BACKGROUND: The Alvarado score (AS) and the Appendicitis Inflammatory Response score (AIRS) were developed to diagnose acute appendicitis (AA). The aim of this study was to evaluate the severity of AA using the AS and the AIRS tools. METHODS: Patients who presented between January 2016 and December 2017 and underwent surgery for AA and who had a preoperative AS and AIRS value were evaluated retrospectively. The details of age, sex, pathological severity, the presence of local peritonitis or fecaloid, drainage, appendix diameter, and operation type were evaluated according to the AS and the AIRS. RESULTS:A total of 578 patients were included in the study. Appendicitis was the most common pathological severity classification (44.4%). The most common appendix diameter group was 7-10 mm (59.2%). The difference observed in the AS and AIRS results for all of the pathological severity categories was statistically significant (p<0.05). The AIRS revealed a statistically significant difference (p<0.05) in the detection of uncomplicated and complicated appendicitis. The AIRS difference was statistically significant for appendix diameter (p<0.05). The AS and the AIRS results were both statistically significant for drainage (p<0.05). The AS was correlated with pathological severity, local peritonitis, and drainage, while the AIRS was correlated with pathological severity, uncomplicated/complicated determination, appendix diameter, and drainage (p<0.05). CONCLUSION: Both the AS and the AIRS can evaluate pathological severity, but only the AIRS can evaluate complicated or uncomplicated appendicitis and the diameter of the appendix. These tools can be used to reduce the number of unnecessary radiological or surgical interventions.

BACKGROUND: The mean survival is less than 6 months in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. Gastrointestinal(GI) bleeding frequency due to HCC invasion is 0.05% to 2.0%, and may be fatal. CASE PRESENTATION: We encountered a case of HCC with direct invasion to the gastrium that caused a life-threatening upper GI bleeding. Our patient was a 62 year old male who was a heavy smoker and drinker for almost 30 years. He had several upper GI bleeding episodes during the previous 6 months. Computed tomography (CT) revealed a 13 cm liver tumour directly invading the gastrium. Partial hepatic resection and subtotal gastrectomy were performed. Unfortunately, the patient died at the intensive care unit postoperatively due to hepatic failure. DISCUSSION: Although the prognosis of HCC that has invaded the gastrium is very poor due to the advanced stage of the disease, surgical resection may be a favourable treatment option for patients with a massive upper GI bleeding. CONCLUSIONS: The incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue. Highlights:

Aim: While laparoscopic appendectomy is the gold standard in the treatment of acute appendicitis, there is no consensus on reliable closure of the appendix stump. The aim of this study was to examine appendiceal stump closure techniques and their reliability during laparoscopic appendectomy. Material and Methods: Between January 2019 and August 2021, 692 patients who underwent laparoscopic appendectomy with the diagnosis of acute appendicitis were included in the study. Demographic characteristics, length of hospital stay, pathology, appendix stump closure methods, operation time, complications, and cost results were analyzed retrospectively. Results: Intracorporeal knotting (ICK) was used in 66.9% (n=463), and endoclip (EC) was used in 33.1% (n=229) of the patients. There was no statistically significant difference between the two groups in terms of length of hospital stay (p=0.054). While the mean operative time was 55.1±15.6 minutes in the ICK group, it was 45.7±16.5 minutes in the EC group (p<0.001). The general complication rate was 1.7% (n=12). While the complication rate was 2.2% (n=10) in ICK group, it was 0.9% (n=2) in EC group (p=0.354). While pericecal hematoma and ileus were seen only in the ICK group, the fistula was seen only in the EC group. EC was found to be more costly than ICK (p<0.001). Conclusion: It was concluded that closure of the appendix stump with an EC in patients who underwent laparoscopic appendectomy is more useful, regardless of the severity of appendicitis, with a shorter operation time and shorter length of hospital stay, low complication rate, and ease of application.

