To evaluate the diagnostic and treatment approaches for patients diagnosed with mesenteric panniculitis. We retrospectively reviewed all patients diagnosed with mesenteric panniculitis between January 2010 and March 2016. We recorded the demographic features, clinical symptoms, laboratory values, radiological methods, treatment approach, and outcomes of the patients. We evaluated 22 patients (17 male and five female) with a mean age of 45.8±15.7 years. The most frequent complaint was abdominal pain. The patients' histories included colon cancer (n=1), prostatic cancer (n=2), renal cell cancer (n=1), diabetes mellitus (n=4), and chronic obstructive pulmonary disease (n=1). Laboratory values revealed elevated C-reactive protein levels in 14 patients (43%). Computed tomography was performed in all the patients. Only 10 patients were followed up in the surgical ward, the remaining 12 underwent outpatient treatment. No complication associated with hospitalization or during outpatient follow-up period was observed. Mesenteric panniculitis can be successfully treated conservatively without surgical intervention. Clinical doubt is of great importance for diagnosis, and plausible underlying malignancy should be kept in mind.

While COVID-19 pandemic has become an enormous and devastating pandemic for today’s world, studies on the morbidity of the disease mainly show the disease’s progress with pneumonia and thromboembolic pathologies. In this disease with a predisposition to thromboembolism, findings of nontraumatic focused hemorrhages are unexpected. As spontaneous retroperitoneal hematoma is a serious condition with the absence of symptoms, creating a challenge for diagnosis, it should also be considered in COVID-19 which is thought to be predisposed to thromboembolism. Here, a 47-year-old woman with COVID-19 pneumonia diagnosis (diagnosed by computed tomography (CT) scan and approved by nasopharyngeal swab test) is presented with spontaneous retroperitoneal hematoma, and its management is reported. This case highlights the importance of considering both thromboembolic events and bleeding in cases with COVID-19 positivity. The balance between two sides of clotting mechanisms needs to be understood with novel research.

Anastomotic leaks can be very dangerous in colorectal cancers. Protective loop ileostomy is life-saving in low anterior rectal tumors to prevent pelvic sepsis. The aim of this study is to compare early morbidities for stapled, handsewn closure (end to end) or handsewn closure (anterior wall only) of loop ileostomy, and to further assess efficacy and safety for each technique. Patients who underwent loop ileostomy closure from January 2014 and December 2019 retrospectively were analyzed. Multivariate logistic regression was used to determine the effect of the potential risk factors on the rate of each complication. The patients were divided into three groups based on the anastomoses. The first group included patients who had handsewn anterior closure; the second group included patients who had side-to-side anastomosis using linear stapler, and the third group included patients who had end-to-end handsewn anastomosis. The primary endpoint of the study was the postoperative 30 days. IBM Statistical Package for the Social Sciences (SPSS), version 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. A total of 198 patients underwent reversal. There was a statistical difference between the handsewn anterior wall and stapler anastomosis in terms of postoperative ileus and wound infection. The handsewn group was superior to anastomosis with stapler (p: 0.027 and p: 0.042, respectively). A statistical difference was found between handsewn anterior wall closure and handsewn end-to-end anastomosis in terms of postoperative ileus, wound infection, and postoperative hospital stay (p: 0.013, p: 0.037, and p: 0.046, respectively). When stapled anastomosis and handsewn end-to-end anastomosis techniques were compared, a statistical difference was found in terms of postoperative ileus risk (p: 0.043), but no significant difference was found in terms of postoperative wound infection and hospital stay. There was no significant difference in the rate of anastomotic leakage between the handsewn and stapled techniques. The rate of small-bowel obstruction was higher in the handsewn group. As a result, in this study, it was revealed that the handsewn anterior wall closure technique is the best among all ileostomy closure techniques.

Gastric malignancies constitute the sixth most common cancer with regards to incidence and have the fifth most mortality rates. Extended lymph-node dissection is the surgical modality of choice while treating advanced stage gastric cancer. It is yet a topic of debate, whether or not the amount of positive lymph nodes after a pathological examination following the surgical intervention is of prognostic value. In this study, it is aimed to evaluate the prognostic significance of positive lymph nodes following the surgery. A total of 193 patients who underwent curative gastrectomy between January 2011 and December 2015 have been considered for a retrospective data collection. The cases with R1-R2 resections, palliative or emergent surgeries are excluded. Metastatic to total number of lymph nodes, corresponded a ratio which was analyzed in this survey and practiced as a predictive parameter of disease outcome. This survey includes 138 male (71.5%) and 55 female (28.5%) patients treated between 2011 and 2015 in our clinic. The survey follow-up duration of the cases range between 0, 2, and 72 months, corresponding an average of 23.24 ± 16.99 months. We calculated cutoff value of 0.09 with, sensitivity is 76.32% for positive to total number of lymph nodes ratio, whereas specivity applies for 64.10%, positive predictive value for 58% and negative predictive value for 80.6%. Positive lymph node ratio has a prognostic value in terms of predicting the prognosis of the patients with gastric adenocarcinoma following a curative gastrectomy. This might in long term contribute to the prognostic analysis of patients if integrated in the current staging system.

Liver hydatid cyst is a disease of zoonosis caused by Echinococcus granulosus or less frequently by Echinococcus multilocularis and Echinococcus oligarthrus. The primary carriers are canines, while human beings are secondary hosts. Early diagnosis is important for cysts not to become complicated and for the treatment not to get difficult. The most effective treatment of uncomplicated hydatid cyst is to reduce the dead space of the cavity and to discharge the fluid as much as possible. However, if the cysts get complex, there is no standard treatment management defined other than offered management options by authors. In complex conditions, the treatment is determined according to the stage of the cyst and the relation of the cyst with biliary ducts or surrounding organs. In this chapter, the treatment regimens of liver hydatid disease mainly based on interventions and surgical operations are going to take a part.

Papillary thyroid cancer can usually metastasize to neck lymph nodes. Distant metastases are generally seen as solid organ metastases, in contrast, skin metastasis can rarely be seen. We present a case with papillary thyroid cancer diagnosed with skin metastasis as first clinical sign of distant organ metastasis. A 63-year-old male patient admitted with a skin lesion in the left lateral neck. He had undergone subtotal thyroidectomy 14 years ago without relevant history of malignancy. Follicular variant papillary thyroid cancer was detected in the excisional biopsy performed from the cutaneous lesion. A 12 x 10 x 8 mm hyperechoic nodule in the left lobe was detected in USG and evaluated as Bethesta-III in fine needle aspiration biopsy. Bilateral multiple lung metastases were detected on thorax CT, trucut-biopsied from largest nodule and confirmed as metastasis. Carcinoma was not detected in total thyroidectomy, and post-operative multiple RAI therapies were applied. Patients without history of thyroid cancer rarely present with skin metastases and thyroid cancer should not be overlooked in differential diagnosis. Despite meticulous evaluation of the thyroidectomy specimen, tumor may not be detected in the gland. Skin metastasis in papillary thyroid cancer should be evaluated as distant metastasis and investigations for other metastases should be done, and the treatment should be planned in a multidisciplinary manner.