COVID-19 is a new disease, based on currently available limited information, older adults and people of any age who have severe underlying medical conditions may be at higher risk for severe illness from COVID-19. People of all age groups are also at risk. Healthcare providers have always been the professionals most exposed to the risk of contracting to any kind of infection due to the nature of their profession. Elective interventions have been postponed to give care of patients with COVID-19. However, some interventions cannot be delayed, such as trauma surgery, acute abdomen, and emergency endoscopies. To maintain the sustainability of the healthcare system, the protection of healthcare providers should be the top priority. On the other hand, patients, who need emergency healthcare, should also be provided with appropriate treatment. Healthcare professionals should choose a treatment method appropriately in the circumstances to protect themselves and their patients as much as possible. This paper aims to summarize how a surgeon may act appropriately when an intervention is inevitable during the COVID-19 pandemic.

BACKGROUND: Management of the skin degloving injuries is still a problematic issue, and the avulsed part of the skin may become necrotic. We hypothesized that the anticoagulant pharmacological agents, fondaparinux and dabigatran may be beneficial in the treatment of degloving injuries by enhancing the viability of the reattached flap.
METHODS: Twenty four Wistar rats were divided into three groups as follows: control group (Group 1), fondaparinux group (Group 2) and dabigatran group (Group 3). A model of a degloving injury on the tail of rats was developed in all groups. After 15 minutes, the avulsed flaps were sutured back. Group 1 received 1ml/day saline intraperitoneally for 10 days. Group 2 received 0.3 ml/kg/day fondaparinux intraperitoneally for 10 days. Group 3 received 30 mg/kg/day dabigatran orally for 10 days. At the end of the treatments, gross morphological and histopathological tail tissue survivals were evaluated.
RESULTS: Histopathological examination of the fondaparinux and dabigatran groups revealed that the tail skin was mostly viable with mild inflammation. The mean necrotic length in tails and severity of inflammation was significantly higher in the control group compared to the fondaparinux and dabigatran groups (p<0.05). No statistically significant differences were noted between the fondaparinux and dabigatran groups in histopathologic evaluations. There was no significant difference in necrosis lengths and the other histopathological parameters between dabigatran and fondaparinux groups.
CONCLUSION: Dabigatran and fondaparinux improved tissue survival in skin degloving injuries concerning gross morphological and histopathological findings. However, the findings of this study should be supported and improved by new experimental and especially clinical studies.

BACKGROUND: Acute ischemia/reperfusion (I/R) injury of skeletal muscle, an important mortality and morbidity cause, is associated with oxidative stress. Lycopene is a carotenoid pigment with potent antioxidant activity and is found in vegetables and fruits. This study aims to investigate the protective effects of lycopene against I/R injury in rat hind limb muscle model.
METHODS: Thirty-two Wistar-albino rats were randomly allocated to control, lycopene, I/R and I/R+lycopene groups. In lycopene and I/R+lycopene groups, the rats received 10 mg/kg/day lycopene orally for 15 days before the experiment. Dissection around abdominal aorta at the infrarenal level was performed in all rats under general anesthesia. The aorta was clamped at the infrarenal level in the I/R and I/R+lycopene groups for two hours. Then, reperfusion was allowed for two hours in these groups. Samples were obtained from the hind limb muscles of rats after sacrifice for biochemical and histopathological analyses.
RESULTS: Serum and tissue malondialdehyde and ischemia-modified albumin levels were significantly lower in the I/R+lycopene group compared to I/R group (p<0.001). Serum glutathione peroxidase (GSH-Px) levels were significantly lower in the I/R group compared to those in control and I/R+lycopene groups (p<0.05). Tissue GSH-Px levels were significantly lower in the I/R group compared to the Lycopene group (p=0.003). Serum superoxide dismutase (SOD) levels were significantly lower in the I/R group compared to three groups (p<0.001). Tissue SOD levels were significantly lower in the I/R group compared to those in control and Lycopene groups (p=0.005). Histopathological assessments revealed that inflammatory changes following I/R injury were significantly reduced in the I/R+lycopene group.
CONCLUSION: The findings obtained in this study show lycopene’s cytoprotective activity against I/R injury in rat skeletal muscle model.

