PubMed Health⌕ Search

Biomedical subjects

Durkaya Oren

Publications and source records attributed to Durkaya Oren.

6 recordsLinked to original sources
PubMed2007

Ileosigmoidal knotting in children: a review of 9 cases.

BACKGROUND: The purpose of this study was to review nine pediatric cases of ileosigmoidal knotting (ISK), which is an unusual form of intestinal obstruction common in adults, characterized by double-loop obstruction. METHODS: A retrospective analysis was designed to examine preoperative, operative, and postoperative findings of the nine children with ISK who were surgically treated in a university hospital throughout a 38.5-year period. RESULTS: The mean age was 10.6 years (range: 7-16 years). Seven patients (77.8 %) were male. The most common symptoms were abdominal pain, distention, obstipation, and vomiting, and the most common signs were abdominal tenderness and distention. The most common form was type 1A in 4 patients (44.4%) in whom the active ileum encircled the passive sigmoid colon in clockwise direction. There was a gangrene in both ileum and sigmoid colon in 7 patients (77.8%), one patient (11.1%) had gangrene in only the sigmoid colon, and the bowels were viable in 1 patient (11.1%). In the gangrenous cases, nonviable small bowel segments were resected, and anastomosis was performed, while gangrenous sigmoid colon was resected and Hartmann procedure or primary anastomosis was used. In the nongangrenous case, detorsion was performed and sigmoidopexy was added. One patient in this series (11.1%) died. CONCLUSIONS: Ileosigmoidal knotting is a rare disease in children. Its preoperative diagnosis is not easy. It is generally misdiagnosed as an obstructive emergency. Aggressive preoperative resuscitation, effective and prompt surgery, and postoperative support are the basic principles of treatment. Although resection with primary anastomosis is advised in gangrenous cases, stomas may be lifesaving in unstable patients. In nongangrenous cases, definitive surgical procedures are generally used.

Adolescent↗
PubMed2007

An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases.

PURPOSE: This study was designed to review the outcomes of emergent treatment of sigmoid colon volvulus. METHODS: The records of 827 patients were reviewed retrospectively. RESULTS: The mean age was 57.9 years (range, 10 weeks to 98 years), and 688 patients (83.2 percent) were male. Nonoperative reduction was applied in 575 patients (barium enema in 13, rigid sigmoidoscopy in 351, and flexible sigmoidoscopy in 211, with rectal tube placement in all patients). The results were as follows: success of 78.1 percent, mortality of 0.9 percent, complication of 3 percent, and early recurrence of 3.3 percent. Surgical treatment was performed on 393 patients (detorsion in 46, mesosigmoidopexy in 56, exteriorization in 4, resection with Hartmann's procedure in 146, resection with Mikulicz procedure in 14, resection with primary anastomosis in 51, tube cecostomy and colonic cleansing with resection in 75, and laparotomy in 1). The results were as follows: mortality of 15.8 percent, complication of 37.2 percent, early recurrence of 0.8 percent, and late recurrence of 6.7 percent. CONCLUSIONS: Nonoperative reduction is the initial treatment of sigmoid colon volvulus, and flexible sigmoidoscopy with rectal tube placement can be used successfully. Patients in whom bowel gangrene or peritonitis is present or nonoperative treatment is unsuccessful need emergency surgery. In surgical treatment, resection and primary anastomosis is the first choice, and it can be performed with acceptable mortality and morbidity rates if the patient is stable and a tension-free anastomosis is possible. Nondefinitive procedures have high recurrence rates; thus, definitive surgical techniques must be preferred.

Adolescent↗
PubMed2005

Internal herniation concurrent with ileosigmoid knotting or sigmoid volvulus: Presentation of 12 patients.

