AMAÇ: Baðýrsaklarýn iskemi/reperfüzyon yaralanmasý ciddi bir cerrahi durumdur. Bu çalýþma, oluþturulan bir iskemi/reperfüzyon yaralanmasý modelinde nispeten artan ozon dozu ile ozon tedavisinin etkilerini ortaya koymayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: Bu çalýþmada 24 adet albino Wistar rat üç grupta incelendi. Kontrol grubundaki sýçanlara (KG, n=8) sadece laparotomi uygu-landý. Sahte grupta (SG, n=8) ve ozon grubunda (OG, n=8) sýçanlarýn superior mezenterik arteri (SMA) 1 saat süreyle týkandý. SMA deoklüzyondan sonra karýn kapatýldý, SG'de intraperitoneal olarak fizyolojik salin infüze edildi ve OG'de intraperitoneal olarak artan ozon/oksijen karýþým dozu (0.7 mg/kg'dan 1 mg/kg'a) infüze edildi. Baðýrsak mukozal hasarýn histopatolojik incelemesi için 24. saatte ince baðýrsak örnekleri alýndý ve Chiu skoruna göre deðerlendirildi. Ayrýca oksidan düzeyler için Malondialdehit (MDA) ve Miyeloperoksidaz (MPO) düzeyleri, doku antioksidan sistemini deðer-lendirmek için ise Glutatyon (GSH) enzim aktivitesi ölçüldü.
BULGULAR: Histopatolojik olarak Chiu skoru KG'de en düþüktü. Ozonun baðýrsak mukozasý üzerindeki iyileþtirici etkisini gösteren OG'de SG'ye kýyasla daha düþüktü. OG'deki Chiu skoru, KG'ye kýyasla daha yüksekti, ancak istatistiksel olarak anlamlý deðildi. OG'de SG'ye kýyasla önemli ölçüde daha yüksek bir GSH seviyesi gözlendi ve bu da antioksidan aktiviteyi kanýtladý.
SONUÇ: Sýçanlarda iskemi/reperfüzyonun bu deneysel modelinde, artan ozon seviyesi ile tedavi, antioksidan mekanizmalar yoluyla inflamatuar süreci azalttý ve baðýrsak mukozal hasarý azalttý. Bununla birlikte, ozon tedavisinin etkinliði dozajlarýna baðlýdýr.

BACKGROUND: Ischemia/reperfusion injury of the intestines is a severe surgical condition. This study aimed to reveal ozone therapy effects with relatively increased ozone dosage in a created ischemia/reperfusion injury model.
METHODS: In this study, 24 albino Wistar rats were examined in three groups. Rats in the control group (CG, n=8) underwent only a laparotomy. In the sham group (SG, n=8) and ozone group (OG, n=8), the superior mesenteric artery (SMA) of the rats was occluded for 1 h. After de-occluding the SMA, the abdomen was closed, physiological saline was infused intraperitoneally in the SG, and an increased ozone/oxygen mixture dose (from 0.7 mg/kg to 1 mg/kg) was infused intraperitoneally in the OG. Small intestine samples were obtained at the 24th h for histopathological examination of intestinal mucosal injury and evaluated according to the Chiu score. In addition, Malondialdehyde and Myeloperoxidase levels were evaluated for oxidant levels, whereas, Glutathione (GSH) enzyme activity was measured to evaluate the tissue antioxidant system.
RESULTS: Histopathologically, the Chiu score was the lowest in the CG. It was lower in the OG compared to the SG showing the ameliorating effect of ozone on the intestinal mucosa. Chiu score in the OG was higher compared to that in the CG, but not statisti-cally significant. A significantly higher GSH level was observed in the OG compared to the SG, proving antioxidant activity.
CONCLUSION: In this experimental model of ischemia/reperfusion in rats, treatment with an increased ozone level decreased the inflammatory process through antioxidant mechanisms and reduced intestinal mucosal damage. However, the effectiveness of ozone therapy depends on its dosages.

AMAÇ: Perkütan trakeostomi (PT) uzun süreli ventilasyona baðlý yoðun bakým hastalarýnda sýklýkla gerekli olabilir.Genel riskler düþük olmakla birlikte, özellikle çocuklarda ciddi komplikasyonlar meydana gelebilir. Bu çalýþmada, 5-13 yaþ arasý çocuklarda PT giriþ noktasýnýn dijital palpasyonla belirleme doðruluðunun deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Katýlýmcýlardan dijital palpasyon kullanarak PT için iðne giriþ noktasýný (2./3. veya 3./4. trakeal halkalar arasýndaki boþluk) belirlemeleri istendi. Daha sonra, tek bir operatör lineer yüksek frekanslý transduser kullanarak trakeal bölgede ilgili anatomik yapýlarý belirledi. Doðru tahmin, orta hat içinde ilgili trakeal halkalarýn üst ve alt sýnýrlarý arasýndaki iþaret olarak tanýmlandý.
BULGULAR: 104 hastayý kapsayan çalýþmada sonografik bulgularla karþýlaþtýrýldýðýnda hastalarýn toplam %50.9'unda dijital palpasyonla PT giriþ yeri doðru olarak saptandý. USG ile PT giriþ noktasýnýn belirlenmesi için gereken süre palpasyon tekniðinden daha uzundu (114.7'ye karþý 43.8 saniye, p<0.001). Deriden hava mukoza temas çizgisi arasýndaki mesafesi ne kadar düþükse, dijital palpasyon yöntemiyle PT giriþ noktasý tespitinin baþarýsý o kadar yüksekti. Her iki yöntem giriþ noktalarý arasýndaki ortalama mesafe 4.53±2.03 mm idi. Hatalý deðerlendirmelerin çoðu (%45) 2. trakeal halkanýn yukarýsýndaydý.Vücut kitle indeksindeki bir birimlik artýþ, baþarýsýzlýk riskinin 1.1 kat artmasýyla iliþkiliydi (p=0.030).
SONUÇ: 5-13 yaþ arasý çocuklarda özellikle VKÝ arttýkça PT yerleþtirme yerinin belirlenmesinde önemli yanlýþlýklar bulunmaktadýr. Prosedür öncesi USG, PT için yer iþaretlerinin belirlenmesine yardýmcý olabilir.

BACKGROUND: Percutaneous tracheostomy (PT) may be required frequently in long-term ventilated intensive care patients. Although the overall risks are low, serious complications may occur, especially in children. Hence, this study aimed to assess physician accuracy in identifying PT insertion sites by digital palpation in children aged between 5 and 13 years.
METHODS: Participants were asked to identify the needle entry point (interspace between 2nd and 3rd or 3rd and 4th tracheal rings) for PT using digital palpation. Then, a single operator scanned the neck of each child with a linear high-frequency transducer. An accurate estimation was defined as a mark made between the upper and lower borders of the tracheal rings within the midline.
RESULTS: In the study including 104 patients, the PT insertion site was accurately identified with digital palpation in a total of 50.9% of patients, compared with sonographic findings. The time required to determine the PT entry point by USG was longer than the palpation technique (114.7 vs. 43.8 s, P<0.001). The mean distance between the entry points of both methods was 4.53±2.03 mm. The majority of inaccurate assessments (45%) was above the 2nd tracheal ring. The lower the skin-to-air-mucosal interface distance, the higher the success of the PT entry point detection with the digital palpation method. A one-unit increase in body mass index was related to increasing the risk of failure by 1.1 times (P=0.030).
CONCLUSION: Significant physician inaccuracy exists in PT insertion sites in children aged between 5 and 13 years, especially as BMI increases. Pre-procedural USG may help identify the landmarks for PT.

AMAÇ: Bu araþtýrmanýn amacý yönlendirilmiþ kemik rejenerasyonunu (GBR) artýrmak için oluþturulmuþ kolajen (COL) kaplý nano-hidroksiapatit (nHA) ile zenginleþtirilmiþ polikaprolakton (PCL) membranýn rat mandibular defektinde yeni kemik oluþumu üzerine etkilerini ve biyouyumluluðunu deðerlendirmektir.
GEREÇ VE YÖNTEM: Yirmi sekiz adet 12 haftalýk diþi Long Evans sýçana tek taraflý 5 mm çaptaki trefan frez ile mandibular angulus defekti oluþturul-du ve iki gruba ayrýldý. Test grubu membran (M-1, M-2) ile tedavi edilirken, kontrol grubu ise kendiliðinden iyileþmeye (C-1, C-2) býrakýldý. Ameliyat sonrasý 2. haftada (M-1, C-1) ve 8. haftada (M-2, C-2) sýçanlar sakrifiye edildi. Sýçanlarýn mandibular kemiði histopatolojik olarak deðerlendirildi. Rejenere kemiðin yoðunluðu PET/CT ile deðerlendirildi.
BULGULAR: Histopatolojik olarak defektin periferinden baþlayan yeni kemik oluþumu (NBF) M-1'de zengin hücresel karaktere sahipti. M-2, M-1'den anlamlý olarak daha yüksek yeni kemik oluþumuna sahipti (p=0.003). Ayrýca M-2’de, M-1'ye göre anlamlý derecede daha az inflamasyon bulundu (p<0.05).
SONUÇ: Bu çalýþma, yönlendirilmiþ doku rejenerasyonu prensipleri ile oluþturulan yeni üretilmiþ kolajen kaplý nHA ile zenginleþtirilmiþ polikaprolak-ton membranýn alveolar defektlerde doku mühendisliði için umut verici bir tasarým olabileceðini göstermektedir.

