AMAÇ: Acil servise skrotal aðrý nedeniyle baþvuran çocuklarýn %15–20’sinde altta yatan neden testis torsiyonudur. Testisin spermatik kord dü-zeyinde kendi etrafýnda dönmesi olarak tanýmlanan testis torsiyonu dolaþýmýn bozulmasý nedeniyle organ kaybýna neden olabilir. Organ kaybýnýn önlenmesi için ilk altý saat içinde testisin detorsiyone edilmesi önerilmektedir. Çalýþmanýn amacý, detorsiyona ek olarak yapýlan Tunica Albuginea insizyonunun torsiyone olmuþ testisin canlýlýðýna etkisini incelemektir.
GEREÇ VE YÖNTEM: Araþtýrma deneysel tasarýma sahiptir. Çalýþma 3 grup (sham, testis torsiyonu [T-DT] ve tunica albuginea insizyonu [TAI]) sýçan üzerinde uygulanmýþtýr. On günlük izlem sonrasýnda gruplardaki testisler patolojik inceleme için alýnmýþtýr. Patolojik incelemede tüm patolojik örneklerde, nekroz, iskemik deðiþiklikler, Johnsen skoru, ödem, enflamasyon ve bazal membran kalýnlaþmasý deðerlendirilmiþ ve skorlanmýþtýr. BULGULAR: TAI ve T-DT grubu deðiþkenler bakýmýndan karþýlaþtýrýldýðýnda; nekrozun, iskemik deðiþikliðin, ödemin, enflamasyon ve bazal memb-rane kalýnlaþmasýnýn TAI grubunda anlamlý seviyede az olduðu saptanmýþtýr. Ayný zamanda, ortalama Johnsen Scores T-DT (7.44±0.52) ve TAI (8.60±0.51) gruplarý arasýnda anlamlý olarak farklýdýr.
TARTIÞMA: Bulgular TAI grubundaki testislerin sadece detorsiyon uygulanan testislere göre daha iyi korunabildiðini göstermiþtir. Testis torsiyonunda, detorsiyon iþleminin testisi korumak için yeterli olmadýðý, TAI’nýn iþleme eklenmesinin yararlý olacaðý ileri sürülebilir.

BACKGROUND: Testicular torsion is the underlying cause in 15–20% of children presenting to the emergency department with scrotal pain. Testicular torsion, which is defined as the rotation of the testis around itself at the level of the spermatic cord, may cause organ loss due to impaired circulation. It is recommended to detortion the testis within the first 6 h to prevent organ loss. The aim of the study is to examine the effect of Tunica Albuginea incision (TAI) made in addition to detorsion (DT) on the viability of the torted testis.
METHODS: The research has an experimental design. The study was carried out on three groups of rats (Sham, testicular torsion-(T-DT), TAI, and testicular torsion-detortion. After 10 days of follow-up, testes in the groups were taken for pathological examination. In the pathological examination, necrosis, ischemic changes, Johnsen score, edema, inflammation, and basement membrane thickening were evaluated and scored in all pathological samples.
RESULTS: Necrosis, ischemic changes, edema, inflammation, and basal membrane thickening were found to be significantly less in the TAI group. Furthermore, the mean Johnsen Scores were significantly different between the T-DT (7.44±0.52) and TAI (8.60±0.51) groups.
CONCLUSION: The results showed that the testicles in the TAI group were better preserved than the testicles, in which only DT was applied. It can be argued that in testicular torsion, the DT procedure is not sufficient to protect the testis, and it would be bene-ficial to add TAI to the procedure.

AMAÇ: Bu çalýþmada, adipoz kökenli mezenkimal kök hücrelerin (AT-MSC) ve sildenafil sitratýn tek baþýna veya kombine edilerek deneysel kolon anastomozu modeline iyileþtirici etkilerinin deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Toplam 40 diþi Wistar cinsi sýçan rastgele dört gruba daðýtýldý: Kontrol grubu (anastomoz esnasýnda ve sonrasýnda herhangi bir müdahale olmayan), kök hücre (anastomoz bölgesine AT-MSC enjeksiyonu yapýlan), sildenafil sitrat (10 mg/kg sildenafil sitratýn oral gavajý uygulanan) ve kök hücre + sildenafil sitrat (AT-MSC enjeksiyonu ve sildenafil sitratýn oral uygulamasý) grubu. Tüm sýçanlar anastomoz sonrasý beþinci gün sakrifiye edildi. Anastomoz iyileþmesini deðerlendirmek için, karýn içi yapýþýklýk durumu ve anastomoz patlama basýncý ölçüldü. Doku örneklerinde hidroksiprolin ve TNF-α düzeyi, nötrofil lökosit infiltrasyonu, epitel rejenerasyonu ve nekroz miktarý incelendi.
BULGULAR: Gruplar arasýnda anastomoz kaçaðý ve anastomoz patlama basýncý ölçümlerinde anlamlý fark yoktu. Sildenafil, kök hücre ve kök hücre + sildenafil ile tedavi, kontrol ile karþýlaþtýrýldýðýnda perianastomotik adezyonlarýn derecesini azaltmýþtýr (p<0.05). Kök hücre ve kök hücre + sildenafil gruplarýnda hidroksiprolin düzeyinde önemli bir artýþ kaydedildi (p=0.001). AT-MSC enjeksiyonu tek baþýna veya sildenafil sitrat ile kombinasyon halinde anastomoz bölgesinde TNF-α konsantrasyonunu düþürmüþtür (p=0.001). Histopatolojik inceleme, kontrol grubu ile karþýlaþtýrýldýðýnda sildenafil ve kök hücre uygulamalarýnýn nekrotik dokularýn temizlenmesini arttýrdýðýný, lökosit infiltrasyonunu azalttýðýný ve anastomoz uçlarýnýn bir-leþimini hýzlandýrdýðýný ortaya koydu (p=0.001). Epitel rejenerasyonu, kök hücre grubunda diðer gruplara göre daha belirgindi (p=0.001). Makrofaj yoðunluðu, sildenafil veya kök hücre gruplarý ile tedavi edilen gruplarda kontrol ve kök hücre + sildenafil gruplarýna göre daha düþüktü (p=0.001). TARTIÞMA: Kolon anastomozu yapýlan sýçanlarda sildenafil sitrat ve/veya AT-MSC uygulamalarý, özellikle kök hücre uygulanan gruplarda daha be-lirgin olacak þekilde anastomoz iyileþmesine katký saðladý.

BACKGROUND: This study aimed to evaluate the healing effects of adipose tissue-derived mesenchymal stem cells (AT-MSC) and sildenafil citrate alone or in combination of colon anastomosis experimental model.
METHODS: A total of 40 female Wistar rats were randomly distributed to four groups: Control (without any intervention post-anas-tomosis), stem cell (AT-MSC injection on the anastomosis site), SIL (oral gavage of 10 mg/kg sildenafil citrate), and stem cell + SIL (AT-MSC injection and oral administration of sildenafil citrate) groups. Rats were euthanized 5 days post-anastomosis. Intra-abdominal adhesion status and anastomotic burst pressure were measured to assess anastomotic healing. Hydroxyproline and TNF-α level, neu-trophil leukocyte infiltration, epithelial regeneration, and necrosis in the anastomosis tissue were examined.
RESULTS: Anastomosis leakage and anastomosis burst pressure were not different among the groups. Treatment with sildenafil, stem cell, and stem cell + SIL reduced the degree of perianastomotic adhesions compared to control (p<0.05). A significant increase was noted in hydroxyproline in the stem cell and stem cell + SIL groups (p=0.001). AT-MSC injection alone or in combination with sildenafil citrate reduced the TNF-α concentration at the anastomosis site (p=0.001). Histopathological examination revealed that all treatments enhanced the clearance of the necrotic debris, reduced leukocytes infiltration, and accelerated the retraction of anastomo-sed ends except control (p=0.001). Epithelial regeneration was more pronounced in the stem cell group than other groups (p=0.001). Macrophage density was lower in groups treated with the SIL or stem cell groups than the control and stem cell + SIL groups (p=0.001).
CONCLUSION: Sildenafil citrate and/or AT-MSC in the anastomosed rats promoted the anastomosis healing that was more pro-nounced in groups receiving stem cell injections.

AMAÇ: Postoperatif Ýleus (POI), baðýrsak lümeninde gaz ve sývý birikimine neden olan bir tür baðýrsak dismotilitesidir. Transkutanöz elektriksel sinir stimülasyonu (TENS), aðrý tedavisi ve sinir stimülasyonu gibi týbbi uygulamalarda sýklýkla kullanýlmaktadýr. Bu deneysel hayvan çalýþmasýnda amacýmýz, TENS’in POI üzerindeki etkilerini araþtýrmak ve TENS uygulamasýndan sonra sýçan baðýrsaðýndaki histopatolojik deðiþiklikleri göstermektir. GEREÇ VE YÖNTEM: Bu çalýþma, deneysel bir hayvan çalýþmasýdýr. Ýki grupta 16 adet Wistar-Albino erkek sýçan kullanýldý ve laparotomi yapýldý. Kolorektum ve ince baðýrsak manipüle edildikten sonra, aktif kömür ve Nil kýrmýzýsý oral gavaj ile uygulandý. Sýçanlarýn karýn derisine elektrotlar yerleþtirildi ve TENS yöntemi kullanýldý. Ýki gruptaki sýçanlar 24. saatte öldürüldü. Sýçanlarýn özefagusu, midesi ve tüm baðýrsaklarý rezeke edilerek direkt röntgen ve bilgisayarlý tomografi taramasý ile “J” görüntüleri alýnarak aktif kömürlerin ilerlemesi radyolojik olarak ölçüldü. Histopatolojik ve mikroskobik deðerlendirme yapýldý.
BULGULAR: Aktif kömür ilerlemesinin ölçüm ortancasý TENS grubunda 429 mm (178–594), kontrol grubunda 203 mm (149–313) olarak bulundu ve bunlar istatistiksel olarak anlamlýydý (p=0.004963). Histopatolojik nekroz açýsýndan iki grup arasýnda anlamlý fark vardý (p=0.041). Ek olarak, GI yolundaki Nil Red (550 nm) miktarý, TENS’in ardýþýk uygulamalarý ile sekiz saatlik gavajdan sonra artmýþtý.
TARTIÞMA: Bu çalýþma, bir deneysel sýçan modelinde TENS’in POI üzerindeki koruyucu ve terapötik etkinliðini radyolojik ve histo-patolojik olarak göstermiþtir. Klinik pratikte, TENS POI üzerinde incelenebilir. Bulgularýmýzý doðrulamak ve genelleþtirmek ve ayrýca TENS’in postoperatif aðrý üzerindeki etkisini deðerlendirmek için daha ileri çalýþmalara ihtiyaç vardýr.

BACKGROUND: Post-operative ileus (POI) is a type of bowel dismotility causing accumulation of gas and fluid. Transcutaneous electrical nerve stimulation (TENS) has been frequently used for medical applications such as pain treatment and nervous stimulation. In this experimental animal model of POI, our aim is to investigate the effects of TENS on POI, and to demonstrate histopathological changes in rat intestine after TENS application.
METHODS: The present study is an experimental animal model of POI. Sixteen Wistar-Albino male rats in two groups were used and laparotomy was performed. After colorectum and small intestine were manipulated, activated charcoal and Nile red were ad-ministered by oral gavage. Electrodes were placed to the abdomen skin of the rats and TENS method was used. Rats in two groups were sacrificed on 24 h. The esophagus, stomach, and all intestines of the rats were resected and a direct X-ray and computerized tomography scan, and “J” images were taken, and the progression of active coals was measured radiologically. Histopathological and microscopic evaluation was performed.
RESULTS: The median of activated charcoal measure was 429 mm (178–594) in TENS group, 203 mm (149–313) in the control group, respectively, and these were statistically significant (p=0.004963). There was a significant difference between the two groups in terms of histopathological necrosis (p=0.041). In addition, the amount of Nil Red (550 nm) in the GI track is increased after 8 h of gavage with sequential applications of TENS.
CONCLUSION: This study demonstrated the protective and therapeutic efficacy of TENS in POI in a rat model by radiologically and histopathologically. In clinical practice, TENS may be examined on POI. Further studies are warranted to validate and generalize our findings, and to assess the impact of TENS for post-operative pain also.

