Mikail Çakır - Academia.edu (original) (raw)

Papers by Mikail Çakır

Research paper thumbnail of Isolated Hydatid Cyst of the Spleen: A Case Report

Research paper thumbnail of A Fast and Reliable Method to Interpret Short-Term Mortality in Perforated Peptic Ulcer: Red Cell Distribution Width is Sensitive and Specific

Surgery Research and Practice, 2021

Introduction. Peptic ulcer is an important health problem worldwide with a prevalence of around 5... more Introduction. Peptic ulcer is an important health problem worldwide with a prevalence of around 5%. Peptic ulcer perforation is a potentially mortal complication of peptic ulcer disease. We aimed to investigate the potential use of red cell distribution width as a prognostic marker in peptic ulcer perforation. Methods. The files, operation notes, biochemical and hematological parameters, and prognosis of patients who were operated for a peptic ulcer perforation were reviewed in a retrospective cohort study. The relation of red cell distribution width (RDW) to main outcome in-hospital mortality was assessed. Results. The mean age of the 172 patients was 40 ± 17.89. There were 158 (92%) males and 14 (8%) females. The in-hospital mortality was 8.7% (15/172). The median RDW in the group with mortality was 15.00 (interquartile range (IQR): 14.30–17.20) compared with the median RDW in the group with no mortality as 13.2 (IQR: 12.80–14.00, p ≤ 0.001 ). Receiver operator characteristic curv...

Research paper thumbnail of Elevated serum bilirubin levels may predict perforation of the appendix

Annali italiani di chirurgia, 2019

AIM Acute appendicitis is one of the most common pathology requiring emergency operations, and if... more AIM Acute appendicitis is one of the most common pathology requiring emergency operations, and if perforated, can cause morbidity and mortality. The serum bilirubin levels were studied to see whether an elevation predicted perforation. MATERIAL AND METHODS In a retrospective cohort study the medical files of 221 patients who were operated for acute appendicitis were reviewed. RESULTS Total and indirect bilirubin levels were significantly higher in patients with a perforated appendicitis compared with patients with simple appendicitis. Elevated serum bilirubin had a sensitivity of 50.00 (95% CI 29.93 to 70.07) and a specificity of 80.73 (95% CI 74.43 to 86.05) when predicting a perforated appendicitis. CONCLUSIONS Appendiceal perforation may be accompanied with elevated serum bilirubin level. Assessment of bilirubin levels must be a part of the initial evaluation of a suspected appendicitis in the emergency room. KEY WORDS Acute appendicitis, Gangrenous appendicitis, Perforated appen...

Research paper thumbnail of Endoscopic Retrograde Cholangiopancreatography Related Bleeding Complication and Easy Management

Medical Bulletin of Haseki, 2020

Research paper thumbnail of Practices in Obstructive Jaundice as An Emergency: A Training and Research Hospital Experience

İstanbul Kanuni Sultan Süleyman Tıp Dergisi, 2020

Objective: Management of emergency obstructive jaundice is quite complicated. It is important to ... more Objective: Management of emergency obstructive jaundice is quite complicated. It is important to select appropriate imaging methods to make differential diagnosis of a large number of causes. Providing proper biliary drainage is important in patient stabilization. Our aim is to reveal practical points in diagnosis and treatment. Method: A total of 173 patients with obstructive jaundice, who were hospitalized from emergency department, were analyzed retrospectively in the context of clinical, laboratory, imaging and biliary drainage methods. Results: The average age was 57,2. While, 105 (60,7%) patients were female and 68 (39,3%) were male. USG was performed on all patients. CT was performed in 91 (52,6%) patients immediately in the emergency department. The correct diagnostic guidance of these two imaging modalities were 56,6% and 61,5%, respectively. After transfer of the patients to General surgery ward, using additional imaging methods, accurate diagnosis was achieved in respective proportions of patients when only MRCP (93.8%), MR-MRCP (91.6%), CT and MR-MRPC (94.5, and EUS (96%) were performed. The benign causes of obstructive jaundice were seen at a rate of78%, and the most common cause was choledocholithiasis (54.9%), while the malignant causes were seen at a rate of 22%, and the most common one being pancreatic tumor (12.7%). Conclusion: The first imaging method to be performed after USG is MRCP. There are a lot of unnecessary imaging modalities performed. The diagnostic significance of EUS is increasing, and it is the method with the highest disgnostic yield. Choosing PTC or ERCP for drainage is important for the progression of the disease.