BACKGROUND: This research investigated the ability of fabricated collagen (COL) coated nano-hydroxyapatite (nHA) enriched polycaprolactone (PCL) membrane to facilitate new bone formation (NBF) and its biocompatibility.
METHODS: Unilateral mandibular angulus defects of 28 female 12-week-old long Evans rats were created with a trephine bur with 5 mm in diameter and divided into two groups. While the test group was treated with the membrane (M-1, M-2), the control was left as self-healing (C-1, C-2) and sacrificed at 2nd (M-1, C-1) and 8th week (M-2, C-2) postoperatively. The mandibular bone of the rats was evaluated histopathologically. Density of the regenerated bone was evaluated with PET/CT.
RESULTS: Histopathologically, NBF which started from the periphery of the defect had rich cellular character in M-1. Significantly higher NBF was found in M-2 when compared to M-1 (P=0.003). Furthermore, significantly lesser degree of inflammation was found in M-2 when compared to M-1 (P<0.05).
CONCLUSION: This study suggests that the novel COL-coated nHA-enriched PCL membrane can serve a promising design for tissue engineering as guided bone regeneration in alveolar defects.

AMAÇ: Bu çalýþmanýn amacý, açýk tibia kýrýklarýnda uygulanabilen minimal invaziv plak osteosentezi (MIPO), subkutan plaklama (SP) ve unilateral eksternal fiksatörlerin (UEF) mekanik özelliklerinin araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: 60 adet taze koyun tibia örneðinde kemiklerin ortasýndan osteotomi yapýlarak stabil olmayan diyafiz tibia kýrýðý oluþturuldu. Örnekler 3 gruba ayrýldý. SP grubu için numunelere standart bir MIPO tekniði ile kemikten 15 mm implante edilen kýrýk fiksasyonu uygulandý. UEF grubuna unilateral uniplanar eksternal fiksatörler uygulandý. Ýlk olarak, otuz numune (her grup için 10 numune) tibial eksen boyunca dikey olarak 1800 N'ye yüklendi. Ýkinci olarak, metal yorgunluðunu önlemek için döngüsel yükleme için önceden hazýrlanmýþ diðer 30 kemik kullanýldý. Dinamik testler için 10.000 döngü için 350 N'lik bir kuvvet uygulandý.
BULGULAR: Üç fiksasyon aletinin sýkýþtýrma testinde (1800 N'ye kadar dikey yükleme); yapý sertliði SP ve UEF gruplarý ile karþýlaþtýrýldýðýnda MIPO grubunda en yüksekti. MIPO grubunun sertliði SP grubuna benzer iken UEF grubuna göre istatistiksel olarak daha yüksekti (sýrasýyla p=0.08 ve p=0.002). SP grubu, UEF grubuna göre anlamlý olarak daha sertti (p=0.0021). Ortalama pik yük SP grubunda en yüksek, UEF grubunda en düþüktü. SP grubunda tepe yük MIPO grubuna benzer, UEF grubundan istatistiksel olarak yüksekti (sýrasýyla p=0.743 ve p=0.002).
SONUÇ: Bu in vitro hayvan modeli çalýþmasýndan elde edilen biyomekanik özelliklere dayanarak, subkütan plaklama tekniði biyomekanik olarak UEF'den daha güçlüydü ve eksenel yükleme açýsýndan MIPO ile benzer biyomekanik özelliklere sahipti.

BACKGROUND: The aim of this study is to investigate mechanical properties of minimally invasive plate osteosynthesis (MIPO), supracutaneousplating (SP), and unilateral external fixators (UEF) which can be performed for open tibial fractures.
METHODS: An unstable diaphysial tibia fracture was created in 60 fresh sheep tibia specimens by performing an osteotomy at the middle of bones. Specimens were divided into 3 groups. Specimens underwent fracture fixation with a standard MIPO technique, im-planting the plate 15 mm from the bone for SP group. Unilateral uniplanar external fixators were achieved for UEF group. First, thirty specimens (10 specimen for each group) were loaded vertically along the tibial axis to 1800 N. Second, other 30 preperated bones were used for cyclical loading to avoid metal fatigue. For dynamic tests, a 350 N force was applied for 10,000 cycles.
RESULTS: In compression testing (vertical loading up to 1800 N) of the three fixation instruments; construct stiffness was highest in MIPO group when compared with SP and UEF groups. While the stiffness of the MIPO group was similar to SP group, it was statistically higher than UEF group (P=0.08 and P=0.002, respectively). SP group was significantly stiffer than UEF group (P=0.0021). The mean peak load was highest in SP group and lowest in UEF group. The peak load in SP group was similar to the MIPO group, it was statistically higher than the UEF group (P=0.743 and P=0.002, respectively).
CONCLUSION: Based on the biomechanical properties from this in vitro animal model study, SP technique was biomechanically stronger than UEF and has similar biomechanical properties with MIPO in terms of axial loading.

AMAÇ: HALP skorunun akut pankreatitte kýsa vadeli mortaliteyi öngörme gücünü incelemek.
GEREÇ VE YÖNTEM: Çalýþma üçüncü basamak bir hastanenin scil servisinde yapýldý. Acil servise baþvuran ve akut pankreatit tanýsý alan hastalarýn týbbi kayýtlarý retrospektif olarak incelendi. HALP skorunun bu hastalarda kýsa dönem mortaliteyi tahmin etme yeteneði analiz edildi. BULGULAR: Çalýþma toplam 634 hasta ile gerçekleþtirildi. Bu hastalarýn yaþ ortalamasý 59.7±16.6 olup, 381'i (%60.1) kadýndý. Dahil edilen toplam hastalarýn 42'si (%6.6) yoðun bakým ünitesine (YBÜ) alýnýrken, 58'i (%9.1) öldü. HALP skorlarýnýn kýsa vadeli mortaliteyi öngörme gücünü incelemek için alýcý çalýþma karakteristikleri (ROC) analizi kullanýldý. Eðri altýndaki alan (AUC) deðeri 0.891 (%95 GA: 0.833-0.949) olarak bulundu. HALP skorunun kýsa dönem mortaliteyi belirlemede cut-off deðeri >15 olduðunda skorun duyarlýlýðý % 82.8, özgüllüðü % 86.8, pozitif öngörü deðeri (PPV) %38.7 ve negatif öngörü deðeri ( NPV) %98.0.
SONUÇ: Akut pankreatit, erken taný ve yeterli tedavi gerektiren bir hastalýktýr, deðilse yüksek oranda mortalite ve morbiditeye neden olabilir. Bu çalýþma sonucunda HALP skorunun akut pankreatit tanýlý hastalarda kýsa dönem mortaliteyi öngörmede kullanýlabileceði kanýsýna varýldý.

BACKGROUND: To examine the hemoglobin, albumin, lymphocyte, and platelet (HALP) scores’ predictive power in predicting short-term mortality from acute pancreatitis (AP).
METHODS: The study was conducted at the emergency department (ED) of tertiary care hospital. The medical records of patients who admitted to the ED and were diagnosed with AP were reviewed retrospectively. Ýt was analyzed that the ability of the HALP score in predicting short-term mortality of these patients.
RESULTS: The study was achieved with a total of 634 patients. The mean age of these patients was 59.7±16.6 and 381 (60.1%) were female. While 42 (6.6%) of the total included patients were required to the intensive care unit, 58 (9.1%) died. To examine the HALP scores’ predictive power in predicting short-term mortality, the Receiver Operating Characteristic (ROC) analysis was utilized. The value of the area under the curve was found as 0.891 (95% CI: 0.833–0.949). When the cut-off value of the HALP score in determining short-term mortality is >15, the Sensitivity of the score was found to be 82.8%, Specificity 86.8%, Positive Predictive Value 38.7%, and Negative Predictive Value 98.0%.
CONCLUSION: AP is a disease that requires early diagnosis and adequate treatment if not it can cause a high rate of mortality and morbidity. As a result of this study, it was concluded that the HALP score can be utilized during the prediction of short-term mortality for patients diagnosed with AP.

AMAÇ: Akut apandisit en yaygýn cerrahi acil durum nedenidir. Laparoskopik apendektomi ile tedavi edilmesi gereken akut apandisit vakalarýný açýk cerrahi ile tedavi edilmesi gereken vakalardan ayýrt etmek zor olabilir. Bu çalýþmanýn amacý, ilk cerrahi deðerlendirme sýrasýnda laparoskopik apendektomiden açýk apendektomiye dönüþüm için potansiyel risk faktörlerini belirleyerek uygunsuz teknik seçimini ve buna baðlý komplikasyonlarý önlemektir.
GEREÇ VE YÖNTEM: Bu çalýþma, akut apandisit nedeniyle laparoskopik eksplorasyon yapýlan hastalarýn retrospektif bir analizidir. Çalýþmaya Ocak 2016 ve Temmuz 2021 tarihleri arasýnda 18 yaþ üstü hastalar dahil edilmiþtir. Hastalar cerrahi yaklaþýma göre iki gruba ayrýldý: laparoskopik apendek-tomi (LA) yapýlanlar ve önce laparoskopik eksplorasyon yapýlýp daha sonra açýk apendektomiye (AAG) geçilen olgular. Gruplar arasýnda demografik özellikler, perioperatif faktörler ve sonuçlar karþýlaþtýrýldý.
BULGULAR: Çalýþmaya apendektomi için laparoskopik eksplorasyon yapýlan 634 eriþkin dahil edildi. %80.8'sinde LA yapýldý ve %19.2'sinde (n=122) AAG gerekti. AAG hastalarýnýn yaþ ortalamasý LA hastalarýndan anlamlý olarak daha yüksekti (48.5 yýla karþý 37.8 yýl, p<0.001). Konversiyon oraný 65 yaþ üstü hastalar için %63.8 iken, 65 yaþ altý hastalar için %15.6 idi (p<0.001). AAG hastalarda LA hastalarýna kýyasla daha yüksek bilirubin düzeyleri (%36.1'e karþý %13.5, p<0.001), daha yüksek ASA skorlarý (ASA>2, COA %52.5'e karþý %7.8, p<0.001) ve daha yüksek BT görüntüleme ihtiyacý (%84.4'e karþý %67.6, p<0.001) vardý. Alvarado skoru LA'yý AAG 'dan önemli ölçüde ayýrmýþtýr (skor>6 olan %62,6'ya karþý %39.4, p<0.001). AAG hastalarýnda oral alýma baþlayana kadar geçen süre (31.6'ya karþý 9,9 saat, p<0,001) ve komplike apandisit oranlarý (%40.9'a karþý %0.6, p<0.001) an-lamlý derecede yüksekti. Ameliyattan sonra, AAG'da LA'ya kýyasla daha yüksek komplikasyon oranlarý görüldü: cerrahi alan enfeksiyonlarý (%8.2'ye karþý %2.7, p=0.004), yeniden ameliyat (%13.1'e karþý %0, p<0.001), hastaneye tekrar yatýþ (%14.7'ye karþý %2.3, p<0.001) ve mortalite (%1.6'ya karþý %0, p<0.004).
SONUÇ: Ýleri yaþ ve özellikle 65 yaþ üstü, yüksek bilirubin düzeyleri, ASA>2 skoru ve BT taramasý kullanýlarak ameliyat öncesi tanýlama ihtiyacýnýn artmasý, açýk apendektomiye geçiþ için önemli belirleyiciler olarak bulundu. Konversiyon grubunda ameliyat süresi, oral alýma kadar geçen süre ve komplike apandisit insidansý anlamlý olarak daha yüksekti. Konversiyon grubunda ameliyat sonrasý komplikasyon, cerrahi alan enfeksiyonu, hastaneye tekrar yatýþ ve ölüm oranlarý anlamlý derecede yüksekti. Açýk cerrahiye dönüþüm ile iliþkili komplikasyon oranlarýndaki artýþtan kaçýnmak için, ileriye dönük risk faktörleri olan bir hastanýn ilk deðerlendirilmesi faydalý olabilir.

