Ahmet Murat Sendil

Piyojenik karaciğer apsesi (PKA), nadir olgularda solid görünümlü hepatik lezyon şeklinde prezente olarak primer ya da metastatik karaciğer malignitelerini taklit edebilmektedir. Bu tür atipik klinik ve radyolojik prezentasyonlar, yanlış tanıya bağlı olarak gereksiz majör hepatik rezeksiyonlara yol açma potansiyeli taşımaktadır. Altmış iki yaşında, uzun süreli diyabetes mellitus öyküsü bulunan erkek hasta, sağ üst kadran ağrısı ve istemsiz kilo kaybı şikâyetleri ile başvurdu. Radyolojik incelemelerde sol hepatik lobda yerleşimli, malignite ile uyumlu olabilecek, yaklaşık 7 cm çapında heterojen karakterde bir lezyon saptandı. Serum tümör belirteçleri normal sınırlarda bulundu. Bilgisayarlı tomografi eşliğinde gerçekleştirilen perkütan biyopsi, inflamatuvar değişiklikler göstermesine karşın maligniteyi kesin olarak dışlayamadı. Bu bulgular doğrultusunda malignite ön tanısı ile planlanan hepatektomi amacıyla eksploratif laparotomi gerçekleştirildi. İntraoperatif ultrasonografi ve eş zamanlı frozen kesit incelemesi, lezyonun piyojenik karaciğer apsesi ile uyumlu inflamatuvar karakterde olduğunu ortaya koydu. Bunun üzerine cerrahi strateji revize edilerek rezeksiyondan kaçınıldı; apsenin drenajı sağlandı ve uygun antibiyotik tedavisi başlandı. Postoperatif izlemde, 7 aylık takip sürecinde lezyonun tamamen gerilediği radyolojik olarak doğrulandı. Piyojenik karaciğer apsesi, özellikle diyabetes mellitus gibi predispozan faktörlere sahip hastalarda, solid görünümlü hepatik lezyonların ayırıcı tanısında mutlaka göz önünde bulundurulmalıdır. İntraoperatif ultrasonografi ve frozen kesit incelemesi, intraoperatif karar verme sürecinde yüksek tanısal değer sağlayarak gereksiz majör hepatik rezeksiyonların önlenmesinde kritik rol oynamaktadır.

The preoperative identification of patients who are at high risk for serious postoperative outcomes after pancreaticoduodenectomy is important for their management. Our aim was to investigate the factors affecting the serious complications after pancreaticoduodenectomy (PD). 92 patients who were operated for periampullar region tumor were retrospectively analyzed between November 2017 and July 2024. Patients were divided into two groups (patients without serious complication (woSC) and patients with serious complication (wSC)) and these groups were compared with demographic data, laboratory results, pathological findings, perioperative findings, and 30-day mortality rate. Risk factors affecting postoperative serious complications were determined. Logistic regression analyses were performed to identify the risk factors of postoperative serious complication. Twenty-four (26%) patients developed serious complications after PD. The albumin levels were significantly lower in the wSC group compared with the woSC group (p=0.035). The albumin was found to be an independent factor in multivariate analysis. Receiver operating characteristic (ROC) curve analysis showed that 37.8 g/L was the optimal cut-off value for postoperative serious complication in PD. So, lower albumin level (≤37.8 g/L) is associated with increased postoperative serious complications in PD for periampullar cancer.

