Abstract Objective. Hepatic hemangiomas (HHs) are the most common benign hepatic tumors. Elective surgery for giant HHs is still controversial. The aim of this retrospective paper is to present our experience with 42 patients with giant cavernous HHs referred to our institution. Material and Methods. Forty two patients underwent surgery for giant HHs at Naval Hospital of Varna, Bulgaria between January 2001 and December 2014. Clinical presentation, diagnosis, treatment, and postoperative complications are analyzed. Results. Forty one patients (97.6%) underwent elective surgery while in 1(2.4%) patient an emergency right hemihepatectomy had to be performed because of a ruptured haemangioma. The major indication for elective removal of HHs is abdominal pain. A total of 24 (57.1%) major liver resections and 18(42.8%) enucleations were performed. Five patients had complications, including a biloma (n=2), a liver abscess (n=1), postoperative bleeding (n=1) and a wound infection (n=1). Resection and enucleation were both relatively safe with an acceptable complication rate (11.9%) and there was no mortality. The complication rates for enucleation and resection were 5.5% (1/18) and 16.6% (4/24), respectively, but the difference was not statistically significant (p = 0.623). Clinical features including large tumor size (p=0.011), symptomatic tumors (p=0.013), increased blood loss (p=0.035), and prolonged operative time (p=0.005), indicating higher risks, were associated with an increase in postoperative complications. Conclusion. Recent advances in surgical techniques and established perioperative management have now made it possible to perform liver resection or enucleation safely in most specialized units. Identifying the discriminatory factors that predict postoperative complications are important in establishing effective strategies for surgical procedures.

service. Patients and methods: It was a retrospective study from January 1st 2006 to December 31th 2013 of 20 patients operated laparoscopically for gynecological emergencies in the General Surgery Department at Aristide Le Dantec teaching hospital. The parameters studied were the characteristics, indications, operative findings and postoperative data. Results: During the study period, 20 patients were included. The average age was 32 years, ranging from 16 to 50 years. The indications were dominated by ectopic pregnancies (40%). Ultrasonography was performed in all cases and helped clarify the diagnosis in 7 cases. Laparoscopic surgical exploration has readjusted the preoperative diagnosis in 13 cases. Laparoscopy was a therapeutic mean in 65% of cases (n = 13). The most performed of the gesture was adnexectomies followed by salpingectomies. The conversion rate was 20% (n = 4). No intraoperative complications were registered. The average hospital stay was 2 days for patients operated exclusively by laparoscopy with extremes of 1 and 4 days. All surgical specimens were examined by pathologists and no evidence of malignancy was found. No cases of operative morbidity and mortality associated with laparoscopy were noted. Conclusion: Laparoscopy offers significant advantages in the management of gynecological emergencies even in a developing country like ours.

Breast cancer is a major health issue with progressively increasing incidence rates both in our country and in the world. Axillary lymph node dissection (ALND), which is considered as an integral part of the treatment of breast cancer, leads to various morbidities and complications although it allows staging and local control of the disease. 457 patients with diagnosis of breast cancer in whom modified radical mastectomy (MRM) and breast conservation surgery (BCS) were performed and ALND was successively applied, or ALND was applied due to positive sentinel lymph node biopsy results at the 1st Surgery Clinic, Ataturk Training and Research Hospital, Izmir Katip Celebi University between January 2002 and December 2011 were included in our study. The median mean age of the patients was 55.85. Axillary lymph node metastasis was positive in 253 (55.2%) patients. The factors influencing axillary lymph node positivity, i.e age, menopausal status, the location and side of the tumor, tumor histology, estrogen, progesteron receptor, c-erb-B2, p53 and Ki- 67 positivity and the size and stage (according to TNM (T: Tumor, N: Lymph Node, M: Metastasis)) of the tumor, were reviewed with the help of the literature. The positive and independent predictive factors identified were tumor size, TNM stage and tumor histology. There are pre-operative independent predictive factors for ALND. With these findings, we would be able to identify node- negative patients and provide better consultancy to patients who require axillary dissection. These factors would provide predictive information in deciding between ALND and SLNB.