BACKGROUND: Acute appendicitis is the most common cause of surgical emergencies. It can be difficult to distinguish cases of acute appendicitis that should be managed by laparoscopic appendectomy (LA) from those that should be managed by open surgery. This study aimed to prevent the inappropriate choice of technique and associated complications by identifying potential risk factors for conversion from laparoscopic to open appendectomy (OA) at the time of initial surgical assessment.
METHODS: This is a retrospective analysis of patients who underwent laparoscopic exploration for acute appendicitis. The study included patients over 18 years of age between January 2016 and July 2021. Patients were divided into two groups according to the surgical approach: those who underwent a LA and those who initially underwent laparoscopic exploration first and then converted to OA. Demographics, perioperative factors, and outcomes were compared between groups.
RESULTS: The study included 634 adults undergoing laparoscopic exploration for an appendectomy. About 80.8% had LA, and 19.2% (n=122) required COA. COA patients’ average age was significantly higher than LA patients’ (48.5 years vs. 37.8 years, P<0.001). The conversion rate for patients over 65 was 63.8%, compared to 15.6% for those under 65 (P<0.001). COA patients had higher bilirubin levels (36.1% vs. 13.5%, P<0.001), higher American Society of Anesthesiologists (ASA) scores (ASA >2, COA 52.5% vs. LA 7.8%, P<0.001), and a higher need for CT imaging (84.4% vs. 67.6%, P<0.001) than LA patients. An Alvarado score >6 significantly differenti-ated LA from COA (62.6% vs. 39.4%, P< p<0.001). COA patients experienced significantly increased periods until starting oral intake (31.6 vs. 9.9 h, P<0.001) and higher rates of complicated appendicitis (40.9% vs. 0.6%, P<0.001). After surgery, COA had higher rates of complications compared to LA: surgical site infections (8.2% vs. 2.7%, P=0.004), reoperation (13.1% vs. 0%, P<0.001), hospital re-admission (14.7% vs. 2.3%, P<0.001), and mortality (1.6% vs. 0%, P<0.004).
CONCLUSION: Advanced age, especially over 65 years, elevated bilirubin levels, an ASA >2 score, and an increased need for pre-operative diagnostics using CT scans were found to be significant predictors of conversion to OA. In the conversion group, operative time, time to oral intake, and the incidence of complicated appendicitis were significantly higher. The conversion group had significantly higher rates of postoperative complications, surgical site infections, hospital readmissions, and mortality. To avoid the increased rate of complications associated with conversion to open surgery, the initial evaluation of a patient with prospective risk factors may be beneficial.

AMAÇ: Bu çalýþmanýn amacý, akut kolesistitli hastalarda laparoskopik kolesistektomi sýrasýnda açýk cerrahiye geçiþ için preoperatif ultrason bulgularýnýn rolünü deðerlendirmek; ayrýca operasyon ve yatýþ süreleri üzerine etkilerini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmaya 1 Ocak – 30 Haziran 2023 tarihleri arasýnda akut kolesistit sebebiyle laparoskopik kolesistektomi tekniðiyle ameliyata baþlanan 80 hasta dahil edildi. Preoperatif ultrasonografide kese duvar kalýnlýðý ve perikolesistik mayi varlýðý ile ameliyat süresi, açýk cerrahiye geçme ve hastanede yatýþ süreleri arasýndaki iliþkisi deðerlendirildi.
BULGULAR: Safra kesesi duvar kalýnlýðý, açýk cerrahiye geçilen hastalarda 7.0 (6.0- 8.0) mm iken, diðer grupta 5.0 (4.0- 5.0) mm ölçüldü ve fark istatistiksel olarak anlamlýydý(p<0.001). Ayrýca preoperatif ultrasonografide perikolesistik mayi bulunmasý açýk cerrahiye geçilen ve laparoskopik tamamlanan hasta gruplarý arasýnda deðerlendirildiðinde istatistiksel olarak anlamlý fark bulundu (p=0,012). Safra kesesi duvar kalýnlýðýnýn ameliyatýn açýk cerrahiye geçilmesinde ayýrt edici gücü ROC analizi ile deðerlendirildi. Area Under Curve (AUC) deðeri 0.907 olarak saptandý. ROC eðrisine göre safra kesesi duvar kalýnlýðý ≥5.75 milimetre için duyarlýlýk ve özgüllük yüzdesi sýrasýyla, %85.7; %84.9 bulundu.
SONUÇ: Akut kolesistit ataðý geçiren hastalarda, perikolesistik mayi bulunmasý ve safra kesesi duvar kalýnlýðýnýn 5.75 mm ve daha büyük olmasýnýn laparoskopik kolesistektominin teknik olarak daha zor geçeceðini gösteren faktörler olarak deðerlendirilebilir.

BACKGROUND: The aim of this study is to evaluate the role of pre-operative ultrasound findings for conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis and to evaluate the effects of pre-operative ultrasound findings on operation time and length of stay.
METHODS: The study included 80 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 1 and June 30, 2023. The relationship between gallbladder wall thickness and the presence of pericholecystic fluid on pre-operative ultrasonography and the duration of surgery, conversion to open surgery, and hospitalization was evaluated.
RESULTS: The patient group undergoing open surgery exhibited a statistically significant increase in both the median gallbladder wall thickness (P<0.001) and the frequency of pericholecystic fluid on pre-operative ultrasound (P=0.012). Receiver operating characteristic (ROC) analysis was used to assess the discriminative power of gallbladder wall thickness for predicting the requirement to convert from laparoscopic surgery to open surgery. The area under the curve value was found to be 0.907, indicating a strong discriminative power. Based on the ROC curve, a gallbladder wall thickness of ≥5.75 millimeters showed a sensitivity of 85.7% and specificity of 84.9% in predicting the requirement for open surgery.
CONCLUSION: Our study highlights the significance of two factors in predicting the conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis. The presence of pericholecystic fluid and a gallbladder wall thickness of 5.75 mm or greater are indicators that the laparoscopic procedure may be more challenging in such cases. These results can aid surgeons in making informed decisions and planning the surgical approach accordingly for better patient outcomes.

