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Intrauterine device (IUD) is one of the frequently used contraceptive methods in the developing countries, due to its high efficacy, low risks and low costs. However, it may cause some important complications. One of these complications is migration of IUD to adjacent organs. The migration of IUDs to sigmoid colon is rare and it is reported as case reports. In this article, we wanted to share the colonoscopic evaluation of a 38-year-old female patient who presented with chronic abdominal pain, meanwhile the detection of IUD in the sigmoid colon and its removal with colonoscopy. [ABSTRACT FROM AUTHOR]

Hypertension is present in almost a third of Türkiye's adult population. The Ministry of Health of the Republic of Türkiye in conjunction with the World Health Organization, rolled out a pilot primary health care model from February 2019 to 2020 to improve hypertension screening, management, and follow-up across the provinces of Erzincan, Çankırı and Uşak. The model was conducted in selected family health centers for one year and included multiple interventions - training of multidisciplinary primary care teams, implementation of evidence-based, standardised clinical guidelines related to monitoring and treatment of hypertension, clinical supervision and performance monitoring, and provision of health education to hypertensive individuals. Repeat surveys of population-based random samples of 975 patients were taken before (December 2018) and after (February 2020) model implementation to evaluate its effect on care delivery. There was an almost 6.5-fold increase in the measurement and subsequent recording of blood pressure compared to before model implementation (from 50 to 323). Blood pressure control improved to 58 % of measured individuals compared to 46 % of those measured at initial evaluation. The frequency of measuring risk factors and outcomes related to hypertension at least once a year increased for creatinine from 71 % to 79 %, fasting blood glucose from 70 % to 78 %, and tobacco use from 22 % to 31 %. Prescription of antihypertensive drugs increased from 49 % to 61 %. With improvements in hypertension-related care in all measures and across all regions, this primary healthcare model represents a potential paradigm for nationwide implementation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: There are several studies on thyroid functions and thyroid gland features in patients with leprosy in the literature. The relationship between them have not been clarified yet. These studies are time-expired and don't contain ultrasonography examination. The purpose of the study is to investigate thyroid functions and gland characteristics in leprosy patients by ultrasonography (US) and current laboratory techniques., Patients and Methods: This retrospective study was conducted by collecting the data of patients with lepramatous leprosy. Serum thyroid-stimulating hormone, free triiodothyronine, free thyroxine, anti-thyroid peroxidase, antithyroglobulin, and thyroglobulin values and thyroid ultrasonography reports were collected from previous records., Results: The mean age is 75.12±9.89 years of total 17 subjects and 10 patients (58.8%) were male. Thyroid US was performed on 14 of the patients, nodules were detected in a total of 7 (50%) patients. The mean FT3, FT4, TSH, Anti-Tpo, Anti-TG, and TG values of the patients were found to be within normal limits., Conclusion: In the present study, no changes were detected in the thyroid functions and structures of the patients with Lepromatous Leprosy. We consider that prospective randomized studies that will include larger sample sizes are needed to determine whether there is a relationship between leprosy and thyroid disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ozkan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA., Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up., Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections., Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception., (© 2024. The Author(s).)

Objective: The aim of this study was to compare the body fat content, vitamin D, serum lipid levels, and obesity values of individuals doing sports indoors and outdoors and sedentary individuals., Patients and Methods: The research was conducted as a case-control study. The case group consisted of 30 participants between the ages of 18-30 who did outdoor sports, the first control group consisted of 30 participants doing sports indoors, and the second control group consisted of 30 sedentary participants. Voluntary consent was obtained from the research group, which consisted of 90 participants in total. As inclusion criteria for the study, they were asked to be healthy, not have chronic diseases, to be doing sports outdoors or indoors, and as the control group, individuals who did not do sports. Participants were asked to complete a questionnaire about their socio-demographic characteristics, vitamin D level, and factors affecting body fat ratio., Results: 57.8% of the participants (52 participants) were male, and 42.2% (38 female) were female. The mean age of the study group was 22.26 ± 3.86. The body mass index (BMI) was 22.91 ± 4.06. Waist/hip ratio 0.76 ± 0.06. Serum values averages were as follows: calcium 11.74 ± 0.06, cholesterol 156.23 ± 32.34, high-density lipoprotein (HDL) 48.68 ± 12.45, magnesium 1.83 ± 0.14, phosphorus 3.52 ± 0.78, triglyceride (TGL) 120.76 ± 56.25, vit 25-OH 24.71 ± 1.35, parathormone (PTH) 48.24 ± 2.95. BMI was 21.03 ± 2.94 for those doing outdoor sports, 23.51 ± 3.31 for those who play sports in the indoor area, and 24.06 ± 5.22 for those who cannot do any sport, the difference was statistically significant (p = 0.001). Vitamin 25-OH was found to be 30.75 ± 11.54 in the outdoor sports, 21.59 ± 7.04 in the indoor sports 22.77 ± 3.16 in the non-sports groups and the difference was statistically significant (p < 0.004). Total cholesterol levels were 150.63 ± 6.09 for those doing outdoor sports, 150.92 ± 4.56 for those doing indoor sports, and 169.61 ± 6.57 for non-athletes. Total cholesterol was significantly lower in those who do sports indoors and outdoors compared to those who do not (p < 0.02 and p < 0.03, respectively)., Conclusions: Sport has a positive effect on body mass index and serum cholesterol levels. Outdoor sports have a more positive effect on the vit 25-OH levels and serum lipid profile than indoor sports.

Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not., Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not., Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]., Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands., (© 2022. The Author(s).)

Background: Acute cholecystitis (AC) is caused by chemical and bacterial inflammation of the gallbladder. The use of Tokyo guidelines is recommended in determining the diagnosis of AC and its clinical severity. In the early stages of AC, many cytokines are secreted due to the local inflammatory cell activation, leading to exacerbation of inflammation and organ failure. Ischemia modified albumin (IMA) is a type of albumin that occurs in ischemia and oxidation and is used as a marker of hypoperfusion and oxidative stress. This study aims to investigate the effectiveness of ischemia modified albumin, C-reactive protein (CRP), and some other inflammation parameters in predicting the severity of the AC on admittance., Methods: Forty-two patients diagnosed with AC and 30 healthy individuals in the control group were included in the study. The severity assessment of the patients was performed based on the revised Tokyo guidelines (TG 13). The patients were divided into 3 groups according to severity of the disease. Blood samples were taken from the subjects on admittance. Serum IMA levels were studied using an ELISA kit. SPSS 22.00 package program was used for statistical analysis., Results: Thirty (71.4%) of the participants were in the mild group, while 12 (28.6%) were in the moderate group. There were no patients in the severe group. Leukocyte, CRP, and IMA values in the patient group were higher than those of the control group (p > 0.05). According to the Tokyo classification, a significant difference was found between the groups with mild and moderate grades in terms of CRP and IMA values (p < 0.001 and p < 0.05, respectively). When the cutoff value of IMA was 84 ng/mL, the sensitivity was found to be 76% and specificity was determined to be 40% (AUC: 0.665, p = 0.017, 95% Confidence Interval)., Conclusions: It is considered that IMA could be useful in predicting the clinical severity of TG13-based acute cholecystitis and, therefore, could be used in the management of treatment by the clinician such as medical treatment, early surgery, and interval surgery.

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted., Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018., Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO 2 ) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8., Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments., Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study., Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%., Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low., Competing Interests: The data was completely anonymized, and no patient or hospital information was collected in the database. The study protocol was approved by the board of the WSES, and the study was conducted under its supervision. The board of the WSES grants the proper ethical conduct of the study.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Introduction: Hepatic ischemia-reperfusion (I/R) injury is commonly observed in severe sepsis, hemorrhagic shock, liver transplantation, hepatic resection, and major trauma. Ketamine suppresses the production of cytokines, such as IL-6 and TNF-α, via NF-κB inhibition. We investigated the anti-inflammatory effects of ketamine in liver I/R injury., Materials and Methods: Female Wistar-Albino rats (n = 18), weighing 150-200g, were divided into three groups (n = 6 each). Group I underwent reperfusion for 4h following 30 min of ischemia. Group II received 2.5 mg/kg ketamine IM following 30 min of ischemia and 4h of reperfusion and Group III received 10 mg/kg ketamine IM following 30 min of ischemia and 4h of reperfusion. Blood samples were obtained before and after ischemia and reperfusion. MDA, AST, ALT, TNF-α, IL-1β, IL-6, and NO levels were determined. Liver tissue samples were evaluated histologically., Results: Increased TNF-α, IL-1β, and IL-6 levels were observed in all groups post-ischemia versus pre-ischemia (p <0.05). The TNF-α, IL-1β, and IL-6 levels in Group III increased less than they did in Groups I and II (p <0.05). Higher MDA, NO, AST, and ALT levels were found during the ischemia and reperfusion periods compared with during the pre-ischemia period in all groups (p <0.05). The MDA, NO, AST, and ALT levels of rats that received ketamine increased less than did those of Group I (p <0.05). Significantly less injury was observed in the histopathological analysis of livers of rats administered ketamine (p <0.05)., Conclusions: Ketamine showed a dose-dependent anti-inflammatory effect in I/R injury in the liver when administered after ischemia.

