In this case report, we wanted to present the diagnostic and treatment process of a patient who was diagnosed with acute appendicitis in the preoperative period, was taken to surgery, and was diagnosed with cecum diverticulitis in the perioperative period. A 36-year-old female patient was admitted to our emergency department with complaints of abdominal pain, nausea, and loss of appetite for 3 days. Abdominal pain started in the lower right abdomen and gradually increased in severity as the day passed. On physical examination, there was defense and rebound localized to the lower right quadrant of the abdomen. In the laboratory, the white blood cell count was within normal limits (7.4 10*9 L-1) and the c-reactive protein (CRP) level was 79 mg L-1 (0-5 mg L-1). On abdominal ultrasonography, the diameter of the appendix vermiformis was measured as 8.5 mm, and it was observed that there was increased echogenicity in the fatty tissue around the appendix vermiformis. The patient was taken to emergency surgery. During exploration, the appendix was observed to be oedematous. Additionally, diverticulitis was observed in the anterior wall of the cecum, close to the ileocecal area. Simultaneous appendectomy and diverticulectomy were performed. The patient was discharged without complications on the 4th postoperative day.

Objective: Radioguided parathyroidectomy using a handheld gamma probe is widely used to facilitate gland localization, yet its incremental value in routine primary hyperparathyroidism (pHPT) surgery especially in resource-limited settings—remains debated. We evaluated outcomes of parathyroidectomy performed with selective gamma probe use in a single center.Methods: We retrospectively reviewed 50 consecutive patients undergoing parathyroid surgery in 2025. Preoperative localization relied on cervical ultrasound with or without sestamibi scintigraphy. Gamma probe guidance was used selectively at surgeon discretion. We compared operative and early biochemical outcomes between patients with and without gamma probe use. Continuous variables were compared with Welch’s t-test and categorical outcomes with Fisher’s exact test.Results: Gamma probe guidance was used in 14/50 patients (28%). Mean age was 54.6±6.9 years and 82% were female. Mean operative time was similar between groups (46.1±2.9 vs 44.4±6.7 min; p=0.239). Transient hypocalcemia occurred in 8 patients (16%), all in the non–gamma probe group (0% vs 22.2%; p=0.087), and no permanent hypocalcemia occurred. Early biochemical response, assessed by percent PTH reduction from baseline to postoperative measurement, was lower in the gamma probe group (mean 85.2% vs 90.5%; p=0.006).Conclusion: In this real-world single-center cohort, selective gamma probe use was not associated with shorter operative time and was likely used in more complex cases, possibly reflecting case complexity rather than an effect of radioguidance itself. Prospective studies are warranted to clarify which patient subgroups derive measurable benefit from radioguidance.

Objective: Although Bethesda II benign thyroid cytology is generally associated with a low risk of malignancy, false-negative results may occur in a subset of patients. Examining clinical, laboratory and ultrasonographic characteristics may help characterize patients with malignancy despite benign cytology. This study aimed to evaluate factors associated with postoperative malignancy in surgically treated patients with preoperative Bethesda II thyroid cytology. Materials and methods: This retrospective single-center study included patients who underwent thyroid surgery following a preoperative Bethesda II fine-needle aspiration biopsy result between January 2020 and December 2024. Demographic characteristics, thyroid function tests, inflammatory markers and ultrasonographic findings were retrospectively analyzed. EU-TIRADS classification was categorized as low risk (< 4) and high risk (≥ 4). Patients were divided into benign and malignant groups according to postoperative histopathological results. Univariable and multivariable logistic regression analyses were performed to evaluate factors associated with postoperative malignancy. Results: A total of 176 patients with Bethesda II cytology were included in the study. Postoperative histopathological examination revealed malignancy in 20 patients (11.4%). Patients in the postoperative malignant group were significantly younger than those in the benign group [29 years (IQR: 26.75–32) vs. 41 years (IQR: 35–49), p = 0.0006]. The rate of EU-TIRADS ≥ 4 was significantly higher in the malignant group (45.0% vs. 12.2%, p = 0.001). The malignancy rate was 7.4% in patients with EU-TIRADS < 4 and 32.1% in those with EU-TIRADS ≥ 4. In multivariable logistic regression analysis, younger age (OR: 0.918, 95% CI: 0.868–0.970, p = 0.002) and EU-TIRADS ≥ 4 classification (OR: 5.72, 95% CI: 2.01–16.27, p = 0.001) were independently associated with postoperative malignancy. Inflammatory markers such as neutrophil-to-lymphocyte ratio, systemic immune-inflammation index and C-reactive protein were not significantly associated with malignancy. Conclusion: Younger age and EU-TIRADS ≥ 4 were associated with postoperative malignancy in this selected surgical cohort of patients with Bethesda II cytology. No statistically significant associations were observed for systemic inflammatory markers. These findings require confirmation in larger, prospective multicenter cohorts before their potential contribution to clinical risk assessment can be established.