AMAÇ: Ýnternal herniler, gastrointestinal sistemin mezenterik veya peritoneal defektlerle iliþkilendirilen baðýrsak herniasyonlarýdýr. Etyolojik olarak, internal herniler genellikle konjenital veya edinsel olarak iki kategoriye ayrýlýr. Ýnternal herniler genellikle nonspesifik semptomlarla baþvururlar. Bilgisayarlý tomografinin yaygýnlaþmasý ile tanýsal zorluklar azalmýþ olsa da görüntüleme bulgularý ile taný doðruluðu arasýnda yaþanan uyumsuzluk klinisyenler için hala sorun olmaya devam etmektedir. Bu çalýþma ile, acil servise karýn aðrýsý þikayetiyle baþvuran ve bilgisayarlý tomografi (BT) ile internal herni ön tanýsý alan hastalarýn laparotomi sonucu sonlanýmlarýnýn karþýlaþtýrýlmasýný amaçladýk.
GEREÇ VE YÖNTEM: Araþtýrmamýz retrospesktif, gözlemsel ve tanýmlayýcý bir araþtýrmadýr. Araþtýrmamýza acil servise karýn aðrýsý ile baþvuran, BT çekilerek internal herni ön tanýsý alan hastalar dahil edilmiþtir. Hasta verisi olarak: hastalarýn yaþ, cinsiyet, BT ile belirlenen internal herni tipi, ameliyat olup olmadýðý, ameliyat tanýsý, hastane yatýþýnýn olup olmadýðý, yatýþ olduysa kaç gün yattýðý, baðýrsak rezeksiyonu, mortalite ve kan parametreleri kaydedilmiþtir. Ýnternal herni tipi için Welch sýnýflamasý kullanýlmýþtýr.
BULGULAR: Abdomen BT sonucunda internal herni ön tanýsýna sahip olan 112 hastanýn yaþlarýnýn median deðeri 52 yýl olarak bulundu (46 kadýn, 66 erkek). Tüm hastalardan 87 tanesi takip ve operasyon için hastaneye yatýrýlýrken 25 hasta acil servis takibi sonrasýnda taburcu edildi. Paraduodenal herniler 48 hasta ile en çok düþünülen ön taný oldu. Bu hastalardan 45 tanesine acil servis ve klinik gözlem sonrasýnda þikayetlerinin geçmesi üzerine elektif þartlarda deðerlendirilmek üzere taburcu edilmiþtir. Bu hastalarýn kesin tanýsý bilinmemektedir. 32 hastanýn cerrahi sonrasý tanýsý internal herni olarak doðrulanmýþtýr. Bunlardan 15 tanesi kadýn, 17 tanesi erkektir. Yaþlarýnýn median deðeri 52'dir. Ýnternal herni tanýsý alan hastalarýn median hastane yatýþ gün sayýsý 5 olarak bulunmuþtur. Konjenital ve edinsel herniler, rezeksiyon iþlemi ve mortalite açýsýndan incelenmiþtir. Edinsel hernilerde rezeksiyon oraný ve mortalite daha fazla olmasýna raðmen istatistiksel fark bulunamamýþtýr. 35 hastanýn ise tanýsýnýn farklý olduðu görülmüþtür. 19 hasta brid ileus, 5 hasta volvulus, 6 hasta apandisit, 1 hasta duodenal perforasyon, 3 hasta jinekolojik malignite, 1 hasta renal malignite tanýsý almýþtýr. SONUÇ: Ýnternal herniler nadir görülen bir durum olsa da mortalite riskinin fazla olmasý nedeniyle erken teþhis ve tedavi çok önemlidir. Çalýþmamýz sonucunda yaygýnlaþan BT kullanýmý ile daha erken taný ve tedavi þansý yakalayan hastalarýn daha iyi bir prognoza sahip olduðu bulunmuþtur. Çalýþmamýz literatürdeki en fazla vaka serisine sahip çalýþmalardan biridir. Radyolojik görüntüleme ile ön tanýsý internal herni olan hastalarýn deðerlendirildiði, cerrahi sonrasý tanýnýn kesinleþmesi ve internal herni ile karýþabilecek diðer durumlarýn karþýlaþtýrýlmasý ile farklý bir bakýþ açýsý yansýtan, bu sayede literatüre katký saðlayacaðýný düþündüðümüz bir çalýþmadýr.

BACKGROUND: Internal hernias involve the herniation of intestines through mesenteric or peritoneal defects in the gastrointestinal system. Etiologically, they are generally classified as congenital or acquired. Internal hernias often present with non-specific symptoms. Despite the increased use of computed tomography (CT), discrepancies between imaging findings and diagnostic accuracy continue to pose challenges for clinicians. This study aims to compare the outcomes of patients presenting to the emergency department with abdominal pain and receiving a preliminary internal hernia diagnosis through CT, followed by laparotomy.
METHODS: Our research is a retrospective, observational, and descriptive study. It includes patients presenting to the emergency department with abdominal pain, who were provisionally diagnosed with internal hernia based on CT. Patient data recorded age, gen-der, CT-identified internal hernia type, surgery, diagnoses, hospitalization status, duration of hospital stay, bowel resection, mortality, and blood parameters. The Welch classification was used to categorize internal hernia types, with eight types examined.
RESULTS: Among 112 patients with a preliminary internal hernia diagnosis based on abdominal CT, the median age was 52 years. Of these, 46 were female and 66 were male. Among all patients, 87 were admitted to the hospital for observation and surgery, while 25 were discharged after emergency department. Paraduodenal hernias were the most common provisional diagnosis (48 cases). Among these patients, 45 were discharged after symptom relief and were advised for elective re-evaluation. The exact diagnosis for these pa-tients remains unknown. Post-surgery, the diagnosis of internal hernia was confirmed in 32 cases. Among them, 15 were female and 17 were male, with a median age of 52. The median hospital stay for patients diagnosed with internal hernia was 5 days. Although acquired hernias exhibited higher resection and mortality rates, no statistically significant difference was found. Thirty-five cases received dif-ferent diagnoses: 19 had brid ileus, five had volvulus, six had acute appendicitis, one had duodenal perforation, three had gynecological malignancies, and one had renal malignancy.
CONCLUSION: Although internal hernias are rare, early diagnosis and treatment are very important due to the high risk of death. The study findings indicate that increased CT utilization leads to earlier diagnosis and treatment, resulting in improved prognosis for patients. This study holds one of the largest case series in the literature. It provides a novel perspective by evaluating radiologically-diagnosed cases, confirming diagnoses post-surgery, and comparing conditions that mimic internal hernias, thereby making a valuable contribution to the literature.

AMAÇ: Diyabetik ayak krizi, diyabetik ayaðýn en kötü klinik tablolarýndan biri olarak kabul edilir. Diyabetik ayak krizinde amputasyonu önlemek ve hastanýn yaþamýný kurtarmak için hýzla hareket etmek gerekir. Bu çalýþmanýn amacý, diyabetik ayak krizinin karakteristik özelliklerini ortaya çýkarmak ve saðlýk profesyonellerine bu hastalarý yönetme ve gerektiðinde sevk etme konusunda rehberlik etmektir.
GEREÇ VE YÖNTEM: Diyabetik ayak krizi nedeni ile deðerlendirilen 65 hasta retrospektif olarak incelendi. Demografik veriler toplandý. Hastalarýn Infectious Diseases Society of America/ International Working Group on the Diabetic Foot (IDSAIWDGF) evreleri, Site Ischemia Neuropathy Bacterial Infection and Depth (SINBAD) ve Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) skorlarý hesaplandý. Bu ölçümlere göre hastalar kategorilere ayrýldý ve istatistiksel sonuçlar elde edildi.
BULGULAR: Çalýþmada, acil cerrahi müdahale gerektiren hastalarýn, merkezimize gelmeden önce ortalama 2 hastaneye baþvurduðu ve ilk þikayet baþladýðýndan beri geçen medyan kabul süresinin 9 gün olduðu bulundu. Tüm hastalarýn IDSA/IWDGF evreleri 3 ve 4'tü. SINBAD skoru 4 ile 6 arasýndaydý. Hesaplanan LRINEC skorlarýna göre hastalarýn %60'ý nekrotizan fasiit açýsýndan yüksek risk altýndaydý. Periferik arteriyel týkanýklýk gö-rülme oraný %58.2 iken hastalarýn %69.2'sine amputasyon yapýldý. Hastalarýn %21.3'ü yoðun bakým ünitesinde takip edildi.Mortalite oraný %4.2 idi. SONUÇ: Diyabetik ayak krizi, yüksek klinik þüphe gerektiren bir acil cerrahi durumdur. Taný konulup acil cerrahi tedavi yapýlmazsa yüksek mortalite ve amputasyon oranýna sahiptir. Hastalarýn yüksek beyaz küre sayýsý, lokal ve sistemik enflamasyon bulgularý, direkt grafide, alt ekstremitelerde cilt altýnda amfizem olmasý ve kan þekeri yüksekliði diyabetik ayak krizi için uyarýcý olmalýdýr. Bu hastalara hýzla acil cerrahi müdahale yapýlmalý, hasta cerrahi için uygun bir merkezde deðil ise deneyimli klinisyenlere sahip bir merkeze hýzla sevk edilmelidir.

BACKGROUND: Diabetic foot attack (DFA) is considered one of the worst manifestations of diabetic foot. It is necessary to act quickly to prevent amputation and save the patient’s life. The aim of this study is to reveal the characteristic features of DFAs and be a guide to healthcare professionals to manage and refer these patients.
METHODS: Sixty-five patients with DFAs were analyzed retrospectively. Demographics were collected. All patients’ ýnfectious dis-eases Society of America/International Working Group on the Diabetic Foot (IDSA/IWDGF) stages, site ýschemia neuropathy, bacterial ýnfection and depth (SINBAD) and laboratory risk ýndicator for necrotizing fasciitis (LRINEC) scores were calculated. According to these measurements, patients were categorized and statistical results were obtained.
RESULTS: We found that patients who underwent emergency surgery due to DFA applied to an average of two hospitals before applying to our facility and the median acceptance time since the beginning of the first complaint was 9 days. All patients were IDSA/IWDGF stages three and four. Most of the patients had SINBAD scores between four and six. 60% of the patients were at high risk for necrotizing fasciitis according to the LRINEC score. 58.2% of patients had periferic arterial stenosis and the amputation rate was 69.2%. 21.3% of the patients were followed in the intensive care unit, and our patients’ mortality rate was 4.2%.
CONCLUSION: DFA is an emergency surgical condition that requires high clinical suspicion. If not diagnosed and treated with emergency surgery, it has a high mortality and amputation rate. High white blood cell count in patients, local and systemic signs of inflammation, presence of subcutaneous emphysema in the lower extremities on a direct X-ray radiography, and high blood sugar should be considered as warning signs for DFA. Emergency surgical intervention should be performed on these patients, and if the patient is not in a suitable center for emergency surgery, they should be rapidly referred to a center with experienced clinicians.