BACKGROUND: The debate continues concerning surgical timing in a peripheral nerve injury. This study aims to evaluate the result of immediate versus delayed primary (after seven days) repair of peripheral nerve injury.
METHODS: In this study, Wistar rats were divided into four groups as follows: The nerve was sharply transected in Group 1, 2 and 4. It was immediately sutured in Group 1 and sutured seven days later in Group 2, and it was not sutured in Group 4. In Group 3, the left sciatic nerve was only explored. Eight weeks later, tissue samples were extracted from the injured nerve area. Both gastrocnemius muscles were weighed. The nerve samples were examined for axon degeneration. Myelin vacuolization, axon irregularity, and edema/inflammation parameters were evaluated.
RESULTS: There were not any significant differences in the score of axon degeneration and the weight of the gastrocnemius muscle between the immediate and delayed primary repair groups. However, these parameters were significantly better in both repair groups than to be in the control group and significantly worse than to be in the sham-operated group.
CONCLUSION: To delay the repair about one week did not affect the histological results and weight of the muscle that was innervated by the sectioned nerve comparing to be in the immediate repair in a sciatic nerve transaction model in rats.

BACKGROUND: The present study aims to observe the effects of ischemia-reperfusion (IR) on small intestines at a molecular level and to prospectively assess the potential preventive role of adalimumab (ADA) and antioxidants.
METHODS: A total of 24 male Sprague–Dawley rats were randomly divided into three groups–a control group, an IR group and an IR+ADA group.
RESULTS: Although there was no change in SOD levels in the small bowel tissue of the IR group, we observed increased malondialdehyde (MDA) levels and increased numerical density of caspase-3 and TNF-α positive enterocytes p=0.00 and p=0.00, respectively). We also observed that IR caused the degeneration of villus crypt structures.
CONCLUSION: We found that ADA treatment reduced MDA levels and decreased the numerical density of caspase-3 and TNF-α positive enterocytes compared to the IR group (p=0.00; p=0.011; p=0.00, respectively). We conclude that ADA can be beneficial in preventing intestinal injury that arises from IR.

BACKGROUND: The most frequent etiologic cause is alkaline substances. We investigated the protective effects of the plant St. John ‘s Wort (Hypericum perforatum).
METHODS: We included 42 Wistar albino rats weighing between 200–300 grams and divided into six groups as Group 1: Control, Group 2: Burn+Saline (BS), Group 3: Burn+St. John’s Wort (BSJW), Group 4: Burn+Plasebo (BP), Group 5: St. John’s Wort (SJW), Group 6: Placebo (P). After 15 days of treatment, esophagus, stomach and liver tissue samples were derived by dissection for histopathologic and biochemical markers. The cytotoxic effects of formulation on fibroblasts is evaluated in vitro on human dermoblast fibroblast line (HDFa, Gibco Invitrogen cell culture, C-013-5C).
RESULTS: The weight of the rats increased in Group 1, 3, 4, 6, decreased in Group 2 and did not change in Group 5. In the BSJW group, submucosal collagen accumulation, muscularis mucosa damage, tunica muscularis damage and collagen accumulation in esophagus were similar to the control group but lesser than BS and placebo group. In the stomach, mucosal damage, gastric gland dilatation, submucosal polymorphonuclear infiltration were similar to the control group and lesser than the BS group. The lethal concentration of SJW was 2.58 gr/mL.
CONCLUSION: SJW substrate is effective in protecting the esophagus and stomach in mild to moderate alcali corrosive burns in the subacute period. We should keep in mind the protective effects of STW substrate in alkaline corrosive burns of the gastrointestinal system.

