen bir patolojidir. Yaklaşık olarak 10.000 endoskopinin 4’ünde görülür ve çoğunluk- la tesadüfen saptanır. Mide’de en sık gastroözofageal bileşkeye yakın arka duvarda yerleşir. 1 cm’den 10 cm genişliğine kadar olan olgular bildirilmiştir. Çok küçük olanlar ülser veya kanser ile, özofagogastrik bileşkeye yakın olanlar ise paraözofageal herni ile karıştırılabilir. Tanısı bu olguda da gösterildiği gibi baryumlu grafi ve gastroskopik muayeneye dayanır. Nadiren ağrı veya dispeptik yakınmalardan sorumlu tutulabilir

ÖzetAortoenterik fistüller(AEF) geçirilmiş aorta cerrahisi hikayesi varlığına ya da yokluğuna göre, primer ve sekonder tipler olarak sınıflandırılabilirler. Sekonder aortoenterik fistül(SAEF); abdominal aortik rekonstriktif cerrahinin seyrek görülen fakat çok önemli bir komplikasyonudur. Bu komplikasyon sıklıkla orijinal cerrahiden aylar, yıllar sonra görülür. Aortik rekonstrüktif cerrahi sonrası SAEF gelişimi ve insidansı %0,4 - 4 olarak rapor edilmiştir. Klinik öykü ve muayene bulgularının nonspesifik olmasından dolayı, aortoenterik fistüllerin preoperatif tanıları güçlük arzeder. Aorta ile sindirim kanalı arasında fistül formasyonu gelişmesi gastrointestinal kanama nedenlerinden biridir. Klinikte nerdeyse tamamen gastrointestinal kanamayla ortaya çıkarlar. Burada geçirilmiş aortik rekonstruksiyon cerrahisinin komplikasyonu olarak gelişen aortoduodenal fistüle bağlı şiddetli gastrointestinal kanama nedeniyle ameliyat ettiğimiz 49 yaşındaki erkek hasta sunuldu.Anahtar sözcükler: Aortoenterik fistül, gastrointestinal kanama, aortik rekonstruktif cerrahi.AbstractAortoenteric fistüla(AEF) can be classified into primary and secondary types according to the presence or absence of a prior history of aortic surgery. Secondary aortoenteric fistula(SAEF) is an uncommon but very important complication of abdominal aortic reconstrictive surgery. This complication often occurs months to years after the original surgery. SAEF develops after aortic reconstructive surgery and the the incidence has been reported to be % 0.4-% 4. Because of the nonspesific nature of the clinical history and physical findings, diagnosis of aortoenteric fistula is difficult to make preoperatively. Fistula formation between the aorta and alimentary tract is one of the causes of gastrointestinal bleeding. The most common clinical manifestation of the aortoenteric fistula is gastrointestinal bleeding. In this article, we report a case of a 49 years old man who underwent surgical treatment because of severe gastrointestinal bleeding which was related to an aortoduodenal fistula due to abdominal aortic reconstruction.Key words: Aortoenteric fistula, gastrointestinal bleeding, aortic reconstructive surgery.

ÖzetCaroli hastalığı intrahepatik safra yollarının kistik dilatasyonu ile karakterize, konjenital, nadir görülen bir hastalığıdır. Caroli hastalığının klinik özellikleri hepatolitiazis veya bakteriyel kolanjite bağlı olarak gelişen sarılık, sağ üst kadran ağrısı, ateşi kapsamaktadır. Endoskopik veya perkutan kolanjiografi geleneksel tanı yöntemidir, fakat günümüzde manyetik rezonans kolanjiopankreatografi tercih edilen tanı aracı olarak ortaya çıkmıştır. Caroli hastalığının tedavisi; kolanjit için antibiyoterapi ve destek tedavisi, hepatolitiazis için ursodeoksikolik asit tedavisini kapsamaktadır. Karaciğerin tek lobunu tutan lokalize Caroli hastalığında cerrahi rezeksiyon başarı ile uygulanmaktadır. Diffüz tutulumlarında ise ortotopik karaciğer nakli seçilecek tedavi olmalıdır. Biz burada 58 yaşında, 3 yıldır karın ağrısı şikayeti, kolanjit atakları olan ve sonuçta cerrahi rezeksiyon ile tedavi edilen Caroli olgusunu sunduk.Anahtar sözcükler : Caroli hastalığı, kistik genişleme, kolanjitAbstractCaroli's disease is a rare congenital disease of the liver characterized by cystic dilatation of the intrahepatic bile duct. The clinical features of Caroli's disease include jaundice, right upper abdominal pain and fever due to the associated complications of hepatolithiasis or bacterial cholangitis. Endoscopic or percutaneous cholangiography is the traditional method of diagnosis, but nowadays magnetic resonance cholangiopancreatography is emerging as the diagnostic modality of choice. The treatment for Caroli's disease includes supportive care with antibiotics for cholangitis and ursodeoxycholic acid for hepatolithiasis. Surgical resection has been used successfully in patients with monolobar disease. For patients with diffuse involvement, the treatment of choice is orthotopic liver transplantation. In this article, we report a 58 years – old male patient with Caroli’s disease. The patient had abdominal pain and episodes of cholangitis for 3 years and finally, he was treated with surgical resection.Key words : Caroli’s disease, cystic dilation, cholangitis

Sepsis leads to systemic hypotension, disturbed perfusion, inflammation and tissue toxicity in vital organs. Neuropeptide W (NPW) has modulatory effects in the control of blood pressure and inflammatory processes, implicating a potential beneficial effect against sepsis-induced oxidative damage. Under anesthesia, male Sprague Dawley rats underwent cecal ligation and puncture. Immediately after surgery, either saline or TNF-alpha inhibitor (etanercept; 1 mg/kg) antibiotic (ceftriaxon; 100 mg/kg) combination or NPW (0.1, 1 or 3 µg/kg) was given subcutaneously, and injections were repeated at 12th and 24th h. The sham-operated control group was treated with saline at the same time points. All rats were euthanized at the 25th h of surgery. Sepsis resulted in oxidative damage of the brain, heart, lung, liver and kidney. Elevations in blood urea nitrogen and alkaline phosphatase, showing renal and hepatic dysfunction, were not evident when septic rats were treated with NPW. NPW reduced serum levels of C-reactive protein, corticosterone and interleukin-6, while histopathologically verified tissue damage in all the studied tissues was ameliorated. NPW treatment suppressed lipid peroxidation in the heart, lung and brain, and the depleted antioxidant GSH levels of the brain and heart were replenished by NPW. Moreover, sepsis-related neutrophil recruitment to liver and lung was also suppressed by NPW. Although survival rate of the rats was not significantly prolonged by NPW, most of these improvements in systemic and local inflammatory events were comparable with those reached by the etanercept and antibiotic combination, suggesting the therapeutic impact of NPW during the acute period of sepsis.

Purpose: To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Methods: Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Results: Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Conclusions: Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.