AMAÇ: Sitoredüktif cerrahi (SRC) ve hipertermik intraperitoneal kemoterapi (HÝPEK) sonrasý komplikasyonlara baðlý acil relaparotomi yapýlan hastalarýn immün skorlamalarla tahmin edilip, edilemeyeceðinin deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Kliniðimizde 2007–2020 yýllarý arasýnda SRC&HÝPEK prosedürü uygulanan 661 hasta analiz edildi. Bu hastalarýn 28’ine (%4.2) acil relaparotomi (URL) yapýlmasý gerekmiþtir. Hastalarýn 22’si (%78.6) kadýn, median yaþ 57 (76–24) idi. Hastalarýn 22’si (%78.6) 65 yaþ altýndaydý. Tüm standart klinikopatolojik özellikler, ameliyat bulgularý ve morbid-mortalite sonuçlarý analiz edildi. Nötrofil-lenfosit oraný (NLR), nötrofil-trombosit oraný (NTR) ve CRP (C-reaktif protein)-albümin oraný (CAR) gibi iyi bilinen immünoskorlar belirlendi.
BULGULAR: URL için ana endikasyon ince baðýrsak anastomoz kaçaðýydý (n=13, %46.4). Ýkinci en sýk endikasyon ise karýn duvarý defektleriydi (evise-rasyon-evantrasyon) (n=5, %17.9). Hastalarda patoloji en sýk ince baðýrsak kaynaklýydý. Hastalarýn %28.6’sýna (n=8) erken ameliyat sonrasý dönemde (ilk 7 gün), geri kalanýna (n=20, %71.4) 7–90 gün aralýðýnda URL yapýldý. URL hastalarýnýn çoðu (n=16, %57.1) birden fazla komorbiditeye sahipti. Genel gruba bakýldýðýnda, 104 (%16.4) hastada Clavien-Dindo (C-D) evre I-II ve 88 (%13.9) hastada C-D evre III-IV komplikasyon görülürken, URL hasta grubunda 22 (%78.6) hastada C-D evre III-IV komplikasyon görüldü. Bu ileriye yönelik kohortta, URL yapýlmayan hastalarda genel mortalite oraný %3.2 (n=20) idi. URL hastalarýnda altý (%21.4) hasta ameliyat sonrasý dönemde kaybedildi ve kurtarýlamamanýn ana nedeni entero-enteral anastomoz kaçaðýna baðlý sepsisti. Bu hastalarýn dördünde çok sayýda komorbidite vardý. URL öncesi medyan NLR, NTR ve CAR deðerleri sýrasýyla 9.12 (1.72–37.5), 0.03 (0.01–0.12) ve 41.4 (4.2–181.3) idi. SRC öncesi tahmin edilen NLR ve CAR deðerleri (4.71 ve 28.8), ameliyat sonrasý dö-nemde çeþitli komplikasyonlara baðlý URL yapýlan hastalarda anlamlý olarak yüksekti (p=.01 ve p<.01). Bu immün skor deðerleri, SRC ve URL sonrasý kaybedilen hastalar arasýnda herhangi bir iliþki göstermedi.
TARTIÞMA: SRC sonrasý URL gerektiren ciddi komplikasyonlar genellikle artan mortalite oraný, kýsa saðkalým, primer tümörün erken rekürrensi, merkezin kaynaklarýnýn tükenmesi ve yüksek maliyetlerle iliþkilidir. URL, SRC&HÝPEK prosedürü için önemli bir kalite göstergesi olarak kabul edilebilir. URL ile tedavi edilen hastalarda morbi-mortalite sonuçlarýný azaltmak için zamanýnda cerrahi müdahale ve yoðun yönetim stratejisi son derece önemli konulardýr.

BACKGROUND: The objective of the study was to evaluate the morbidity-mortality results in terms of immunscore factors and to predict the outcomes of urgent re-laparotomized patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
METHODS: Prospectively maintained database of 661 patients treated with potentially curative intent of CRS and HIPEC through the years of 2007 and 2020 was evaluated. URL was done for 28 (4.2%) patients as unplanned re-explorative surgery; 22 (78.6%) of them was female. The median age was 57 year (ranging, 24–76 years). There were 22 (78.6%) elderly patients over 65 years old. All standard clini-co-pathological characteristics, re-operative findings, and the morbidity-mortality results were analyzed. The well-known immunoscores such as neutrophil-lymphocyte ratio (NLR), neutrophil-thrombocyte ratio (NTR), and CRP-albumin ratio (CAR) were determined.
RESULTS: The main indication for URL was small bowel anastomotic leak (n=13, 46.4%). The abdominal wall disruption (n=5, 17.9%) was the second indication. The frequent localization of injured organ was again small bowel. The 28.6% of patients (n=8) were re-op-erated in early postoperative period (in 7 days), while as the rest of them (n=20, 71.4%) in 90 days. There was only one repeat-URL patient in this series. Many of the URL patients (n=16, 57.1%) had more than one co-morbidities. Delving into the overall group, there were Clavien-Dindo (C-D) Grade I-II complications in 104 (16.4%) patients and C-D Grade III-IV in 88 (13.9%) patients, whereas in URL patient group, C-D Grade III-IV complications were seen in 22 (78.6%). In this prospective cohort, the overall mortality rate was 3.2% (n=20) in patients who were not re-explored. Six (21.4%) patients were lost in URL patients, which the main reason for fail-ure-to-rescue was sepsis due to entero-enteral anastomotic leak. In four of them, multiple co-morbidities were affected the post-URL period of complex cancer care. Pre-URL median NLR, NTR, and CAR values were 9.12 (ranging, 1.72–37.5), 0.03 (ranging, 0.01–0.12), and 41.4 (ranging, 4.2–181.3), respectively. NLR and CAR values (4.71 and 28.8) estimated before pre-CRS were also significantly high (p=0.01 and p<0.01) in patients who were going to be operated for URL. These immunoscores values did not show any association in between pre-CRS and pre-URL mortal patients.
CONCLUSION: The crucial decision-making factors at work were complex and complicated in “unplanned” URL. The overall mor-bidity-mortality results seemingly depends on the severity and extent of peritoneal metastatic disease. Medically-unfit URL patients with high-risk factors should be selected to a vigilant monitoring and clinical care. Timely surgical intervention and intense management strategy are utmost important issues to lower morbi-mortality results in patients treated with URL.

AMAÇ: Perforasyona baðlý peritonitte laparotomi sonrasý cerrahi alan enfeksiyonu, morbiditeyi ve hastanede kalýþ süresini arttýrdýðý ve yaþam kalitesini düþürdüðü için önemli bir sorun olmaya devam etmektedir. Perforasyona baðlý peritonitte karýn içi dren yerleþtirilmesi rutin bir uygulamadýr. Çalýþmamýzýn amacý perforasyona baðlý peritonit nedeniyle ameliyat edilen iki grup hastada cerrahi alan enfeksiyonu insidansýný karþýlaþtýrmaktýr: Birinci grupta karýn içi dren yerleþtirilmiþken, ikinci gruba dren yerleþtirilmedi.
GEREÇ VE YÖNTEM: Mevcut tek merkezli, ileriye yönelik, randomize olmayan çalýþma, Hindistan’da Yüksek Lisans Týp Eðitimi ve Araþtýrma Ens-titüsü Genel Cerrahi Anabilim Dalý’nda yürütülmüþtür. Gastroduodenal ve ince baðýrsak perforasyonuna baðlý peritonit için keþif amaçlý laparotomi uygulanan toplam 122 hastadan 100’ü, belirtilen dahil edilme ve hariç tutulma kriterlerine göre bu çalýþmaya alýndý. Dren grubuna ve drensiz gruba her birinde 50 katýlýmcý olacak þekilde hasta alýndý. Primer kapama veya rezeksiyon-anastomoz yapýlan perforasyon peritonitli her alternatif hastaya bir dren yerleþtirildi. Diyabet, böbrek yetmezliði ve hemodinamik instabilitesi olan hastalar ve semptom baþlangýcýndan bu yana 72 saatten fazla zaman geçtikten sonra baþvuranlar çalýþma dýþý býrakýldý. Periton sývýlarýndan kültür alýndý. Birincil son nokta, iki grupta cerrahi alan enfeksiyonlarýnýn insidansýný belirlemekti. Ayrýca her iki grupta da baðýrsak hareketlerinin geri dönüþü için geçen süreyi, nazogastrik sondanýn (NGS) takýlma süresini, ameliyattan sonraki 30 gün içinde lokal veya genel anestezi altýnda herhangi bir müdahale yapýlýp yapýlmadýðýný, hastanede kalýþ süresini ve postope-ratif dönemde onarým kaçaðý tanýsýnýn konulma kolaylýðýný karþýlaþtýrdýk.
BULGULAR: Her iki gruptaki katýlýmcýlarýn demografik özellikleri eþleþtirildi. Cerrahi alan enfeksiyonu insidansý açýsýndan drenli ve drensiz gruplar arasýnda anlamlý bir fark gözlenmedi (p=0.779). Dren olmayan grupta ameliyat süresi ve hastanede kalýþ süresi anlamlý olarak daha kýsaydý. Peritoneal kültürde üreme açýsýndan iki grup arasýnda anlamlý fark gözlendi ve dren grubunda bakteri üremesinde artýþ görüldü. Clavien-Dindo sýnýflamasýna göre sýnýflandýrýlan iki grup arasýnda morbidite açýsýndan anlamlý bir fark görülmedi.
TARTIÞMA: Karýn içi drenlerin rutin kullanýmý cerrahi alan enfeksiyonlarýný önlemede etkili bulunmadý, ancak seçim yanlýlýðý göz ardý edilemez. Dren olmayan hastalarýn hastanede kalýþ süreleri önemli oranda daha kýsaydý.

BACKGROUND: Surgical site infection continues to be a major problem after laparotomy for perforation peritonitis, as it increases morbidity and hospital stay and decreases the quality of life. Intra-abdominal drain placement is a routine practice in perforation peri-tonitis. The aim of our study is to compare the incidence of surgical site infection in two groups of patients who were operated for perforation peritonitis: The first group received the intraperitoneal drain, while no drain was placed in the second group.
METHODS: The present single-center, prospective, non-randomized study was conducted in the Department of General Surgery at the Postgraduate Institute of Medical Education and Research, India. A total of 122 patients underwent exploratory laparotomy for gastroduodenal and small bowel perforation peritonitis, of which 100 participants were included in this study, based on specified cri-teria for inclusion and exclusion. A total of 50 participants each were included in the drain group and the no drain group, respectively. A drain was placed in every alternate patient with perforation peritonitis who received primary closure or resection anastomosis. Patients with diabetes, renal failure, and hemodynamic instability and those who presented more than 72 h since symptom onset were excluded from the study. Peritoneal fluids were cultured. The primary endpoint was to identify the incidence of surgical site infections (SSIs) in the two groups. We also compared the time taken for the return of bowel movements, duration for which a nasogastric tube was inserted, whether any intervention was performed under local or general anesthesia within 30 days of surgery, the duration of hospital stay, and the ease of diagnosing repair leak in the post-operative period in both the groups.
RESULTS: Demographics of participants in both the groups were matched. No significant difference was observed between the drain and no-drain groups with respect to the incidence of surgical site infection (p=0.779). The duration of surgery and length of hospital stay were significantly lower in the no drain group. A significant difference was observed between the two groups concerning the peritoneal culture growth, and increased bacterial growth was seen in the drain group. No significant difference in morbidity was noted between the two groups, which was classified according to the Clavien-Dindo classification.
CONCLUSION: Routine use of intra-abdominal drains was not found to be effective in preventing SSIs, but a selection bias cannot be ruled out. Patients with no drains had a significantly shorter duration of hospital stay.

AMAÇ: Yaralý hastalarýn durumlarýnýn ciddiyetinin objektif olarak deðerlendirilmesi, yeterli triyaj, karar verme, operasyon ve yoðun bakým yönetimi, önlem ve koruma, sonuç çalýþmalarý ve sistem kalite deðerlendirmesi açýsýndan çok önemlidir. Bu çalýþma, yaygýn olarak kullanýlan altý travma skorlama sistemini mortalitenin öngörücüleri olarak karþýlaþtýrmayý ve sýnýrlý kaynaklara sahip ortamlarda aralarýnda en güçlü olaný belirlemeyi amaçlamýþtýr. GEREÇ VE YÖNTEM: Haziran 2018–Aðustos 2020 tarihleri arasýnda Acil Cerrahi Kliniði yoðun bakým ünitesine (Birinci basamak travma merkezi, CSS Belgrad) baþvuran yetmiþ beþ çoklu travmalý hasta çalýþmaya dahil edildi. Dahil edilme kriterleri; yaþ ≥16, ISS ≥16 ve SOFA ≥5 idi. Puanlar, lojistik regresyon modeli ve alýcý iþletim karakteristiði (ROC) eðrisi altýndaki alanlarýn (AUC) analizi kullanýlarak deðerlendirildi.
BULGULAR: Yirmi altý aylýk süre boyunca, çoðunlukla künt travma (%97.3), trafik kazasý (%68) ve serbest düþme (%25.3) olmak üzere yüksek seviyede seçilmiþ vakalar dahil edildi. Toplam mortalite oraný %36 ile, 56 (%74.7) olguda cerrahi ve 19 (%25.3) olguda nonoperatif tedavi indikas-yonu verildi. Lojistik regresyon analizi, altý travma skorunun tamamýnýn (ISS, NISS, APACHE2, SOFA, TRISS, KTS) anlamlý mortalite öngörücüleri olduðunu göstermiþtir (p<0.001). Gözlemlenen eþik deðerleri olan ISS: 39.5, NISS: 42, APACHE 2: 25, SOFA: 6.5 puanlarý, hayatta kalamayanlarda mortalite için öngörücü deðerlerdir. Çok deðiþkenli bir analiz, en güçlü mortalite öngörücülerinin TRISS ve APACHE 2 olduðunu ve sýrasýyla AUC’le-rin 0.9 ve 0.866 olduðunu göstermiþtir.
TARTIÞMA: Çalýþmamýza göre, en güçlü mortalite öngörücüleri APACHE 2 ve TRISS’dir; sýnýrlý kaynaklara sahip hastane ortamlarýnda bile istatistiksel olarak anlamlý olan KTS, beklendiði gibi performans göstermemiþtir. “Altýn saat”ten faydalanma aracý olarak KTS’yi, kabul aþamasýnda ISS veya NISS kullanýmýný, ve yoðun bakým ünitesine kabulden sonraki ilk 24 saatte kullaným için APACHE 2 veya TRISS’i önermekteyiz.