BACKGROUND: In this study, we aimed to evaluate the superiority of intracorporeal sutures and Hem-o-lok clips about efficiency, reliability and cost.
METHODS: We performed laparoscopic surgery for acute appendicitis in this study. Appendiceal stump was closed by Hem-o-lok clips (Group I) and intracorporeal knotting (Group II) in a randomized manner. Groups were compared for demographic data (age, sex, body mass index, American Society of Anesthesiologists score) operation time, total cost, 2.6.12.24.hours and 7th day pain score.
RESULTS: Demographic data, such as age, gender and BMI, were similar between groups (p>0.05). There was no significant difference between the groups concerning peroperative and postoperative complications (p>0.05). No postoperative nausea, vomiting, ileus and intraabdominal abscess were observed in patients. There was no significant difference between the groups about duration of operation, length of hospital stay and cost analysis (p>0.05). There was no significant difference in pain scores of groups. The effect of the operation type on pain scores was not statistically significant (p>0.05).
CONCLUSION: This study showed that both intracorporeal knotting and Hem-o-loc clips were effective, reliable and similar cost-effective in laparoscopic appendectomy. The decision should be based on the surgeon’s experience.

BACKGROUND: This study aims to investigate the role of thiol/disulfide homeostasis parameters in the diagnosis of acute appendicitis and to determine whether it is beneficial to use these parameters in combination with the modified Alvarado and RIPASA scoring systems.
METHODS: This study was prospectively carried out on 265 patients who presented to the emergency department with the complaint of right lower quadrant pain between 01.07.2017 and 31.12.2017, and met the inclusion criteria of this study. Oxidative stress markers were evaluated on two groups. The relationship between these parameters and the modified Alvarado and RIPASA scoring systems was analyzed.
RESULTS: The mean levels of disulfide, disulfide/native thiol and disulfide/total thiol were found to be significantly higher in the appendicitis group (p<0.001). The mean levels of native thiol, total thiol and native thiol/total thiol were significantly lower in the same group (p<0.001, 0.001 and 0.007, respectively). The mean levels of disulfide, disulfide/native thiol and disulfide/total thiol were recorded to be significantly higher in the high-risk group according to the results of RIPASA (p=0.016, 0.003 and 0.001, respectively).
CONCLUSION: Thiol/disulfide homeostasis parameters can be used with the modified Alvarado and RIPASA scoring systems in the diagnosis of acute appendicitis.

BACKGROUND: There is no consensus on the optimal timing for laparoscopic cholecystectomy (LC) after emergent endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis. Although certain data suggest that an early interval or single-stage treatment by LC, together with laparoscopic bile duct exploration, has more favorable outcomes, delayed LC is most often preferred as the standard treatment of patients with gallstones and choledocholithiasis following ERCP due to lack of experience, necessary instrumentation, or organizational restrictions. This study aims to compare the effects of different time intervals between ERCP and LC on perioperative outcomes.
METHODS: In this paper, preoperative and postoperative data from consecutive patients who were treated for common bile duct stones with emergent ERCP and then underwent LC were reviewed retrospectively. To evaluate the impacts of different time intervals on outcomes, patients were classified into three groups according to the duration from the last ERCP to LC: within two weeks (Group 1), between 2–6 weeks (Group 2), and over six weeks (Group 3).
RESULTS: This study involved an analysis of 67 patients with a mean age of 52.8 years. Overall conversion rate was 20.0% in Group 1, 25.0% in Group 2, and 13.6% in Group 3 (p=0.646). The rate of conversion to open surgery was 25.0% in male patients and 14.2% in females. In addition, no significant difference was found between the groups concerning gender, comorbidities, laboratory and gallbladder features, operation time, and length of the hospital stay. The perioperative complication rate was found to be 17.9%; however, there was no significant difference between the three groups.
CONCLUSION: Our results support that LC after ERCP is more complex and has higher conversion rates than LC for uncomplicated cholelithiasis. Although no significant effect of different time intervals between ERCP and LC on perioperative outcomes was demonstrated in patients with common bile duct stones concomitant with cholelithiasis, the 2–6 weeks after ERCP is a critical period for conversion to open surgery. It is recommended that LC after ERCP should be performed in the early period, considering that serious complications may occur in the late period and recurrent biliary attacks may occur.

