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Of all ingested foreign bodies, 2.4% comprise of sewing needles. Through perforation of gastrointestinal tract, which occurs in 1% of cases, they can migrate into the liver and pancreas. Foreign bodies in pancreas should be considered in the differential diagnosis of chronic abdominal pain. Computed tomography scans provide valuable information for the localization of the lesion, which guide the surgeon during the operation. Secondary to foreign bodies that migrate to the pancreas, complications with high mortality such as pancreatitis, pseudoaneurysm, and pancreas abscess can be seen. Thus, for this patient group, diagnostic laparoscopy is recommended, considering its advantages of decreased postoperative pain, decreased wound infection, and faster recovery time. Here we present a case of a 23-year-old female patient, from whom an ingested needle that migrated from the back wall of the stomach to the pancreas was extracted by laparoscopic surgery. Keywords: Sewing needle, pancreas, laparoscopy INTRODUCTIONOut of all the ingested foreign bodies, 43.7% are organic, 56.3% are inorganic, and 2.4% are sewing needles. Most of the ingested foreign bodies are excreted spontaneously (1). These foreign bodies may reach pancreas and liver in 1% of patients, through penetration of small intestine or stomach wall (1, 2). Foreign bodies in pancreas might cause serious complications such as pancreatitis, pancreatic abscess, and pseudoaneurysm. These should be removed either endoscopically or surgically (1, 3, 4). In few cases, foreign bodies can also be removed using open surgical techniques (2, 5). However, the suggested technique is the laparoscopic approach before open surgery (3, 6, 7). Here we report the case of a 23-year-old female patient, who presented with epigastric pain and a sewing needle was removed laparoscopically from her pancreas parenchyma. CASE PRESENTATIONA 23-year-old female patient presented with epigastric pain and retrosternal burns that continued intermittently for seven years. She had used proton pump inhibitors (PPI) and as her symptoms did not resolve, she presented to the hospital. In her physical examination, there was minimal tenderness and discomfort in the epigastric area without rebound sign or defense. Laboratory blood tests including her hemogram, biochemical markers, liver function tests, kidney function tests, and amylase levels were within normal limits. Her standing abdominal x-ray was also normal ( Figure 1a). During gastroscopy, no sign of any pathology related to a foreign body was observed. We performed a barium follow-through x-ray with an initial diagnosis of gastroesophageal reflux disease, and in this test, we observed a foreign body in the epigastric area (Figure 1b). When patient's medical history was questioned again, it was found that she had accidentally swallowed a sewing needle seven years ago. She underwent computed tomography screening and we saw that a foreign body was present starting from the posterior side of the stomach reaching head and body of the pancreas. (Fig...

Here, we report the case of an 84-year-old woman with acute mechanical intestinal obstruction (AMIO) who was admitted to our Emergency Department. Computed tomography (CT) scan revealed an incarcerated bilateral obturator hernia, and the defect was resolved using transabdominal preperitoneal (TAPP) technique with polypropylene mesh. The patient was administered an oral regimen two days after the operation. The patient stayed in the intensive care unit for 4 days and was uneventfully discharged on the 9th postoperative day. Follow-up was scheduled at the 6th month, during which no adverse events were detected and the patient did not report any complaints. Obturator hernia is among the differential diagnoses of intestinal obstruction requiring early diagnosis and prompt surgical intervention. Laparoscopic approach is less invasive compared with open surgery, and it can be attempted in cases presenting with no sign of ischemia or peritonitis. TAPP technique should be preferred since it allows the control of all intraabdominal pathologies and the viability of the intestines.