BACKGROUND: Objective evaluation of the severity of injured patients is crucial for the adequate triage, decision-making, operative and intensive care management, prevention, outcome studies and system quality assessment. This study aimed to compare six, widely- used, trauma scores as predictors of mortality, and to identify the most powerful among them in limited-resources settings.
METHODS: Seventy-five polytraumatized patients, admitted to the ICU of the Clinic for Emergency Surgery (Level 1 trauma center, CSS Belgrade) from June 2018-August 2020, were included in the study. The inclusion criteria were age≥16, ISS≥16 and SOFA≥5 points. Scores were evaluated using logistic regression model and analysis of areas under the receiver operating characteristic (ROC) curve (AUC).
RESULTS: During the 26 months period, highly selected cases, mostly of blunt trauma (97.3%), due to a road traffic accident (68%) and free-falls (25.3%) were included. Surgery was indicated in 56 (74.7%) and non-operative treatment in 19 (25.3%) cases, with overall mortality rate at 36%. Logistic regression analysis demonstrated that all six trauma scores (ISS, NISS, APACHE2, SOFA, TRISS, KTS) were significant mortality predictors (p<0.001). Observed cut-off values for ISS: 39.5, NISS: 42, APACHE 2: 25, SOFA 6.5 points are predictive for mortality in non-survivors. A multivariate analysis showed that the most powerful mortality predictors are TRISS and APACHE 2 with AUCs: 0.9 and 0.866.
CONCLUSION: According to our study the most powerful mortality predictors are APACHE 2 and TRISS, even in limited-resources hospital settings, while statistically significant KTS, did not perform as expected. We propose the appliance of the KTS, as the tool for exploiting “golden hour”, ISS or NISS during admission stage and APACHE 2 or TRISS for use in the first 24 hours after admission to ICU.

AMAÇ: Masif transfüzyon (MT), geleneksel olarak, hasta kabülünden sonraki ilk 24 saat içinde 10 üniteden fazla eritrosit (RBC) transfüzyonu olarak tanýmlanýr. Bu çalýþmanýn amacý, bölgesel bir travma merkezinde taze donmuþ plazma (TDP) ve eritrosit oraný dahil olmak üzere masif transfüzyon (MT) eðilimini analiz etmektir.
GEREÇ VE YÖNTEM: Geriye dönük veriler 2014’ten 2016’kadar tarandý. Baþvurudan sonraki ilk 24 saat içinde 10 üzeri eritrosit ünitesi alan toplam 185 hasta çalýþmaya alýndý. Baþvurudan sonra her bir 4 saatlik dilimlerde ve 24 saat sonra transfüzyon gereksinimleri analiz edildi. Hayatta kalan ve hayatta kalmayan grup arasýnda, yüksek TDP: eritrosit grubu (≥1: 2) ve düþük TDP: eritrosit grubu (<1: 2) arasýnda ve ilk yarý ile ikinci yarý dönem arasýndaki transfüzyon özellikleri karþýlaþtýrýldý.
BULGULAR: Masif transfüszyon protokolünü uyguladýktan sonra FFP: eritrosit oranýnda bir iyileþme eðilimi vardý. FFP: eritrosit oraný, bavurudan sonraki 24 saat içinde 1: 1.7’den 1: 1.4’e yükselmiþti. Ýlk transfüzyona kadar geçen süre kýsalmýþtý (137 dakikadan 106 dakikaya). Mortalite, yüksek TDP: eritrosit grubunda, düþük TDP: eritrosit grubuna göre daha düþüktü.
TARTIÞMA: Çalýþmamýzda, MT protokolü FFP: eritrosit oranýný iyileþtirmiþtir. Daha yüksek bir TDP: eritrosit oraný da MT hastalarýnda ölüm oranýnda bir iyileþmeye yol açmýþtýr.

BACKGROUND: Massive transfusion (MT) is traditionally defined as transfusion of more than 10 units of red blood cells (RBCs) within the first 24 h after admission. The aim of this study is to analyze the trend of MT in regional trauma center including ratio of fresh frozen plasma (FFP) and packed RBC.
METHODS: Retrospective data were driven from 2014 to 2016. A total of 185 patients who received more than 10 packed RBC units within the first 24 h after admission were included in the study. We analyzed transfusion requirements for each time interval 4 h and 24 h after admission. Moreover, we compared transfusion characteristics between survival and non-survival group, between high FFP: RBC group (≥1: 2) and low FFP: RBC group (<1: 2), and between the first half and latter half period.
RESULTS: There was a trend for improvement in the FFP: RBC ratio after applying the MT protocol. The FFP: RBC ratio increased from 1: 1.7 to 1: 1.4 within 24 h after arrival. The time to first transfusion was shortened (137–106 min). Mortality was lower in high FFP: RBC group than that of low FFP: RBC group.
CONCLUSION: In our study, the MT protocol improved the FFP: RBC ratio. A higher FFP: RBC ratio also led to an improvement in the mortality rate in MT patients.

AMAÇ: Elli yaþ üzerindeki akut apandisit hastalarýnda yapýlan çalýþmalarda daha yüksek mortalite, daha yüksek perforasyon oranlarý, semptom baþlangýcýndan hastaneye yatýþa kadar daha fazla gecikme, daha yüksek komplikasyon oranlarý ve histopatolojik incelemelerde daha yüksek malignite sonuçlarý bildirilmiþtir. Bu çalýþmada, akut apandisit tanýsý alan ve bu taný nedeniyle ameliyat edilen 50 yaþ ve üzeri bir hasta popülasyonunda ameliyat ve ameliyat sonrasý bulgularý etkileyebilecek klinik, laboratuvar ve görüntüleme bulgularýnýn aydýnlatýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmaya, Ocak 2017 ile Ocak 2020 arasýnda akut apandisit nedeniyle tek bir üçüncü basamak hastanede ameliyat edilen 50 yaþ ve üzerindeki tüm hastalar alýndý. Hastalarýn demografik verileri, komorbiditeleri, laboratuvar ve görüntüleme bulgularý, ame-liyat ve ameliyat sonrasý sonuçlarý, hastalarda geliþen cerrahi komplikasyonlar ve alýnan örneklerin histopatolojik deðerlendirmeleri detaylý olarak incelendi.
BULGULAR: Ortanca yaþý 59 olan, acil apendektomi yapýlan 50 yaþ ve üzerinde toplam 152 hasta çalýþmaya alýndý. Ameliyat öncesi iki ya da daha fazla konorbidite varlýðýnýn ve ameliyat sonrasý yoðun bakým ünitesinde (YBÜ) yatýþ süresinin cerrahi komplikasyonlarýn geliþimiyle anlamlý derecede iliþkili olduðu gösterildi (sýrasýyla, p=0.002 ve p=0.006). Cerrahi komplikasyon geliþen hastalarda toplam yatýþ süresinin daha uzun (p<0.001), ameliyat öncesi albümin düzeylerinin daha düþük (p=0.017) ve takipte YBÜ’de yatýþ süresinin daha yüksek (p=0.006) olduðu görüldü. Açýk apendektomi yapýlan hastalarda ameliyat öncesi lökosit düzeylerinin daha yüksek olduðu görüldü (p=0.047). Ameliyat öncesi karýn aðrýsý süresinin hastanede yatýþ süresi ile güçlü bir þekilde iliþkili olduðu gözlendi (p<0.001). Ayrýca hastalarýn hastanede yatýþ süreleri ile ameliyat öncesi C-reaktif protein düzeyleri arasýnda güçlü bir korelasyon saptandý (p<0.001).
TARTIÞMA: Akut apandisitin geç eriþkinlerde yönetiminin taný ve ameliyat sonrasý süreçler açýsýndan zorlu olduðu öne sürülmüþtür. Bu nedenle, bu hastalara ait ameliyat öncesi klinik, laboratuvar ve görüntüleme verileri dikkatli ve titizlikle deðerlendirilmelidir.

BACKGROUND: Studies reported higher mortality and perforation rates, marked increase in delay from symptom onset to hospital admission, significant complication rates, as well as excessive malignancy outcomes on histopathological examinations in patients older than 50 years of age with acute appendicitis. Herein, it was aimed to reveal the clinical, laboratory, and imaging findings that might affect the operative and post-operative findings in a population of patients over the age of 50 who were diagnosed with and operated for acute appendicitis.
METHODS: Patients who were older than 50 years of age and operated for the diagnosis acute appendicitis between January 2017 and January 2020 in a single tertiary hospital were included in this retrospective study. Demographic data, comorbidities, laboratory and imaging findings, operative and post-operative results, surgical complications, as well as the histopathological evaluation of the excised materials of all patients were analyzed in detail.
RESULTS: A total of 152 patients who were older than 50 years of age and who underwent emergent appendectomy with a median age of 59 were included in the study. It was demonstrated that the development of surgical complications was significantly associated with post-operative hospitalization at the intensive care unit (ICU) and the presence of 2 or more comorbidities preoperatively (p=0.006 and p=0.002, respectively). It was observed that the duration of total hospitalization was longer (p<0.001), pre-operative al-bumin levels were lower (p=0.017), and the rate of hospitalization at ICU during the follow-up period was higher (p=0.006) in patients with surgical complications. Pre-operative white blood cell counts appeared to be significantly increases in patients who had open appendectomy (p=0.047). Moreover, both the duration of pre-operative abdominal pain and pre-operative C-reactive protein levels was found to significantly correlate with the duration of hospitalization (p<0.001 and p<0.001, respectively).
CONCLUSION: The management of acute appendicitis in late adulthood was suggested to be challenging both in terms of diagnosis and post-operative processes. Therefore, pre-operative clinical, laboratory, and imaging data obtained from these patients should be carefully and elaborately evaluated.

AMAÇ: Non-operative management (NOM), künt dalak travmasý olan hemodinamik olarak stabil hastalarda standart bir tedavi haline gelmiþtir. Çalýþmalarda, NOM için çok sayýda prediktör ve risk faktörü tanýmlanmaktadýr. Ancak, bu faktörlerin NOM baþarýsýzlýðýndaki rolleri tartýþýlmaya devam etmektedir. Bu çalýþma, NOM uygulanan hastalardan elde edilen verilerin geriye dönük analiziyle, bu faktörlerin NOM baþarýsýzlýðýndaki rolünü sunmayý amaçladý.
GEREÇ VE YÖNTEM: Mart 2009–Haziran 2021 tarihleri arasýnda künt karýn travmasý ile getirilen ve künt dalak travmasý tanýsý alan 189 hastanýn ilk deðerlendirmesi yapýldý. Hemodinamik instabilite nedeniyle acil ameliyata (immediate splenektomi) alýnan 13 ve hayatýný kaybeden 18 hasta çalýþmaya alýnmadý. Geri kalan 158 hastaya (stabil veya stabilleþen) NOM planlandý. NOM planlanan hastalar baþarýlý (s-NOM; n=139) veya baþarýsýz (f-NOM; n=19) olarak gruplandýrýlarak, sonuçlar geriye dönük olarak analiz edildi.
BULGULAR: NOM için planlanan 158 hastanýn 115’i erkekti. Ortalama yaþ; s-NOM 32.2±14.5 ve f-NOM’da 36.1±16.1) idi. Ortalama hastanede kalýþ süresi 8 (4–21) gün, takip süresi ise 12 (6–18) aydý. Planlanan NOM grubunda 60 (%43.2) hastaya USG ve 137 (%98.6) hastaya BT yapýldý. NOM planlanan hastalarda (n=158) grade I-V sýrasýyla 20 (%12.6), 54 (34.1) 56 (%35.4), 26 (%16.4) ve 2 (%1.3) idi. Grade I-V baþarý oranlarý sýrasýyla 20 (%100), 52 (%96.3), 52 (%92.8), 15 (%57.7), 0 (%0.0) idi. s-NOM grubundaki 41 hastaya 102 ünite eritrosit transfüzyonu (ortalama 2.46 ünite) uygulanýrken, f-NOM grubundaki 19 hastaya 81 ünite (ortalama 4.26 ünite) uygulandý (p<0.001). ISS skoru >15 hastalar %57.5 (ortalama skor, 22.8) ve f-NOM grubunda %78.9 (ortalama skor, 34.8) idi (p<0.001). Bu çalýþmada genel NOM baþarýsý %88.0, toplam komplikasyon %10.1 ve mortalite %1.2 idi.
TARTIÞMA: Bu çalýþmada grade I-III künt dalak travmalý hastalara NOM protokolü uygulanarak baþarýyla tedavi edildi. Ancak, grade IV dalak yaralanmalarýnýn sadece %57.7’si NOM ile baþarýlý bir þekilde yönetildi. Standart bir plan dahilinde prediktör ve risk faktörleri belirlenmesi ve bu plan dahilinde takip ve tedavilerinin yapýlmasý NOM baþarýsýný artýracaðýný öngörüyoruz.

BACKGROUND: Non-operative management (NOM) has become a standard treatment in hemodynamically stable patients with blunt splenic trauma. Studies have identified numerous predictors and risk factors for NOM. However, these factors’ role in NOM failure continues to be debated. This study aimed to reveal the role of these factors in NOM failure through retrospective analysis of data from patients who underwent non-operative treatment.
METHODS: After the initial evaluation of 189 patients brought to the emergency department between March 2009 and June 2021 and diagnosed with blunt splenic trauma, 13 patients underwent emergency surgery due to hemodynamic instability (immediate splenectomy), and 18 patients who died were excluded from the study. NOM was planned for the remaining 158 patients (stable or stabilized). Patients scheduled for NOM were grouped as either successful NOM (s-NOM; n=139) or failure NOM (f-NOM; n=19) and analyzed the results, retrospectively.
RESULTS: Of the 158 patients scheduled for the NOM, 115 were male. The mean age in s-NOM and f-NOM was 32.2±14.5 versus 36.1±16.1. The mean hospital stay was 8 (4–21) days. The mean follow-up period was 12 (6–18) months. Used USG for 60 (43.2%) patients and CT for 137 (98.6%) in the NOM. The number of Grades I-V in the NOM planned patients (n=158) was 20 (12.6%), 54 (34.1%) 56 (35.4%), 26 (16.4%), and 2 (1.3%), respectively. The success rates according to the Grades I-V were 20 (100%), 52 (96.3%), 52 (92.8%), 15 (57.7%), and 0 (0.0%), respectively. There were 102 units of red cell transfusions administered (mean, 2.46 units) to 41 patients in the s-NOM group, while 81 units (mean, 4.26 units) were administered to 19 patients in the f-NOM group (p=0.001). ISS score >15 was 57.5% (mean score, 22.8) and those in the f-NOM group were 78.9% (mean score, 34.8), respectively (p<0.001). Overall NOM success was 88.0%, total complications were 10.1%, and mortality was 1.2% in this study.
CONCLUSION: Grades I-III blunt splenic trauma patients were successfully treated using the NOM protocol in this study. However, more than half of Grade IV (57.7%) splenic injuries were successfully treated using NOM. Identifying predictors and risk factors based on a standardized plan will likely increase this success.

AMAÇ: En sýk görülen peptik ülser komplikayonlarýndan birisi perforasyondur (PÜP) ve önemli bir morbidite-mortalite nedeni olmaya devam etmektedir. Bu çalýþmada benzer ameliyat öncesi skorlama indeksi sonuçlarýna (Boey, Charlson co-morbidite indeksi ve Mannheim peritonit indeksi) sahip olup laparoskopik ve açýk cerrahi uygulanmýþ olan hastalarýn sonuçlarýnýn karþýlaþtýrýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: PÜP tanýsý ile acil þartlarda ameliyata alýnmýþ olan hastalarýn dosyalarý geriye dönük olarak incelenerek ameliyat öncesi Boey, CCI ve MPI skorlarý hesaplandý. Belirtilen skorlama indekslerinin skorlarý ‘düþük’ olarak belirlenen hastalar laparoskopik ve açýk cerrahi yapýlanlar olmak üzere iki gruba ayrýldý (laparoskopik cerrahi uygulananlar/Grup-1 ve açýk cerrahi uygulananlar/Grup 2). Gruplarýn peroperatif ve erken ameliyat sonrasý sonuçlarý karþýlaþtýrýldý.
BULGULAR: Gruplar arasýnda demografik veriler, hastaneye baþvuru süresi ve hastanede yatýþ süresi açýlarýndan istatistiksel fark saptanmadý. Operasyon zamaný Grup 1’de (110.2 dk, std ±20.6 / 75–150 dk) Grup 2’ye göre (54.2 dk, std±15.7 / 30–120 dk) uzun bulundu (p<0.001). Morbidite Grup 1’de daha az bulundu (%4’e %14.6) (p<0.001).
TARTIÞMA: Peptik ülser perforasyonunda laparoskopik yöntem seçilmiþ olgularda ameliyat sonrasý komplikasyon oranlarýnýn daha az olmasý ve minimal invaziv cerrahinin bilinen avantajlarý nedeniyle güvenle uygulanabileceðini düþünüyoruz.

BACKGROUND: One of the most common peptic ulcer complications is perforation (PUP) which also remains an important cause of morbidity and mortality. In this study, it was aimed to compare the results of patients who had similar pre-operative scoring index results (Boey, Charlson Comorbidity Index (CCI) and Mannheim Peritonitis Index (MPI), and type of surgery.
METHODS: Pre-operative Boey, CCI, and MPI scores were calculated by retrospectively examining the files of patients who were operated under emergency conditions with the diagnosis of PUP. The patients divided into two groups those who underwent laparoscopic surgery/Group-1 and open surgery/Group-2.
RESULTS: There was no statistical difference between the groups in terms of demographic data, hospital admission time, and length of hospital stay. The operation time was found to be longer in the laparoscopic group (110,2 SD20,6/75–150 min) than open group (54,2 SD15,7/30–120 min) (p<0.001). Morbidity was less in laparoscopic group (4% versus 14.6%) (p<0.001).
CONCLUSION: The laparoscopic method may be used safely in PUP due to the lower post-operative complication rates and known advantages of minimally invasive surgery.

AMAÇ: Bu çalýþmanýn amacý, uzun süredir kabul gören þok indeksi ve verileri sýnýrlý olan glukoz/potasyum oranýnýn izole künt torakoabdominal travmalý hastalarda prognostik deðerini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük gözlemsel çalýþma üçüncü basamak bir referans hastanede yürütüldü. Aðustos 2020 ile Þubat 2022 arasýnda acil serviste künt torakoabdominal travma nedeniyle tedavi edilen 18 yaþ ve üstü ardýþýk hastalar alýndý. Giriþte arteriyel kan gazlarýndan elde edilen glukoz/potasyum oranlarý ve þok indeksi düzeylerinin mortalite ve cerrahi endikasyonu öngörme yeteneði, ROC eðrileri altýnda kalan alanlar hesaplanarak deðerlendirildi.
BULGULAR: Sað kalan grubunda 91 ve mortalite grubunda 11 olmak üzere toplam 102 hasta analiz edildi. Glikoz/potasyum oraný ve þok indeksi ile mortaliteyi tahmin etmek için ROC eðrileri altýnda kalan alanlar sýrasýyla 0.854 (%95 GA, 0.742–0.967) ve 0.809 (%95, 0.666–0.952) idi. Ameliyat endikasyonunu tahmin etmek için glukoz/potasyum oraný ve þok indeksinin ROC eðrileri altýnda kalan alanlarý sýrasýyla 0.761 (%95 GA, 0.657–0.864) ve 0.582 (%95 GA, 0.416–0.747) idi.
TARTIÞMA: Bu çalýþma, izole künt torakoabdominal travmalý hastalarda cerrahi endikasyonu ve mortalityi öngörmede þok indeksi ve glikoz/potasyum oranýnýn etkinliðini ve glikoz/potasyum oranýnýn þok indeksine göre daha üstün olduðunu bildirmiþtir.

BACKGROUND: The aim of this study, investigate the prognostic value of shock index (SI), which has been accepted for a long time, and glucose-potassium ratio (GPR), which has limited data in patients with trauma and those with isolated blunt thoracoabdominal trauma.
METHODS: This retrospective observational study was conducted at the tertiary reference hospital. Consecutive patients aged 18 years and older treated for blunt thoracoabdominal trauma in the emergency department between August 2020 and February 2022 were included in the study. The ability of GPRs obtained from arterial blood gases and SI levels on admission to predict mortality and indication for surgery was evaluated by calculating areas under receiver operating characteristic curves Area under the curve (AUCs).
RESULTS: A total of 102 patients, of which 91 in the survivor group and 11 in the non-survivor group, were analyzed. The AUCs for estimating mortality with GPR and SI were 0.854 (95% confidence interval [CI], 0.742–0.967) and 0.809 (95%, 0.666–0.952), respectively. The AUCs of GPR and SI to estimate the indication for surgery were 0.761 (95% CI, 0.657–0.864) and 0.582 (95% CI, 0.416–0.747), respectively.
CONCLUSION: This study reported the efficacy of SI and GPR in predicting surgical indication and mortality in patients with isolated blunt thoracoabdominal trauma and the superior predictive role of GPR over SI.

AMAÇ: Laparoskopik cerrahi iþlemler sýrasýnda artan karýn içi basýncýnýn gastroözofageal reflü geliþiminde bir faktör olduðu bildirilmiþtir. Bu çalýþma, laparoskopik apendektomi geçiren çocuklarda gastroözofageal reflü varlýðýný ve iliþkili faktörleri 24 saatlik pH monitörizasyonu kullanarak deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Haziran 2017–Haziran 2018 tarihleri arasýnda akut apandisit düþünülerek laparoskopik cerrahi uygulanan çocuklar çalýþmaya dahil edildi. Ameliyat öncesi endotrakeal entübasyondan sonra, 24 saatlik pH monitörizasyonu için kateter yerleþtirildi. Gastroözofageal reflü ile iþlem süresi, ameliyat öncesi açlýk süresi, yaþ, kilo ve vücut kitle indeksi arasýndaki iliþkiler deðerlendirildi.
BULGULAR: Toplam 60 çocuk hasta çalýþmaya alýndý. Ortalama (SD) yaþlarý 11.82 (3.71) yýl (4–17 yaþ arasý) idi. Ortalama (SD) vücut aðýrlýðý 41.27 (16.72) kg (aralýk, 15–90 kg) ve ortalama (SD) vücut kitle indeksi 17.96 (4.37) idi. Ameliyat öncesi ortalama açlýk süresi 15.52 (12.1) saat, ortalama ameliyat süresi 38.42 (17.96) dakika idi. Daha düþük yaþ ve aðýrlýk, ameliyat sonrasý gastroözofageal reflü varlýðý ile anlamlý olarak iliþkiliydi (p<0.05). Ortalama iþlem süresi, ameliyat öncesi ortalama açlýk süresi ve vücut kitle indeksi, intra veya ameliyat sonrasý gastroözofageal reflü ile anlamlý olarak iliþki saptanmadý (p>0.05).
TARTIÞMA: Ortalama iþlem süresi ile gastroözofageal reflü arasýnda anlamlý bir iliþkinin olmamasý, bu çalýþmada yapýlan laparoskopik iþlemlerin ortalama süresinin gastroözofageal reflü açýsýndan güvenli olduðunu düþündürmektedir. Sonuçlar ayrýca laparoskopik apendektomi yapýlan çocuk hastalarda genç yaþ ve düþük kilonun gastroözofageal reflü için risk faktörleri olarak düþünülmesi gerektiðini göstermektedir.

BACKGROUND: The increased intra-abdominal pressure during laparoscopic surgical procedures was reported to be a factor in the development of gastroesophageal reflux. This study evaluated the presence of gastroesophageal reflux and associated factors using 24-h pH monitoring in children undergoing laparoscopic appendectomy.
METHODS: Children who underwent laparoscopic surgery for presumed acute appendicitis between June 2017 and June 2018 were included in the study. After pre-operative endotracheal intubation, pH catheters were placed for 24-h esophageal pH monitoring. Relationships between gastroesophageal reflux and procedure time, pre-operative fasting time, age, weight, and body mass index (BMI) were evaluated.
RESULTS: A total of 60 pediatric patients were included in the study. Their mean (SD) age was 11.82 (3.71) years (range, 4–17 years). The mean (SD) body weight was 41.27 (16.72) kg (range, 15–90 kg) and the mean (SD) BMI were 17.96 (4.37). The mean pre-operative fasting time was 15.52 (12.1) h, while the mean operative time was 38.42 (17.96) min. Lower age and weight were significantly associated with the presence of post-operative gastroesophageal reflux (p<0.05). Mean procedure time, mean pre-operative fasting time, and BMI were not significantly associated with intra- or post-operative gastroesophageal reflux (p>0.05).
CONCLUSION: The lack of a significant relationship between mean procedure time and gastroesophageal reflux suggests that the mean duration of the laparoscopic procedures performed in this study is safe in terms of gastroesophageal reflux. The results also indicate that young age and low weight should be considered risk factors for gastroesophageal reflux in pediatric patients undergoing laparoscopic appendectomy.

AMAÇ: Amerika Birleþik Devletleri’nde Acil Genel Cerrahi (AGC) olgularýnda hastaneye yatýþlar 2001 yýlýndan bu yana %28 artmýþ olup, bu olgularýn maliyetlerinin 2060 yýlýna kadar yýllýk %45 artarak 41.20 milyar dolara çýkacaðý tahmin edilmektedir. Literatüre göre genel cerrahi kliniði ekibi günde ortalama 5.5 saatini acil servis konsültasyonlarý için ayýrmaktadýr. Bu çalýþmadaki amaç, bölge hastanelerinden elde edilen verilerle, ülkemizde acil servisten yapýlan konsültasyonlarýn AGC yaklaþýmýna etkilerini belirlemek ve uygun çözüm önerileri oluþturmaktýr.
GEREÇ VE YÖNTEM: Çalýþmamýzdaki verilerin kaynaðý 2017–2020 yýllarý arasýndaki üç yýllýk süreçte Ulusal Travma ve Acil Cerrahi Derneði Ýç Anadolu Bölgesi Travma ve Acil Cerrahi toplantýlarýnda 10 bölge hastanesi tarafýndan sunulan AGC olgu sayýlarýdýr. Verilerin analizi ve grafiklerin oluþturulmasýnda MATLAB R2021b (The MathWorks, Inc., Natick, Massachusetts, ABD) ve SPSS (IBM SPSS Statistics for Windows, version 22.0, IBM Corp., Armonk, NY, ABD) programlarý kullanýldý.
BULGULAR: Yatýþ/konsültasyon oraný acil serviste çalýþan doktorlarýn AGC olgularýný tanýma baþarýsý olarak deðerlendirilmiþ olup, tüm hastaneler genelinde ortalama deðer %20.15’tir. Acil servisten yatýrýlan hastalarýn ne kadarýnýn ameliyat edildiðini gösteren ameliyat/acil yatýþ oraný tüm merkezler göz önüne alýndýðýnda %59.17’dir. Akut kolesistit olgularýnda ameliyat/yatýþ oraný tüm merkezler için %31.49’dur. Hastane iþ yükünün artýþý ile birlikte yatýþ/konsültasyon oranýnýn azaldýðý görülmektedir. Laparoskopik/toplam appendektomi oraný tüm merkezler genelinde %22.78’dir. TARTIÞMA: Akut apandisit olgularý ile AGC konsültasyon sayýlarý arasýnda bir korelasyon bulunmakta, fakat laparoskopik appendektomiyle konsültasyon sayýlarý arasýnda bir korelasyon bulunmamaktadýr. Ayrýca konsültasyon yükünün arttýðý merkezlerde akut kolesistit olgularýnda týbbi takip, konsültasyon yükünün daha az olduðu merkezlerde ise daha yüksek oranda kolesistektominin tercih edildiði görülmektedir. Dünya genelinde AGC hastalarýna yaklaþým ve sonuçlarý iyileþtirmek için Ulusal AGC sistemlerine ihtiyaç duyulmakta ve bu sistemler geliþtirilmeye çalýþýlmaktadýr. Ülke kaynaklarýný koordine ve sonuçlarý optimize eden ulusal bir AGC bakým sistemi kurmanýn zorunlu olduðu düþünülmektedir.

Background: Hospitalizations in emergency general surgery (EGS) cases in the USA have increased by 28% since 2001. The costs of these cases are estimated to increase by 45% annually until 2060, reaching 41.20 billion dollars. According to the literature, the general surgery clinic team allocates an average of 5.5 hours a day for emergency room consultations. The aim of this study is to determine the effects of consultations from the emergency room in our country on the EGS approach and to create appropriate solution proposals with the data obtained from the regional hospitals.

Methods: The source of the data in our study is the number of EGS cases presented by 10 regional hospitals at the Central Anatolia regional meetings of The Turkish Association of Trauma and Emergency Surgery between 2017 and 2020. MATLAB R2021b (The MathWorks, Inc., Natick, Massachusetts, USA) and SPSS (IBM SPSS Statistics for Windows, version 22.0, IBM Corp., Armonk, NY, USA) programs were used for data analysis and graphics creation.

Results and Conclusions: The hospitalization/consultation rate was evaluated as the success of the doctors working at the emergency department in recognizing EGS cases; the average value was 20.15% across all hospitals. The surgery/emergency hospitalization rate, which shows rate of the hospitalized patients underwent surgery, is 59.17% when all centers are taken into account. The rate of surgery/admission in acute cholecystitis cases is 31.49% for all centers. It is seen that the hospitalization/consultation rate decreases with the increase in hospital workload. The rate of laparoscopic/total appendectomy is 22.78% across all centers. There is a correlation between acute appendicitis cases and EGS consultation numbers, but there is no correlation between laparoscopic appendectomy and consultation numbers. In addition, it is seen that medical follow-up is preferred in acute cholecystitis cases in centers where the consultation burden is increased; cholecystectomy is preferred at a higher rate in centers where the consultation burden is less. National EGS systems are needed and tried to be developed in order to improve the approach and outcomes of EGS patients worldwide. It is considered essential to establish a national EGS maintenance system that coordinates country resources and optimizes outcomes.

AMAÇ: Travma hastalarýnda skorlama sistemleri yaygýn olarak kullanýlmaktadýr ve travma hastalarýnýn bakýmýnda oldukça önemlidir. Bu çalýþmada, travma merkezi olmayan bir hastaneye ateþli silah yaralanmasý nedeniyle getirilen hastalarýn, skorlama sistemleri ile deðerlendirilmesi ve travma merkezinde tedavi olmasý gereken hastalarýn tanýmlanmasýnda skorlama sistemlerinin etkinliðinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Ocak 2010–Aralýk 2019 tarihleri arasýnda ateþli silah yaralanmasý nedeni ile Hakkari Yüksekova Devlet Hastanesi’ne getirilen hastalar geriye dönük olarak araþtýrýldý. On altý yaþ ve üzeri hastalar çalýþmaya alýndý. Hayatýný kaybetmiþ olarak hastaneye getirilen hastalar ve hastanede kardiyopulmoner resüsitasyona yanýt alýnmayan hastalar çalýþma dýþý býrakýldý. Ayrýca ayaktan basit týbbi müdahale yapýlan hastalarda hasta grubuna dahil edilmedi. Hastalar, demografik olarak deðerlendirildi. Travma hastalarýnýn deðerlendirilmesinde yaygýn olarak kullanýlan travma skorlama sistemlerinin mortalite öngörüsü incelendi. Ayrýca travma merkezlerinde tedavi olmasý gereken hastalarýn tanýmlanmasýnda skorlama sistemlerinin etkinliði araþtýrýldý.
BULGULAR: Çalýþmada %96.9’u erkeklerden oluþan 331 hasta deðerlendirildi. Hasta grubu genç hastalardan oluþtu ve yaþ median deðeri 27 (IQR, 24–29) yýl olarak bulundu. Yetmiþ dört (%22.4) hasta taný ve tedavi için travma konusunda referans olan hastanelere yönlendirildi. Toplam 46 (%13.9) hastada mortalite geliþti. Hastalarda Glasgow Koma Skoru, Yaralanma Ciddiyeti Skoru, Revize Travma Skoru, Yeni Travma Skoru ve Revize Travma Yaralanma Ciddiyeti Skoru mortalite öngörüsü için etkin bulundu ve skorlama sistemleri birbirleri ile korelesyon gösterdi. Ancak travma merkezinde tedavi olmasý gereken hastalarýn ayýrýmýnda skorlama sistemleri etkin bulunmadý.
TARTIÞMA: Skorlama sistemleri ateþli silah yaralanmasý olan hastalarýn mortalite tahmininde anlamlýdýr. Ancak travma merkezine yönlendirilmesi gerekli hastalarýn ayýrýmýnda travma skorlama sistemleri etkin bulunmamýþtýr.

BACKGROUND: Scoring systems are widely used in trauma patients and are very important in the care of trauma patients. The objective of this study was to investigate the effectiveness of scoring systems in evaluating the patients who were brought to a hospital without a trauma center due to firearm injuries (FIs) using scoring systems, and the efficacy of these systems in identifying patients who should be treated in a trauma center.
METHODS: Patients brought to Hakkari Yüksekova State Hospital due to FIs between January 2010 and December 2019 were retrospectively investigated. Patients aged 16 and over were included in the study. Patients who were brought to the hospital while deceased and those who did not respond to cardiopulmonary resuscitation in the hospital were excluded from the study. In addition, patients who underwent simple outpatient medical intervention were not included in the patient group. Patients were evaluated demographically. The mortality predictions of trauma scoring systems, which are widely used in the evaluation of trauma patients, were examined. In addition, the effectiveness of scoring systems in identifying patients who should be treated in trauma centers was investigated.
RESULTS: In the study, 331 patients, 96.9% of whom were male, were evaluated. The patient group consisted of young patients and the median age was 27 (IQR, 24–29) years. A total of 74 (22.4%) patients were referred to trauma referral hospitals for diagnosis and treatment. Mortality occurred in 46 (13.9%) patients. Glasgow coma scale, injury severity score (ISS), revised trauma score, new trauma score, and trauma revised ISS were found effective for predicting mortality in patients, and scoring systems were correlated with each other. However, scoring systems were not found effective in distinguishing patients who should be treated in a trauma center.
CONCLUSION: Scoring systems are significant in predicting mortality of patients with gunshot wounds. However, trauma scoring systems have not been found to be effective in distinguishing patients who require referral to a trauma center.

AMAÇ: COVID-19 pandemisi nedeniyle kronik öksürük ataklarý ve antikoagülan tedavi nedeniyle rektus kýlýf hematomu (RKH) insidansýnda artýþ olmuþtur. Bu çalýþma, COVID-19 hastalarýnda RKH tanýsý öncesi ve sýrasýnda hangi parametrelerin farklýlýk gösterdiðini ve taný ve takip sýrasýnda neler beklenebileceðini belirlemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Mart 2016 ile Mart 2021 arasýnda RKH tanýsý alan 35 hasta geriye dönük olarak deðerlendirildi. COVID-19 grubu 11 hastadan oluþuyordu. Hastalarýn geçmiþi ve taburculuk/ölüm zamaný dahil olmak üzere çeþitli bilgileri alýndý ve deney gruplarý arasýnda karþýlaþtýrýldý. BULGULAR: COVID-19’lu hastalarda, baþvuru sýrasýnda hipotansiyon oranlarý (p=0.011) ve defans ve rebound (p=0.030) oranlarý, olmayanlara göre daha yüksekti. Kanama geniþliði açýsýndan fark olmamasýna raðmen, COVID-19 hastalarýnda hemoglobin düzeylerinde (p=0.009) daha büyük bir düþüþ oldu ve o grupta eritrosit süspansiyonu ihtiyacý (p=0.040) anlamlý olarak arttý.
TARTIÞMA: Bu çalýþma, COVID-19 hastalarýnda RKH’nun ilk deðerlendirmesini oluþturmaktadýr. COVID-19 hastalarýnda yüksek hipotansiyon, defans veya rebound oranlarý ve hemoglobin seviyelerindeki düþüþler nedeniyle klinik durum ciddidir. Bu, RKH’nun klinik yönetimini daha da zorlaþtýrarak daha uzun hastanede yatýþla sonuçlanýr. Bu zorluklara raðmen, COVID-19 enfeksiyonu morbidite veya mortaliteyi artýrmaz.