Research paper thumbnail of Delayed Gastric Emptying as a Complication of Whipple’s Procedure: Could it be Much Less Frequent than Anticipated? Could the Definition Be Revised? A Single Center Experience

Medeniyet Medical Journal, 2020

Objective: Whipple's procedure for periampullary tumors has significant risks and complications. ... more Objective: Whipple's procedure for periampullary tumors has significant risks and complications. Delayed gastric emptying has the highest rate. Although the International Study Group of Pancreatic Surgery defined (ISGPS) this entity, multiple definitions still exist among authors. This study aims to revise the definition. Method: Seventy-three consecutive patients were analyzed for complications, particularly delayed gastric emptying. All patients underwent a standardized surgery. Procedures used for total pancreatectomies and benign diseases were excluded. Results: A total of 73 patients were included in the study. Intra-abdominal complications were observed in 15 (20.6%) patients. Grade C delayed gastric emptying was observed in only one (1.4%) patient. Grade A and B disease were observed in three (4.1%) patients. However, they responded well to conservative methods, causing no extra morbidity. Conclusion: Grade A and B delayed gastric emptying can be observed after any gastrointestinal surgery. These patients respond well to simple conservative methods with nasogastric intubation. Drainage of the intra-abdominal collection resolves the emptying problem (if any). Only grade C disease without other intra-abdominal complications can be accepted as a complication of this procedure. ISGPS definition does not include the cause. Thus, the definition and grading can be revised.

Research paper thumbnail of Skolosidal Ajanlardan Kaynaklanan Sklerozan Kolanjitin Önlenmesinde Halofuginon ve Ursodeoksikolik Asidin Etkileri

Mustafa Kemal Üniversitesi Tıp Dergisi, 2020

Biliyer skleroz, otoimmünite, operatif travma, toksik ajanlar, kanser ve kronik inflamatuvar koşu... more Biliyer skleroz, otoimmünite, operatif travma, toksik ajanlar, kanser ve kronik inflamatuvar koşulların neden olduğu yaşamı tehdit eden durumdur. Karaciğer dokusu, fibrotik skar dokusunun ilerlemesi ile belirgin siroza doğru ilerleyebilir. Alkaloid febrifugine bitkisinin aktif bileşeni olan halofuginonun, fibrozisi inhibe ettiği gösterilmiştir. Gereç ve Yöntem: Elli sıçan, bir tanesi salin infüzyonu içeren bir kontrol grubu da içinde olmak üzere beş gruba randomize edilerek, koledoka skolosidal bir ajan olan povidon iyot (PI) enjeksiyonu ile bir biliyer skleroz modeli oluşturuldu. PI grupları (kontrol hariç tüm gruplar) daha sonra ya halofuginon, ya ursodeoksikolik asit (UDCA), ya ikisi beraber, ya da hiçbir madde verilmeyerek 90 gün takip edildi. Takip sonunda sıçanlar, intrahepatik ve hiler fibrozis tespiti için sakrifiye edildi. Karaciğer hasarının laboratuvar parametreleri ve kollajen degradasyonunu göstermek üzere hidroksiprolin düzeyleri serumda çalışıldı. Fibrotik değişikliklerin analizi için karaciğer ve koledokun histolojik incelemesi yapıldı. Bulgular: Ursodeoksikolik asit kullanılmış olsun veya olmasın, halofuginon kullanılan grupların histolojik analizinde diğer gruplara göre istatistiksel açıdan alamlı derecede az skleroz mevcut idi. SGOT, SGPT ve ALP'nin serum analizleri incelendiğinde; "sadece PI kullanılan grup" ve halofuginon grupları arasında anlamlı farklılıklar vardı. GGT sadece PI kullanılan grup için anlamlı derecede yüksekti. Bilirubin düzeyleri açısından gruplar arasında anlamlı fark yoktu. Hidroksiprolin serum düzeyleri "sadece PI kullanılan grup" için en yüksek olup, bunu sadece UDCA kulanılan grup ve ardından halofuginon grupları izledi. Sonuç: Halofuginon, sıçanlarda indüklenen bir sklerozan kolanjit modelinde UDCA'ya ek bir tıbbi tedavi olarak karaciğer ve safra yollarında fibrozun önlenmesinde etkili olmuştur.