Objective: To determinate the safety of the surgical treatment of acute biliary pancreatitis and acute cholecystitis in elderly patients., Study Design: Observational study., Place and Duration of Study: Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey, from January 2010 to July 2012., Methodology: Records of 172 patients with acute complications of biliary calculi, aged over 65 years, were included. Patients were assessed for demographic information, hospitalisation diagnosis, leucocyte count, ASA classification, treatment type, conversion rates, length of hospital stay, morbidity and mortality. Statiscal analyses were performed using the SPSS version 20.0., Results: The sample included 128 females (74.4%) and 44 males (25.6%). Patients' diagnoses included 135 (78.4%) acute cholecystitis and 37 (21.6%) acute pancreatitis. Medical treatment was offered to 113 patients (65.7%). Open cholecystectomy was directly performed in 17 patients (9.9%). Two patients (4.8%) were converted to an open cholecystectomy during surgery, while a laparoscopic cholecystectomy was performed sucessfully on 42 patients (24.4%). Those who underwent surgery were discharged as cured, except for minimal surgical complications., Conclusion: Treatment choice in acute gallstone complications in the elderly depends on the patient's general condition, severity of the disease, and ASAscore. Early laparoscopic cholecystectomy is a good option in selected elderly patients with acute cholecystitis and non-severe acute biliary pancreatitis.

Background: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression., Methods: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study., Results: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4., Conclusions: WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.

Objective: Previous studies have shown an association between thyroid function and insulin resistance and obesity. We compared insulin resistance and body mass index (BMI) in patients with normal TSH levels (2.5-4.2 µIU/mL), patients diagnosed with subclinical hypothyroidism, and healthy control subjects., Methods: The study included 104 subjects and was conducted at the Taksim Education and Research Hospital. The subjects were divided into three groups according to TSH levels: Group 1 (high-normal), TSH levels were 2.5-4.2 µIU/mL (n=33); Group 2 (subclinical hypothyroidism), TSH levels were 4.2-10 µIU/mL (n=42); and Group 3 (healthy control), TSH levels were 0.27-2.5 µIU/mL (n=29). The fT3 and fT4 levels were within normal limits in all groups. Insulin resistance and BMI were compared among groups. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to estimate insulin resistance., Results: HOMA-IR and BMI were not significantly different among groups (p>0.05). A significant positive correlation was found between BMI and HOMA-IR in the high-normal TSH (p>0.059) and subclinical hypothyroidism (p>0.05) groups., Conclusions: HOMA-IR and BMI are important for the assessment of diabetes and cardiovascular diseases. We found no significant difference in HOMA-IR and BMI values among the three TSH reference range groups.

Leiomyomas are benign tumours that usually originate from the genital tract organs, particularly from the uterus. Spontaneous rupture of leiomyomas is a relatively rare condition. Herein, we report a 70 years old lady who was admitted through the emergency room with sudden abdominal pain. A ruptured mass originating from the fallopian tube, causing haemoperitoneum was revealed at laparotomy. Pathological examination revealed cellular leiomyoma.

Littoral-cell angioma (LCA) is a rare vascular tumor of the spleen. It was thought to be a benign, incidental lesion. However, many recent reports have described it to be a malignant lesion with congenital and immunologic associations. We report a case of LCA of the spleen, which has been infrequently communicated in the literature. A 41-year-old female patient was admitted to our hospital with a three-week history of weakness, weight loss, anorexia, and intermittent upper abdominal pain which improved slightly with antacid medication.Imaging studies, including computed tomography (CT) and magnetic resonance imaging (MRI), showed multiple lesions in the spleen. Laparoscopic splenectomy was performed.

