Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Solid Variant of Aneurysmal Bone Cyst of The Rib Presenting As A Left Intrathoracic Mass Without Radiological Bone Destruction(2014) Gezer, Hasan Ozkan; Oguzkurt, Pelin; Temiz, Abdulkerim; Demir, Senay; Hicsonmez, Akgun; https://orcid.org/0000-0002-4635-2613; https://orcid.org/0000-0001-8789-6003; https://orcid.org/0000-0002-4209-9075; 25341605; J-3197-2013; A-4719-2018; AAK-9310-2021An aneurysmal bone cyst (ABC) is a benign but often rapidly expanding osteolytic multi-cystic osseous lesion that occurs as a primary, secondary, intra-osseous, extra-osseous, solid, or conventional lesion. A 15-year-old boy presented with a left-sided intrathoracic mass displacing the lung without bone destruction. The mass was totally resected without rib resection, and the pathological diagnosis was ABC. The clinical manifestations, etiology, management, and pathology are discussed, with a brief discussion regarding the difficulty in the preoperative differential diagnosis.Item Comment on "Management of Nonparasitic Splenic Cysts in Children: A French Multicenter Review of 100 Cases"(2018) Temiz, Abdulkerim; https://orcid.org/0000-0001-8789-6003; 29678406; A-4719-2018Item Choledochal Cysts in Children: Intrahepatic Ductal Dilatation Does Not Indicate True Intrahepatic Biliary Duct Disease(2016) Gezer, Hasan Ozkan; Oguzkurt, Pelin; Ince, Emine; Ezer, Semire Serin; Temiz, Abdulkerim; Hicsonmez, Akgun; https://orcid.org/0000-0002-9597-3264; https://orcid.org/0000-0001-8789-6003; 26620959; J-3197-2013; A-4719-2018Background/Aims: Choledochal cysts (CCs) are rare abnormalities of the biliary tract. Presenting our clinical experience with CCs herein, we aimed to identify if intrahepatic ductal dilatation indicates true intrahepatic biliary duct disease. Materials and Methods: We retrospectively reviewed all cases of CCs in children diagnosed at a single center (Baskent University Faculty of Medicine, Department of Pediatric Surgery) institution from 2005 to 2015. Results: Of 18 patients with CCs, 7 were males (39%). The age range was 3 months to 17 years (mean age, 6.2 +/- 3.8 years). Intrahepatic bile duct dilatation was detected in 13 (72%) patients by preoperative scanning. Type I, II, III, and IVA cysts were diagnosed in 13, 1, 1, and 3 patients, respectively. In all patients, total cyst excision and Roux-en-Y hepaticoenterostomy were performed. Conclusion: In this study, most intrahepatic ductal dilatations seen on preoperative imaging were thought to be caused by a distal obstruction, not true intrahepatic biliary duct disease. This study supports the hypothesis that preoperatively distinguishing between type I and type IVA CCs is not necessary; it does not affect the initial treatment. We consider that complete cyst excision with Roux-en-Y hepaticojejunostomy is safe and should be performed soon after diagnosis, irrespective of symptom severity to avoid future complications.Item Meckel Diverticulum in Children: Evaluation of Macroscopic Appearance for Guidance in Subsequent Surgery(2016) Gezer, Hasan Ozkan; Temiz, Abdulkerim; Ince, Emine; Ezer, Semire Serin; Hasbay, Bermal; Hicsonmez, Akgun; 0000-0002-4635-2613; 0000-0001-8789-6003; 0000-0002-9597-3264; 26435520; J-3197-2013; A-4719-2018; AAJ-9529-2021Background: The treatment of incidentally encountered asymptomatic Meckel diverticulum(MD) is controversial. We evaluated whether the macroscopic appearance correlates with clinical features, histopathological findings, future complications, and management decisions. Methods: Patients who underwent MD resection at a single institution from 2000 to 2012 were retrospectively analyzed in terms of age, sex, clinical features, laboratory data, perioperative findings (diverticulum length, diameter, depth, thickening, and height-to diameter ratio [HDR]), pathology, and postoperative follow-up. Results: Fifty children were enrolled. Sixteen percent of the resected MDs were found incidentally. Of 42 complicated MDs, 17 (40%) were long (HDR >= 2), 14 (33%) were thickened, and 29 (70%) exhibited base widening. Histopathologically, ectopic mucosa was found in 32 (64%) of all MDs and in 5 (62%) of incidentally removed MDs. There was no statistical difference between the macroscopic appearance and clinical signs, sex, or presence of ectopic tissue based on palpation. Conclusion: The macroscopic appearance of MD does not indicate the presence or absence of HGM and cannot be used to guide subsequent surgery. Additionally, 40% of symptomatic patients in our study had life-threatening complications requiring prompt fluid resuscitation. We consider that incidentally detected MD should be removed regardless of its macroscopic appearance. (C) 2016 Elsevier Inc. All rights reserved.Item Intestinal Malrotation Needs Immediate Consideration and Investigation(2016) Ezer, Semire