BACKGROUND: Internal herniation concurrent with ileosigmoid knotting or sigmoid volvulus is an unusual and complex form of closed-loop obstruction that may result in a fatal outcome unless treated timely and properly. The aim of this article was to review our experience with this condition, with emphasis on the etiopathogenesis, clinicopathologic features, and treatment options. METHODS: We conducted a retrospective analysis of medical records of 12 patients treated at 2 university hospitals over a period of 30 years between 1970 and 2000. RESULTS: In this series, the internal herniation resulted in ileosigmoid knotting in 8 cases, whereas it was concomitant with sigmoid volvulus in 4 cases. The types of internal herniation were identified as transmesenteric through the Treves field in 8 patients and as transomental, intersigmoidal, pericecal, and around omphalomesenteric fibrous cord in 1 patient each. The rate of gangrenous bowel was 100%. En bloc resection for combined gangrene of small bowel and large bowel was the treatment of choice in 7 patients, of whom 5 underwent the Hartmann's procedure and 2 underwent primary sigmoidectomy-anastomosis in addition to primary enterectomy-anastomosis. Primary sigmoidectomy-anastomosis and Mikulicz's procedure were performed in 2 patients for gangrenous sigmoid colon only. Three patients underwent primary enterectomy-anastomosis for gangrenous small bowel only. The morbidity rates and the mortality rate were both 33.3%. The mean length of hospital stay following emergency operations was 11.2 days. CONCLUSIONS: In particular, surgeons who are from developing countries that form the world's "volvulus belt" should be aware of this entity's features and be ready to perform an appropriately selected surgical option for a given patient to accomplish the optimal clinical outcome.

Adolescent↗
PubMed2004

Ileosigmoidal knotting: outcome in 63 patients.

PURPOSE: This study was designed to review the outcomes of 63 patients with ileosigmoidal knotting. METHODS: Sixty-three, surgically treated patients (47 males; 74.6 percent) were reviewed retrospectively. The mean age was 45.6 (range, 7-75) years. The most common symptoms were abdominal pain and obstipation, and the most common signs were abdominal tenderness and distention. The preoperative diagnosis was obstructive emergencies in 49 patients (77.8 percent) and nonobstructive emergencies in 14 (22.2 percent). RESULTS: All patients underwent emergency laparotomy. The most common type of ileosigmoidal knotting was Type 1A in 30 patients (47.6 percent), in which the active ileum encircled the passive sigmoid colon in a clockwise direction. Fifty patients (79.4 percent) developed gangrenous bowel. Resection of gangrenous segments and enteroenteric or enterocolic anastomosis combined with the Hartmann procedure was the most preferred operation, used in 34 patients (54 percent). The mortality rate was 15.9 percent (10 patients), and toxic shock was the most frequent cause of death. CONCLUSIONS: Ileosigmoidal knotting is a rare but serious form of intestinal obstruction. Its preoperative diagnosis is difficult and may present as an obstructive or nonobstructive emergency. Early and effective resuscitation, prompt surgical intervention selected on the basis of clinical and operative findings, and effective postoperative intensive care are the basis of treatment.

Adolescent↗
PubMed2002

Hydatid disease in childhood.

To review the results of different modalities of treatment of hydatid disease of the liver (HDL) in pediatric patients, 31 children treated surgically between 1990 and 2000 at the departments of general surgery and pediatric surgery, Atatürk University School of Medicine, were reviewed retrospectively; 19 were male and 12 were female. The mean age was 8.4 years (range 4-12 years). The most common complaints were an abdominal mass and right-upper-quadrant pain, which were present in 35.5% and 77.4% of cases, respectively. Twenty-five cysts were in the right lobe, 2 in the left lobe, and 4 in both lobes; 8 patients had multiple hepatic cysts and 5 had coexisting cysts in other organs. Surgical procedures were: unroofing plus tube drainage (UTD); capitonnage; omentoplasty; and pericystectomy. Of the patients treated by UTD, 2 developed cholangitis and 1 developed a biliary fistula. Of the patients with capitonnage, 1 developed cholangitis. Surgery is still one of treatment modalities for management of HDL. Omentoplasty and capitonnage are the most effective modalities for the management of the cyst cavity.

Child↗