BACKGROUND: Tick is among the important ectoparasites of humans and animals. Ticks may transmit disease-causing pathogens to humans. Tick contact may be resulted in several viral and bacterial infections, including Crimean-Congo Hemorrhagic Fever. Timely removal of ticks with appropriate methods is important in prevention of disease transmission. There are many methods reported for tick detachment. In this study, we aimed to evaluate two of them, suture lassoing and freezing and to compare both methods and to examine technical mistakes with these techniques.
METHODS: This study was designed as a prospective cross-sectional study, and included the ticks detached by healthcare professionals or directly by patients who presented to the emergency department due to tick contact. The ticks were recorded as larvae, nymphs, and adults according to their growth period. Ticks detachment types with surgical sutures and removal mistakes were recorded.
RESULTS: The majority (77.4%) of the ticks were removed by healthcare professionals and a lower rate by patients themselves with hand (22.6%). No technical mistake was found in 72 (77.4%) patients, and the tick was detached as a whole, while detached broken in 15 (16.1%) patients, and the tick was detached as a whole, but the sutures were attached wrong in six (6.5%) patients. Tick broken off due to technical mistakes was most commonly seen in the ticks removed by the individuals themselves.
CONCLUSION: The results of this study suggest that when appropriately and correctly used, both suture lassoing and tweezers are effective in tick removal. Public awareness-raising and training programs should be increased on this issue.

BACKGROUND: As life expectancy increases in humans, surgical procedures applied to the elderly people are also increasing in parallel with the developments in surgery and postoperative care. A significant number of studies investigating the morbidity-mortality of geriatric patients are related to patients who are undergoing emergency operations. The present study aims to investigate the factors affecting mortality and morbidity after emergency surgery in elderly people.
METHODS: The data of 200 patients aged 65 years and over who were operated under emergency conditions in the University of Health Sciences Kartal Dr. Lütfi Kýrdar Training and Research Hospital between January and December 2018 were evaluated retrospectively.
RESULTS: Patient’s demographic information, including age, gender, ASA physical status, comorbidities, functional dependency or non-dependency of patients, types of operation, anesthesia technique, duration of operation, intraoperative blood transfusion, the changes of hematocrit levels (during the perioperative period), the outcome after surgery (intensive care admission or ward transfer), were recorded. The risk prediction of short-term mortality has been estimated using CCI and APACHE II scoring systems.
CONCLUSION: The mean age of the patients was 74.8±6.7 and the number of females (n=134, 67%) outweighed the males. Higher ASA physical status scores, dependent living conditions, long operation time, general anesthesia, intraoperative blood transfusion, low Htc values (<25%), high APACHE II scores and lower scores of 10-years survival by CCI were the factors that affected the acceptance into ICU.

BACKGROUND: Decompressive craniectomy (DC) is performed in the management of intracranial hyper-tension after traumatic brain injury (TBI). This study aims to investigate the effects of transcranial Dop-pler ultrasonography (TCD) measurements on the indication of decompressive surgery.
METHODS: Sixteen TBI patients with a Glasgow Coma Score (GCS) <9 were included in this study. Intra-cranial pressure (ICP) monitoring and transcranial Doppler ultrasonography (TCD) measurements were recorded continuously. DC was performed according to the records of ICP and TCD. Glasgow Outcome Scale (GOS) scores were evaluated after three months.
RESULTS: Mean age of the patients was 31.18±17.51; GCS ranged between three and 14 with a mean of 9.62±3.95. Mean GOS was 3.12±1.85. Craniectomy was performed in two patients (12.5%) and cra-niectomy and lobectomy together were performed in 14 (87.5%) of them. The decline in ICP (22.12±10.41, 22.62±7.35, 15.50±6.64) and pulsatility index (PI) (1.96±1.10, 1.64±0.75, 1.91±2.48) were strongly significant between days 3–5, and 1–5. The range of PI and Vmax values through five days did not present any significance.
CONCLUSION: TCD, as a real-time monitor, may help for an early decision of surgical approach in the management of TBI patients.