Research paper thumbnail of Can elongation of the ileum by epiploic appendagitis result in acute abdomen?

The Turkish Journal of Gastroenterology, 2018

Epiploic appendagitis mimics acute abdomen or is a condition associated with acute abdomen, altho... more Epiploic appendagitis mimics acute abdomen or is a condition associated with acute abdomen, although it is usually not treated by emergent surgical intervention and has characteristic findings on computed tomography (1). Mechanical intestinal obstruction is not a real manifestation of the disease because those small appendages (inflamed or not) cannot easily obstruct the small or large intestines because of their small sizes. Epiploic or omental appendages are in fact visceral peritoneal pouches that arise from the serosal and antimesenteric surface of the large intestine. They may act as defending mechanisms, similar to the omentum (2). They can even be helpful in spontaneous healing of small perforations in the hollow viscera, and they can also be used as a patch during surgical interventions, such as in appendectomy, by the surgeon. Because of their roles in defending mechanisms, they can also be speculatively interpreted as dwarf omental structures. Consisting of fat tissue and vessels, they have a length of 0.5-5 cm. While epiploic appendages located near the sigmoid colon are the biggest, >100 such appendages may also occur. None of them are found at the rectal wall. Unfortunately, epiploic appendages are detected on computed tomography only when they are inflamed or surrounded by fluid accumulation. Torsion of epiploic appendages results in vascular occlusion that might lead to ischemia (3). Although there are rare reports about acute epiploic appendagitis, a condition resulting in mechanical obstruction of the ileum elongated like a horse by inflamed and fused epiploic appendagitis has not been reported previously. An 87-year-old female and obese patient with hypertension, diabetes mellitus, and Alzheimer disease was admitted to emergency service because of abdominal distention, nausea, vomiting, and subfebrile fever lasting

Research paper thumbnail of C-reactive protein and red cell distribution width as indicators of complications in patients with acute appendicitis

ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE, 2019

Aim: Acute appendicitis is one of the most common operations in general surgery. When complicated... more Aim: Acute appendicitis is one of the most common operations in general surgery. When complicated, mortality and morbidity increases. We aimed to find out whether use of C-reactive protein (CRP) and red cell distribution width (RDW) may help to find out development of complications with acute appendicitis at initial evaluation in an emergency department. Methods: Files of the patients who underwent operations for acute appendicitis between January 2017 and August 2017 were reviewed. Development of complications was recorded and the patients were grouped as with and without complications and were compared about age, sex RDW, CRP, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Diagnostic efficiency of CRP and RDW on the development of complications in acute appendicitis was investigated with regression analysis and by receiver operator characteristic curve analysis. Results: Age, CRP and RDW were found to be significantly related to perforation (p<0.001 for all) (Bonferoni correction), while white blood cell (WBC), AST and ALT were found to be insignificant (p=0.052, p=0.806 and p=0.804, respectively. There was a significant correlation between RDW and CRP in the Spearman nonparametric correlation analysis (correlation coefficient r=0.244 and p<0.001). There was no significant correlation of WBC to CRP and RDW. Conclusion: CRP and RDW are biochemical parameters that help us to identify the development of complications in acute appencitis. CRP may be elevated in acute appendicitis; however, it must be kept in mind to be cautious about a potentially complicated acute appendicitis after a certain level, RDW in our study has been found to be elevated in complicated appendicitis cases; but, it may not helpful to detect for perforated or gangrenous appendicitis.

