Laparoscopic Nissen fundoplication is known to be a safe and feasible method in the treatment of hiatal hernias. However, a recurrence rate of 42% has been reported. Using mesh repair in patients undergoing Nissen fundoplication has shown fewer recurrence rates than the primary suture, even though there have been few complications reported. Some complications that may occur with mesh placement are; severe fibrosis, esophageal strictures, esophageal perforations, mesh migration to the upper gastrointestinal tract, and mesh erosion in the intestinal wall, etc. In this report, the migration of the leathery esophagus developed after about 11 years was presented. In such cases, patients may have several surgical options. Among these options, the mesh was completely removed endoscopically. No further surgery was required. In conclusion, it is recommended to use a very selective mesh in the laparoscopic repair of the hiatal hernias, considering the surgeon's experience, hiatus anatomy, and patient's symptoms.

A 33-year-old female patient was admitted to our clinic with complaints of nausea and vomiting for two days and the inability to tolerate food. The patient had a Nissen fundoplication three years ago. Computed tomography (CT) showed a bezoar image in the distal esophagus. The patient stated that the symptoms began after he ate a persimmon two days ago. The patient underwent esophagogastroduodenoscopy. A bezoar was observed in the distal esophagus at the esophagogastric junction. No pathology was observed in the stomach and duodenum. After the bezoar was shredded with a snare and removed with a retrieval snare. Here, we further describe this case of a bezoar that caused ileus in the distal esophagus after a fundoplication operation. '+st+' Mohammadi A, Mojtahedzadeh M, Ahmadi A, Imanipour MH, Saghafi F, Soltaninejad S, et al. Bowel Obstruction by Persimmon Phytobezoar. IJMTFM. 2021; 11(3):32507. doi: 10.32598/ijmtfm.v11i3.32507. DOI: https://doi.org/10.32598/ijmtfm.v11i3.32507 Gökbulut V, Kaplan M, Kaçar S, Akdoğan Kayhan M, Coşkun O, Kayaçetin E. Bezoar in upper gastrointestinal endoscopy: A single center experience. Turk J Gastroenterol. 2020 Feb;31(2):85-90. doi: 10.5152/tjg.2020.18890. DOI: https://doi.org/10.5152/tjg.2020.18890 Georgiev YP, Karashmalakov AG, Zafirov GK. Esophageal bezoar after repeated fundoplications. Quant Imaging Med Surg. 2018 Mar;8(2):257-8. doi: 10.21037/qims.2017.06.07. DOI: https://doi.org/10.21037/qims.2017.06.07 Ustaoğlu M, Paköz ZB. Üst Endoskopide Yabancı Cisim Saptanan Hastaların Analizi: Doğu Karadenizde Tek Merkezli Retrospektif Çalışma. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2020;22(1):1-6. doi: 10.24938/kutfd.586116 DOI: https://doi.org/10.24938/kutfd.586116 Altintoprak F, Dikicier E, Deveci U, Cakmak G, Yalkin O, Yucel M, Akbulut G, Dilek ON. Intestinal obstruction due to bezoars: a retrospective clinical study. Eur J Trauma Emerg Surg. 2012 Oct;38(5):569-75. doi: 10.1007/s00068-012-0203-0. DOI: https://doi.org/10.1007/s00068-012-0203-0 Khalil H, Parmar C, Sufi P. Conservative Managing of Bezoar in Giant Hiatus Hernia Causing Gastric Outlet Obstruction During the COVID-19 Pandemic. Obes Surg. 2021 Jun;31(6):2780-2. doi: 10.1007/s11695-021-05250-y. DOI: https://doi.org/10.1007/s11695-021-05250-y Padhya K, Dhamija A, Carlson C, Farivar A. Post-Fundoplication Esophageal Bezoar Resolved With Endoscopic Instillation and Oral Ingestion of Cola. The American Journal of Gastroenterology. October 2019;114:S1022-3. doi: 10.14309/01.ajg.0000596816.59903.5b. DOI: https://doi.org/10.14309/01.ajg.0000596816.59903.5b Copyright (c) 2023 Mehmet Emin Gönüllü , Mevlüt Pehlivan , Mehmet Fuat Çetin , Erman Yekenkurul This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Objective Post-ERCP pancreatitis (PEP) is the most common complication of ERCP. Identifying simple and accessible biomarkers to predict PEP risk may enhance patient safety and guide clinical decisions. Material and Methods This retrospective, single-center study included 613 adult patients who underwent ERCP between January 2017 and December 2024. Demographic data, comorbidities, procedural details, and preoperative laboratory parameters were collected from institutional electronic health records. The primary outcome was the development of PEP, defined by standard diagnostic criteria. Results Post-ERCP pancreatitis occurred in 52 patients (8.5%). Demographic characteristics and comorbidities, including age, sex, body mass index, diabetes mellitus, and hypertension, were not significantly associated with PEP. Pancreatic duct cannulation was significantly more frequent among patients with PEP (53.8% vs. 24.8%, p < 0.001) and remained an independent risk factor in multivariable analysis (aOR: 3.05, 95% CI: 1.65–5.64, p < 0.001). Patients who developed PEP had higher preoperative neutrophil-to-lymphocyte ratio (NLR) (3.7 ± 1.9 vs. 2.9 ± 1.5, p = 0.001) and C-reactive protein (CRP) levels (18.5 ± 11.2 vs. 11.4 ± 8.3 mg/L, p = 0.001). In adjusted analysis, both NLR (aOR: 1.14, 95% CI: 1.02–1.28, p = 0.02) and CRP (aOR: 1.04, 95% CI: 1.01–1.08, p = 0.008) remained statistically significant but modest independent predictors of PEP. ROC analysis demonstrated limited discriminative ability for both NLR (AUC: 0.64) and CRP (AUC: 0.66), with moderate sensitivity and specificity. Conclusion Elevated preoperative NLR and CRP levels, together with pancreatic duct cannulation, were independently associated with an increased risk of post-ERCP pancreatitis. Although these inflammatory markers demonstrated statistically significant associations, their predictive strength was modest. Therefore, NLR and CRP should be interpreted as supportive parameters rather than standalone predictors and may contribute to pre-procedural risk stratification when integrated with established clinical and procedural risk factors. Further prospective, multicenter studies are warranted to validate these findings and clarify their role in clinical practice.