BACKGROUND: Distal tibial epiphyseal fractures damage to epiphyseal growth plate. Epiphyseal growth arrest (EGA), reflex sympathetic dystrophy and ankle joint stiffness may also occur after distal tibial epiphyseal injury. This study aims to evaluate the role of trauma mechanism, fracture pattern and fixation technique on clinical outcomes and EGA in the surgically treated distal tibial epiphyseal fractures.
METHODS: Twenty seven patients who underwent surgery for distal tibial epiphyseal fracture between the 2011 and 2017 were evaluated retrospectively. The effects of trauma mechanism, fixation technique, preoperative duration, fracture patterns on the clinical results and EGA were examined. AOFAS (The American Orthopedic Foot and Ankle Score) and MOXFQ (The Manchester-Oxford Foot Questionaire) were used for clinical evaluation.
RESULTS: Twenty seven patients (17 male and 10 female) were included in this study. The most important complication of epiphyseal injury was the growth pause in eight patients. No statistically significant difference was observed concerning clinical scores and complications according to trauma mechanism, fixation techniques and fracture patterns (p>0.05).
CONCLUSION: Regardless of the trauma mechanism, fracture pattern and the fixation material, an anatomical reduction should be obtained in distal tibial epiphyseal fractures to reduce complications and prevent the EGA.

BACKGROUND: This study aimed to investigate the role of computed tomography (CT) in identifying missed unstable blunt cervical injuries.
METHODS: Patients admitted to the emergency department between June 2014 and June 2018 with a diagnosis of blunt cervical trauma were included in this study. All participants underwent cervical magnetic resonance imaging (MRI) after an initial cervical CT investigation. All imaging results were reviewed, and decisions were taken by the consensus of a team consisting of an emergency medicine specialist, a neuroradiologist, and a neurosurgeon. Other variables included age, sex, the Glasgow Coma Scale, medical comorbidities, multi-trauma, neurological deficits, accompanying intracranial hemorrhage, extremity fractures, and the mechanism of the injury.
RESULTS: Data for 195 patients were analyzed. The mean (±standard deviation) age of the participants was 47.34±21.90 years, and 140 (71.8%) were males. Eighteen patients (9.2%) were below age <18. The most frequent mechanism of injury was fall from height (n=100; 51.3%). Using MRI as the gold standard, the sensitivity of CT in diagnosing unstable cervical injury was 77.7% (95% CI [67.1–86.1]), while its specificity was 100.0% (95% CI [59.0–100.0]).
CONCLUSION: Although computed tomography is relatively good in diagnosing unstable cervical injuries, its sensitivity in detecting positive cases is not as successful. Thus, the use of MRI in patients with an unstable injury seems to be warranted.

BACKGROUND: This study aimed to evaluate the effects on mortality of implant selection used and time to surgery in patients aged over 65 years operated for hip fractures.
METHODS: A total of 301 patients aged over 65 years were investigated in this study. Patients were divided into three groups as follows: Group 1 cemented hemiarthroplasty (CH), Group 2 cementless hemiarthroplasty (CLH), and Group 3 proximal femoral nail (PFN). Time of surgery, fracture and demographic information were retrospectively recorded.
RESULTS: After removing 59 patients with missing information, this study included 242 patients. Mean age of patients was 80.5 years. When patient groups were examined according to treatment method, Group 1 (n=146) comprised 60.3%, Group 2 (n=54) comprised 22.3% and Group 3 (n=42) comprised 17.4% of the study group. There was no significant difference in survival between the patients operated in the first 48 hours and the patients operated later (p=0.834). There was an effect on the survival of treatment implant selection (p=0.016). Patients with CH were observed to survive longer than patients with CLH and PFN.
CONCLUSION: Operation in the first 48 hours was not observed to affect mortality. Additionally, while sex and age were found to be effective on mortality, implant selection was also concluded to affect mortality.

