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Background/aims: the sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus. Methodology: we present our experience of 81 cases of sigmoid volvulus admitted to our department. Results: preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60%) was higher than with a rigid rectosigmoidoscope (42%). In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies laparatomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmann’s pouch. There were 9 deaths (21%) among 42 patients who underwent an emergency operation, and one (5.2%) among the 19 patients who had elective surgery died because of a cerebral embolus. Conclusions: initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process.

Background: The aim of the present study was to describe the clinical presentation, diagnostic work-up, surgical therapy, and prognosis of 13 patients with small bowel tumor admitted for surgical procedures in an emergency setting., Methods: From 1996 to 2008, 13 consecutive surgical cases of small bowel tumors were treated at the Cumhuriyet University Faculty of Medicine, Department of General Surgery, and Kütahya State Hospital, Department of General Surgery. Clinical and radiological charts of these patients were reviewed retrospectively from the department database., Results: Intestinal obstruction (7 cases) and perforation (5 cases) were the most common clinical presentations, followed by intussusception (1 case). Adenocarcinoma was the most frequent histologic type (4 cases), while small bowel sarcoma was seen in three cases and non-Hodgkin lymphoma in two cases. The remaining cases had carcinoid tumor, small bowel angioleiomyoma, Brunner's gland adenoma, and inflammatory pseudotumor of the small intestine., Conclusion: Small bowel tumors are rare, the symptoms often non-specific, and the accuracy of different diagnostic tests remains to be improved. Timing and type of the intervention to the process and biological behavior of the pathological cells predict the prognosis.

Background/aims: The sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus., Methodology: We present our experience of 81 cases of sigmoid volvulus admitted to our department., Results: Preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60%) was higher than with a rigid rectosigmoidoscope (42%). In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmann's pouch. There were 9 deaths (21%) among 42 patients who underwent an emergency operation, and one (5.2%) among the 19 patients who had elective surgery died because of a cerebral embolus., Conclusions: Initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process.

Background/aims: The aim of this paper was to report our experience and comparison of surgical treatment methods for hepatic hydatid cyst disease., Methodology: Between January 1990 and December 1998, 66 patients with hepatic hydatid disease in two centers were operated on. Patients were assessed by clinical examination, laboratory methods and ultrasonography and computed tomography and magnetic resonance. We also compared omentoplasty or cappitonage with external drainage with or without cyctectomy., Results: Common pathology was solitary cysts and most of them were placed in the right lobe. Omentoplasty was performed for 35 cysts and cappitonnage for 36 and external drainage for 31 cysts. No operative mortality was reported. Patients with omentoplasty developed fewer complications and had a significantly shorter hospitalization than those with external drainage., Conclusions: Although omentoplasty seems to be the best possible surgical alternative for the radical treatment of hepatic hydatid cysts, the management of hydatid cysts should be flexible, taking into consideration a number of factors and variables.

Backgrounds/aims: Depression of non-specific immunity is one of the systemic complications of biliary obstruction. Vitamin E, which decreases during prolonged obstructive jaundice, may be beneficial to diseased function of neutrophils. In this study we want to investigate changes in neutrophil phagocytosis and the effect that vitamin E supplementation has on this function, Methodology: Rats were divided into 5 groups as follows: the control group and 4 other groups that underwent double ligation and division of the common bile duct. Two of these 4 groups (Group 3 and 5) received vitamin E during the experiment. Alkaline phosphatase, aspartate aminotransferase, bilirubin serum levels, white blood cell count and neutrophil phagocytosis index were determined for group 2 and 3 at the end of the 15 days and for group 1, 4 and 5 at the end of the 21 days., Results: There was a significant increase in white blood cell counts and biochemical parameters in group 2, 3, 4, and 5 (P < 0.05). Neutrophil phagocytosis index significantly increased 15 days after bile duct ligation (P < 0.001) (Group 2) and significantly decreased 21 days after bile duct ligation (P < 0.001) (Group 4). Neutrophil phagocytosis index in vitamin E pretreated groups were significantly decreased at the end of the 15 days (P < 0.001) (Group 3) and increased at the end of the 21 days (P < 0.001) (Group 5)., Conclusions: Finally, If vitamin E is administered for further days and weeks of prolonged jaundiced, neutrophil phagocytosis index improves.

We investigated the effect of 16,16-dimethyl prostaglandin E2 indomethacin and Ginkgo biloba extract on the survival in two experimental sepsis models in rats due to administration of 1 x 10(7) cfu and 1 x 10(9) cfu Escherichia coli. Animals in each model were then randomly divided (10/group) into four groups, administered saline, indomethacin, G. biloba extract and prostaglandin E2 respectively. When compared, there was no significant difference in the survival period between the two sepsis models (P > 0.05). The best survival rate was observed in the PGE2-administered animals in the first major model (P < 0.05). Indomethacin appeared not to decrease the mortality rates. There was no significant difference in PGE2 levels between two sepsis models (P > 0.05). Our results suggest that elevated prostaglandin E2 levels following major trauma are not responsible for the postinjury increased susceptibility to infectious complications. Our observations should also discourage aggressive use of cyclo-oxygenase inhibitors for protection against infectious complications after major trauma.

There are several important aetiologies of extrahepatic biliary obstruction (EBO). If EBO is surgically reconstructed in the critical time period, liver damage can be halted or reversed. In this golden period, lipid peroxidations significantly intensify liver defects. We hypothesised that alpha tocopherol (alpha-T) could protect the liver from the damage caused by response to EBO. In standard conditions, albino rats of Wistar strain were divided into two groups. All rats underwent double ligations and divisions of common bile ducts (CBD). One of these groups received alpha-T (CBDL-alpha-T). The other CBDL animals received intramuscular injections of normal saline (CBDL-NS). Serum samples were taken for biochemical analyses by light microscopy. The data showed a decrease in plasma bilirubin and liver enzyme levels in CBDL-alpha-T group, when compared with CBDL-NS (p < 0.05). Morphologic analyses showed better results for CBD-alpha-T. Serum levels of Malonyldialdehyd (MDA) in the CBDL-alpha-T group was 9.2 +/- 3.4 nmol/g compared to that in CBDL-NS, 12.3 +/- 4.4 nmol/g (p < 0.05). In conclusion, a dramatic protective effect of alpha-T on functional and structural features of the liver in rats with EBO was demonstrated. The data suggest that EBO may cause liver damage by stimulation of lipid peroxidation and that alpha-T may slow down liver damage in this setting.

Hydatid cyst (H.C.) disease, frequently seen in our country, has been known since ancient times. It can localise in each part of the body but more frequently in the liver. However, diaphragmatic localization is known to be rare. In this article, we report a case of hydatid cyst with diaphragmatic localization.