Background: Congenital bands cause 3 % of all intestinal obstruction and almost always lead to small bowel obstruction. In adults, obstruction due to bands is even rarer., Materials and Methods: A multicenter study in Turkey. From January 2000 to December 2010 inclusive - a period of 10 years - all adult patients admitted to the emergency departments with a clinical diagnosis of acute intestinal obstruction due to congenital peritoneal band were included in the study. Surgery was defined as emergency. Recorded operative findings included the site of obstruction, and the operative procedure to relieve it. In the present study, the findings in adult patients with congenital band reported in the literature together with findings in ten cases operated at four center were retrospectively assessed with respect to their demographic, preoperative, peroperative, and postoperative characteristics., Results: There were 8 males and 2 females aged between 18 and 72 year. There were no history of abdominal or inguinal surgery. Plain abdominal X-rays radiography revealed air- fluid levels in all patients. All the bands were ligated and divided. On histopathological examination, the bands were composed of loose connective tissue containing blood vessels. There were no calcification in the bands., Conclusion: an anomalous congenital band could be included in the differential diagnosis of intestinal obstruction. This clinical situation requires early surgical intervention that will be diagnostic and therapeutic (Tab. 1, Fig. 4, Ref. 21).

Swallowed foreign bodies encounter a major problem especially in children, but fortunately they mostly do not cause any related complication and are easily passed with the stool. In this paper, an interesting journey of a needle is presented. A 20-year old female admitted to our emergency service after she had swallowed a sewing machine needle, which is initially observed in the stomach in the plain abdominal radiography. During the follow-up period, the needle traveled through bowels, and surprisingly was observed in the left lung on 10th day of the follow-up. It was removed with a thoracotomy and pneumotomy under the fluoroscopic guidance. The postoperative period was uneventful and the patient was discharged from the hospital on the day 5. We also review the literature on interesting extra-abdominal migrations of swallowing foreign bodies.

Sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.

Little is known about the presentation, management, outcome, and recurrence of hydatid cyst perforations. We reviewed the charts of all patients admitted to our emergency service for 7 years to identify patients who were surgically treated for intra-peritoneal hydatid cyst perforations. Twelve hydatid cysts were identified in 7 patients (5 males; median age 22 yr; range 8-67). The perforations occurred spontaneously in 5 patients, and were the result of mild trauma in 2 patients. Diagnostic tools included ultrasound (US, n = 4), computed tomography (CT, n = 3), and diagnostic peritoneal lavage (DPL, n = 1). The cysts were treated with radical (n = 3) or conservative (n = 9) operative techniques. Intra-cavitary and intra-abdominal spaces were washed in 6 and 5 patients, respectively. The median follow-up time was 41 months (range 3-58). Indirect hemagglutination test was positive in 3 patients, but CT confirmed cyst recurrence in only 2 of these patients. Both had had large cysts and had undergone conservative therapy (endocystectomy and external drainage). An intra-abdominal recurrence was observed in a patient whose abdomen had not been washed during surgery. In conclusion, patients with hydatid cyst perforations in our study generally presented with severe abdominal findings. US, CT, and DPL may be helpful for the diagnosis. Recurrence may be related to operative technique, location of the cyst, and abdominal wash during the surgery.

The goal of this retrospective study was to evaluate factors that increase the risk of bowel necrosis and document the outcome of bowel resection in patients with strangulated hernias. We identified 102 patients (60 men, 42 women) who underwent surgical treatment for an incarcerated hernia at the Kartal Education and Research Hospital Emergency Unit between April 1997 and April 2001. Patients in group 1 required intestinal resection (n = 16), and patients in group 2 did not (n = 86). The median age of the patients was 53 years (range 3-96). Demographic and surgical data were obtained from the patients' charts and compared between the two groups. Women required bowel resections more often than men (p < 0.05). Patients older than 65 years and those with femoral or epigastric hernias required resection more often than patients younger than 65 years and those with inguinal, umbilical, or incisional hernias (p < 0.05 for all). Group 1 patients had a longer hospitalization and experienced more overall complications and wound infections than group 2 (p < 0.05 for all). In conclusion, incarcerated hernias are more common in men, but intestinal resection is required more often in women. The risk of intestinal resection is higher for patients with femoral hernias and those older than 65 years. Patients who undergo intestinal resection have a higher overall complication rate related to wound infections but not an increased risk of other complications or mortality.