BACKGROUND: This study aims to evaluate the effects of the anesthesia technique on the intraoperative blood loss in acetabular fracture patients undergoing the Modified Stoppa approach.
METHODS: We retrospectively identified 63 patients who underwent a Modified Stoppa approach for acetabular fracture from January 2014 to July 2018. A total of 20 patients were excluded from this study for the following reasons: bilateral acetabular fractures (n=6), undergoing antiaggregant treatment (n=3), incomplete anesthesia records (n=3), emergency pelvic surgery due to hemodynamic instability (n=5), splenic rupture (n=2), and liver laceration (n=1). The patients were divided into two groups as follows: patients undergoing general anesthesia (GA) (n=22) and patients undergoing combined epidural-general anesthesia (CEGA) (n=21). The main outcome measurements studied were the intraoperative blood loss and the need for intraoperative and/or postoperative blood transfusions.
RESULTS: No statistically significant differences were found between the groups concerning the age, gender, type of fracture, mechanism of injury, time from injury to surgery, Injury Severity Score, associated injuries, and comorbidities (p>0.05). The mean intraoperative blood losses were 717.27 ml (300–1.600 ml) in the GA group and 473.81 ml (150–1.020 ml) in the CEGA group (p<0.001). In the cases with only an isolated acetabular fracture, the intraoperative blood transfusion means were 2.43 units (1–5 units) in 14 patients in the GA group and 1.27 units (1–4 units) in 15 patients in the CEGA group (p<0.001).
CONCLUSION: Less intraoperative bleeding was seen in those patients undergoing CEGA when compared to those undergoing GA. This is a significant advantage for acetabular surgery, which has a long learning curve and a high risk of bleeding.

BACKGROUND: This study aimed to examine the relationships between the initial anatomic severity of hand, wrist and forearm injuries, as evaluated by the Modified Hand Injury Severity Score (MHISS), and each of the following parameters: disability rating and time to return to work.
METHODS: In this study, 94 patients who underwent operations due to acute hand, wrist and forearm injuries were included. MHISS was used to assess the severity of the injury. Disability rates of the patients were calculated six months after injury in accordance with the ‘Regulation on Disability Criteria, Classification and Health Board Reports to be Given to Disabled People’. The time to return to work was defined as the length of time (in days) between the injury and the patient’s return to work. Spearman rank correlation analysis was performed to analyse correlations between the MHISS and each of the following: disability rates and time to return to work.
RESULTS: The mean overall MHISS was 125.23 (5–880). The mean overall upper extremity disability ratio (UEDR) was 17.64±22.6 (range: 0–94), and the mean overall total body disability ratio (TBDR) was 10.57±13.45 (range: 0–56). Among the study population, 87 (92.6%) patients were able to return to their jobs. The mean overall time to return to work was 138.69 (range: 35–365 days). A statistically significant correlation was found between MHISS and UEDR, TBDR and time to return to work and UEDR, TBDR (p<0.001).
CONCLUSION: As a result, as the initial injury severity increased, greater disability remained and the time to return to work increased. Predicting prognosis by determining the injury severity in the initial evaluation of patients may be important in predicting a patient’s future permanent disability level, which can contribute to maintaining patient expectations at a reasonable level, thereby aiding in psychosocial support.

