Splenic artery aneurysms (SAAs) are the third most frequent intra-abdominal aneurysm, following abdominal aorta and iliac artery aneurysms. SAAs are classified according to their involvement of arterial wall layers: true aneurysms involve all 3 layers (intima, media, and adventitia), and pseudoaneurysms involve only one or two. Herein we present a new case of giant pseudo SAA. A 65-year-old female patient with a pancreatic mass and iron deficiency was referred to our clinic for further investigation. Abdominal ultrasonography, contrast-enhanced CT and magnetic resonance imaging showed a lesion resembling a subcapsular hemangioma in the spleen, and aneurysmatic dilation of the splenic artery with a diameter of >5 cm. The large size of the aneurysm and the clinical findings were indications for surgical treatment. The patient underwent en bloc resection of the spleen, distal pancreas, and aneurysmatic segment of the splenic artery. The patient remains complication-free 2 months after the operation. Spontaneous rupture is the most important life-threatening complications of giant SAAs. Therefore, all symptomatic patients with SAA should be treated, as well as asymptomatic patients with lesions ≥2 cm, who are pregnant or fertile, have portal hypertension, or are candidates for liver transplantation. Despite advances in endovascular techniques, conventional abdominal surgery remains the gold standard for treatment.

Introduction: Bochdalek hernia is the most common type of congenital diaphragmatic hernia and constitutes 85% of cases. Bochdalek hernia (BH) in adults is extremely rare. We present a BH case in an adult patient and discuss the literature. Presentation: 22-year-old female patient with abdominal pain, occasional cramps, dysphagic problems, constipation, shortness of breath and choking for about 2 years applied to our clinic. Diagnosis: A defect about 5 cm in the left hemidiaphragm posterior area and herniation of intra-abdominal fat plan in the left hemithorax was seen in intravenous and oral whole abdominal CT. Treatment: Patient was operated laparoscopically. Transverse colon and a large portion of the omentum entering into hemidiaphragm were pulled in to intraperitoneal area carefully. Approximately 10 × 8 cm intraabdominal mesh was fixed to the defect area with the help of laparoscopic tacker. Conclusion: Adult BH is very rare and when confronted laparoscopic treatment with mesh fixation can be performed safely.

Altiok M, et al. Ann Surg Treat Res. 2022 Apr;102(4):185-192. https://doi.org/10.4174/astr.2022.102.4.185

Purpose: This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG).Methods: Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses.Results: The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the nonsurvivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=–0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; area under the ROC curve, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8–146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5–72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6–121.1; P=0.003) were independent risk factors for death.Conclusion: The CRP ratio is a simple method to use to predict mortality in FG.

This study aimed to determine the frequency of Enterobius vermicularis in appendectomy specimens and evaluate the histopathological characteristics of adult and pediatric cases with E. vermicularis infection. Appendectomies examined from 1 January 2010, to 1 December 2020, were analysed retrospectively. Cases were divided into two groups: under 18 years (children) and 18 and over (adults). Demographic and histopathological characteristics of patients were also examined. Out of 14.797 patients that underwent appendectomy, 6.130 were children and 8.667 were adults. E. vermicularis was detected in 268 patients, wherein 64.2% were children and 35.8% were adults. In the detection of E. vermicularis in appendectomy specimens, the frequency was higher in children compared to that in adults (2.85%, 1.1%, respectively) (p<0.001). Histopathologically, acute appendicitis was defined in 31.7% (n=85) of 268 cases, and E. vermicularis was found to cause a higher rate of acute appendicitis in adults (p<0.001). The frequency of E. vermicularis in appendectomy specimens is higher in children. However, E. vermicularis causes acute appendicitis more frequently in adults.