BACKGROUND: There has been an increased incidence of rectus sheath hematoma (RSH) due to chronic cough attacks and anti-coagulant therapy due to the COVID-19 pandemic. The present study aims to determine, in which parameters differ before and during the diagnosis of RSH in COVID-19 patients and what may be expected during diagnosis and follow-up.
METHODS: Thirty-five patients diagnosed with RSH were evaluated retrospectively between March 2016 and March 2021. The COVID-19 group comprised 11 patients. Various information including patient history and time of discharge/death were retrieved and compared between the experimental groups.
RESULTS: The rates of hypotension on admission (p=0.011) and the rates of defense and rebound (p=0.030) were higher in the patients with COVID-19 than in those without. Although there was no difference in terms of bleeding width, there was a greater decrease in the hemoglobin levels (p=0.009) in the COVID-19 patients and the need for erythrocyte suspension (p=0.040) increased significantly in that group.
CONCLUSION: The present study constitutes the first evaluation of RSH in COVID-19 patients. The clinical situation is serious due to high rates of hypotension, defense or rebound, and decreases in hemoglobin levels in COVID-19 patients. This makes the clinical management of RSH more difficult, resulting in longer hospitalization. Despite these difficulties, COVID-19 infection does not increase morbidity or mortality.

AMAÇ: Bu çalýþmada, hekim gözlemine (POB) veya protokole baðlý (PB) weaning protokolünün total antioksidan kapasite (TAC) ve total oksidatif stres (TOS) düzeyleri ve weaning baþarý düzeyleri üzerindeki etkilerini karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmamýz Ocak 2015–Ocak 2018 tarihleri arasýnda hastanemiz yoðun bakým ünitesinde acil servisten baþvuran hastalar üzerinde yapýldý. Spontan solunum denemesi sýrasýnda, belirtilen kriterlerden biri geliþtiðinde, SBT sonlandýrýldý ve önceki mekanik ventilatör parametrelerine dönüldü. Hastalarýn ertesi sabah tekrar SBT’ye alýnmasý planlandý. Spontan solunum denemesi baþarýlý olursa ekstübasyona karar verildi. Doktor gözlemine dayalý ekstübasyon kararý, hastanýn bilinç durumu ve günlük vizit sýrasýnda yeterli göðüs ekspansiyonu durumuna göre verildi. BULGULAR: POB grubu hastalarda ekstübasyon öncesi ve sonrasý TAK ortalama deðerindeki düþüþ anlamlý bulundu (p=0.001). PB grubu hastalarda ekstübasyon öncesi ve sonrasý TAK ortalama deðerindeki azalma anlamlý bulundu (p=0.03).
TARTIÞMA: Çalýþmamýzda PB grubunda TAK deðerleri POB grubuna göre daha yüksek bulundu ve ayrýca yeniden entübasyon oraný daha düþük bulundu. Bir PB olarak weaning yönetiminin TAC ve TOS arasýndaki dengeyi korumaya ve yeniden entübasyon oranýný düþürmeye katkýda bulunabileceðini düþünüyoruz.

BACKGROUND: We aimed to compare the effects of observation of the physician (POB) or by adhering to the protocol-based (PB) weaning methods on total antioxidant capacity (TAC) and total oxidative stress (TOS) levels and weaning success levels.
METHODS: Our study was conducted on patients admitted from the emergency department between January 2015 and January 2018 in the intensive care unit of our hospital. During the spontaneous breathing trial (SBT), when one of the criteria specified in developed, SBT was terminated and the previous mechanical ventilator parameters were returned. The patient was planned to be taken to SBT again the next morning. If the SBT was successful, extubation was decided. The extubation decision based on physician observation was made according to the patient’s state of consciousness and adequate chest expansion during the daily visit.
RESULTS: The decrease in TAC average value before and after extubation was found to be significant in the POB group patients (p=0.001). The decrease in the average TAC value of the PB group patients before and after extubation was found to be significant (p=0.03).
CONCLUSION: In our study, TAC values were found to be higher in the PB group than in the POB group, and in addition, the reintubation rate was found to be lower. We think that the management of weaning as a PB may contribute to maintaining the balance between TAC and TOS and reduce the rate of reintubation.

AMAÇ: Nötrofil-lenfosit oraný (NLR) ve C-reaktif protein albümin oraný (CAR) enflamatuvar yanýtýn basit ve nesnel bir belirtecidir. Ancak, bu iki belirteç travmatik beyin hasarýnda birlikte çalýþýlmamýþtýr. Bu yüzden çalýþmada TBH’li hastalarda NLR ve CAR’nin hastane içi mortaliteyi öngörmede hangisinin daha iyi bir biyobelirteç olduðu çalýþýldý.
GEREÇ VE YÖNTEM: Çalýþmaya Ocak 2016 ile Aralýk 2021 yýllarý arasýnda hastaneye kabul edilen ardýþýk 257 hasta dahil edildi. Tüm travmatik beyin hasarlý 18 yaþ üstü hastalarýn dosyalarý geriye dönük olarak incelendi. Hastanede kaldýklarý süre içindeki verileri kaydedildi. Klinik özellikleri glaskow koma skorlarý (GKS) kaydedildi. Bilgisayarlý beyin tomografisi (BBT) ile tanýlarý sýnýflandýrýldý. Hastalarýn ilk 12–24 saat arasýndaki rutin kan incelemeleri kaydedildi. Hastanede kaldýklarý sürece ölenlerle ölmeyenlerin laboratuvar sonuçlarý karþýlaþtýrýlarak analiz edildi.
BULGULAR: Mann-Whitney U testine göre hastanede kaldýklarý sürede ölen hastalarda ortanca CRP, CAR, NLR, WBC, monosit, nötrofil, RDW-CV, RDW-SD ve trombosit deðerleri anlamlý derecede yüksek, ortanca albümin ve RBC deðerleri ölmeyen hastalara göre anlamlý olarak daha düþüktü. Student t-testi, ölen hastalarda ortalama hemoglobinin ölmeyen hastalara göre anlamlý derecede düþük olduðunu gösterdi. Tek deðiþkenli lojistik regresyon modelinde yaþ, albümin, CRP, CAR, NLR, WBC, monosit, nötrofil, RBC, RDW-CV, RDW-SD ve hemoglobin mortaliteyi öngören faktörlerdi. Bununla birlikte, çok deðiþkenli lojistik regresyon modelinde yalnýzca yaþ, albümin, CAR ve WBC’nin mortaliteyi öngören faktörler olduðu bulundu. Eðri altýnda kalan alanlar; CAR 0.891 (%95 GA, 0.847–0.935), WBC 0.759 (%95GA, 0.696–0.823) ve NLR 0.671 (%95 GA, 0.598–0.744).
TARTIÞMA: Bu çalýþma, TBH’de hastane içi mortaliteyi ön görmede CAR’nin NLR ye göre daha iyi prognostik deðere sahip olduðunu göstermiþtir.

BACKGROUND: Neutrophil-lymphocyte ratio (NLR) and C-reactive protein-albumin ratio (CAR) are simple and objective markers of inflammatory responses. However, there are no studies in the literature evaluating these two markers together in traumatic brain injury (TBI). Therefore, this study aimed to examine whether CAR or NLR is a better biomarker for predicting in-hospital mortality in patients with TBI.
METHODS: A total of 257 consecutive patients admitted to the hospital between January 2016 and December 2021 were included in the study. The files of all patients aged >18 years with TBI were retrospectively reviewed. Clinical characteristics, Glasgow Coma Scale, and patient data during hospital stay were recorded. Definitive diagnosis was made using computed brain tomography. Routine blood tests were performed in the first 12–24 h of hospitalization. Laboratory results of patients with and without in-hospital mortality were comparatively analyzed.
RESULTS: According to the Mann–Whitney U-test, median CRP, CAR, NLR, WBC, monocyte, neutrophil, RDW-CV, RDW-SD, and platelet values were significantly higher, whereas median albumin and RBC values were significantly lower in patients with in-hospital mortality. Student’s t-test showed that the mean hemoglobin level was significantly lower in patients with in-hospital mortality compared to other patients. Univariate logistics regression model revealed that age, albumin, CRP, CAR, NLR, WBC, monocyte, neutrophil, RBC, RDW-CV, RDW-SD, and hemoglobin were the factors predicting mortality. However, in the multivariate logistic regression model, only age, albumin, CAR, and WBC were the factors predicting mortality. Areas under the curve were 0.891 for CAR (95% GA, 0.847–0.935), 0.759 for WBC (95% GA, 0.696–0.823), and 0.671 for NLR (95% GA, 0.598–0.744).
CONCLUSION: The results of this study showed that CAR has better prognostic value than NLR in predicting in-hospital mortality in patients with TBI.

AMAÇ: Anevrizmal subaraknoid kanamasý olan hastalarýn ikinci basamak hastanelerden, üçüncü basamak hastanelere sevk edilmesi sýrasýnda ortaya çýkan; Glaskow Koma Skalasý skoru (GKS), Fisher evrelemesi ve World Federation of Neurological Surgeons (WFNS) derecesi deðiþiklikleri araþtýrmak.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmaya, 1 Aralýk 2016 ile 1 Aralýk 2019 tarihleri arasýnda ikinci basamak hastanelerden, üçüncü basamak olan merkezlerimize kara ambulansý ile nakledilen ve anevrizmal subaraknoid kanamasý olan 75 hasta alýndý. Her iki hastanede, GKS skoru, Fisher evrelemesi ve WFNS derecesi, hasta demografileri, nakil süresi ve mesafesi ile ilgili veriler analiz edildi.
BULGULAR: Kadýn/erkek oraný 46: 29 ve ortanca hasta yaþý 55 yýldý. Median taþýma süresi üç saat ve yapýlan mesafe 161 kilometre idi. Taþýma sýrasýnda GKS anlamlý olarak azaldý (p=0.004), Fisher ve WFNS skorlarý anlamlý olarak arttý (sýrasýyla, p=0.003 ve p=0.003). Nakil sýrasýnda GKS veya Fisher evreleme sistemi deðil ama WFNS deðerlendirme derecesi, entübe olan ve olmayan hastalar arasýnda anlamlý derecede farklýydý (p=0.036). TARTIÞMA: Anevrizmal subaraknoid kanamasý olan hastalarýn ikinci basamak hastanelerden, üçüncü basamak hastanelere sevk edilmesi sýrasýnda ortaya çýkan; GKS, Fisher evrelemesi ve WFNS derecesinde önemli deðiþiklikler meydana geldiði tespit edildi. Parametrelerdeki bu deðiþiklikler, hastalarýn gelecekteki prognozlarýný etkileyebilir ve deðiþtirebilir.

BACKGROUND: The objective of the study was to investigate the changes in Glasgow Coma Scale (GCS) score, Fisher’s grade, and World Federation of Neurological Surgeons (WFNS) grade that occur during transport of patients with aneurysmal subarachnoid hemorrhage (aSAH) from secondary hospitals to a tertiary care center.
METHODS: Seventy-five patients with aSAH who were transported through ground ambulance from secondary hospitals to our tertiary care centers between December 1, 2016, and December 1, 2019, were enrolled in this retrospective study. Data regarding GCS, Fisher’s grade, and WFNS grade from both hospitals, patient demographics, and duration and distance of transport were analyzed.
RESULTS: The female-to-male ratio was 46: 29 and median patient age was 55.0 years. Median transport time was 3.0 h and median distance traveled was 161.0 kilometers. GCS significantly decreased (p=0.004) and Fisher and WFNS grade significantly increased during transport (p=0.003 and p=0.003, respectively). The change in the WFNS grade during transport, but not GCS score or Fisher’s grade, was significantly different between non-intubated patients and intubated patients (p=0.036).
CONCLUSION: Significant changes in Fisher’s grade, GCS, and WFNS grade occurred during ground transport of patients with aSAH from secondary hospitals to tertiary care centers. These changes in the parameters may affect and change patients future prognoses.