BACKGROUND: One of the most common complaints about presentation at the Emergency Department (ED) in childhood is minor head trauma. In recent years, clinical decision rules (CDRs) have been published to assist in determining the need for performing computed tomography (CT) in these patients. The present study aims to investigate the compliance with Pediatric Emergency Care Applied Research Network (PECARN) rules in the decisions for CT examination in children aged below two years old with minor head trauma in our center.
METHODS: This retrospective, single-center study was conducted on a patient group aged below two years old, who presented at the ED within 24 hours of a trauma incident and were diagnosed as mild head trauma Glasgow Coma Scale score 14 and 15).
RESULTS: A total of 262 patients were included in this study. Of these patients, 214 (81.7%) received CT examination, and 48 (18.3%) patients did not receive any CT examination. None of these 48 patients showed clinically important traumatic brain injury (ci TBI). Among 214 patients who received CT examination, 89 (34%) patients met the PECARN rules criteria and 125 (47.7%) patients did not meet PECARN rules criteria. None of the patients who received CT examination and did not meet the PECARN rules criteria showed ci TBI. Among 89 patients who recieved a CT examination and also met the PECARN rules criteria, only 4 (1.5%) patients showed ci TBI. According to these results, the rate of compliance with PECARN rules in our institution ED was 52.3%.
CONCLUSION: In this study, which was conducted by including all the predictor values of the PECARN guidelines, the rate of compliance with PECARN rules was determined to be very low. Using these rules directly or with modification could establish a starting point for clinicians to reduce the rates of unnecessary CT scans. However, the effects of the clinician’s experience, parental expectations, medicolegal constraints and economic factors on the decision making process should not be forgotten.

BACKGROUND: Diaphragmatic injuries, which can be seen after penetrating thoracic traumas, have some difficulties in diagnosis. Undiagnosed small diaphragmatic lacerations may lead to serious health problems. This study aims to evaluate the role of VATS (Video Assisted Thoracoscopic Surgery) in the diagnosis and treatment of diaphragmatic injuries after penetrating thoracic traumas.
METHODS: Among 268 penetrating thoracic trauma patients, we retrospectively evaluated a total of 22 patients performed VATS due to suspected diaphragmatic injury in our department between June 2008 and June 2018.
RESULTS: Twenty (91%) patients were male, and two (9%) patients were female with a mean age of 28.01±6.4 (18–42) years. In 11 (50%) patients, VATS was performed on the right side and the others on the left side according to the penetrating area of trauma. In 10 (45%) patients, diaphragmatic laceration was detected and was repaired. In six cases (27%) in which diaphragmatic laceration detected with VATS, preoperative traumatic pathologies were detected radiologically. The missed injury rate was 18%. VATS had a specificity, sensitivity, positive predictive value and negative predictive value of 75%, 71.5%, 60% and 83.3%, respectively. There was no significant statistical difference between types of penetrating trauma, ages and gender of cases (p>0.05). No complication was detected during the mean follow up period of 36.2±9.3 (range 9–62) months.
CONCLUSION: Our opinion is that VATS is important and feasible in hemodynamically stable patients with suspected isolated diaphragmatic laceration after penetrating thoracic trauma that cannot be determined by radiologically.

This study aims to evaluate the clinical use and outcomes of transcatheter embolization in the setting of pediatric blunt renal trauma cases using an index case and review of the literature. Although the treatment method selection depends on the grade of the trauma and the hemodynamýc status of the patient, conservative methods are considered initially in the setting of pediatric blunt renal trauma. Transcatheter embolization, which is a relatively conservative treatment option, is commonly utilized in adult blunt renal trauma patient population; however, experience in the pediatric population is scarce. A seven-year-old male patient was admitted due to grade IV renal injury secondary to blunt abdominal trauma. He was conservatively followed until -on the post-trauma day 15- he developed gross hematuria and an unstable hemodynamic status. A renal angiogram was performed, which revealed right-sided renal inferior segmental artery pseudoaneurysm and arterio-venous fistula. Subsequently, a transcatheter embolization was performed. There were no complications and no permanent renal injury. Review of the literature revealed that the success rate of transcatheter embolization is 89.47% in the setting of pediatric blunt abdominal trauma-related renal injury regardless of the renal trauma grade. Four patients underwent nephrectomy due to a failed transcatheter embolization procedure. There are not any patients who suffered from embolization-related complications. These results suggest that transcatheter embolization can be safely performed in children with renal injuries due to blunt abdominal trauma with high success and low complication rates and preservation of renal function.

