Introduction Acute pancreatitis (AP) is one of the urgent diseases of gastroenterology. Due to the growth of the elderly population, the frequency of the disease in the elderly population is also increasing. Aim To evaluate the contributing factors of mortality in geriatric patients (age ≥...

Acute pancreatitis (AP) is inflammation of the pancreas of various severity ranging from mild abdominal pain to mortality. AP may be classified as acute interstitial edematous pancreatitis (AEP) or acute necrotizing pancreatitis (ANP), according to the revised Atlanta criteria. Most of the patients with AP are AEP (75-85% of patients), while 15-25% of patients have ANP. The mortality rate is 3% in AEP and 15% in ANP. Thus, it is important to predict the severity of AP to decrease the morbidity and mortality. The aim of the study was to evaluate the relationship between red cell distribution width (RDW) and the severity of AP on admission to hospital. Patients admitted to Adana Numune Research and Educational Hospital with a diagnosis of AP through the time frame of January 2014-May 2016 were included in our study. Diagnosis of AP was made according to the revised Atlanta classification. Patients' age, sex, etiology of AP, and RDW values were recorded on admission to the hospital. A total of 180 patients were included in the study. Eighty patients (44%) were male and 100 patients were female. Mean age was 56.25 ±18.3 years (52.66 ±14.4 in males; 59.84 ±20.2 in females). There was no statistically significant difference between patients' age. The most frequently observed etiologic factor was gallstone disease followed by alcohol intake and the use of pharmaceuticals. Drug-related AP was associated with azathioprine, furosemide, and thiazide diuretics. One hundred forty-four (80%) patients had AEP and 36 (20%) patients had ANP. RDW values showed a statistically significant difference between patients with AEP and ANP (p = 0.011). The cut-off value of RDW was 16.4 and the area under curve (AUC) value was 0.591 (p = 0.0227) with a sensitivity of 29.2% and specificity of 89.83%. Red cell distribution width could be used to evaluate the prognosis of acute pancreatitis.

Background. Ectopic opening of the common bile duct (EOCBD) is a very rare entity. It has been reported in the 3rd or 4th portion of the duodenum, pyloric canal, duodenal bulb, and the stomach. Objectives. The aim of this study was to evaluate the clinical characteristics, laboratory values and imaging studies of patients with EOCBD into the duodenal bulb retrospectively. Material and methods. The files of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2003 and November 2015 were reviewed. The demographic data, presentations, abdominal ultrasonography, computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and ERCP findings of patients with EOCBD into the duodenal bulb were evaluated retrospectively. Results. Ectopic openings of the CBD into the duodenal bulb were found in 20 out of 3270 patients who had undergone ERCP. Twenty patients (15 males and 5 females) with a median age of 59 (40-88) years were included in the study. Ectopic opening of the CBD into the duodenal bulb were found in 20 patients (0.61%). Laboratory test abnormalities included: hyperbilirubinemia in 20 (100%) patients, leukocytosis in 14 (70%) patients, and an elevated serum alkaline phosphatase and gamma-glutamyl transferase level in 20 (100%) patients. Indications for ERCP were CBD dilatation and extrahepatic cholestasis (n = 20), cholangitis (n = 12), only choledocholithiasis (n = 7), and acute pancreatitis (n = 2). Conclusions. In patients with recurrent duodenal ulcers and/or apical stricture with accompanying CBD dilatation, extrahepatic cholestasis and cholangitis, EOCBD into the duodenal bulb should be considered.