AMAÇ: Yanýklar dünya çapýnda en yaygýn travmalardan biridir. Ciddi yanýk hastalarýnda, mortalite ve morbidite riski oldukça yüksektir. Bu çalýþmada, yanýk mortalitesi için risk faktörlerini deðerlendirmeyi ve bu faktörler için altý farklý Makine Öðrenimi (MÖ) Algoritmasýnýn tahmin performanslarýný karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Yanýk tedavi merkezinde tedavi edilen yanýk hastalarýnýn týbbi kayýtlarý retrospektif olarak incelendi. Hastalarýn yaþ ve cinsiyet, Toplam Yanýk Yüzey Alaný, Ýnhalasyon Yaralanmasý, tam kat yanýklarý, yanýk tipleri gibi verileri kaydedildi ve MÖ modellerinde girdi özelliði olarak kullanýldý. Hastalar Yaþayanlar ve Yaþamayanlar olarak iki grup altýnda incelendi. Mortaliteyi tahmin etmek için k-Nearest Neighbor, Decision Tree, Random Forest, Support Vector Machine, Multi-Layer Perceptron, ve AdaBoost olmak üzere altý MÖ algoritmasý kullanýldý. Her algoritma için birçok farklý öðreti kombinasyonu deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilen hasta sayýsý 363 idi. MÖ algoritmalarýna dahil edilen altý parametrenin tümü tek deðiþkenli analizde anlamlý bir fark gösterdi (p<0.001). Sonuçlar, tüm girdi özelliklerini kullanan AdaBoost algoritmasýnýn %90 Doðruluk ve %92 AUC ile en iyi tahmin performan-sýna sahip olduðunu göstermektedir.
SONUÇ: Doðru verilerin öðretildiði MÖ algoritmalarý, yanýk mortalitesinde yüksek tahmin performansý göstermiþtir. Yanýk hastalarý için uygun verilerin öðretildiði MÖ modellerinin, klinik pratikte kullanýþlý olabileceðini düþünmekteyiz. Bu nedenle, bu konuda daha ileri araþtýrmalara ihtiyaç vardýr.

BACKGROUND: Burns is one of the most common traumas worldwide. Severely injured burn patients have an increased risk for mortality and morbidity. This study aimed to evaluate well-known risk factors for burn mortality and comparison of six machine learn-ing (ML) Algorithms’ predictive performances.
METHODS: The medical records of patients who had burn injuries treated at Izmir Bozyaka Training and Research Hospital's Burn Treatment Center were examined retrospectively. Patients’ demographics such as age and gender, total burned surface area (TBSA), Inhalation injury (II), full-thickness burns (FTBSA), and burn types (BT) were recorded and used as input features in ML models. Pa-tients were analyzed under two groups: Survivors and Non-Survivors. Six ML algorithms, including k-Nearest Neighbor, Decision Tree, Random Forest, Support Vector Machine, Multi-Layer Perceptron, and AdaBoost (AB), were used for predicting mortality. Several different input feature combinations were evaluated for each algorithm.
RESULTS: The number of eligible patients was 363. All six parameters (TBSA, Gender, FTBSA, II, Age, BT) that were included in ML algorithms showed a significant difference (p<0.001). The results show that AB algorithm using all input features had the best predic-tion performance with an accuracy of 90% and an area under the curve of 92%.
CONCLUSION: ML algorithms showed strong predictive performance in burn mortality. The development of an ML algorithm with the right input features could be useful in the clinical practice. Further investigations are needed on this topic.

AMAÇ: Ateþli silah yaralanmalarýna (ASY) baðlý meydana gelen ölümler Türkiye’de ve yurt dýþýnda giderek artarak önemli bir halk saðlýðý problemi olmuþtur. Bu çalýþmada ASY konusundaki makalelerin bibliyometrik analizinin yapýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Araþtýrma kapsamýnda Web of Science (WoS) veri tabanýnda Bibliometrix programý ile incelemeler yapýlmýþtýr. Gunshot wound, gunshot injuries, gunshot injury, firearm wound, firearm injuries, firearm injury kelimeleri anahtar kelime olarak kullanýlmýþtýr. BULGULAR: Yapýlan analiz sonucunda 1980-2022 yýllarý arasýnda 479 farklý dergide yayýnlanan 1236 makaleye ulaþýldý. Makalelerin yýllýk büyüme oraný %6.69, makale baþýna ortalama atýf 9.78 idi. Amerika Birleþik Devletleri (ABD) (n=562, %45.4), Türkiye (n=102, %8.25) ve Hindistan (n=42, %3.4) yayýn performansý en yüksek üç ülke idi. Güney Afrika’dan Elias Degiannis ve Roger Saadia, ABD’den C. William Schwab en etkili ilk üç araþ-týrmacýdýr. Türkiye kökenli en etkili araþtýrmacý ise Ersin Erdogan idi. “Journal of Trauma-Injury Infection and Critical Care”, “American Surgeon” ve “Injury-International Journal of the Care of the Injured” dergileri yayýn ve atýf sayýlarý açýsýndan en etkili ilk üç dergidir. Türkiye kökenli “Ulusal Travma ve Acil Cerrahi Dergisi” en etkili sekizinci dergidir. Atýflarý yönüyle en etkili araþtýrmanýn Katherine A Fowler tarafýndan 2015 yýlýnda Prev Med’de yayýnlanan “Firearm injuries in the United States” baþlýklý çalýþma olduðu bulunmuþtur.
SONUÇ: Araþtýrma sonucunda ASY konusunda çalýþmalar yapan araþtýrmacýlar için faydalý bilgiler ortaya çýkarýlmýþtýr. ASY konusundaki ilk kapsamlý bibliyometrik çalýþma olmasý, bu araþtýrmayý özgün kýlmaktadýr.

BACKGROUND: Deaths due to gunshot wounds (GSWs) have become an increasingly important public health problem in Türkiye and abroad. The aim of this study was to conduct a bibliometric analysis of articles about GSW.
METHODS: Within the scope of the research, the Web of Science database was examined with the bibliometrix program. GSW, gunshot injuries, gunshot injury, firearm wound, firearm injuries, and firearm injury were used as keywords.
RESULTS: As a result of the analysis, 1236 articles published in 479 different journals between 1980 and 2022 were reached. The an-nual growth rate of the articles was 6.69% and the average citation per article was 9.78. The United States of America (USA) (n=562, 45.4%), Türkiye (n=102, 8.25%), and India (n=42, 3.4%) were the top three countries with the highest publication performance. The top three most influential researchers are Elias Degiannis and Roger Saadia from South Africa and C. William Schwab from the USA. The most influential researcher of Turkish origin was Ersin Erdogan. “Journal of Trauma-Injury Infection and Critical Care,” “Ameri-can Surgeon,” and “Injury-International Journal of the Care of the Injured” are the top three most influential journals in terms of the number of publications and citations. “Turkish Journal of Trauma and Emergency Surgery” from Türkiye is the eighth most influential journal. The most influential study in terms of citations was found to be the study titled “Firearm injuries in the United States” by Katherine A Fowler, published in Prev Med in 2015.
CONCLUSION: As a result of the research, useful information has been revealed for researchers working on GSW. Being the first comprehensive bibliometric study in the field of GSW makes this research unique.

AMAÇ: Nekrotizan fasiit, fasyalar üzerinden hýzla ilerleyen ölümcül olabilen bir yumuþak doku enfeksiyonudur. Taný koyduracak inspeksiyon bulgu-larýnýn hastalýðýn geç döneminde oluþmasý ve hýzlý seyri nedeniyle hýzlý taný koymak zor olabilir. Hýzlý ve doðru taný konulmasý sonrasýnda erken dönemde yapýlacak uygun cerrahi müdahale ile hastalýðýn ilerleyiþi durdurulabilir. Doðru ve zamanýnda tedaviyle bile mortalite diðer yumuþak doku enfeksiyonlarýndan çok daha sýk görülür. Bu çalýþmada nekrotizan fasiitli hastalardaki klinik parametrelerin mortalite üzerine olan etkileri araþtýrýlacaktýr. GEREÇ VE YÖNTEM: Çalýþmaya 2009-2018 yýllarý arasýnda nekrotizan fasiit tanýsý almýþ 37 hasta dahil edilmiþtir. Hastalara ait demografik özellikler (yaþ, cinsiyet, komorbid durumlar), eðer diyabet tanýsý varsa taný aldýðýndan itibaren geçen süre, taný aldýðý andaki kan þekeri düzeyi, yaradan kültür ile izole edilen mikroorganizma, hemokültür pozitifliði olup olmamasý, uygulanan antibiyoterapi, baþvuru anýndaki LRINEC skoru, geçirilen cerrahi iþlem sayýsý ve þekilleri, hastanede kalýþ süresi ve mortalite oranlarý retrospektif olarak kaydedilmiþtir. Baðýmlý ve baðýmsýz deðiþkenlerin istatistiksel incelemesi t-testi, Mann-Whitney U, ki-kare ve Fisher’ýn kesinlik testi ile yapýlmýþtýr.
BULGULAR: Yaþ, mortalite grubunda ortalama 70 olarak bulunmuþ olup mortalite olmayan gruba göre anlamlý olarak yüksektir. Yüksek LRINEC skoru, komorbidite varlýðý, Hemokültür pozitifliði de mortalite ile iliþkili olarak anlamlý bulunmuþtur. Geçirilen cerrahi iþlem sayýsýnýn azlýðý mortalite grubunda anlamlý olarak daha düþüktür.
SONUÇ: Zamanýnda ve doðru taný sonucu uygulanan uygun antibiyoterapi ve cerrahi iþlem ile tedavi edilebilen bir hastalýk olan nekrotizan fasiitli hastalarda yüksek mortalite ile iliþkili durumlarý ortaya koyan bu çalýþma, yüksek riskli grup hastalara yaklaþýmý güncellemek için önem arz etmekte ve nekrotizan fasiit tanýsýný koyma eþiðini düþük tutmaya fayda saðlayacak bir bilgi sunmayý amaçlamaktadýr.

