Intestinal endometriosis is a rare condition that can cause gastrointestinal symptoms such as abdominal pain, constipation, and diarrhea. It occurs in approximately 5%-15% of women with endometriosis. Although it rarely leads to obstruction or perforation, there is no clear consensus on its optimal management. Hormonal therapy is considered the first-line treatment for endometriosis; however, the best approach for intestinal involvement remains controversial. This study aims to contribute to the literature by evaluating patients with intestinal endometriosis who underwent surgery for acute abdomen. Sixteen patients who underwent emergency surgery for acute abdomen at the Emergency General Surgery Clinic of İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty of Medicine, between February 2016 and April 2023 were identified. Four patients voluntarily withdrew from the study, and 12 were included in the analysis. Demographic data, laboratory findings, surgical records, length of hospital stay, pathology reports, postoperative complications within the first 30 days, and their management were reviewed. Patients' current health status was assessed through telephone interviews. The mean age of the patients was 39.3+-9.2 years. Nine patients underwent surgery with a preoperative diagnosis of intestinal obstruction, while three were operated on for suspected acute appendicitis. Among the patients with intestinal obstruction, three underwent laparoscopic ileocecal resection, and three had segmental small bowel resection. One patient underwent anterior resection with appendectomy, and another underwent both anterior resection and ileocecal resection with ileocolostomy. One patient underwent a left hemicolectomy. The mean hospital stay was 7.9+-5.9 days. Postoperative complications occurred in three patients (25%). The mean age of patients who experienced complications was significantly higher than that of those who did not (p<0.007). Histopathological examination revealed benign full-thickness endometriosis in all cases. The mean follow-up period was 50.6 months, with no recurrences observed. Acute abdomen due to intestinal endometriosis-related obstruction is extremely rare. In reproductive-aged women presenting with acute abdomen, intestinal endometriosis should be considered in the differential diagnosis. In cases of clinical suspicion, intraoperative consultation with a gynecologist is recommended, and a multidisciplinary approach should be adopted to optimize treatment planning.

Heterotopic ossification is the formation of bone tissues in areas other than the skeletal system. It is more often seen as a complication of orthopedic surgery; however, it is a pathological condition that might be observed during the healing of abdominal incisions in the midline. The aim of this study is to present a case of a 63-year-old male patient with complaints of induration and pain on the region of his previous incision through which he had been operated for achalasia. Heterotopic ossification has also been discussed in the light of the current literature.

Background and Objectives: Chronic mucosal infection with Helicobacter pylori (H. pylori) plays a key role in the development of gastroduodenal disorders such as chronic gastritis, peptic ulcers, gastric lymphoma, and gastric cancer by triggering local immune responses and inducing hypoxic and inflammatory conditions in the gastric mucosa. This study aims to evaluate the potential diagnostic value of hypoxia-inducible factors HIF-1α and HIF-2α, along with transmembrane prolyl 4-hydroxylase (P4H-TM), as biomarkers in H. pylori-positive patients. Additionally, the study investigates the association between these markers and alterations in lipid profiles, as well as their involvement in the molecular mechanisms underlying gastric conditions like gastritis, particularly in the context of H. pylori infection. Materials and Methods: This study was conducted at Istanbul Avcılar Murat Kölük State Hospital’s General Surgery Outpatient Clinic. A total of 60 participants were included: 40 patients diagnosed with chronic gastritis (20 H. pylori-positive and 20 H. pylori-negative) and 20 healthy controls confirmed negative by 13C-urea breath test. Blood samples were collected for ELISA analysis of HIF-1α, HIF-2α, and P4H-TM levels. Additionally, lipid profiles were measured and compared among the groups. Results: No significant differences were found among the groups in terms of demographic factors such as age, sex, or body mass index (BMI). However, significant variations were observed in the levels of HIF-1α, HIF-2α, and P4H-TM across all groups (p < 0.001 for each marker). These markers were substantially elevated in the H. pylori-positive gastritis group compared to both the H. pylori-negative and healthy control groups. Receiver Operating Characteristic (ROC) curve analysis revealed that all evaluated markers exhibited strong diagnostic accuracy in differentiating H. pylori-positive individuals from other groups. HIF-1α (AUC: 0.983) and HIF-2α (AUC: 0.981) both achieved 100% sensitivity with specificities of 93.3% and 91.1%, respectively. P4H-TM showed an AUC of 0.927, with 85% sensitivity and 95.6% specificity. Conclusions: These findings indicate that HIF-1α, HIF-2α, and P4H-TM may serve as effective biomarkers for diagnosing H. pylori-positive patients and may be linked to changes in lipid metabolism. The elevated expression of these markers in response to H. pylori infection highlights their potential roles in the inflammatory and hypoxic pathways that contribute to the pathogenesis of gastric diseases such as gastritis.