Serin; Oguzkurt, Pelin; Temiz, Abdulkerim; Ince, Emine; Gezer, Hasan Ozkan; Demir, Senay; Hicsonmez, Akgun; 0000-0002-4209-9075; 0000-0001-8789-6003; 0000-0002-4635-2613; 0000-0002-9597-3264; 27353636; AAK-9310-2021; J-3197-2013; AAJ-9529-2021; A-4719-2018BackgroundThe aim of this study was to evaluate clinical presentation, diagnostic studies, and volvulus rate and to describe the unusual clinical clues of intestinal malrotation. MethodsA retrospective descriptive review was carried out of all patients diagnosed with intestinal malrotation between 2002 and 2014. Patients were divided into two groups: infants (1year, n=16; group 1); and children (>1year, n=12; group 2). Patient demographics, clinical history, symptoms, physical examination, diagnostic work-up, operative findings and early outcome were evaluated. ResultsBilious vomiting was the cardinal complaint in both groups. Unusual symptoms such as respiratory insufficiency, dehydration, afebrile convulsion, and lethargy were prominent symptoms in six patients in group 1, whereas history of frequent hospitalization due to recurrent abdominal pain and feeding intolerance were prominent in six patients in group 2. Midgut volvulus was identified in 15 patients, four of whom were in group 2. Standard Ladd's procedure was done in addition to correction of volvulus. ConclusionMalrotation with or without midgut volvulus is not a rare condition and should be kept in mind for any age group. Specific signs of diagnosis are not easily identified. In the case of unusual clinical presentation, diagnosis may be delayed and can result in catastrophic consequences if intestinal perfusion occurs. Although midgut volvulus is seen most frequently in infants, risk and complication rate are high beyond 1year of age as well, and can manifest as failure to thrive, food intolerance, and abdominal pain needing recurrent hospitalization. Diagnostic suspicion and interdisciplinary coordination are essential for timely diagnosis and surgical treatment.Item Management of Traumatic Bile Duct Injuries in Children(2018) Temiz, Abdulkerim; Ezer, Semire Serin; Gedikoglu, Murat; Serin, Ender; Ince, Emine; Gezer, Hasan Ozkan; Canan, Mehmet Oguz; Hicsonmez, Akgun; https://orcid.org/0000-0001-8789-6003; https://orcid.org/0000-0002-9597-3264; https://orcid.org/0000-0002-0138-6107; https://orcid.org/0000-0002-4635-2613; https://orcid.org/0000-0003-0614-4497; 29948144; A-4719-2018; AAJ-9529-2021; AAM-7281-2021; J-3197-2013; AAI-9386-2021Pediatric experience with biliary tract injuries (BTI) is limited and mostly consists of case presentations. The purpose of this study is to evaluate clinical and radiological findings of possible BTI, treatment strategies, and results. The records of nine patients with the diagnosis of BTI between July 2009 and November 2017 were reviewed retrospectively. There were seven boys and two girls (mean 8.05 +/- 4.39 years). The mechanisms were motor vehicle occupant, fall, crush and gunshot wound. Hepatic laceration routes that extended into the porta hepatis and contracted the gall bladder were demonstrated on computerized tomography (CT). Bile duct injury was diagnosed with bile leakage from the thoracic tube (n = 2), from the abdominal drain (n = 2) and by paracentesis (n = 5). Extrahepatic (n = 8) and intrahepatic (n = 1) bile duct injuries were diagnosed by cholangiography. Endoscopic retrograde cholangiography, sphincterotomy, and stent placement were successfully completed in five patients. Peritoneal drainage stopped after 3-17 days of procedure in four patients. The fifth patient was operated with the diagnosis of cystic duct avulsion. Cholecystectomies, primary repair of laceration, cystic duct ligation, and Roux-en-Y hepatoportoenterostomy were performed in the remaining four patients. All patients presented with clinically normal findings, normal liver functions, and normal ultrasonographic findings in the follow-up period. The presentation of the parenchymal injury extending to the porta hepatis with contracted gall bladder on CT and diffuse homogenous abdominal fluid should be considered as signs of BTI. We suggest a multi-disciplinary approach for the diagnosis and treatment of BTIs. Surgery may be indicated according to the patient's clinical condition, radiological findings and failure of non-operative treatment.Item Hedgehog Signal Defect Leading to Familial Exudative Vitreoretinopathy-Like Disease and Gastrointestinal Malformation(2022) Keskek, Nedime Sahinoglu; Akkoyun, Imren; Temiz, Abdulkerim; Kutuk, Ozgur; https://orcid.org/0000-0001-8544-103X; https://orcid.org/0000-0002-2860-7424; https://orcid.org/0000-0001-9854-7220; 35770050; T-4258-2017; AAK-7713-2021Objectives: The aim of the study was to present a new generic association presenting with gastrointestinal tract malformations (GTMs) and familial exudative vitreoretinopathy (FEVR)-like disease and review the genetics of