BACKGROUND: The determination of a definitive preoperative diagnosis of acute appendicitis (AA) remains a challenge; however, delays in diagnosis increase complication rates. The aim of this study was to investigate the contribution of the Alvarado score (AS) alone and the AS combined with the use of the biological indicators of C-reactive protein (CRP), procalcitonin (PCT) and neopterin (NP) in the diagnosis. METHODS: Serum was collected from 100 patients who were admitted to the general surgery clinic of Istanbul University, Cerrahpasa Medical Faculty between March 4, 2014 and July 29, 2015 with the pre-diagnosis of AA and who agreed to take part in the study. The serum samples were stored at-70°C. The patients were divided into 2 groups: AA-positive (n=60) and AA-negative (n=40). The AA positive group was divided into subgroups of complicated (n=11), uncomplicated AA (n=49) and the AS, CRP, PCT, NP levels were compared. RESULTS: The study population consisted of 45 men (45%) and 55 women (55%), with a mean age of 32.8±13.7 years (range: 18-92 years). There was no significant difference between the groups in age and gender. There were 24 patients with an AS ≤4 (3 had surgery), 35 patients with an AS of 5-7 (22 had surgery), and 41 patients with an AS of 8-10 (38 had surgery). Three of the 63 patients who underwent surgery were diagnosed with a normal appendix. The serum CRP, PCT, and NP measures were found to be inadequate to make an AA diagnosis alone, these values increased the sensitivity and specificity of the AS. The biological indicators were also significant in differentiating between the complicated and uncomplicated AA groups (p<0.05). CONCLUSION: Although the AS is useful, additional testing and clinical approaches are valuable to inform the diagnostic procedure. When considered alone, serum CRP, PCT and NP values are insufficient for a diagnosis of AA. However, they increased the diagnostic value of the AS and can be helpful in distinguishing complicated AA cases.

IntroductionMetallic foreign bodies (MFB) within the breast develop out of surgical clips, broken pieces of guide-wires and gunshot injuries (GSI) (1). As such, metallic foreign bodies can cause local breast pain, abscess, cardiac tamponade, granuloma or pneumothorax, which are clinically significant (1-2). In this report, we aim to present a 35-year-old female patient diagnosed with a metallic foreign body in the left breast as the second case in the literature in which radio-guided occult lesion localization (ROLL) was used for the excision of the foreign body. Case PresentionA 35-year-old female patient presented to the general surgery department with pain in the left breast. She had a history of a gunshot wound in the breast four months ago, shortly after which the symptoms had started. The patient told that the bullet was still in her breast. Physical examination revealed tenderness in the upper outer quadrant of the left breast. The breast ultrasound indicated a 10 mm hyperechoic formation in the upper outer quadrant of the left breast. The mammography and chest x-ray confirmed the presence of a 10 mm hyperdense MFB within the breast. The object was not fragmented (Figure 1-2). It was decided to surgically remove the foreign body and written informed consent from the patient was obtained. On the morning of surgery, the MFB was marked using the ROLL technique in the radiology unit. The foreign body was excised along with the surrounding fibrosis and inflammatory breast tissue by applying a gamma probe through a 3 cm incision in a 20-minute operation. Specimen mammography was performed on the excision material to confirm that the MFB was located within the tissue (Figure 3). Discussion and ConclusionSince metallic foreign bodies can cause symptoms such as local breast pain, abscess, cardiac tamponade, granuloma or pneumothorax, they have clinical importance (1-2). Korbin et al. (3) reported broken guide-wire pieces in 5 of 3500 patients who underwent guide-wire biopsy. Montrey et al. (4) reported that the most common types of MFB in the breast are surgical clips and broken pieces of guide-wires. In that same study, the prevalence of MFB related to broken guide-wire pieces was found to be 0.2%. As reported in several studies addressing MFB in the breast, surgical clips, pieces of guide-wires and GSIs are the most common factors in etiology. Mammography is usually helpful for the diagnosis (1, 2, 5). In our case, the patient had a history of GSI as well as pain in the left breast as consistent with the literature. The MFB was clearly visualised in ultrasound, mammography and chest x-ray. Eur J Breast Health 2017; 13: 159-160 DOI: 10.5152/ejbh.2017.3428 159 Extraction of a Foreign ABSTRACTThe most common clinical causes of metallic foreign body in the breast are surgical clips, pieces of guide-wire and gunshot wounds. Metallic foreign bodies can lead to local breast pain, abscesses, pneumothorax after granulomas or migration, and cardiac tamponade. Mammotome biopsy, fluoroscopy, guide-wire biopsy and radi...

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