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Background: Acute appendicitis (AA) is one of the most common emergency surgical pathologies in patients presenting to emergency department. with abdominal pain. In patients diagnosed with Acute appendicitis, rapid and accurate diagnosis is necessary to reduce morbidity and mortality. Hemogram parameters are important in diagnosis of acute appendicitis. In this study, we aimed to investigate the place of acute appendicitis, in histopathological diagnosis by examining the hemogram parameters of the patients who were first examined in the emergency department. Materials and Methods: Hemogram parameters and postoperative pathology results of 116 patients who presented with abdominal pain to the Emergency Department of SBÜ Ş.Urfa Mehmet Akif İnan SUAM hospital between January 2018 and June 2020 and operated with the preliminary diagnosis of acute appendicitis were analyzed retrospectively. Patients were divided into three groups according to their pathology results and were questioned whether there was a relationship between hemogram parameters and acute appendicitis. Results: Of the 116 patients who underwent appendectomy, the average age was 12.0 (9.0-15.0), of which 60.3% (N=70) were male and 39.7% (n=46) were female. In the study, there were 60.3% (n=70) male patients and 39.7% (n=46) female patients. Abdominal Ultrasonography (USG) was performed to 76.7% (n=89) patients and abdominal Computed Tomography (CT) was performed to 18.1% (n=21) the patients before surgery. Both USG and abdominal CT were performed in 5.2% (n=6) patients. After postoperative pathological analysis, 11.2% (n=13) of the patients had normal appendix, 70.1% (n=82) of the patients had simple inflamed appendicitis, 18.7% (n=21) of the patients had Complicated (phlegmenous, gangrenous, perforated) appendicitis. Hemogram parameters of non- acute appendicitis and acute appendicitis patients were compared. There was statistically significant difference between Neutrophil/lymphocyte ratio (NLR) (p<0.05). There was no statistically significant difference between Red blood cell width (RDW), Platelet mass index (PMI), White blood cells (WBC), neutrophil count (p>0.05). Conclusion: White blood cells (WBC), neutrophil count, NLR, RDW, PMI, are easily accessible and fast assessable hemogram parameters, available for diagnosis of acute appendicitis patients. However, these parameters alone are not enough for diagnosis of acute appendicitis. A good anamnesis, physical examination and appropriate radiologic imaging studies are needed to make a timely and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Superior mesenteric artery syndrome, also known as Wilkie's Syndrome, is a life threatening clinical entity which developes as a result of obstructed second or third part of duodenum compressed between aorta and superior mesenteric artery. In this rare syndrome, a rapid weight loss is accompanied by stomach ache, abdominal distension, lack of appetite, nausea and vomiting after meals. In patients admitted for acute abdomen, superior mesenteric artery syndrome should be included in the differential diagnosis in case of a precedeing rapid weight loss. X-ray of barium passage, abdominal ultrasound, gastroscopy, abdominal angio-tomography or abdominal magnetic resonance angiography may be useful for diagnosis. Conservative and surgical approaches are available for the treatment. In this report we aimed to emphasize that superior mesenteric artery syndrome cases may admit for acute abdomen and that superior mesenteric artery syndrome should be included in differential diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Abdominal pain is one of the most common causes of hospitalization in childhood. Here we aimed to evaluate the contribution of positive findings in the upright abdominal x-ray and ultrasound imaging for the diagnosis of acute appendicitis in children admitted with abdominal pain. Material and Methods: The upright abdominal x-ray and ultrasound images of children who presented to our outpatient clinic with suspected acute appendicitis in 2010 were analyzed retrospectively. The patients were divided into 2 groups. The children with a final diagnosis of acute appendicitis constituted group 1, while the patients who were operated on for suspected appendicitis and where the pathology examination was negative for appendicitis and children who required only observation in the hospital or as outpatient for suspected appendicitis made up group 2. Findings accepted to suggest a diagnosis of acute appendicitis on plain x-ray were air-fluid level at the right lower quadrant, diffuse air-fluid levels, presence of fecalith, blurring or loss of the properitoneal fat stripe, lumbar scoliosis with a left convexity, free air under the diaphragm, and gas shadow in the appendix. The criterion for the diagnosis of appendicitis by US was detection of a non-compressible, fluid-filled and blind-ended tubular intestinal segment in connection with the cecum that was more than 6 mm in diameter. Furthermore, findings that support the diagnosis of appendicitis such as presence of an appendicolith, increased periappendiceal mesenteric echogenicity, presence of abscess and conglomeration of intestinal loops to the right lower quadrant were also evaluated. Results: A total of 744 patients presented at our outpatient clinic for suspected acute appendicitis during the year 2010. Group I consisted of 350 and group II of 394 children. The mean age was comparable between the groups (p>0.05). Upright abdominal x-ray was available for 87.5% and ultrasound imaging for 78.5% the patients. Only 59.4% of the ultrasound examinations were carried out by our institution's radiology department while the rest (40.6%) were performed elsewhere. In group I, the findings on plain abdominal x-ray suggestive of acute appendicitis were as follows; air-fluid levels at right lower quadrant (46.8%), lumbar scoliosis with left-sided convexity (10.5%), presence of fecalith (4.7%), and blurring of the right properitoneal fat shadow (4.1%). The sensitivity of plain abdominal x-ray for acute appendicitis was 56.3% with a specificity of 66.9%. The diameter of the appendix could be measured only in 180 patients with ultrasound imaging. An appendix diameter ≥ 6 mm could be used to diagnose appendicitis with 86.4% sensitivity while unresponsiveness to compression could predict acute appendicitis with a sensitivity of 72.1 %. In group I, appendicolith, abscess and increased mesenteric echogenity on ultrasound imaging were found in 16.2%, 5.5% and 37.5% of the patients respectively. The total sensitivity and specificity of ultrasound imaging were 66.9% and 66.1 % respectively. Conclusion: Only half of the children with acute appendicitis have a positive finding on plain x-ray. Although variability exists depending on the experience of the radiologist, ultrasound imaging is one of the most sensitive imaging modalities for the diagnosis of childhood acute appendicitis. In conclusion, we believe that acute appendicitis cannot be diagnosed by relying solely on imaging features and correlation of the imaging features with clinical parameters is essential. [ABSTRACT FROM AUTHOR]