Background/Aim: Percutaneous cholecystostomy (PC) is an alternative procedure to surgery in selected patients with acute cholecystitis (AC). This study aimed to review the clinical and surgical results of patients who underwent percutaneous cholecystostomy. Methods: The records of patients who underwent PC for AC were evaluated for age, gender, comorbidities, survey, catheterization timing, complications, control, removal timing, operation type, interval time, pathology, C-reactive protein (CRP) level and white blood cell count (WBC), ultrasonography (USG) and computed tomography (CT) results. Results: One hundred and thirty-six AC patients who underwent PC were included in the study. The median age was 73 (32-96) years and 57.3% of the patients were male. Out of the 136, 106 (78%) had an American Society of Anesthesiologists (ASA) classification score of 3 or 4. The median Charlson’s comorbidity index (CCI) score was 5 (0-13). The median timing of catheterization was 23 (20-144) hours and length of hospital stay (LOS) was 3 (1-25) days. Dislocation was the most common complication of PC, and 7.4% (n=10) had recurrent AC. The median time until tube removal was 26.5 (1-238) days. Among all, 41.2% (n=56) of the patients underwent interval cholecystectomy, which equates to 76.8% of the those performed laparoscopically. The median time until the operation was 100 (1-264) days. Chronic cholecystitis was the most common pathology of cholecystectomy after PC. Bacterial bile cultures were analyzed in 36 of the patients and showed positive results in 66.7%, with no overall effect on the outcome. Nine patients (6.6%) died. Conclusion: The importance of PC in AC increased with the Covid19 pandemic. PC was performed especially for old patients with ASA ≥3, and CCI ≥5 due to lower complication and recurrence rates. PC could be the final treatment for selected AC patients. Interval cholecystectomies performed after 8 weeks had a shorter LOS and a lower rate of complication. '+st+' Indar AA, Beckingham IJ. Acute cholecystitis. BMJ. 2002 Sep 21;325(7365):639-43. doi: 10.1136/bmj.325.7365.639. Halpin V. Acute cholecystitis. BMJ Clin Evid. 2014 Aug 20;2014:0411. PMID: 25144428. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54. doi: 10.1002/jhbp.515. Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, et al. Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):87-95. doi: 10.1002/jhbp.504. Morales-Maza J, Rodríguez-Quintero JH, Santes O, et al. Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review. Rev Gastroenterol Mex. 2019 Oct-Dec;84(4):482-91. English, Spanish. doi: 10.1016/j.rgmx.2019.06.004. Somuncu E, Kara Y, Kızılkaya MC, Bozdağ E, Yıldız ZB, Özkan C, et al. A. Percutaneous cholecystostomy instead of laparoscopy to treat acute cholecystitis during the COVID-19 pandemic period: single center experience. Ulus Travma Acil Cerrahi Derg. 2021 Jan;27(1):89-94. English. doi: 10.14744/tjtes.2020.69804. Chou CK, Lee KC, Chan CC, Perng CL, Chen CK, Fang WL, et al. Early Percutaneous Cholecystostomy in Severe Acute Cholecystitis Reduces the Complication Rate and Duration of Hospital Stay. Medicine (Baltimore). 2015 Jul;94(27):e1096. doi: 10.1097/MD.0000000000001096. Masrani A, Young D, Karageorgiou JP, Mani NB, Picus DD, Kim SK. Management algorithm of acute cholecystitis after percutaneous cholecystostomy catheter placement based on outcomes from 377 patients. Abdom Radiol (NY). 2020 Apr;45(4):1193-7. doi: 10.1007/s00261-020-02449-y. Gulaya K, Desai SS, Sato K. Percutaneous Cholecystostomy: Evidence-Based Current Clinical Practice. Semin Intervent Radiol. 2016 Dec;33(4):291-6. doi: 10.1055/s-0036-1592326 Bundy J, Srinivasa RN, Gemmete JJ, Shields JJ, Chick JFB. Percutaneous Cholecystostomy: Long-Term Outcomes in 324 Patients. Cardiovasc Intervent Radiol. 2018 Jun;41(6):928-34. doi: 10.1007/s00270-018-1884-5. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi: 10.1016/0021-9681(87)90171-8. Elsharif M, Forouzanfar A, Oaikhinan K, Khetan N. Percutaneous cholecystostomy… why, when, what next? A systematic review of past decade. Ann R Coll Surg Engl. 2018 Oct 5;100(8):1-14. doi: 10.1308/rcsann.2018.0150. Dvorak P, Hoffmann P, Renc O, Dusek T, Rejchrt S, Slezak O, Vyroubal P. Percutaneous cholecystostomy in the management of acute cholecystitis - 10 years of experience. Wideochir Inne Tech Maloinwazyjne. 2019 Dec;14(4):516-25. doi: 10.5114/wiitm.2019.84704. Luk SW, Irani S, Krishnamoorthi R, Wong Lau JY, Wai Ng EK, Teoh AY. Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Endoscopy. 2019 Aug;51(8):722-32. doi: 10.1055/a-0929-6603. Anderson JE, Chang DC, Talamini MA. A nationwide examination of outcomes of percutaneous cholecystostomy compared with cholecystectomy for acute cholecystitis, 1998-2010. Surg Endosc. 2013 Sep;27(9):3406-11. doi: 10.1007/s00464-013-2924-5. Karakaş DO, Yeşiltaş M. Validity of the Glasgow prognostic score and modified systemic inflammation score in predicting complicated cholecystitis. Hippokratia. 2020 Jan-Mar;24(1):15-20. Bakkaloglu H, Yanar H, Guloglu R, Taviloglu K, Tunca F, Aksoy M, et al. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention. World J Gastroenterol. 2006 Nov 28;12(44):7179-82. doi: 10.3748/wjg.v12.i44.7179. Hsieh YC,...