Background and Aim: Pilonidal sinus disease (PSD) is a common surgical disease seen especially in the young.The most important prognostic factors for patients are relapse after surgery; wound infection, seroma, hematoma and wound separation which can reduce the quality of life and increase costs and labor. Objectives: The aim of our study was to evaluate the complications following Limberg flap (LF) procedure for PSD. Materials and Methods: From January 2013 to August 2014, PSD patients treated with LF were retrospectively analyzed and data collected regarding age, gender, hospital stay, wound infection, re-hospitalization, postoperative urinary distention, postspinal headache and narcotic analgesic requirement 30 days postoperatively. Results: A total of one hundred and three patients were assessed. 92 were male and 11 were female. The average age was 26,4(16-68) and the average hospitalization stay was 1,9(1-7) days. The mean admission to the clinic after surgery was 2,9(1-8) while 2(1,9%) were rehospitalized because of postspinal headache and hematoma. Wound infection occured in 5(4,8%) patients during the 30 day follow-up. Only one patient(<1%) complained about urinary retantion and one (<%1) needed narcotic analgesic medication in addition to routine postoperative analgesics. Postoperative flap necrosis, recurrence and wound seperation were not observed. As expected, more patients suffering complication were admitted to the clinic than those with no complications (p=0.038). The age and postoperative complication rate were not related and there was no significant relationship between rate of complications and length of stay in hospital(p=0.239, p=0.079). Conclusion: LF is a safe method for surgical treatment of PSD, because of fast return to daily activities, no significant pain and acceptable wound infection rates.

Relaparotomy in the immediate postoperative period, due to a complication, is the fear of any surgeon. Early reoperations after abdominal or pelvic surgery still have a high morbidity and significant mortality. Purpose. The present work aims to report our experience regarding the management of early reoperations after abdominopelvic surgery. Patients and method. This is a descriptive retrospective study from 01 January 2000 to 31 December 2010 having collected 104 cases of reoperation for early complication. They were 62 men (59.6%) and 42 women (40.4%) with a sex ratio of 1.47. The average age was 40 years with extremes of 16 and 80 years. Indications for reoperation, morbidity and mortality were particularly studied; as the factors influencing mortality were analyzed. Results. Eighty-six patients were operated in emergency and 18 elective surgery. The details of the initial intervention were dominated by peritonitis (29.8%), occlusion (23%) in emergency; gastrointestinal tumors (12.6%) for scheduled surgery, among others. Clinical signs leading to reoperation were dominated by abdominal distention (79.8%), fever (61.5%) and tachycardia (60.5%). Visceral failures have been identified in 24 patients (23%). All patients were treated in the 72 hours following the indication of revision surgery and 75% of patients underwent reoperation within 24 hours. Indications for reoperation were postoperative peritonitis in 51 cases (49%) ; evisceration in 19 cases (18.3%) ; intestinal fistula in 13 cases (12.5%) ; postoperative occlusions in 11 cases (10.5%) ; complications of stomas in 8 cases (7.7%) ; and postoperative hemorrhage in 2 cases (2%). Morbidity involved in 23 patients (22%). Mortality rate was 25% (26 cases). Age > 50 years, organ failure, postoperative occlusion and late reoperation were bad prognostic factors for mortality. Conclusion. Reoperation performed as early as possible, framed by an efficient resuscitation, could help to reduce significantly the mortality rate of these surgical complications.

Background: Pancreaticopleural fistulas are a rare complication of acute and chronic pancreatitis. The chronic pancreatitis leading to pancreaticopleural fistulas is often alcoholic in origin; gallstones, trauma, idiopathic pancreatitis and pancreatic duct anomalies are rare causes. Optimal treatment strategies have been medical management with exocrine suppression with octreotide and endoscopic retrograde cholangiopancreatography stenting of the fistulous pancreatic duct. Surgery is necessary when medical and endoscopic management fails, or the underlying condition requires it. Case presentation: A 60-year-old male reported nonproductive cough, dyspnea, left-sided chest pain, abdominal fullness. Leftsided massive pleural effusion, and a pancreatic cyst attached to left diaphragm and associated with pleura at the paramedian level were detected on abdomino-thoracic computed tomography (CT). Concervative management was planned. During treatment the patient underwent an emergency operation, and rupture of the pancreatic pseudocyst was seen. A cholecystectomy, abdominal lavage and external drainage were performed. Two months later, he was re-admitted to the hospital with complaints of fever, weakness and loss of appetite. Abdomino-thoracic CT showed an abdominal collection located between the pancreatic tail and posterior of the gastric corpus and a cystic lesion in the corpus of the pancreas. The peripancreatic collection was drained using percutaneous drainage, and an endoscopic cystogastrostomy and a stent insertion were performed. Conclusion: Pancreaticopleural fistulas may be complicated by pseudocyst rupture, but the persistence of pseudocysts after drainage of the ruptured pseudocysts make the procedure more complicated. Endoscopic ultrasonography (EUS)-guided cystogastrostomy and a stent insertion, combined with drainage of the abdominal cavity by a percutenous catheter may be used for persistent pseudocyst.