Background/Objectives: Circulating biomarkers reflecting distinct aspects of tumor and host biology may provide complementary information in gastric cancer. We characterized serum R-Spondin-1, nesfatin-1, and irisin and explored whether their combined assessment improved case–control discrimination beyond individual markers. Methods: In this single-center case–control study, serum concentrations were measured by ELISA in 49 patients with histopathologically confirmed gastric adenocarcinoma and 50 age- and sex-frequency-matched apparently healthy controls; all samples were obtained before any gastric resection. Between-group differences were quantified using effect sizes and 95% confidence intervals. Associations with gastric cancer status were examined using Firth penalized logistic regression; discrimination was explored using ROC analysis with bootstrap internal validation. Results: R-Spondin-1 was higher in gastric cancer than in controls (14.03 ± 2.75 vs. 8.47 ± 2.48 ng/mL; Cohen’s d = 2.12), whereas nesfatin-1 (2.79 ± 0.88 vs. 4.19 ± 0.81 ng/mL; d = −1.65) and irisin (7.48 ± 2.18 vs. 11.52 ± 1.97 ng/mL; d = −1.95) were lower. Associations remained after adjustment. Individual AUCs were 0.926, 0.885, and 0.913; the exploratory three-marker signature yielded an AUC of 0.964 (95% CI 0.932–0.996) and an optimism-corrected AUC of 0.958. Results were materially similar in treatment-naive patients. Conclusions: Gastric cancer was associated with increased R-Spondin-1 and decreased nesfatin-1 and irisin. This pattern likely reflects tumor–host interaction, including mucosal and wasting-related contributions, rather than independent tumor-specific signals. These case–control estimates do not represent diagnostic accuracy, do not support early-detection use, and require prospective validation in clinically representative cohorts.

Background and Objectives: Accurate identification of the internal opening is a key determinant of success in perianal fistula surgery, as missed openings are strongly associated with persistent infection and recurrence. Although magnetic resonance imaging provides detailed preoperative mapping, intraoperative confirmation relies largely on surgical judgment. This study evaluated the technical feasibility and early observed outcomes of flexible rectoscopy-guided identification of the internal opening during loose seton placement in patients with transsphincteric perianal fistula whose internal opening could not be localized by routine assessment or pelvic MRI. Materials and Methods: This single-center retrospective descriptive feasibility series included 44 adult patients with cryptoglandular transsphincteric perianal fistula who underwent loose seton placement. All included patients had an internal opening that could not be localized by routine preoperative assessment or pelvic MRI. Intraoperative flexible rectoscopy was used to identify the internal opening in relation to the dentate line. The primary endpoint was successful intraoperative visualization of the internal opening. Operative time, healing time, early follow-up outcomes, Wexner continence score and patient satisfaction were descriptively recorded. Results: The mean age was 41.00 ± 12.06 years and the mean BMI was 29.86 ± 3.65 kg/m². The internal opening was successfully visualized using flexible rectoscopy in all 44 patients (100%). Mean operative time was 6.66 ± 1.49 min and mean healing time was 59.45 ± 9.96 days. During the available 3–7-month early follow-up, no complications were documented, while recurrence occurred in one patient (2.3%) at the fourth postoperative month. The exact binomial 95% confidence interval for the observed recurrence rate was 0.06–12.02%. The median postoperative Wexner score was 0 (IQR 0–0; range 0–1). Conclusions: Flexible rectoscopy enabled intraoperative identification of the internal opening in all patients in this descriptive series and may represent a feasible adjunct when routine assessment and pelvic MRI fail to localize the opening. The absence of a comparator and the relatively short follow-up prevent conclusions regarding comparative accuracy, safety or recurrence reduction. Larger prospective comparative studies with long-term follow-up are required.