Hedgehog signaling. Materials and Methods: Three neonates were diagnosed with FEVR-like retinal vascular disease upon routine ophthalmological examination during hospitalization in the neonatal surgical intensive care unit for GTMs. Generic analysis of the neonates was performed. Results: Gestational age of the neonates was 39, 38, and 39 weeks and birth weights were 3,500, 3,600, and 3,300 grams, respectively. All six eyes of the three infants were treated by laser photocoagulation. Recurrence was not seen in any of the eyes. Genetical analysis of all the neonates diagnosed with FEVR-like disease revealed defects in the Hedgehog pathway. Conclusion: FEVR is a genetically well-defined retinal vascular disease. The current study is the first to show an association between FEVR-like retinal vascular disease and GTMs. This study demonstrates the importance of the Hedgehog pathway in retinal vascular and gut development.Item Letter to Editor in response to: CT scans for pediatric injury in a middle-income country trauma center: Are we repeating past mistakes?(2022) Acer-Demir, Tugba; Temiz, Abdulkerim; https://orcid.org/0000-0001-5391-9094; 35613978; E-4455-2019Item Pancreatic Tumors in Children(2021) Gezer, Hasan Ozkan; Temiz, Abdulkerim; Ezer, Semire; Yazici, Nalan; Demir, Senay; Hasbay, Bermal; Oguzkurt, Pelin; 0000-0002-4635-2613; 0000-0002-4209-9075; 0000-0001-6702-7265; A-4719-2018; AAJ-9529-2021; AAM-5138-2021; AAK-9310-2021Objective: Pancreatic rumors in children are exceedingly rare and hence present diagnostic and therapeutic challenges to pediatric surgeons. In this study, we aimed to present our experiences and treatment outcomes related to these rare tumors. Methods: The clinical data, laboratory investigations, radiological imaging, and the pathology and surgical details of patients with pancreatic tumors who were diagnosed between 2005 and 2019 were retrospectively reviewed. Results: A total of 9 patients (5 men) were included in the study. The most common symptom at the time of presentation was vague abdominal pain. A pancreatic rumor was detected incidentally in 4 patients. All tumors were non-functional primary rumors. Histopathological diagnosis of these tumors were solid-pseudopapillary tumors (n=3), congenital pancreatic cysts (n=3), pancreatoblastoma (n=1), rhabdomyosarcoma (n=1), and an undifferentiated carcinoma (n=1). In addition, 8 patients were treated surgically (through tumor excision, central pancreatectomy + distal pancreaticojejunostomy, distal pancreatectomy, and cystogastrostomy). Two deaths from tumor dissemination were recorded. The patients were followed-up at a mean duration of 72 months (range: 6-120 months). Conclusion: Pediatric pancreatic tumors arc rare and are usually benign in nature. They present symptoms that are often nonspecific. In non-metastatic cases, surgical tumor removal is the preferred method for the treatment. For most tumors, surgical resection is the optimal treatment that may be successfully performed with low morbidity rate when the lesion is either in the body or in the tail of the pancreas. The long-term outcomes with this approach are generally good.Item Ingested foreign bodies in children: Do they really pass spontaneously from the gastrointestinal tract? A single-centre experience with 1000 cases(2020) Gezer, Hasan Ozkan; Ezer, Semire Serin; Temiz, Abdulkerim; Ince, Emine; Hicsonmez, Akgun; 0000-0002-9597-3264; 0000-0002-4635-2613; 0000-0001-8789-6003; 32185763; AAJ-9529-2021; J-3197-2013; A-4719-2018BACKGROUND: Foreign body (FB) ingestion is frequently encountered in all departments that treat children. FB may bring about significant anxiety for parents and physicians. The present study aims to determine the appropriate approach for FB ingestion in children. METHODS: The records of 1000 children with a history of FB ingestion between the years 2005 and 2017 were reviewed retrospectively in this study. RESULTS: Of 1000 children, 53.8% were male. The most common types of FBs were coins (35%). X-ray was negative in 49% of the patients, and 86% of these patients received no intervention. Of the 504 (51%) X-ray-positive patients, the oesophagus (68%) was the most common location. Life-threatening complications were tracheo-oesophageal fistula (I), Meckel's diverticulum perforation (I), and perforation due to rigid endoscopy (I). CONCLUSION: We demonstrated that coins, which are the most commonly ingested FBs, have various types and sizes according to their countries of origin, and this affects spontaneous passage. We found that only 48% (quite low compared to the literature) of the coins passed spontaneously. In asymptomatic patients with a gastric button battery, we suggest a "watchful waiting" approach. The patients should be observed and managed at home. In our study, we found that 85% of the button batteries that reached the stomach passed spontaneously.