Purpose: Intestinal ischemia in strangulated abdominal wall hernias is a life-threatening condition that requires early detection and timely intervention. Since both systemic inflammation and nutritional status play a crucial role in surgical outcomes, identifying reliable predictive markers is essential. This study explores the potential of albumin-based nutritional indices—the CALLY Index, Prognostic Nutritional Index (PNI), and modified Glasgow Prognostic Score (mGPS)—to assess their ability to predict the risk of intestinal ischemia and the need for surgical resection. Methods: We retrospectively analyzed 125 patients who underwent surgery for incarcerated abdominal hernias between January 2015 and August 2024. Patients were categorized based on whether they had intestinal or omental ischemia. Key demographic data, perioperative findings, and laboratory parameters—including CRP, albumin, lymphocyte count, PNI, CALLY, and mGPS—were recorded. We performed univariate and multivariate regression analyses to identify independent risk factors, while ROC analysis was used to determine the optimal cutoff value for the CALLY Index. Results: Out of 125 patients, 66 (52.8%) were female, and the median age was 67 (58–76) years. Intestinal ischemia was found in 73 (58.4%) of the patients, while 23 (18.4%) had only omental necrosis. In the multivariate regression analysis, GPS 2 (OR: 19.299, p = 0.015) and CALLY < 2.5 (OR: 5.397, p = 0.017) were identified as independent predictors of intestinal ischemia. ROC analysis showed that a CALLY value below 2.5 had strong predictive power (AUC: 0.828, 95% CI: 0.753–0.902, p < 0.001). Conclusion: Our findings suggest that the CALLY Index and mGPS are valuable tools for predicting intestinal ischemia in strangulated abdominal hernias. By incorporating inflammatory and nutritional markers into risk assessment, these indices can assist in early diagnosis and timely surgical decision-making.

Purpose: The aim of the study is to demonstrate the prognostic impact of preoperative nutritional status indicators, including prognostic nutritional index (PNI), hemoglobin-albumin-lymphocyte-platelet (HALP) score, sarcopenia index (SI), and bone mineral density (BMD) values, on postoperative complications and survival in patients with resectable pancreatic cancer (PC). Materials and methods: The medical data and computed tomography (CT) images of 85 patients who undergone surgery for PC between January 2017 and 2023 were evaluated retrospectively. Patients were grouped according to the presence or absence of sarcopenia and osteoporosis, high and low PNI and HALP scores. The groups were compared in terms of the complication development rate, 30- and 90-day mortality, and 5-years overall survival (OS). Sarcopenia and osteoporosis were determined from CT images (sarcopenia index used for sarcopenia, bone mineral density for osteoporosis). Results: Except from OS (p < 0.0001), no differences were found between sarcopenic and non-sarcopenic groups in terms of postoperative complications, 30- and 90-day mortality (p = 0.775, p = 0.704, p = 0.196, respectively). There were no differences between the groups with and without osteoporosis in terms of the presence of postoperative complications, 30- and 90-day mortality, and OS (p = 0.770, p = 0.608, p = 0.196, p = 0.09, respectively) as low and high HALP score groups (p = 0.236, p = 0.696, p = 0.299, p = 0.45, respectively). Except from a 30-day mortality (p = 0.03), no differences were found between low and high PNI groups in terms of postoperative complications, 90-day mortality, and OS (p = 0.82, p = 0.09, p = 0.18, respectively). Conclusion: PNI may be used as prognostic data for early postoperative mortality, while sarcopenia may be indicative of 5-year OS in patients with resectable PC. Our results suggest that providing nutritional support may potentially improve prognosis. Future studies, in which other factors effective in prognosis are evaluated together with nutritional status, will show more information on this subject.

Aim: Fournier gangrene disease (FGD) is a condition that requires emergent surgery due to its high risk of mortality. The use of biomarkers to predict outcomes after surgery for patients with FGD may be critical, as they assist in tailoring treatment approaches to individual needs. Our aim in our study is to investigate the presence of simple and easily accessible biochemical markers that can be used to predict early mortality.Methods: The medical records of 100 patients diagnosed with FGD at our hospital between January 2015 and December 2023 were retrospectively reviewed. Clinical and laboratory variables were assessed, and predictive factors for mortality were analyzed using multivariate logistic regression.Results: Demographics and perioperative clinical data of the whole study group, and subgroups according to the mortality status are evaluated. CRP was found to be independent predictor for 30‐day mortality in FGD. In ROC curve analysis provided a cutoff value of 121.3 mg/L for CRP which was significantly associated with 30‐day mortality for FGD.Conclusion: Preoperative CRP ≥ 121.3 mg/L value could be predict 30‐day mortality in patients diagnosed with FGD.