Intussusception is a common cause of acute intestinal obstruction in children but it constitutes only 1-5% of all the bowel obstructions in adults. When intussusception lasts for more than 2 weeks it is called as chronic intussusception. The acute type does not present as great a diagnostic problem as does the chronic intussusception. Jejunojejunal intussusception is uncommon in adults and usually has an underlying lead point which is a well-defined pathologic entity in majority of the cases. We hereby report the case of a 20 year old male who presented with pain in abdomen, recurrent vomiting and abdominal pain for 1 month and was diagnosed as subacute intestinal obstruction due to chronic jejunojenunal intussusception after careful history examination and investigations. Exploratory laparotomy revealed multiple large polyps in the jejunum, one of which was forming the lead point. On histopathological examination these polyps turned out to be tubulo-villous adenoma. Owing to the rarity of presentation and paucity of published literature this case is being reported here

Background: Completely patent vitellointestinal duct results from not obliterated fetal omphalocele coelom during midgut development . Case: 27 years old male came to us having complaints of continuous sero-purulent discharge from umbilicus. It has been increased since the last 15 days. The patient was investigated in form of ultrasonography abdomen, fistulogram which revealed patent vitello intestinal duct. Laparotomy was done and there was communication between umbilicus and distal ileum was found. It was detached from umbilicus and wedge resection with anastomosis over ilium side was done. He was discharged after 5 days without any postoperative complications. Conclusion: Complete Patent vitello-intestinal duct with continuous or intermittent umbilical discharge is a very rare condition in the adult. The intervention is decided as per the clinical presentation and availability of specific investigations.

A peritoneal simple mesothelial cyst is a rare mesenteric cyst of mesothelial origin. The size of the lesion usually ranges between a few centimeters and 10 cm. It is usually asymptomatic. Abdominal ultrasonography and computed tomography demonstrated the presence of a cystic mass. We present six cases of peritoneal simple mesothelial cyst that was successfully treated by complete surgical excision. These are, a 2-year-old girl, a 39-year-old woman, a 52-year-old man, a 66-year-old man, 63-year-old woman, and an 85-year-old woman, admitted to our hospital between years of 2007 and 2014. Complete resection of the lesions were performed. Pathological analysis showed benign multicystic peritoneal mesothelioma in all cases. The treatment of choice is complete surgical excision and the diagnosis always requires pathological analysis.

Background: Giant scrotal extratesticular lipoma is a rare tumour. Case Report: A 72 year old man referred to our clinics with the magnetic resonance imaging (MRI) diagnosis of intrascrotal extratesticular lipoma. He was aware of painless scrotal mass for 9 years; his medical history was unremarkable. He underwent total excision of the mass with salvation of the testis. Histology report came back as lipoma. Patient discharged on the first postoperative day and no follow-up was scheduled. Conclusions: Extratesticular tumours unlike intratesticular ones are usually benign neoplasms. Ultrasound (US) is the modality of choice for initial diagnosis of scrotal tumours.However, US findings of lipoma may often be inconclusive. In such cases MRI can provide a more accurate diagnosis.

Omphalocele is a congenital abdominal wall defect, often associated with genetic and one or more congenital abnormalities. Management is difficult and comprises of different surgical and non-surgical strategies. There is no unified consensus regarding management. Isolated omphalocele has good prognosis, whereas those with genetic abnormalities have not. Giant omphalocele may present as huge abdominal fascial defect but rarely in adults. We report a case of adult presentation of giant omphalocele after repeated surgical failure.

Background. The most common cause of obstructive jaundice is choledocholithiasis. Patients with obstructive jaundice require appropriate endoscopic and/or surgical procedures for their treatment. Endoscopic retrograde cholangio-pancreatography has been recognized as a treatment with less risk and lower mortality than surgery. Case presentation. A 76- year-old man was admitted at our hospital presenting with signs of obstructive jaundice. After laboratory and imaging examinations, patient underwent endoscopic retrograde cholangio- pancreatography treatment. Common bile duct stone was removed by endoscopic retrograde cholangio- pancreatography after conventional endoscopic sphincterotomy. Twentyfour hours after endoscopic treatment, administration of ursodeoxycholic acid started and lasted for fourteen days. Serum-testing including total and conjugated bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, gama-glutamil transpeptidase, albumine, urea, glycaemia, creatinine, and neutrophil- lymphocyte ratio was determined before and after endoscopic retrograde cholangio- pancreatography treatment. Follow-up measures indicative for liver functional restoration have been collected before endoscopic intervention and on the fifth, tenth, and fifteenth days after endoscopic treatment and reviewed. Conclusion. It seems that ursodeoxycholic acid accelerate functional liver restoration in patients with obstructive jaundice in early phase after endoscopic treatment. Positive effect of ursodeoxycholic acid in liver functional restoration requires further extended research in this area.

Giant hydronephrosis, is a rare condition consistent with renal tissue containing 1-2 lt of fluid in the collecting system surrounded by paper-thin renal tissue. We report two patients presenting to our emergency department (ED) with giant hydronephrosis mimicking intra-abdominal hemorrhage after trauma and ileus.