BACKGROUND: Necrotizing fasciitis is a rapidly progressing, potentially fatal soft-tissue infection that spreads through the fascia. Due to the late onset of diagnostic signs during the disease’s advanced stage and its rapid progression, it can be challenging to make a prompt diagnosis. However, with a rapid and accurate diagnosis, the progression of the disease can be halted through appropriate early surgical intervention. Even with correct and timely treatment, the mortality rate for necrotizing fasciitis is higher compared to other soft-tissue infections. This study aims to investigate the effects of clinical parameters in patients with necrotizing fasciitis on mortality.
METHODS: The study included 37 patients with a necrotizing fasciitis diagnosis between 2009 and 2018. Demographic characteristics of the patients (age, gender, comorbid conditions), duration from diabetes diagnosis if present, blood glucose level at the time of diagnosis, microorganisms isolated from wound cultures, presence of positive blood cultures, administered antibiotic therapy, laboratory risk indicator for necrotizing fasciitis (LRINEC) score at presentation, number and types of surgical procedures performed, length of hospital stay, and mortality rates were retrospectively recorded. Statistical analysis of dependent and independent variables was conducted using t-tests, Mann-Whitney U test, Chi-square test, and Fisher’s exact test.
RESULTS: Age was found to be an average of 70 in the mortality group, and it is significantly higher compared to the non-mortality group. A high LRINEC score, the presence of comorbidity, and a positive blood culture were also found to be significant in the mortal-ity group. The low number of surgical procedures performed is significantly lower in the mortality group.
CONCLUSION: This study highlights the conditions associated with high mortality in patients with necrotizing fasciitis, which is a treatable disease through timely and accurate diagnosis followed by appropriate antibiotic therapy and surgical intervention. It emphasizes the importance of updating the approach for high-risk group patients and aims to provide information that will help lower the threshold for diagnosing necrotizing fasciitis.

AMAÇ: Kullaným kolaylýðý ve düþük maliyeti nedeniyle topluluðumuzda e-skuter kullanýmý hýzla artmýþtýr. Bu durumla iliþkili olarak yüksek enerjili travmalara neden olan kazalarýn sayýsýnda da artýþ görülmüþtür. Bu çalýþmanýn amacý, e-skuter kazasý sonrasý acil servise baþvuran hastalarýn demografik özelliklerini, kýrýk paternlerini tanýmlamak ve kaza olasýlýðýný artýran, sýk karþýlaþýlan, düzeltilebilir faktörleri belirlemektir.
GEREÇ VE YÖNTEM: E-skuter kazasý nedeniyle acil servise Ocak 2022 ile Aðustos 2022 tarihleri arasýnda baþvuran ve ekstremite kýrýðý meydana gelen 43 hasta (20 kadýn, 23 erkek) çalýþmamýza dahil edildi. Hastalar cerrahi ve konservatif olarak tedavi edilenler olmak üzere 2 gruba ayrýldý. Kazanýn gerçekleþtiði zaman dilimi, sürücünün eðitim düzeyi, sürüþ esnasýndaki alkol kullanýmý, e-skuter cihaz arýzasý, trafik kurallarýna uyum gibi parametreler üzerinden deðerlendirme yapýldý.
BULGULAR: Cerrahi tedavi gerektiren kazalarýn en sýk 23.00-07.00 saatleri arasýnda meydana geldiði görüldü. Cerrahi tedavi uygulanan hastalarýn çoðunluðu lise mezunuydu. Konservatif olarak tedavi edilen hastalara göre cerrahi uygulanan hastalarda alkol kullanýmý ve eðlence amaçlý scooter kullaným oranlarý istatistiksel olarak daha yüksekti. E-skuter’de arýza bildiren hasta sayýsý opere edilen grupta konservatif olarak tedavi edilen gruba göre anlamlý olarak daha düþüktü. Cerrahi tedavi uygulanan grupta trafik kurallarýna uymama, e-skuter’in son hýzda kullanýlmasý, araç yolunda kullanýlmasý ve kaza anýnda ýslak zeminin bulunmasý nedeniyle kaza oranlarý daha yüksekti. Cerrahi grubun e-skuter cihazýný ilk kez kullanma oraný da daha yüksekti.
SONUÇ: Yönetimler her ne kadar e-skuter kullanýmýna iliþkin birçok düzenleme getirmiþ olsa da mevcut durum sorunlarýn çözümünde yetersiz görünmektedir. E-skuter kullanýcýlarý meydana gelebilecek riskler hakkýnda daha fazla bilgilendirilmeli ve eðitilmelidir. Yetkililer, e-skuter kiralama þirketleri ve sürücüleri üzerindeki denetimlerini sýklaþtýrmalýdýr. Gece kullaným koþullarý gözden geçirilmeli ve cihazýn alkollü kullanýmý kontrol altýna alýnmalýdýr. Kask kullanýmý zorunlu olmalýdýr. Bu tür düzenlemeler sýklaþtýrýlýrsa, kaza oranlarý azaltýlabilir veya yüksek enerjili yaralanmalar önlenebilir. Sonuçlar deneyimli, yavaþ, alkolsüz ve kurallara uyan sürücülerin daha az cerrahi tedavi gerektirdiðini göstermektedir. Bu makalenin farkýndalýðý arttýracaðýný ve e-skuter düzenlemelerini iyileþtireceðini umuyoruz.

BACKGROUND: The percentage of e-scooter use quickly escalated in our community due to its convenience, low cost, and eases of use. The number of accidents causing high-energy traumas has also increased. This study aims to describe the demographic char-acteristics and fracture patterns of patients admitted to the emergency department following an e-scooter accident and to identify common, correctable factors that increased the likelihood of accidents.
METHODS: Between January 2022 and August 2022, 43 patients (20 females and 23 males) who were admitted to the emergency department after an e-scooter accident and developed extremity fractures were included. The patients were divided into 2 groups those treated surgically and conservatively. Parameters such as the time of the accident, education level of the user, alcohol use, e-scooter malfunction, and compliance with traffic rules were evaluated.
RESULTS: Accidents that led to treatment by surgery mostly occurred between 11 pm and 7 am. Surgically treated patients were mostly high school graduates. Alcohol use and recreational scooter use rates were statistically higher in the operated patients when compared to patients who were treated conservatively. The number of patients who reported a malfunction in the e-scooter was significantly lower in the operated group than in the conservative group. The rates of accidents due to non-compliance with traffic laws, driving at full speed of the e-scooter, use on the driveway, and presence of wet ground at the time of the accident were higher in the surgically treated patient group. Surgically treated patients also had a higher rate of being 1st time e-scooter users.
CONCLUSION: Although governments have introduced many regulations regarding e-scooter use, the current situation seems insufficient in solving the problem. E-scooter users should be further educated about the associated risks. Authorities should tighten their supervision of scooter rental companies and drivers. Nighttime usage conditions should be reviewed, and the use of alcohol should be controlled. The use of helmets should be mandatory. If such regulations are tightened, accident rates can be reduced or high-energy impacts from existing accidents can be avoided. The results suggest that experienced, slow, non-alcoholic, and rule-abiding drivers require less operative treatment. This article will hopefully raise awareness and improve e-scooter regulations.

AMAÇ: COVID-19 Pandemisi, týptaki günlük uygulamalarý kökten deðiþtirdi. COVID-19 Pandemisinin, akut biliyer pankreatitli (ABP) hastalarda yönetim stratejilerimiz üzerindeki etkisini retrospektif olarak deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Trakya Üniversitesi Týp Fakültesi'nde 15 Mart 2019-15 Mart 2021 tarihleri arasýnda tedavi edilen ABP'li toplam 91 hasta geriye dönük olarak incelendi. Hastalar COVID öncesi ve COVID dönemi hastalarý olarak sýnýflandýrýldý. Komorbidite belirteçleri, laboratuvar test-lerinden elde edilen veriler, inflamatuar belirteçler ve radyolojik incelemeler deðerlendirildi. Hastanede yatýþ süresi, yoðun bakým ihtiyacý, morbidite, mortalite, tekrarlayan ABP ve kesin tedavi oranlarý deðerlendirildi ve iki döneme ait veriler karþýlaþtýrýldý.
BULGULAR: Çalýþmaya COVID öncesi dönemde 57 ve COVID döneminde 34 olmak üzere iki hasta grubu dahil edildi. Ulusal yeni COVID-19 tanýlarý arttýðý dönemlerde ABP baþvurularýnýn önemli ölçüde azaldýðýný saptadýk. Tip 2 Diyabet (T2DM) COVID dönemindeki hastalarda anlamlý olarak yüksekti (p=0.044) ve COVID hastalarýnda anlamlý olarak daha yüksek total (p=0.004), direkt bilirubin (p=0.007) ve lipaz deðerleri (p<0.001) vardý. Atak sonrasý kolesistektomi oraný, COVID öncesi dönemde %26'dan COVID sýrasýnda %15,6'ya düþtü.
SONUÇ: COVID-19 pandemisi, ABP hastalarýnýn erken evrede hastanelere baþvurularýný çarpýcý bir þekilde azalttý ve kaçýnýlmaz þekilde geç baþvurulara yol açtý. Ayrýca ABP'nin tekrarlama oranlarýnda anlamlý bir artýþ tespit edildi. Bu durum atak sonrasý kolesistektomi oranlarýndaki azalma ile açýklanabilir.