AMAÇ: Avlanma, avlanacak canlýnýn özelliðine göre çeþitli silah veya aletlerin profesyonel þekilde kullanýlmasýný gerektirir. Avlanma esnasýnda farklý sebeplerle (ateþli silah yaralanmasý, yüksekten düþme, vahþi hayvan saldýrýsý veya doðal vb.) ölümler meydana gelebilir. Bu olgularýn adli olgu bildirimi ilk müdahaleyi yapan hekim tarafýndan yapýlmalýdýr. Giriþ ve çýkýþ yaralarýnýn tespiti, týbbi tedavi öncesi yaralarýn fotoðrafýnýn çekilmesi, radyolojik görüntülemede yabancý cisimlerin þekil ve büyüklüklerinin net olarak belirlenmesi ateþli silahýn cinsi, atýþ sayýsý ve atýþ mesafesinin saptanmasýnda faydalý olacaktýr.
GEREÇ VE YÖNTEM: Adli Týp Kurumu Trabzon Grup Baþkanlýðý’nda 2007–2016 yýllarý arasýnda otopsileri yapýlmýþ olgular geriye dönük olarak incelendi. Av faaliyetleri sýrasýnda ölen 26 (%4.1) olgu deðerlendirmeye alýndý. Tüm olgulara toksikolojik inceleme yapýlmýþtýr. Olay yeri inceleme tutanaklarý, avcýlýk malzemeleri, yara özellikleri ve ölüm nedenleri incelendi.
BULGULAR: Olgularýn tamamý erkek (%92.3; n=24), ortalama yaþ 42.5 yýl (14–81; SD: ±17.4) idi. Olaylarýn %42.3’ünün kýþýn, %80.8’inin (n=21) gündüz saatlerinde, %69.2’sinin tarla gibi açýk alanlarda ve %26.9’unun ormanlýk alanda meydana geldiði saptandý. Ölümlerin %88.5’inin av tüfeði saçma tanesi/þevrotin (iri saçma) yaralarý, %7.7’sinin (n=2) uçurumdan düþme ve %3.8’inin yaban domuzu saldýrýsý (vasküler yaralanma) nedeniyle olduðu belirlendi. Atýþlarýn %57.7’sinin uzak, %19.2’sinin yakýn ve %11.5’inin bitiþik atýþ mesafesinden yapýldýðý belirlendi. Faillerin %73.9’u baþka bir avcý iken %26.1’inde ölen kiþinin kendisi olduðu tespit edildi. Yaralanmalarýn %42.3’ü göðüs ve %38.4’ünün baþ-boyun bölgesinde meydana geldiði belirlendi. Olgularýn ¾’ünde görgü tanýðý olmasýna raðmen olgularýn %96.2’sine ilk yardým yapýlmadýðý belirlendi. Sadece üç olguda (%11.5) etil alkol tespit edildi.
TARTIÞMA: Avcýlýk ve týbbi ilk yardým eðitimlerinin benzer olaylarý azaltabileceði düþünülmektedir. Gerekli denetim mekanizmalarýnýn çalýþmasý önemlidir. Ýlave olarak, adli týp uzmanlarýnýn yargýlama sonuçlarýna ulaþabilmesinin benzer olaylarda yeni davranýþ tarzlarýnýn geliþtirilmesi açýsýndan faydalý olacaðý düþünülmektedir.

BACKGROUND: Hunting requires the use of various weapons or tools as professionals according to the characteristics of the creature to be hunted. Deaths during hunting activities may occur as a result of different reasons (firearm wounds, falling from a height, wild animal attack, or natural, etc.). These events’ forensic reports are prepared by the physician who performed the first intervention. Identification of wounds, taking measurement photographs of the wounds before treatment, specifying the shape/sizes of foreign bodies in radiological imaging will be beneficial for determining the type of firearm, the number of shots, and the shooting distance.
METHODS: The cases that performed autopsy between 2007 and 2016 at The Council of Forensic Medicine Trabzon Group Chairmanship were analyzed, retrospectively. Twenty-six (4.1%) deceased were examined. Crime scene investigation reports, hunting equipment, wound characteristics, and causes of death were investigated.
RESULTS: All of our cases consisted of men (92.3%; n=24) with a mean age of 42.5 years (14–81; SD: ± 17.4). It was determined that 42.3% of the incidents occurred in winter, 80.8% (n=21) occurred in the daytime, 69.2% occurred in open areas such as fields, and 26.9% occurred in forested land. It was found that 88.5% of the deaths were caused by shotgun pellet/buckshot injuries, 7.7% (n=2) by falling off a cliff, and 3.8% by wild boar attacks (vascular injury). It was determined that 57.7% of the shots were made from long shooting distance, 19.2% were made from close range, and 11.5% were made from contact distance. It was found that 73.9% of the perpetrators were other hunters and 26.1% were the deceased person himself. It was determined that 42.3% of the injuries occurred in the chest and 38.4% in the head-and-neck region. It was determined that 96.2% of the cases did not undergo first aid intervention even though there were eyewitnesses in approximately ¾ of the cases. Ethyl alcohol was detected in only 3 cases (11.5%).
CONCLUSION: It is thought that similar deaths can be prevented to a certain extent thanks to the hunting and medical first aid training to be given by the local governments. Risk control mechanisms must work properly. Besides, it is necessary to ensure that forensic experts can access the results of the proceedings in such cases. It is thought that this will be more beneficial in terms of developing new behavior styles in similar events.

AMAÇ: Pediatik kýrýklarýn epidemiyolojisi, çok faktörlü bir þekilde, zamanla deðiþim göstermektedir. Bu çalýþmanýn amacý, mevcut AO/OTA kýrýk sýnýflamasýna göre, yol güvenliði için mevcut on yýllýk eylem planý kapsamýnda pediatrik kýrýklarýn son beþ yýllýk epidemiyolojik analizini ortaya koymaktýr. GEREÇ VE YÖNTEM: Bu geriye dönük, epidemiyolojik tanýmlayýcý çalýþmaya birinci düzey bir travma merkezinde ortopedi ve travmatoloji ile iliþkili en az bir kýrýk tanýsý almýþ 3261 pediatrik hasta alýndý. Hastalar yaþlarýna gore; <2, 2–5.9, 6–9.9 ve 10–17.9 olmak üzere dört yaþ grubunda incelendi. Kýrýklar AO/OTA kýrýk sýnýflamasýna göre deðerlendirildi.
BULGULAR: Üç bin iki yüz altmýþ bir hastada 3396 kýrýk vardý. Hastalarýn ortalama yaþý 9.8±4.6 (1–17) idi. Yaþ gruplarýna göre kýrýk sayýlarý sýrasýyla 28 (%0.008), 735 (%22.53), 863 (%26.47) ve 1635 (%50.99) idi. AO/OTA kýrýk sýnýflamasýna göre en sýk görülen üç kýrýk; 23 (radius/ulna distal %22.9), 13 (humerus distal, %13.3) ve yedi (el/karpal, %12) idi. Hastalarýn %68.8’i ameliyatsýz ve %31.2’si ameliyatla tedavi edildi. Toplam ölüm oraný %0.1 idi.
TARTIÞMA: Bildiðimiz kadarýyla bu çalýþma, beþ yýllýk bir dönem boyunca AO/OTA sýnýflandýrmasýna göre pediatrik kýrýklarý analiz eden ilk çalýþmadýr. Geleceðe yönelik olarak, majör travmalarýn önlenmesi için sürdürülebilir bir eylem planý oluþturmak amacýyla daha fazla çok merkezli epidemiyolojik çalýþma yapýlmasý gerekmektedir.

BACKGROUND: The epidemiology of pediatric fractures has been changing timely, in a multifactorial fashion. The aim of this study was to put forward a recent 5-year epidemiological analysis of pediatric fractures, according to the current AO/OTA fracture classification, in the current decade of action for road safety.
METHODS: A total of 3261 pediatric patients who were diagnosed with at least one fracture related with orthopedics and traumatology in a level-one trauma center were included in this retrospective and epidemiological descriptive study. The patients were grouped according to their ages as follows; <2, 2–5.9, 6–9.9, and 10–17.9. The fractures were examined according to the AO/OTA classification.
RESULTS: A total of 3396 fractures were present in 3261 patients. The mean age of the patients was 9.8±4.6 (1–17). The number of patients according to the age groups was as follows; 28 (0.008%), 735 (22.53%), 863 (26.47%), and 1635 (50.99%), respectively. The most frequent three fractures according to the AO/OTA fracture classification were; 23 (radius/ulna distal 22.9%), 13 (humerus distal, 13.3%), and 7 (hand/carpal, 12%). About 68.8% and 31.2% of the patients were treated non-surgically and surgically, respectively. Overall mortality rate was 0.1%.
CONCLUSION: To the best of our knowledge, this study represents the first analysis of pediatric fractures according to the AO/OTA classification, over a 5-year period. As a future prospect, further multicentric epidemiological studies are warranted to constitute a sustainable action plan for the prevention of major traumas.

AMAÇ: Bu çalýþmanýn amacý, açýk redüksiyon ve internal fiksasyon yapýlan skapula kýrýklý hastalarda cerrahi tekniði tanýmlamak ve fonksiyonel sonuçlarý deðerlendirmekti.
GEREÇ VE YÖNTEM: Bu çalýþmada, Mart 2014 Eylül 2019 tarihleri arasýnda üç farklý merkezde, Ideberg tip dört ve beþ skapula kýrýklý, Judet yaklaþýmýyla ameliyat edilen 10 hasta geriye dönük deðerlendirildi. En az iki yýllýk takiplerin sonucunda, tüm hastalarýn DASH ve Constant skorlarý deðerlendirildi.
BULGULAR: Hastalarýn üçünde sol ve yedisinde sað tarafta kýrýk bulunmaktaydý ve ortalama yaþlarý 35.1±9.75’idi. Ortalama Constant ve DASH skorlarý sýrasýyla 87.9±13.68 ve 5.57±5.21’idi. Ýki hastada, yaklaþýk supraglenoid çentikten 2 cm’lik mesafede, supraskapular sinirde travmatik tam kat yaralanma tespit edildi ve epinöral teknikle tamir edildi. Ýki yýllýk takipler sonucunda hastalarda infraspinatus kas atrofisi geliþti.
TARTIÞMA: Sonuç olarak, bu çalýþma glenoid eklem yüzüne uzanan deplase skapula kýrýklý hastalarýn cerrahi tedavisinde Judet yaklaþýmýnýn tatminkar sonuçlarýyla güvenli bir tercih olduðunu desteklemektedir. Ek olarak, iki hastada rastlanan ve cerrahi sýrasýnda tamiri yapýlan travmatik supraskapular sinir hasarýnýn daha kýsýtlý veya modifiye yaklaþýmlarla taný konmasýnýn zor olacaðý kanaatindeyiz.

BACKGROUND: The aim of this study was to describe the surgical technique and evaluate functional outcomes following open reduction and internal fixation in patients with scapular fractures.
METHODS: In this study, ten patients with scapular fractures with Ideberg type four and five, who had undergone operatively with the Judet approach in three different orthopedic centers between March 2014 and October 2018, were evaluated retrospectively. By the end of at least a 2-year follow-up period, postoperative Disabilities of the Arm, Shoulder and Hand (DASH), Constant questionnaires were evaluated by all participating patients.
RESULTS: Three of these patients had fractures on the left; seven patients had fractures on the right side, and the average patient age was 35.1±9.75. Mean Constant and DASH scores were 87.9±13.68 and 5.57±5.21, respectively. In two patients, about 2 cm adjacent to the suprascapular notch, perioperative suprascapular nerve injury was stated and sutured using the epineural technique. By the end of the 2-year follow-up of these two patients, infraspinatus muscle atrophy had occurred. However, external rotation muscle strength was 4/5 in both patients.
CONCLUSION: This study suggests that scapula fractures extending glenoid articular surface can be safely fixed through the Judet approach and had satisfactory results. In addition, two patients with traumatic suprascapular nerve injury were encountered during the surgery and repaired which may be hard to diagnose with modified or minimal incisional approaches.

AMAÇ: Çalýþmadaki amacýmýz Tibia AO Type 42A kýrýklarda konvansiyonel kilitli intramedüller çiviler ile talon kilitlemeli intramedüllerin klinik ve radyolojik sonuçlarýný kýyaslamaktýr.
GEREÇ VE YÖNTEM: AO Type 42 A kýrýðý olan 93 hasta geriye dönük olarak incelendi. Hastalar konvasiyonel intramedüller çivi yapýlanlar (Grup 1) ve talonlu distal kilitleme yapýlanlar (Grup 2) olarak ikiye ayrýlmýþlardýr. Hastalar yaþ, cinsiyet, yaralanma mekanizmasý, takip süresi, kaynama zamaný, sigara içiciliði, açýk kýrýk varlýðý, eþlik eden fibula kýrýðý varlýðý, malunion, nounion geliþmesi ve operasyon sýrasýnda çekilen skopi sayýlarý açýsýndan istatistiki olarak karþýlaþtýrýldý. Hastalar American Orthopaedic Foot and Ankle Society and Tegner Lysholm skorlarý hesaplanarak klinik skorlar açýsýndan da kýyaslandý.
BULGULAR: Çalýþmaya 68 erkek ve 35 kadýn olmak üzere 93 hasta alýndý. Grup 1 35 (%71.4) erkek, 14 (%28.6) kadýn olmak üzere 49 hasta ve grup 2 33 (%75) erkek, 11 (%25) kadýn olmak üzere 44 hastadan oluþmaktaydý. Her iki grup arasýnda yaþ, cinsiyet, yaralanma mekanizmasý takip süreleri, sigara içiciliði, eþlik eden fibula kýrýðý, malunion varlýðý, açýk kýrýk varlýðý açýsýndan anlamlý fark saptanmamýþtýr (p>.05). Her iki grup arasýnda kaynama zamaný, nonunion ve skopi sayýlarý açýsýndan anlamlý fark olduðu görüldü (p<.05). American Orthopaedic Foot and Ankle Society and Tegner Lysholm skoru açýsýndan her iki grup arasýnda istatistiki olarak anlamlý fark bulunamadý (p=0.786 and p=0.764).
TARTIÞMA: Talonlu intramedüller çiviler radyasyon maruziyetini azaltmaktadýr fakat kilitli konvansiyonel intramedüller çivilerde nonunion oranlarý daha düþüktür ve kaynama daha erken saðlanmaktadýr.