Background and Objectives: The best way to distinguish complicated acute appendicitis (CAA) from uncomplicated acute appendicitis (UCAA) is still under debate. The aim of this study was to investigate the potential use of the serum sodium (Na⁺) level and the neutrophil-to-lymphocyte ratio (NLR) to distinguish CAA from UCAA and to evaluate whether CAA is more reliably diagnosed using these two variables together. Materials and Methods: This was a retrospective, cross-sectional, two-center study of patients diagnosed with AA between 1 January 2016 and 31 December 2023. The demographic and analytical variables were analyzed. The NLR was defined as the quotient between the absolute values of neutrophils and lymphocytes. Hyponatremia was defined as a serum Na⁺ level of ≤135 mmol/L. The sensitivity and specificity of the NLR and the serum Na⁺ level in the diagnosis of CAA were determined by assessing the receiver operating characteristic curves. Results: Among the patients who underwent an appendectomy, 3066 histologically confirmed AA cases were identified and included in this study. The registered data revealed that 348 (11.3%) patients had CAA, and the remaining 2718 (88.7%) patients had UCAA. The mean ages were 49.47 ± 18.97 and 38.16 ± 14.50, respectively (p < 0.001). The analysis revealed an exponential correlation between the NLR and the serum Na⁺ level with a moderate degree of agreement with CAA (Cohen’s Kappa: 0.461, p < 0.001). For CAA, using the NLR and the serum Na⁺ level, the areas under the curve and the cutoffs were 0.664, 4.2 with a confidence interval (CI) of 0.647–0.681 and 0.727, 135 mmol/L with a CI of 0.711–0.742, respectively; all these values were significant with a p-value of Conclusions: Although the serum Na⁺ level is a more effective marker than the NLR, using these two variables together can help detect high-risk patients who may benefit from early management by limiting delays in surgery.

Inflammatory pseudotumor (IPT) is a rare liver disease confused with liver tumors. It is a disease that should be known in the differential diagnosis for clinicians as the correct diagnosis of IPT will prevent unnecessary surgery. Demographic datas, diagnoses and imaging modalities of six patients with radiologically and/or histopathologically diagnosed hepatic IPT between 2016 and 2023 were retrospectively analyzed. Four out of six patients were female and median age was 57.5 (47-66). C-reactive protein was higher in four patients, and carbohydrate antigen 19.9 level was higher in one patient. We used magnetic resonance imaging (MRI) for diagnosis in five patients. Only in one patient computed tomography was enough for diagnosis. Tumor locations were segment 5 for two patients, segment 7-8 in two patients, segment 7 in one patient, and 8 in one patient. Liver biopsy was performed in five patients because it could not be distinguished from malignancy by imaging methods. Histopathological results of all these biopsies defined as IPT. Initial tumor median size was 31 (17-55) mm. Two patients were operated on. The first one underwent right hepatectomy due to a 2-fold increase in size within 11 months. The second one had a mass indistinguishable from hepatic adenoma by MRI and underwent nonanatomic resection. In one patient, IPT disappeared completely in the 18^th month of follow-up period while it regressed in size in two patients. Two of our patients had a history of recurrent endoscopic retrograde cholangiopancreatography, which we noticed incidentally before IPT was diagnosed. IPTs are liver masses with low malignant potential and may shrink spontaneously during follow-up. We suspected that biliary tract interventions may be the cause of IPT.

Granulomatous mastitis is a rare benign inflammatory disease of the breast. Although the etiology of granulomatous mastitis is not known exactly, it can be confused with breast cancer due to its findings and appearance. In addition, this disease, which is characterised by inflammation, causes recurrent infections and considerable tissue loss if left untreated. Therefore, diagnosis and early treatment are very important. In our study, we aimed to show the results of intraoperative local steroid administration after surgical resection in the treatment of patients with granulomatous mastitis. In our study, the hospital records and files of 39 patients diagnosed with granulomatous mastitis and treated with surgical treatment and intraoperative local steroid administration were retrospectively analysed. Age, gender, radiological and laboratory findings, surgical methods, postoperative recurrence rates and histopathological features were noted. Success rates were investigated and it was observed that intrathecal steroid treatment given after resection decreased recurrence. As a result, it was concluded that surgical wide or total excision and intraoperative local steroid administration would be the most appropriate treatment for the definitive treatment of granulomatous mastitis. Although abscess drainage and antibiotic treatment is effective in rare cases, surgical treatment should be preferred in chronic and complicated cases.