The clinical manifestations that may occur due to decompression during scuba diving vary widely, but only mild symptoms have been reported mainly in the gastrointestinal tract. In particular, ischemic colitis caused by air embolism is rare. We report a case of full-thickness ischemic colitis treated with failed conservative treatment but successfully treated surgically. The case that was presented here suggests that decompression after scuba diving may cause severe symptoms in the gastrointestinal tract and may require a surgical approach. Treatment depends on the severity of the symptoms and the patient’s condition, but surgical approaches should be considered.

Animal-related injuries should be analyzed based on the behavior and anatomy of the attacking animal. Rhinoceros-related injuries in humans are extremely rare. Hereby, we report a life-threatening traumatic diaphragmatic hernia in a woman who presented three years after a rhinoceros gored her chest. A 47-year-old lady presented with abdominal pain, bilious vomiting and obstipation of one-day duration. She had recurrent attacks of colicky abdominal pain for a week before that. The patient gave the history of being admitted to the ICU three years before, after being gored by a rhinoceros into her chest while working as a veterinary assistant in the zoo. On examination, the abdomen was distended but soft and lax. Bowel sounds were exaggerated. Abdominal x-rays showed multiple air-fluid levels. A gastrographin follow through study hold up in the small bowel and did not reach the colon after seven hours. Abdominal and chest CT scan showed the splenic colonic flexure to be located in the left chest through a left diaphragmatic hernia. Urgent laparotomy showed a healthy splenic flexure of the colon that herniated through a 4 cm postero-lateral defect in the left diaphragm. The colon was reduced, and the defect was repaired with non-absorbable sutures. Postoperative recovery was smooth. The patient was discharged home 10 days after the surgery. Rhinoceros-related injuries in humans are extremely rare. Life-threatening traumatic diaphragmatic herniation may be delayed for few years. High index of suspicion is needed for its diagnosis.

Wandering spleen is a rare condition and has life-threatening complications, such as torsion or infarction. It may be asymptomatic or may present with chronic abdominal pain or intraabdominal mass. Since clinical diagnosis is usually difficult, radiological examinations play a very important role in diagnosis. A 37-year-old multiparous woman was admitted to the emergency room with a complaint of abdominal pain. The patient stated that she underwent an operation due to gastric volvulus nine years ago. Preoperative diagnosis was made by ultrasonography and computed tomography. Splenectomy was performed because of the irreversible infarction. Wandering spleen torsion is a rare clinical condition that may cause an acute abdomen. Computerized tomography is the gold standard for preoperative diagnosis. Gastric volvulus and wandering spleen have similar etiologies. In the literature, the coexistence of these two diseases in adulthood is rarely reported. However, to our knowledge, this case is the first report to describe the emergence of these two pathologies at different times in adulthood.

Intraabdominal vascular injuries due to blunt abdominal trauma are rare. It is very difficult to visualize superior mesenteric vein (SMV) and portal vein injuries under emergency conditions. In this case study, we reported a low-speed car accident, a patient with isolated SMV injury as a result of a blunt abdominal trauma that arose from a collision with a steering wheel. A 62-year-old male patient was admitted to the emergency department with minimal distention and diffuse tenderness in the abdomen. The presence of diffuse fluid in the abdomen and suspected liver injury were reported in ultrasonography. The presence of fluid in perihepatic and perisplenic areas was detected in abdominal tomography. No solid organ injury was observed. Laparotomy revealed an injury in the small intestine mesentery. There was a defect on SMV under splenic vein combination. End side vein anastomosis and primary repair were performed. During six months follow-up, the patient did not have active complaints, and there was no pathology in the SMV and portal vein. We think that the use of vascular repair techniques applied by experienced surgeons in hemodynamically stable superior mesenteric venous injuries is important concerning continuity of anatomical and functional integrity.