Primary umblikal endometriosis is a rare illness. In this report we aimed to discuss the management of this rare condition. A 28-year-old nulliparous woman was present at our clinic who was suffering from painful swelling in the umbilicus during her menstruation for the last 3 months. Her examination showed a dark-color sensitive nodule of 20×15mm in size in the umbilicus. A lower abdominal tomography was performed to exclude the presence of a concomitant pelvic endometriosis, and it showed increased density consistent with subcutaneous inflammation in the umbilicus. Her medical history and physical examination suggested primary umbilical endometriosis. A total resection including umbilicus was performed. Primary umbilical endometriosis is a rare benign disease and clinically difficult to differentiate from other diseases that cause umbilical nodule. Imaging modalities have no pathognomonic findings for diagnosis. Surgical exploration and excision are the definitive and safe treatment of primary umbilical endometriosis. Total umbilical resection should be preferred to avoid local recurrent.

BACKGROUND: The aim of this study was to investigate the incidence of appendiceal neuroendocrine tumors (NET) in an acute appendicitis cohort, as well as to investigate the behavioral form of the tumor. Our secondary aim was to investigate survival in patients with appendiceal NET. METHODS: Between February 2006 and June 2018, 6518 appendectomies were performed for acute appendicitis in the department of surgery, University of Health Sciences, Okmeydani Education and Research Hospital, Istanbul, Turkey. The medical records of these consecutive 6518 appendectomy patients were evaluated retrospectively. After the histopathological analysis, a total of 22 patients were identified as cases of appendiceal NET. These patients were included in the study. A retrospective analysis of data including gender, age, intraoperative surgical findings, duration of postoperative follow-up and survival, tumor localization, the diameter of the tumor, tumor grade, invasion, surgical margin, and stage of the tumor was performed. RESULTS: The incidence of appendiceal NET was 0.33%. Eleven patients were diagnosed as primary pathological stage pT1aN0M0 according to the European Neuroendocrine Tumor Society guidelines. One patient was diagnosed as primary pathological stage pT1bN0M0, and 10 patients were diagnosed as primary pathological stage pT2N0M0. The median tumor diameter was 7.6 mm. There was no patient with a tumor diameter greater than 20 mm. CONCLUSION: The incidence of appendiceal NET in our study is consistent with that stated in the literature. The results of our research suggest that further surgical procedures for NETs that occur coincidentally in patients of the AA cohort are often unnecessary. In addition, the study revealed that disease-free survival (100%) was good over a mean follow-up of 59.2 months.

Objective: To determine the factors associated with mortality in Fournier's gangrene (FG) toward informing the development of effective treatment strategies. Study Design: A descriptive study. Place and Duration of Study: Department of Surgery, University of Health Sciences, Okmeydani Education and Research Hospital, Istanbul, Turkey, from February 2012 to September 2017. Methodology: Informations of 30 patients treated for FG were examined retrospectively. The deceased patients (Group 1, n = 8) were analysed separately from the living ones (Group 2, n = 22). Informations in this analysis contained gender, age score, dissemination score, Uludag Fournier's Gangrene Severity Index (UFGSI) and Fournier's Gangrene Severity Index (FGSI) scores, serum levels of urea, infection source, the presence of diabetes, obesity, and other comorbidities, the presence of stoma for diversion, duration of the vacuum-assisted closure treatment, hospitalisation time, intensive care period, and species of bacteria isolated. Results: The overall mortality rate was detected as 26%. A significant difference between the two groups concerning age score of UFGSI parameters was found. The dissemination score of the infection, which is one of the UFGSI parameters, was significantly higher in Group 1 than in Group 2. According to UFGSI and FGSI scores, the scores of group 1 patients were significantly higher. To determine the incidence of mortality, the UFGSI and FGSI had 87.5% sensitivity and had 96% and 91% specificity, respectively. The cut-off values for UFGSI and FGSI were 10 and seven, respectively. Conclusion: Based on the findings described in this study, age and dissemination scores from the UFGSI can be used to predict patient outcome. Patients with a UFGSI score greater than 10 have a higher mortality rate.

BACKGROUND: The objective of the study was to investigate risk factors affecting mortality rates in patients with Fournier's gangrene (FG) and develop methods to increase the survival rate. METHODS: We collected data of 73 patients treated for FG between February 2012 and June 2021 at Istanbul Professor Doctor Cemil Tascioglu City Hospital General Surgery Clinic. The data of living patients (Group 1, n=56) and deceased patients (Group 2, n=17) were analyzed separately. Demographic data of patients were sex, age, infection rate, Uludag FG severity index (UFGSI) scores and FG severity index (FGSI) scores, urea serum levels, the source of infection, the presence of diabetes, obesity, the presence of diversion stoma, duration of vacuum-assisted closure treatment in days, hospitalization time in days, intensive care period in days, and isolated bacterial species. RESULTS: The mortality rate was 23%. A significant difference in age and dissemination score of the infection was found between the two groups. According to UFGSI and FGSI scores, the scores of the two groups of patients were significantly higher. The UFGSI had 100% sensitivity and 68% sensitivity. FGSI had 82% sensitivity and 58% specificity. The cutoff values for UFGSI and FGSI were 8 and 6, respectively. CONCLUSION: Age and dissemination scores of diseases were important factors that cause mortality in patients with FG. However, an accurate scoring system is important in predicting patients to be treated in the intensive care unit (ICU). Patients with a UFGSI score above 8 face a higher risk of death and should be treated in the ICU.

Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room.

We aimed to present our method called as new isolation technique with stopper (NITS) to manage enteroatmospheric fistula (EAF) in an open abdomen (OA). The patient was a 71-year-old male with Hartmann colostomy and incisional hernia. A dual mesh was used for incisional hernia repair after colorectal anastomosis. The patient was urgently re-admitted to hospital due to EAF on the postoperative 30th day. The NITS application was performed twice at different times. General anesthesia was not required for the applications, but sterile conditions in operation room were provided. A Penrose drain was sutured with 5/0 polydioxanone onto the mucosa of EAF orifice. A small pool was created to protect enteric content from leakage. The leak test was performed by spilling saline into this pool. The sponge with visceral organ protector around the pool was adhered by adhesive sterile drape, and one opening was performed on drape. Negative pressure therapy was launched with -75 mmHg in continuous form. EAF was isolated from the OA wound and sponge with the help of stopper performed with adaptable and obstacle ring paste. After these two applications, EAF was converted to stoma. The anastomosis of small intestine was performed 45 days later. In our NITS system, control of EAF may be successfully provided besides prevention of loss of enteric fluid and electrolyte. Advantages of NITS: 1) Successful control in all types of EAF is possible with NITS. 2) The required material for NITS system can be found easily. 3) All types of EAF can be converted into stoma in a short time. Consequently, the therapy of EAF in Bjorck 4 OA patients may be carried out successfully with NITS method.