Retrorectal tumors are rare and heterogeneous lesions that present significant diagnostic and surgical challenges. Owing to their low incidence, consensus on optimal management strategies is lacking, and large-scale outcome data remain limited. This study aimed to present a large, long-term, single-center experience with retrorectal tumors, focusing on surgical strategies, recurrence outcomes, and the clinical relevance of preoperative biopsy decisions. This retrospective cohort study included 58 patients who underwent surgical treatment for retrorectal tumors between 2000 and 2025. A total of 61 patients were initially enrolled; 3 were censored at their last known contact in the Kaplan–Meier survival analysis. Accordingly, descriptive and comparative analyses were performed on the remaining 58 patients with complete follow-up. Clinical data, including demographics, imaging modalities, surgical approach, histopathological diagnosis, and follow-up outcomes, were collected and analyzed. The surgical approach was determined according to the tumor’s relationship to the third sacral vertebra. Statistical analyses included Kaplan–Meier survival estimation and appropriate comparative tests to evaluate postoperative outcomes. The cohort had a mean age of 46.8 ± 14.7 years, with a marked female predominance (81%). All patients underwent preoperative cross-sectional imaging, and preoperative biopsy was performed in 12% of cases. A posterior surgical approach was employed in 91% of patients. Tailgut cysts were the most frequent histopathological subtype (46.6%). No statistically significant association was observed between preoperative biopsy and postoperative complications ( P > .05). During long-term follow-up, local recurrence occurred in 2 patients (3.4%). Although not statistically significant, a trend toward increased postoperative complications was observed in patients who underwent preoperative biopsy ( P = .067). Although rare, retrorectal tumors can be managed effectively with accurate diagnosis, individualized surgical planning, and vigilant long-term surveillance. Preoperative biopsy should not be performed routinely and should be considered on a case-by-case basis, given its potential complication risk and limited diagnostic yield. This 25-year, single-center experience provides valuable insights into the multidisciplinary management of retrorectal tumors and supports evidence-based clinical decision-making in this anatomically complex region.

Background/Objectives: Chronic anal fissure, an anorectal condition, is characterized by internal anal sphincter fibers at the base of the fissure. The lifetime prevalence is 7–8%. Medical management and lifestyle modifications are the first-line treatments, whereas chemical or surgical internal anal sphincterectomy is an option for refractory cases. The aim of this study was to evaluate the impact of surgical anal canal length and sphincter pressure on postoperative symptom relief and continence outcomes. Methods: A total of 26 patients diagnosed with chronic anal fissures were selected for surgical treatment. Five patients voluntarily withdrew, leaving 21 cases for analysis. In patients undergoing open lateral internal sphincterotomy, anal canal length and sphincter pressure were assessed preoperatively and three months postoperatively using endoanal ultrasonography and high-resolution anal manometry. Results: Postoperatively, all patients experienced complete resolution of pain and bleeding. The expected decrease in resting pressure was not significantly associated with sex. A significant weight gain was observed postoperatively (p = 0.001). Although a significant decrease was observed in preoperative sphincter resting pressure and VAS scores, Wexner scores remained unchanged. Preoperatively and postoperatively, mean sphincter pressure was significantly lower in the spontaneous vaginal delivery group than that in the non-spontaneous vaginal delivery group (p < 0.05). Patients with short anal canal lengths had greater pressures reductions, though not statistically significant. Conclusions: Lateral internal sphincterotomy is an effective and safe treatment for chronic anal fistula when performed by experienced surgeons. Anal canal length may influence postoperative complications and surgical decisions. Larger studies are needed to confirm these findings.

Heterotopic ossification (HO) is a bone formation in a tissue other than the skeletal system. It is more often seen as a complication of orthopedic surgery; however, it is a pathological condition that might be observed during the healing process of abdominal incisions in the midline. The aim of this study is to present a case of a 63-year-old male patient with the complaints of induration and pain on the region of his previous incision through which he had been operated for achalasia. HO is also discussed in the light of the current literature.