BACKGROUND: This study aimed to compare the clinical and radiological outcomes of conventional locked intramedullary nailing (IMN) and talon IMN in AO Type 42A tibial fractures.
METHODS: A total of 93 patients with AO Type 42A fracture were retrospectively analyzed. The patients were divided into two groups: Those treated with conventional IMN (Group 1), and those treated with talon distal locked nailing (Group 2). The patients were statistically compared in terms of age, sex, mechanism of injury, follow-up time, time to union, smoking status, presence of open fracture, presence of concomitant fibula fracture, development of malunion and nonunion, and the number of intraoperative fluoros-copy shots captured. All patients were evaluated with American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores for clinical outcomes.
RESULTS: A total of 93 patients (68 men and 35 women) participated in the study. Group 1 consisted of 35 (71.4%) men and 14 (28.6%) women, a total of 49 patients, while Group 2 consisted of 33 (75%) men and 11 (25%) women, a total of 44 patients. There were no significant differences between the two groups in terms of age, sex, mechanism of injury, follow-up times, smoking status, concomitant fibula fracture, presence of malunion, and presence of open fracture (p>0.05). However, there were significant differences between both groups in terms of time to union, nonunion rate, and the number of fluoroscopy shots captured (p<0.05). American Orthopaedic Foot and Ankle Society and Tegner Lysholm score were analyzed and compared, no statistically differences were found (p=0.786 and p=0.764).
CONCLUSION: Although talon IMN reduces radiation exposure, locked conventional IMN has lower nonunion rates and achieves union faster.

AMAÇ: Bu çalýþmanýn amacý, eklem içi kalkaneus kýrýðýnda cerrahi tedavinin plantar yük daðýlýmý restorasyonuna ve klinik sonuçlara etkisini konservatif tedavi ile kýyaslayarak belirlemektir.
GEREÇ VE YÖNTEM: Tek taraflý eklem içi kalkaneus kýrýðý nedeniyle cerrahi müdahale yapýlmýþ 32 hasta (Grup 1) ve konservatif tedavi edilmiþ 28 hasta (Grup 2) çalýþmaya alýndý. Detaylý statik pedobarografi deðerlendirmesi tüm hastalara uygulandý. Plantar yük daðýlýmý ölçümü; ön ayak maksimum ve ortalama basýnç daðýlýmý, arka ayak maksimum ve ortalama basýnç daðýlýmý ve mediolateral yönde topuk bölgesi basýnç daðýlýmlarý deðerlendirilerek yapýldý. Klinik sonuçlar Amerikan Ortopedik ayak ve ayak bileði derneði (AOFAS) skoru ve görsel analog skala (VAS) ile deðerlendirildi. BULGULAR: Ortalama kontakt alaný kýrýk olan ve saðlam taraflar arasýnda Grup 1’de farklýlýk göstermedi fakat grup 2’de her iki taraf arasýnda anlamlý farklý idi (p=0.009). Yaralanmanýn olduðu tarafta ortalama kontakt alaný (p=0.023) ve ön ayak basýnçlarý (p=0.001) grup 1’e kýyasla grup 2’de daha yüksek idi. Grup 2’deki hastalarda kýrýk taraf arka ayak basýncý saðlam tarafa (p<0.001) ve Grup 1’deki hastalarýn kýrýk tarafýna (p>0.001) göre anlamlý olarak düþük idi. Grup 2’de anlamlý olarak plantar yükte anterolaterale kayma saptandý (p<0.001). Grup 1 ortalama VAS ve AOFAS skorlarý grup 2’ye göre anlamlý olarak yüksek saptandý (p<0.001).
TARTIÞMA: Orta dönem sonuçlarda daha iyi plantar yük daðýlýmý ve klinik skorlar elde edildiðinden eklem içi kalkaneus kýrýklarý tedavisinde konservatif tedavi yerine cerrahi müdahale tercih edilebilir.

BACKGROUND: This study aims to reveal surgical treatment’s effect on plantar load restoration and clinical outcomes compared to conservative treatment in intra-articular calcaneal fractures.
METHODS: Thirty-two patients (Group 1) who underwent surgery for unilateral intra-articular calcaneal fractures and 28 patients who received conservative treatment (Group 2) were included in the study. Detailed static pedobarography examinations were performed on all patients. Plantar load distribution was evaluated based on the forefoot maximum and mean pressure, hindfoot maximum and mean pressure, and distribution of pressure in the heel area in the mediolateral direction. Clinical results were evaluated with the American orthopedic foot and ankle association (AOFAS) score and visual analog scale (VAS) scores.
RESULTS: While the mean contact area between injured and non-injured sides did not differ in Group 1, there was a significant difference between the two sides in Group 2 (p=0.009). Furthermore, on the injured side, the mean contact area (p=0.023) and forefoot pressures (p<0.001) were significantly higher in Group 2 compared to Group 1. Hindfoot pressure on the injured side was significantly lower in Group 2 compared to the uninjured side (p<0.001) and the injured side in Group 1 (p<0.001). A significant anterolateral shift in plantar load was detected in Group 2 (p<0.001). There was a significant difference between the two groups in terms of mean VAS and AOFAS scores in favor of Group 1 (p<0.001).
CONCLUSION: Surgical treatment of calcaneus intra-articular fractures should be preferred primarily as it provides better clinical results and better plantar load distribution in midterm follow-up.

Jejuno-ileal divertiküllerde, duodenal divertiküllere kýyasla, genel komplikasyon geliþme riski dört kat, perforasyon riski 18 kat daha fazladýr. Asemptomatik olgularda rezeksiyon yapýlmazken, yaþamý tehdit eden komplikasyonlarda cerrahi müdahale gerekebilir. Bu olgu raporunda, uzun süredir var olan geçici semptomlarla baþvuran, çok sayýda dev jejunal divertikülü olan 69 yaþýnda bir erkek hasta sunuldu. Hastanýn 15 yýl önce geçirilmiþ apendektomi öyküsü mevcuttu. Son acil servis baþvurusunda çekilen kontrastlý batýn bilgisayarlý tomogafisinde, çok sayýda dev divertiküllü jejunum segmenti saptanmýþtý ve sonrasýnda açýk laparotomi ile eksize edilerek tedavi uygulanmýþtý. Hastanýn takiplerinde þikayetlerinin tekrarlamadýðý ve kilo almaya baþladýðý görüldü. Acil servise uzun süredir var olan karýn aðrýsý, kilo kaybý, þiþkinlik þikayetleri ile baþvuran ve özellikle batýn operasyonu geçmiþi bulunan hastalarda taný konulamadýðý zaman ayýrýcý tanýda jejunum kaynaklý divertiküllerin akýlda bulundurulmasýný öneriyoruz.

Jejunoileal diverticula have a four-fold greater risk of developing general complications and an 18-fold greater risk of perforation compared to duodenal diverticula. While resection is not preferred in asymptomatic cases, surgical intervention may be required in life-threatening conditions. In this case report, a 69-year-old male patient with multiple giant jejunal diverticulum presenting with long-standing and transient symptoms was presented. The patient had a history of appendectomy 15 years before application. During the patient’s last admission to the emergency department, contrast-enhanced abdominal computed tomography was ordered and revealed jejunum segments with multiple giant diverticula which were treated by excision by open laparotomy. It was observed that the patient’s complaints did not recur and he started to gain weight. In patients admitted to the emergency department with complaints of long-standing abdominal pain, weight loss, and bloating, in whom diagnosis cannot be made, it is recommended to consider diverticulum originating from the jejunum in the differential diagnosis, especially in the presence of abdominal surgery history.

Dieulafoy lezyonu, erozyon veya ülserasyon olmaksýzýn, yüzeyel mukozada kanama odaklarý olarak endoskopide görüntülenen, dilate submukozal arter yapýlardýr. Dieulafoy lezyonlarý, akut varis dýþý üst gastrointestinal kanama vakalarýnýn %1–%5.8’ini oluþturur. Huzurevinde kalan Alzheimer hastalýðý ve koroner arter hastalýðý olduðu bilinen 72 yaþýnda erkek hasta, acil servisimize kötü kokulu, cývýk kývamlý ve katran renginde dýþký ile baþvurdu. Özofagogastroduodenoskopide, distal özofagusta Z çizgisinin hemen proksimalinde 3 mm’lik bir Dieulafoy lezyonu izlendi ve çevreleyen ülser görünümü olmaksýzýn taze bir kan pýhtýsý görüldü. Bu lezyona iki endoskopik hemoklip uygulandý. Hasta iþlem sonrasýnda iki gün yoðun bakým ünitesinde izlendi ve daha sonra serviste tedavi ve takibe alýndý. Yatýþýnýn sekizinci gününde hematokezya geliþti. Yapýlan rektosigmoidoskopide dentat hattýn hemen proksimalinde yer alan iki adet 3 ve 4 mm boyutlu Dieulafoy lezyonu saptandý. Bu lezyonlara, iki endoskopik bant ligasyonu uygulanarak baþarýyla tedavi edildi. Dieulafoy lezyonlarý çok nadir de olsa eþzamanlý olarak ortaya çýkabilir ve daha fazla kanamayý önlemek için birden fazla lezyonun dikkatli bir þekilde araþtýrýlmasý gerekir.

Dieulafoy lesions (DLs) are dilated submucosal arterial structures visualized on endoscopy as bleeding foci on the superficial mucosa without erosion or ulceration. DLs account for 1–5.8% of acute non-variceal upper gastrointestinal bleeding cases. A 72-year-old male patient with known Alzheimer’s disease and coronary artery disease, being followed up at a nursing home, presented to our emergency department with foul-smelling, loose, and tarry stool. Esophagogastroduodenoscopy revealed a 3 mm DL immediately adjacent to the Z line in the distal esophagus, demonstrating a fresh blood clot without the appearance of a surrounding ulcer. Two endoscopic hemo-clips were applied to this lesion. The patient was monitored at the intensive care unit for the following 2 days and later transferred to internal medicine inpatient unit. He developed hematochezia on the 8th day of hospitalization. Emergent rectosigmoidoscopy was performed showing two separate 3 and 4 mm sized DLs, located immediately proximal to the dentate line. These lesions were successfully treated using two endoscopic band ligations. DLs can occur synchronously, albeit very rarely, and a careful search for multiple lesions is necessary to avoid further bleeding.

Pnömoperitoneum periton boþluðunda serbest hava bulunmasýdýr. Gastrointestinal sistem perforasyonunun bir bulgusudur. Ancak perforasyon olmadanda gözlenir. Bu durum spontan pneumoperitonium olarak adlandýrýlýr. Elli yedi yaþýnda solunum yetersizliði nedeniyle entübe edilerek mekanik ventilasyona baþlanan kadýn hastamýzda massif spontan pnömoperitoneum ve buna baðlý abdominal kompartman sendromu geliþti. Hastaya peritoneal lavajla hem dekompresyon yapýldý hemde taný desteklendi. Spontan pneömoperitoneumda farkýndalýðýn az olmasý nedeniyle çoðu cerrah refleks bir yanýt olarak laparatomi uygulamaktadýrlar. Ancak laparatominin yeri yoktur. Spontan pneumoperitonium ve abdominal kompartman sendromu birlikteliði ise son derece nadirdir. Bu yazýda amacýmýz, spontan pnömoperitoneumun farkýndalýðýný artýrmak ve gereksiz laparatomilerin önlenmesine katkýda bulunmaktýr.

Pneumoperitoneum is the presence of free air within the peritoneal cavity and indicates perforation of a hollow viscus. However, it may also occur in the absence of perforation and in this case, it is called spontaneous pneumoperitoneum (SP). A 57-year-old female patient who was intubated and mechanically ventilated due to respiratory failure developed abdominal compartment syndrome (ACS) secondary to massive SP. Peritoneal lavage was performed for the patient both to achieve decompression and to support the diagnosis. Many surgeons proceed with laparotomy as a reflex response for SP due to lack of awareness of the condition. However, laparotomy has no place in this setting. SP coexisting with ACS is extremely rare. With this case report, we aimed to raise awareness of SP among physicians and help avoid unnecessary laparotomies.