Background/aim: There are various scoring systems for evaluating prognosis in patients hospitalized in intensive care units (ICUs) with hepatic encephalopathy. These include the Child-Turcotte-Pugh (CTP) classification, Model for End-stage Liver Disease (MELD), chronic liver failure-sequential organ failure assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). In this study, we aimed to compare the various scoring systems to determine the best system for showing the prognosis of patients with a prior diagnosis of cirrhosis who were hospitalized for hepatic encephalopathy. Materials and methods: Patients with known cirrhosis hospitalized in the internal medicine ICU of the Adana Numune Education and Research Hospital with a diagnosis of hepatic encephalopathy were included in the study. Diagnosis and classification of hepatic encephalopathy were done according to the West Haven criteria. The etiology of hepatic encephalopathy was recorded for all patients. APACHE II, CLIF-SOFA, MELD, and CTP scores were calculated for all patients within the first 24 h. Outcomes of patients were recorded as either discharged or deceased. Demographic and biochemical data, duration of hospitalization, and prognostic factors were compared for both groups. Area under the receiver operating characteristic curve (AUROC) values were calculated for each scoring system. Results: A total of 84 patients were included in the study. The etiologies of encephalopathy were infection (n = 35, 41.7%), variceal bleeding (n = 19, 22.6%), constipation (n = 15, 17.9%), consuming excessive protein (n = 8, 9.5%), hypokalemia (n = 6, 7.1%), and hepatocellular carcinoma (n = 1, 1.2%). Nine patients had grade 1 encephalopathy, 34 patients had grade 2, 27 patients had grade 3, and 14 patients had grade 4. AUROC values were 0.986 (0.970-1.003), 0.974 (0.945-1.003), 0.955 (0.915-0.996), and 0.880 (0.800-0.959) for CLIF-SOFA, APACHE II, CTP, and MELD scores, respectively. Conclusion: We found the best prognostic model for patients who were hospitalized in the ICU for hepatic encephalopathy to be CLIF-SOFA, followed by APACHE II, CTP, and MELD scores.

We report here a very rare case of coexistence of gastric diverticulum and gastric cancer. A 48-year-old female patient was admitted to our hospital with complaints of fatigue, abdominal pain, and weight loss. Her medical history did not reveal any disease. On physical examination, conjunctivas were pale and there was mild epigastric tenderness. Laboratory examinations on admission revealed the following: hemoglobin, 7.0 g/dl (normal range: 8.5–11.0 g/L); and mean corpuscular volume, 67.2 fl (normal range: 80–100 fl). Serum ferritin level was 9.9 ng/ml (normal range: 12–150 ng/ml). Erythrocyte sedimentation rate level was 44 mm/hour (normal range: 1–20 mm/hour). Endoscopy showed a diverticulum formation approximately 4 × 3 cm in size, which originated from the gastric fundus (Figure 1A) along with a disseminated ulcerative mass originating from the gastric antrum (Figure 1B). Endoscopic biopsy of the relevant mass was performed, and the histopathological examination revealed a final diagnosis of gastric adenocarcinoma. Abdominal computed tomography revealed the exophytic diverticulum sac of the posteromedial gastric wall at the fundus region and abnormal wall thickening of the gastric antrum within a 6-cm length segment associated with pathological lymphadenopathies at the gastrohepatic region (Figure 2). The patient was inoperable at the time of admission due to the presence of disseminated bone metastasis, and chemotherapy management was administrated consequently. Gastric diverticulum is very rare, and the rate of detection by endoscopy ranges from 0.01% to 0.11% (Marano et al., 2013). It usually occurs in the fifth and sixth decades, with equal distribution among men and women, and can be congenital or acquired. Gastric diverticulum is often single, varying in size from 1 to 3 cm. On the contrary, multiple and larger diverticula being adjacent to the gastroesophageal junction and along the lesser curvature or posterior gastric wall have also been observed. Patients with gastric diverticulum are often asymptomatic and rarely have the symptoms such as dyspepsia, vomiting, and abdominal pain (Marano et al., 2013). Similarly, complications such as ulceration, perforation, hemorrhage, and malignancy are uncommon (Ho et al., 2013; Marano et al., 2013). Moreover, there have been a few reports of neoplasia arising in gastric diverticulum (Oya, Akahoshi, & Toyomasu, 2012). Although gastric cancer incidence and mortality have been appreciably declining for several decades, gastric cancer is still the fourth most common cancer and the second leading cause of cancer deaths worldwide (Oya et al., 2012). The incidence and mortality ratios range widely among different geographic regions in our country, Turkey. However, the incidence is significantly higher in Van, the place where we reside (Ferro et al., 2014; Yalcin, 2009). The treatment of a diverticulum depends basically on the symptoms and diverticulum size. There is no specific therapeutic strategy for an asymptomatic diverticulum. If the diverticulum is large, symptomatic, or complicated by bleeding, perforation, or malignancy, the recommended treatment option is surgical resection. Laparoscopic diverticulectomy is the preferred approach as well (Ho et al., 2013; Marano et al., 2013). In summary, although gastric carcinoma did not originate from the diverticulum region, we report this case because the coexistence is an unusual finding.