Aim: Acute appendicitis is one of the most common causes of acute abdominal pain and has traditionally been treated with appendectomy. However, increasing evidence suggests that antibiotic therapy may be a safe alternative in selected patients with uncomplicated acute appendicitis. This study aimed to evaluate the effectiveness and safety of primary medical treatment in patients with uncomplicated acute appendicitis using real-world clinical and radiological data.Materials and Methods: A single-center retrospective cohort study was conducted including 289 patients diagnosed with acute appendicitis. Patients were classified as having uncomplicated appendicitis based on clinical and computed tomography findings. Twenty-three patients (7.9%) received primary medical treatment, while 266 patients (92.1%) underwent primary surgery. Demographic characteristics, appendix diameter, presence of appendicolith, treatment outcomes, and need for delayed surgery were analyzed.Results: The mean age was 40.6 years in the medical treatment group and 44.8 years in the surgical group. The median appendix diameter was significantly smaller in patients treated medically (8.0 mm [IQR: 7.5–8.25]) compared to those treated surgically (11.5 mm [IQR: 9.5–13.0], p < 0.001). No appendicolith was detected in the medical treatment group, whereas it was present in 12.8% of surgically treated patients.Clinical recovery without surgery was achieved in 19 of 23 patients (82.6%) receiving medical treatment. Four patients (17.4%) required delayed appendectomy due to clinical deterioration. No cases of perforation, generalized peritonitis, or major postoperative complications were observed.Conclusion; Primary medical treatment is a safe and effective alternative to surgery in carefully selected patients with uncomplicated acute appendicitis. Appropriate patient selection, particularly exclusion of appendicolith and close clinical follow-up, allows a substantial proportion of patients to avoid surgical intervention without increasing complication rates.

A 73-year-old male patient was admitted to the emergency department with severe abdominal pain. It was thought that the patient might have colon perforation with the patient’s history, physical and radiological examination. In the patient’s history; since his youth, it was understood that when he has been constipated, he has made an enema with tap water by attaching the garden hose into the rectum and connects the other end to the fountain. In this case report, we wanted to present the colon perforation during the hose penetration, and peritonitis of the patient who had foreign body penetration chronically into the rectum with the purpose of making enema periodically, and the operation performed after. Since our patient was a delayed case, we quickly initiated resuscitation, prophylactic antibiotherapy, and underwent protective colostomy in our operation. We think that colostomy reduces the mortality and morbidity in delayed cases.