The diagnosis of left lower quadrant pain is based on well-established clinical symptoms, physical examination and physician's experience.

No abstract

HighlightsThis is a rare diagnosis, and the differential diagnosis often includes more common causes of inguinal masses.In this document, we aimed to present the rare case of a Nuck canal cyst.

Tuberculosis should be considered in the list of differential diagnoses for thyroid abscesses and nodular lesions in people living in geographic regions with a high tuberculosis prevalence.

Purpose: LigaSure (ValleyLab, CO, USA) is a bipolar diathermy system that seals vessels with reduced thermal spread. The device has been used successfully in abdominal surgery and has been introduced as a new method for hemostasis during thyroidectomy. This study compares the efficacy and advantages of LigaSure, when used for thyroidectomy in benign nodular thyroid disease, with the conventional clamp-and-tie technique. Methods: Between December 2003 and December 2008, 410 patients underwent thyroid surgery (333 with the conventional clamp-and-tie technique and 77 with LigaSure). Nine patients did not sign the ethical approval document and so were excluded from the study; the results of 68 LigaSure patients were evaluated. The main outcomes measured were age, sex, operating time, postoperative hypocalcemia, recurrent laryngeal nerve palsy, and drain use. 0078-6 11 Statistical analysis consisted of the chi-squared test and Student's t-test. Results: The mean operating time was significantly shorter in the LigaSure group by 24.1±1.7 minutes for a total thyroidectomy (P<0.0001) and 7.6±0.1 minutes for one side total plus other side subtotal thyroidectomy (P<0.0001). Bleeding during surgery was significantly lower in the LigaSure group (P<0.0001). There were no significant differences between the study groups in terms of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy, and postthyroidectomy hemorrhage. Conclusion: TheLigaSure vessel sealer is a safe, effective alternative for thyroid surgery that reduces the overall operating time. However, its higher cost is a significant handicap for its use in surgery in developing countries.

In cases of GI bleeding the awareness of the surgeon should be drawn to a clinical suspicion of hemobilia and an underlying hepatic artery pseudoaneurysm that can arise as a complication. CT angiography should be performed for early diagnosis and management in such patients.

BACKGROUND AND OBJECTIVESThe incidence of primary extrahepatic cystic echinococcosis (CE) is rare. Generally, radiological and serological findings can help establish the diagnosis of hepatic and pulmonary CE, but a CE in an unusual location with atypical radiological findings may complicate the differential diagnosis. The objective of this study is to present the characteristics of cases with extrahepatic CE in respect of sites of involvement, clinical presentations, radiological findings, serological diagnostic evaluations, and outcomes of infected patients.DESIGN AND SETTINGSA retrospective analysis of surgically treated CE was conducted between January 1993 and January 2014 in the General Surgery, Pediatric Surgery, Urology, Cardiovascular Surgery, Neurosurgery, and Orthopedics departments of University of Cukurova, Faculty of Medicine, Balcalı Hospital.PATIENTS AND METHODSAmong the 661 patients managed for CE, 134 had unusual sites of involvement. Radiological and serological examinations were used to differentiate CE from alveolar echinococcosis.RESULTSOf 134 cases with unusual sites of involvement, 32 cases had liver CE (23.9%), 7 cases had lung CE (5.2%), and 2 cases had concomitant liver and lung CE (1.5%). In 93 (69.4%) cases, unusual organ involvement was isolated without any liver or lung involvement. The mean age was 45 years. Abdominal pain was the main symptom and was found in 104 patients. Thirty-one (23.1%) of 134 extrahepatic CE cases were evaluated as negative with indirect hemagglutination (IHA). However, positive results were obtained in 54 cases evaluated with Echinococcus granulosus IgG Western blot (WB), including 10 IHA-negative cases.CONCLUSIONCE with unusual localizations may cause serious problems of diagnostic confusion. The combination of clinical history, radiological findings, and serological test results (especially the WB) are valuable in diagnosing extrahepatic CE.

In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier's gangrene patients. Fourty-eight patients with diagnosis of Fournier's gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients' relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients' satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters.