HighlightsPhysicians treating this heterogeneous disease need to know the complex underlying mechanisms as well as the multiple management options.Operative approach is still the definitive treatment and can be preferred to improve patients’ quality of life and to prevent more severe symptoms from developing.Rare and difficult diagnosis of jejunal diverticulum perforation in elderly patients presenting with acute abdomen should be considered in the differential diagnosis.

A 42-year-old female patient with no previous known diseases who had complaints of postprandial epigastric pain and weight loss and who could not be diagnosed by endoscopic biopsy, although gastric cancer was suspected radiologically and endoscopically, was diagnosed with primary gastric tuberculosis by laparotomy and frozen section. Following anti-tuberculosis treatment, a complete clinical, radiological, and endoscopic response was achieved.

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.

No abstract

Öz Purpose: A significant number of the protective stomas temporarily applied in order to reduce the effects of anastomosis complications after rectal cancer surgery cannot be closed and become permanent. In this study, the causes that can lead to a permanent stoma were investigated. Materials and Methods: Patients who underwent elective surgery with low anterior resection and protective ileostomy due to rectal cancer were included in the study. Patients whose stoma could not be closed within one year were evaluated as permanent stoma. Results: 66 patients were included in the study. The mean closing time for the stomas were found as 5, 6 +2,5 (1-12)months. The stomas of twelve (18.2%) of the patients could not be closed and became permanent. The presence of metastatic disease at the time of diagnosis, the proximity of the anastomosis to the anal entry, coloanal anastomosis, and the final pathology showing stage IIIC were found to be risk factors for permanent stoma. Conclusion: Some of the stomas applied temporarily due to surgical treatment of rectal cancer became permanent. Before the index operation, the patient and their relatives should be informed that in the presence of certain risk factors, these stomas may not be closed and become permanent. Amaç: Rektum kanseri cerrahisi sonrası anastomoz komplikasyonlarının etkilerini azaltmak amacı ile geçici amaçla uygulanan koruyucu stomaların önemli bir kısmı kapatılamayarak kalıcı hale gelmektedir. Bu çalışmada kalıcı stomaya neden olabilecek nedenler araştırılmıştır. Gereç ve Yöntem: 2015-2018 tarihleri arasında elektif şartlarda rektum kanseri nedeni ile aşağıanterior rezeksiyon ve koruyucu ileostomi uygulanan hastalar çalışmaya alındı. Bir yıl içerisinde stoması kapatılamayan hastalar kalıcı stoma olarak değerlendirildi. Bulgular: Çalışmaya 66 hasta dahil oldu. Stomaların ortalama kapatılma süresi 5,6 +2,5 (1-12) ay olarak bulundu. On iki hastanın (%18,2) stoması kapatılamayarak kalıcı hale geldi. Tanı anında metastatik hastalık varlığı, anastomozun anal girime yakınlığı, koloanalanastomoz yapılması, cerrahi sonrası patoloji sonucunun evre IIIC olmasıstoma kapatılamaması açısından risk faktörü olarak bulundu. Sonuç: Rektum kanseri cerrahi tedavisinde geçici amaçla uygulanan stomaların bir kısmı kalıcı hale gelmektedir. İndeks operasyondan önce hasta ve yakınlarına, bazı risk faktörü ya da faktörleri varlığında bu stomaların kapatılamayarak kalıcı hale gelebileceği bilgisi verilmelidir.