BACKGROUND: The COVID-19 pandemic thoroughly changed the daily practices of medicine. We retrospectively evaluated the impact of the COVID-19 pandemic on our management strategies for patients with acute biliary pancreatitis (ABP).
METHODS: A total of 91 patients with ABP who were treated at Trakya University Faculty of Medicine between March 15, 2019 and March 15, 2021 were retrospectively recruited. Patients were classified as pre-COVID and COVID-era patients. The comorbidity markers, data from laboratory tests, inflammatory markers, and radiological examinations were evaluated. Length of stay, need for an intensive care unit, morbidity, mortality, recurrent ABP, and definitive treatment rates were evaluated, and the data of the two periods were compared.
RESULTS: Two groups of patients, 57 in the pre-COVID period and 34 in the COVID period, were included in the study. We found that ABP admissions decreased significantly during periods of increased national COVID-19 diagnoses. Type 2 diabetes mellitus was significantly higher in the COVID period patients (P=0.044), and COVID patients had significantly higher total (P=0.004), direct bili-rubin (P=0.007), and lipases (P<0.001). The cholecystectomy rate after an attack decreased from 26% in the pre-COVID period to 15.6% during COVID.
CONCLUSION: COVID strikingly reduced the admissions of ABP patients in the early stages of the disease to hospitals, leading to inevitable admissions in advanced severity. Moreover, a significant increase was detected in the recurrence rates of ABP. This can be explained by the reduction in cholecystectomy performed.

AMAÇ: Proksimal femoral çivileme (PFN) ve kalça artroplastisi (HA), yaþlý hastalarda kalça kýrýklarýný tedavi etmek için en sýk kullanýlan iki cerrahi prosedürdür. Hastalarýn postoperatif postüral dengesi ve fonksiyonel sonuçlarý, PFN ve HA arasýndaki teknik ayrýmlardan önemli ölçüde etkilenebilir. Bu, cerrahýn tercih ettiði tedavi sürecini etkileyecektir. Kalça kýrýðýnýn ardýndan PFN ve HA ile tedavi edilen hastalarýn fonksiyonel sonuçlarýný incelemek için bu çalýþmada bilgisayarlý dinamik postürografi kullanýldý. Bu çalýþmanýn amacý, bu iki tedavi yöntemini karþýlaþtýrarak bunlarýn hastalarýn postoperatif dengesini, postüral stabilitesini ve fonksiyonel rehabilitasyonunu nasýl etkilediðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Kalça kýrýklarý nedeniyle proksimal femoral cerrahi [15 hasta PFN (%58) ve 11 hasta HA (%42)] uygulanan toplam 26 hasta ameliyattan en az 12 ay sonra olacak þekilde deðerlendirildi. Hastalarýn sonuçlarý radyografiler, kalça eklem muayeneleri, Harris kalça skoru ve bilgisayarlý dinamik postürografi cihazý (CDP) ile test edildi.
BULGULAR: 26 hastanýn on iki tanesi (%46) erkek, 14'ü (%54) kadýndý. Çalýþmaya katýlýmcýlarýn ortalama yaþý 67.9±14.2 yýldýr. Ortalama takip süresi 24 (12-44) aydý. PFN grubunun ortalama Harris skoru 79.3 (46.8-100) puan ve HA grubunun 83.7 (61.9-99.9) puandýr. Harris skoru açýsýndan gruplar arasýnda anlamlý bir fark yoktur (p=0.54). PFN grubu için CDP ile elde edilen denge sonuçlarýnýn karma deðerinin ortalamasý (kompozit skor) 70.5 (56-79) puan ve HA grubu için 71.9 (56-83) puan idi. Kompozit skor açýsýndan gruplar arasýnda anlamlý bir fark yoktu (p=0.47). Buna göre, PFN uygulanan hastalarýn 12'sinde (%80) iyi sonuçlar ve 3'ünde (%20) kötü sonuçlar elde edildi. HA uygulananlarýn sekizinde (%72.7) iyi sonuçlar ve 3'ünde (%27.3) kötü sonuçlar elde edildi. Ýstatistiksel olarak anlamlý bir fark yoktu (p = 0.66).
SONUÇ: Denge sonuçlarý için kompozit skor ve rehabilitasyon için Harris kalça skoru sonuçlarýnýn PFN ve HA uygulanan hastalarýn verileri ile karþýlaþtýrýldýðýnda, CDP muayenesinin bir sonucu olarak bu iki teknik arasýnda postüral stabilite ve denge açýsýndan istatistiksel olarak anlamlý bir fark yoktu.

BACKGROUND: Proximal femoral nailing (PFN) and hip arthroplasty (HA) are the two most often utilized surgical procedures for treating hip fractures in older patients. The postoperative postural balance and functional outcomes of patients may be significantly influenced by the technical distinctions between PFN and HA. This will influence the surgeon’s preferred course of therapy. To examine the functional outcomes of patients treated with PFN and HA following a hip fracture, this study used computerized dynamic posturography (CDP). The aim of that study was to evaluate how the two treatment modalities affected patients’ postoperative balance, postural stability, and functional rehabilitation.
METHODS: A total of 26 patients who underwent proximal femoral surgery (15 patients PFN [58%] and 11 patients HA [42%]) due to hip fractures were evaluated at least 12 months postoperatively. They were tested by direct radiographs, hip joint examinations, Harris hip score (HHS), and CDP.
RESULTS: Twelve (46%) of 26 patients were male and 14 (54%) were female. The mean age of the participants in the study was 67.9±14.2 years. The mean follow-up period was 24 (12–44) months. The average Harris score of PFN group was 79.3 (46.8–100) points and HA group was 83.7 (61.9–99.9) points. There was no significant difference between the groups in terms of Harris Score (p=0.54). The average of the mixed value of the balance results obtained with CDP (the Composite score) for PFN group was 70.5 (56–79) points, and for HA group was 71.9 (56–83) points. There was no significant difference between the groups in terms of the Composite Score (p=0.47). Accordingly, 12 (80%) of the patients who underwent PFN had good results and 3 (20%) of them had bad results. Eight (72.7%) of those who underwent HA had good results and 3 (27.3%) had bad results. There was no statistically significant difference (p=0.66).
CONCLUSION: Comparing the composite score for balance results and HHS results for rehabilitation with the data of the patients who underwent PFN and HA, there was no statistically significant difference between these two techniques in terms of postural stability and balance as a result of CDP examination.

AMAÇ: Kýrýklarýn daðýlýmý, yaþa ve cinsiyete göre deðiþebilmektedir. Türkiye gibi yüksek nüfus yoðunluðuna ve büyük bir yüzölçümüne sahip bir ülkede kýrýklarýn bölgelere göre deðiþimi ve hastalarýn hangi saðlýk kuruluþu basamaðýna baþvurduðunu bilmek yeni saðlýk yatýrýmlarýnýn planlanmasýnda önemli olabilmektedir. Çalýþmamýzda, Türkiye’nin 7 bölgesine göre kýrýklarýn yerinin, yaþ, cinsiyet ve kaçýncý saðlýk kuruluþu basamaðýna baþvurulduðunun araþtýrýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Ocak 2021 ve Mayýs 2023 tarihleri arasýnda kiþisel saðlýk kayýt sistemi olan E-nabýz üzerinden toplam kýrýk sayýlarý, kýrýklarýn yerleri, yaþ, cinsiyet, coðrafik bölge ve baþvurulan saðlýk kuruluþunun basamaðý incelendi. Yaþ gruplarý pediatrik (0-19 yaþ), eriþkin (20-64 yaþ) ve geriatrik (≥65 yaþ) olarak ayrýldý. Coðrafi bölgeler, Marmara Bölgesi (MR), Ýç Anadolu Bölgesi (ÝAR), Karadeniz Bölgesi (KR), Doðu Anadolu Bölgesi (DAR), Ege Bölgesi (ER), Akdeniz Bölgesi (AR), Güneydoðu Anadolu Bölgesi (GAR) olarak belirlendi.
BULGULAR: Toplam 2.135.701 hastanýn 2.214.213 kýrýðý çalýþmaya dahil edildi. En sýk üst ekstremite kýrýklarý görüldü. (1.154.819 kýrýk, %52.2) Pediatrik grupta 643.547, eriþkin grupta 1.191.364, geriatrik grupta da 379.302 kýrýk görüldü. Toplam kýrýk sayýsý erkeklerde 1.256.884 (%58.9) ile daha fazla iken, geriatrik grupta kadýnlarýn oraný daha fazlaydý (%67.2). Marmara bölgesi 714.146 kýrýk ile en sýk kýrýk görülen bölgeydi. Ýkinci basamak saðlýk kuruluþu baþvuranlarýn oraný %67.92’idi (1.500.780 kýrýk). Tüm populasyon genelinde en sýk görülen kýrýklar distal radius kýrýklarý ve parmak kýrýklarý olarak bulundu. Geriatrik hasta grubunda en sýk görülen kýrýklar femur kýrýklarý iken eriþkin ve pediatrik yaþ gruplarýnda en sýk görülen kýrýk tipi distal radius kýrýklarý olarak bulundu.
SONUÇ: Türkiye’de kýrýk daðýlýmýnýn kýrýk yerine, bölgelere, yaþa ve cinsiyete göre bilinmesi ile hastalarýn saðlýk hizmetine ulaþýmýnýn planlanmasý daha iyi yapýlabilir. Sýnýrlý saðlýk kaynaðý olan bölgelerde kýrýk daðýlýmlarý ve yaþ gruplarý gözetilerek daha baþýrýlý bir kaynak daðýlýmý saðlanabilir.

BACKGROUND: The distribution of fractures may vary according to age and gender. In a country like Türkiye, which has high population density and covers a large geographical area, it is important to understand the regional variations in fractures and identify the health institutions in which patients seek treatment to plan new health-care investments effectively. The objective of our study was to investigate the distribution of fractures across the seven regions of Türkiye considering age, gender, and the level of health institutions the patients visited.
METHODS: Between January 2021 and May 2023, the total number of fractures, locations of the fractures, patient age and gender, geographical regions, and levels of the health-care institutions to which the patients presented were examined through the e-Nabýz personal health record system. Age groups were divided into pediatric (0–19 years), adult (20–64 years), and geriatric (≥65 years) categories. Geographical regions included the Marmara, Central Anatolia, Black Sea, Eastern Anatolia, Aegean, Mediterranean, and Southeastern Anatolia regions.
RESULTS: A total of 2,135,701 patients with 2,214,213 fractures were analyzed. Upper extremity fractures were the most common among all considered fracture groups (1,154,819 fractures, 52.2%). There were 643,547 fractures in the pediatric group, 1,191,364 fractures in the adult group, and 379,302 fractures in the geriatric group. While the total number of fractures was higher among men with 1,256,884 fractures (58.9%), the rate among women was higher in the geriatric group (67.2%). Geographically, the highest number of fractures was observed in the Marmara region (714,146 fractures), and 67.92% of all patients presented to secondary health-care institutions (1,500,780 fractures). The most commonly diagnosed fracture in the study population was distal radius fractures. The most common fracture in the geriatric group was femur fractures while distal radius fractures were the most common fractures in the adult and the pediatric groups.
CONCLUSION: By understanding the distribution of fractures in Türkiye based on fracture site, geographical region, age, and gender, it becomes possible to improve the planning of patient access to health-care services. In regions with limited health resources, a more successful resource distribution can be achieved by considering fracture distributions and age groups.

AMAÇ: 06 Þubat 2023 tarihinde meydana gelen deprem felaketi, Türkiye'nin güneyinde ciddi yýkým ve can kaybýna neden oldu. Birbiriyle iliþkili iki bölümden oluþan bu makalenin amacý, afet bölgesinin hemen sýnýrýnda yer alan ortopedi kliniðimizin deneyimini aktarmaktýr. Çalýþmanýn ilk bölümü-nün konusu depremzedelerde saptanan ortopedik travmalarýn özellikleri ve uygulanan tedavi yöntemleridir. Ýkinci bölümün konusu kliniðin afet iþ planý ve uygulamadaki sonuçlarýdýr.
GEREÇ VE YÖNTEM: Çalýþmanýn birinci bölümü için deprem felaketinden sonraki ilk 10 günde kliniðimizce tedavi edilen 204 depremzedenin açýkla-yýcý bilgileri, tanýlarý ve uygulanan tedavi yöntemleri arþivden derlendi. Çalýþmanýn ikinci bölümü açýsýndan afetin ilk günü sabahý klinik içi çalýþma planý oluþturuldu. Acil servis, yataklý servis ve ameliyathanede çalýþacak ekipler ve çalýþma saatleri belirlendi. Hastane yönetim birimi ve diðer kliniklerle iletiþim kuruldu ve ortopedik travmalý hastalar için hastane olanaklarýnýn tahsis edilmesi saðlandý.
BULGULAR: Hastalarýn yaþ ortalamasý 42.3 yýldý. Yaþ gruplarý arasýnda en küçük grup 10 yaþ altý çocuklardý (tüm hastalarýn %6.4'ü). Hastalarýn 132'sinin 135 ekstremitesinde en az bir kýrýk bulunuyordu. Yaralanmalarýn çoðu alt ekstremiteyi tutmuþtu. 66 hastada kýrýkla birlikte veya kýrýksýz ezilme yaralanmasý vardý. 144 hastada 181ortopedik cerrahi prosedür uygulandý. En sýk yapýlan ameliyatlar kýrýk içten tespiti ve debridman idi. En sýk kullanýlan implant plak-vida kombinasyou idi. Klinik içi çalýþma planý ve hastane içi yardýmlaþma ve olanaklarýn tahsisi sayesinde hastalarýn yatýrýlmasý, ameliyat ve ameliyat sonrasý takiplerinde ciddi bir sorun yaþamadýk. Dýþ enstitülerden çok sayýda yardým teklifi almamýza raðmen bürokratik engel-ler nedeniyle bu mümkün olmadý. En önemli sorunlarýmýz arasýnda steril elektrikli cerrahi matkap eksikliði ve dinamik hasta bilgileri veritabanýnýn bulunmamasý yer aldý.
SONUÇ: Ortopedi klinikleri deprem felaketi için klinik içi çalýþma planlarýný önceden hazýrlamalýlar ve olanaklarýný geliþtirmeliler. Acil yardýmlaþmada bürokratik engellerle karþýlaþmamak için önceden resmi olarak farklý risk bölgelerindeki ortopedi klinikleri eþleþtirilmelidir. Klinik çalýþanlarýnýn akýllý cep telefonundan ulaþýp revize edebildiði bir hasta veri taban tablosu eþzamanlý yatan çok sayýda hastanýn takibini kolaylaþtýrýr.

BACKGROUND: The earthquake disaster that occurred on February 06, 2023, caused serious destruction and loss of life in the south of Türkiye. The purpose of this article consisting of two interconnected parts is to report the experience of our orthopedics clinic, which is located just on the border of the disaster area. The subject of the first part of the study is the characteristics of ortho-pedic traumas in earthquake victims and the treatment methods applied. The subject of the second part is the disaster work plan of the clinic and its consequences in practice.
METHODS: For the first step, descriptive information, diagnoses, and treatment methods of 204 earthquake victims who were treated by our clinic in the first 10 days after the disaster were compiled from the archives. In terms of the second phase of the study, an in-clinic work plan was created on the morning of the 1st day of the disaster. The teams and working hours in the emergency department, inpatient service, and operating room were determined. Hospital management and other clinics were contacted and hospital facilities were organized for orthopedic trauma victims.
RESULTS: The mean age of the patients was 42.3 years. Among the age groups, the smallest group was children under 10 years old (6.4% of all patients). 132 of the patients had at least one fracture in 135 extremities. Most of the injuries involved the lower extrem-ity. 66 patients had crush injury with or without fracture. 181 orthopedic surgical procedures were performed in 144 patients. The most common operations were internal fracture fixation and debridement. The most used implant was the plate-screw combination. Thanks to the in-clinic work plan and the in-hospital assistance and allocation of facilities, we did not experience serious problems in the hospitalization, surgery, and post-operative follow-ups of the patients. Although we received numerous offers of assistance from external institutions, this was not possible due to bureaucratic obstacles. Among our most important problems were the shortage of sterilized powered surgical drills and the lack of a dynamic patient information database.
CONCLUSION: Orthopedic clinics should prepare their in-clinic work plans for earthquake disasters and develop their facilities. In order not to encounter bureaucratic obstacles in emergency assistance, orthopedic clinics in different risk regions should be formally matched beforehand. A patient database table that clinical staff can access and revise using their smartphones facilitates the follow-up of large numbers of simultaneously hospitalized patients.

Foramen winslow hernisi (FWH) çok nadir görülen ve spesifik muayene bulgularý olmadýðý için taný konulmasý zor olan bir hastalýk olduðu bilinmektedir. Hastalar acil servise ileus tablosu ile baþvurmaktadýr. Tanýda geç kalýnmasý barsak ansýnýn iskemi ve perforasyonuna sebep olabilmektedir. Erken taný konulmasýndaki zorluk bu durumun mortalite ile sonuçlanma ihtimalini artýrmaktadýr. 41 yaþýnda erkek hasta acil servise iki gündür devam eden kolik tarzda karýn aðrýsý ile baþvurdu. Hasta tetkik ve tedavi amacýyla genel cerrahi servisine yatýrýldý. Takiplerinde klinik tabloda rahatlama olmasý üzerine taburcu edildi fakat 2 gün sonra karýn aðrýsýna bulantý ve kusmalarýn eþlik etmesi, gaz-gaita çýkaramama durumunun eklenmesi ile tekrar acil servise baþvurdu. Hastaya yapýlan laboratuar ve görüntüleme incelemeleri sonrasý ameliyat kararý alýndý. Uygulanan laparaskopik incelemede, ileoçekal bileþkeden proksimale doðru ilerlendi ve 220. cm de ince barsak ansýnýn Foramen Winslow’a herniye olduðu görüldü. Herniye barsak ansý redükte edildi. FW açýklýðýna müdahale edilmedi ve operasyon sonlandýrýldý. Foramen winslow hernilerinin nadir görülmesi, ileus nedeniyle acil servise baþvuran hastalarda ön taný olarak düþünülme ihtimalini azaltmaktadýr. Doðustan konjenital anomalileri olan, geçirilmiþ batýn cerrahisi olmayan hastalarda Foramen Winslow Herni ihtimali düþünülebilir. Tanýda en iyi görüntüleme yönteminin Kontrastlý batýn bilgisayarlý tomografi (CT) olup CT’de omentum minusta barsak anslarýnýn görülmesi önemlidir.

It is known that foramen Winslow hernia (FWH) is a very rare disease and difficult to diagnose because there are no specific examina-tion findings. Patients usually present to the emergency department with an intestinal obstruction. Delay in diagnosis may cause isch-emia and perforation of the intestinal loop. Difficulties in early diagnosis increase the probability of this condition resulting in mortality. A 41-year-old male patient was admitted to the emergency department with colic abdominal pain lasting for 2 days. The patient was hospitalized for further examination and treatment. Due to the improvement in his clinical state, the patient was discharged; however, 2 days later, he was readmitted to the emergency department with an inability to pass stool or flatus, nausea, and vomiting, as well as abdominal pain. After laboratory tests and imaging methods were applied to the patient, surgery was decided upon. In the laparoscopic examination, it was observed that the small bowel loop herniated into the foramen Winslow (FW) at 220 cm proximally from the ileocecal junction. Herniated bowel loops were reduced. The open FW was not intervened in, and the operation was terminated. Due to their rarity, FWHs are less likely to be considered a preliminary diagnosis in individuals who present to the emergency department with intestinal obstruction. FWH may be considered in patients with congenital anomalies and without previous abdominal surgery. The best imaging technique for diagnosis is contrast-enhanced abdominal computed tomography (CT), and it is critical to recognize bowel loops in the omentum minus on CT.