In differential diagnosis of acute abdominal pain which is one of the most commonly encountered situations in emergency departments, data in the literature shows variability with regard to diagnostic efficiency of plain abdominal radiography. Radiation dose should be considered especially in pediatric patients and in patients in whom multiple radiographies are required, because radiation dose of plain abdominal radiography (0.7 millisievert) is much higher than that of chest radiography (0.01-0.02 millisievert). In emergency departments, plain radiographies are not usually evaluated by radiologists, by that way; evaluation of radiographies with priority of clinical diagnosis may cause false positive and false negative results. Plain abdominal radiographies have higher diagnostic efficiency especially for intestinal obstruction and gastrointestinal perforation among the other abdominal emergencies. Therefore, plain abdominal radiography should be the first imaging modality in patients with clinical and physical findings compatible with intestinal obstruction and gastrointestinal perforation. However, use of plain abdominal radiography in other acute abdominal pathologies including acute appendicitis does not appear to be appropriate because of inadequate diagnostic efficiency and risk of radiation exposure. [ABSTRACT FROM AUTHOR]

Gossypiboma is a mass lesion at the site of surgery due to a forgotten surgical sponge. Forgotten foreign bodies are mostly retained in the abdominal cavity but there are some cases in the thorax, cranium, breast, and an extremity. Gossypiboma should be considered, especially by radiologists, in patients with a history of surgery, who present with non-specifc symptoms and abdominal mass. In this report, we describe the case of a female patient who presented with non-specifc abdominal discomfort and fever about six months after open cholecystectomy. (The Medical Bulletin of Haseki 2014; 52: 47-9) [ABSTRACT FROM AUTHOR]

Primary teratomas in the retropritoneum are very rare in adults. A 32 years old female patient presented with abdominal pain which abdominal computerized tomography revealed right adrenal tumor. The adrenal mass was not originated from adrenal glanol during exploration in the exploration. Frozen section was benign. After surgical removal microscopic diagnosis came as a primary mature cystic teratom. In case of a retroperitoneal tumor. germ cell tumors should be considered in differential diagnosis and researched before surgery. We describe a case of mature cystic teratoma that was clinically presenting as an adrenal tumor. [ABSTRACT FROM AUTHOR]

Anaplastic large cell lymphoma (ALCL) is a rare NHL, representing only 2-3% of all lymphomas. Pulmonary involvement is rare (5-15%). A thirty one year old female was admitted to a center with purulent fistulized lesions on the neck and axilla and enlargement of the breasts. There was no improvement with antibiotics and she had a fever. Pyogenic granulation was detected in the soft tissue biopsy of the axillary and breast. All the cultures were negative. Antituberculosis therapy was given for three months. This patient was admitted to our clinic due to clinical progression. Bilaterally painful, purulent flowing lesions on the neck and axilla, tension and sensitive breasts and high fever were found. Anemia, thrombocytosis, neutrophilic leukocytosis, low iron level and iron binding capacity and high CRP levels were detected in the laboratory tests. Anaerobic, actinomycosis, mycobacteria, nocardia and tularemia cultures were negative. Thorax CT showed a mediastinal conglomerate LN, left upper apicoposterior cavitary lesion and millimetric nodules. Abdominal CT was normal. Neck CT showed masses which erased the fat plain and submandibular LN. LN biopsy diagnosed an inflammatory variant of CD30(+) ALCL. It was considered to be stage IV due to pulmonary parenchyma, mediastinum, neck, axilla and breast involvement. After five chemotherapy sessions, there was a significant improvement in the lesions. [ABSTRACT FROM AUTHOR]