Research paper thumbnail of A study to use hematological and biochemical parameters as a key in the diagnosis of acute mesenteric ischemia

ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE, 2018

Aim: Acute mesenteric ischemia is still fatal in 59-92% of cases. Delay in diagnosis of acute mes... more Aim: Acute mesenteric ischemia is still fatal in 59-92% of cases. Delay in diagnosis of acute mesenteric ischemia can cause dramatic increase in morbidity and mortality rates. However several diagnostic and disease related factors have been widely studied. Controversy still remains. In this study, we evaluated hematological and biochemical parameters in patients with acute mesenteric ischemia. Methods: 46 patients (study group) who underwent emergent surgery for acute mesenteric ischemia and 46 patients (control group) operated for acute abdomen with another etiology other than acute mesenteric ischemia and internalized to intensive care unit were included in this study. Medical records and clinical data of acute mesenteric ischemia patients between January 2008 and December 2014 were evaluated with regard to 8 parameters; age, amylase, white blood cell count, mean platelet volume, creatine kinase, lactate dehydrogenase, lactate and D-dimer. These parameters were selected for their increased levels in acute mesenteric ischemia patients according to many published medical studies. Control group was formed randomly from patients followed in intensive care unit for their co-morbidities after acute abdomen operation in the same period. Gender was included in the table but was not taken into account as a parameter for the study. Results: Mean values of age, white blood cell count, creatine kinase, lactate dehydrogenase, lactate and D-dimer were significantly higher in acute mesenteric ischemia group than the control group. Mean platelet volume was significantly lower in acute mesenteric ischemia group. The p values were for age (p=0.009), for amylase (0.475), for white blood cell (p=0.001) for mean platelet volume (0=0.001), for creatinine kinase (p=0.017), for lactate dehydrogenase (p=0.001), for lactate (p=0.001), for D-dimer (p=0.001) respectively. Conclusion: White blood cell count, creatine kinase, lactate dehydrogenase, lactate and D-dimer levels increase; mean platelet volume decrease in acute mesenteric ischemia patients significantly.

Research paper thumbnail of Is there any benefit of harmonic scalpel for hemorrhoidectomy versus conventional diathermy?

ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE, 2018

Aim: Symptomatic hemorrhoidal disease is among the most common surgical diseases and it may neces... more Aim: Symptomatic hemorrhoidal disease is among the most common surgical diseases and it may necessitate surgical intervention. The most common and effective approaches used for surgical treatment are harmonic scalpel hemorrhoidectomy and conventional diathermy excision. The aim of the study was to compare the outcomes of hemorrhoidectomy using harmonic scalpel and the conventional diathermy excision techniques. Methods: The files of 113 consecutively operated patients (26 females 23%, 87 males 77%), who were operated on for symptomatic Grade III-IV hemorrhoids, were retrospectively reviewed for length of operation and hospitalization, early and delayed bleeding, urinary retention, postoperative abscess and anal stenosis. Exclusion criteria were additional operations, recurrent cases and inflammatory bowel disease. Results: Conventional diathermy hemorrhoidectomy in 60 (53%) and harmonic scalpel hemorrhoidectomy were used in 53 patients (47%). There were significant differences between the operation and hospitalization times in favor of harmonic scalpel group (p<0.05 for both). The other parameters did not show any significant differences (p>0.05 for all). Conclusion: Harmonic scalpel hemorrhoidectomy is advantageous and superior to conventional diathermy hemorrhoidectomy in regard to shorter operation time and earlier discharge from the hospital with no additonal complications.

Research paper thumbnail of Is the use of intraoperative nerve monitoring an effective method to reduce the rate of permanent recurrent laryngeal nerve paralysis?

ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE, 2018

Aim: Recurrent laryngeal nerve (RLN) paralysis is a common complication of thyroid surgery. In re... more Aim: Recurrent laryngeal nerve (RLN) paralysis is a common complication of thyroid surgery. In recent years, intraoperative nerve monitoring (IONM) has been used to reduce the risk of RLN paralysis. The purpose of this study was to assess the role of IONM in reducing RLN paralysis. Methods: A retrospective clinical study was conducted between January 2015 and January 2017 in a two-centerclinical trial at Lutfiye Nuri Burat State and Haseki Teaching and Research Hospitals. Patients who underwent thyroidectomy using IONM (Group A, n=100) or direct visual technique (Group B, n=232) were included. Patients' files were reviewed for age, body mass index, gender, American Society of Anesthesiologists score, calcium levels, complications, duration of operation and follow-up. Postoperative complications were regarded as the main outcomes. Results: A total of 332 patients (52 male, 280 female) with a mean age of 46.4±12.9 years were enrolled. 30.1% of the patients were in Group A (IONM). Bilateral and unilateral thyroidectomies were performed in 70.8% and 29.2% of the operations, respectively. Operative time was shorter in Group A (76.9±12.0 minutes vs 97.7±27.6 minutes, p <0.001). There was no significant difference between the two groups in terms of preoperative and postoperative calcium levels (p=0.407).There was no statistically significant difference in early RLN paralysis rates between the two groups (for Group A and Group B, 10 (10%) and 34 (14%), respectively) (p=0.251) While it was not present in Group A, permanent RLN paralysis was found in 10 patients in Group B (4.3%) (p = 0.035). Conclusion: The use of IONM may be useful in reducing the rate of permanent RLN paralysis.

Research paper thumbnail of Adenocarsinoma Arising within a Cystic Duplication of the Ileum: A Case Report

Research paper thumbnail of Preperitoneal Mesh Placement with Anterior Approach in Incarcerated Femoral Hernia (Our Experiences with 23 Cases)

Haseki Tıp Bülteni, 2015

To investigate the effectiveness of preperitoneal mesh placement with anterior approach in incarc... more To investigate the effectiveness of preperitoneal mesh placement with anterior approach in incarcerated femoral hernia and to reveal morbidity and recurrence rates. Methods: Twenty-three patients with incarcerated inguinal hernia, who were admitted to our emergency surgery clinic between the years 2009 and 2012 and found to have incarcerated femoral hernia during exploration, were included in the study. All patients underwent inguinal transverse incision suitable for anterior approach. By cutting transversalis fascia, polypropylene mesh was placed preperitoneally between Cooper's ligament and the conjoint tendon. Results:The mean age was 54.2 (39-85) years; 16 (69%) subjects were men, 7 (31%) were women. Five patients had no complaints related to hernia before being admitted to the hospital. Six (26%) patients underwent bowel resection and anastomosis. Small intestines or omentum incarcerated in the hernia sac were reduced into the abdomen in 17 (74%) patients. There was no complication during surgical interventions. Average length of hospital stay in patients with resection and anastomosis were 5.3 days, and 2.1 days in patients with no resection. In follow-up, 3 (13%) patients had hematoma-seroma and 2 (8%) patients had wound infection. In 2-4 years follow-up, no recurrence was detected. Chronic pain related to nerve damage was not observed. Conclusion:Preperitoneal mesh placement with anterior approach in incarcerated femoral hernia as an emergency is safe in terms of complications and recurrence either with or without intestinal resection.

Research paper thumbnail of Two pseudotumor cases mimicking liver malignant tumor

Turkish Journal of Surgery, 2017

Inflammatory pseudotumor of the liver is a rare benign tumor that can be confused with malignant ... more Inflammatory pseudotumor of the liver is a rare benign tumor that can be confused with malignant tumors of the liver. It is usually diagnosed after pathologic evaluation of the resected lesion. If a mass lesion in the liver is suspicious for malignancy on radiologic evaluation then surgical resection is planned for suitable patients rather than a biopsy. Inflammatory pseudotumors are similar to malignant tumors on macroscopic assessment, but microscopically they are characterized by the presence of inflammatory cells. In case of clinical or radiologic suspicion, the lesion is biopsied and once the diagnosis of inflammatory pseudotumor is made the lesion is managed by conservative-medical treatment. It must be kept in mind as part of differential diagnosis to avoid unnecessary surgery.

Research paper thumbnail of Hepatocellular Carcinoma-Liver Resections

Haseki Tıp Bülteni, 2015

Hepatoselüler karsinom (HCC) yılda 500,000 yeni olgu ile onkolojik cerrahide önemli bir morbidite... more Hepatoselüler karsinom (HCC) yılda 500,000 yeni olgu ile onkolojik cerrahide önemli bir morbidite ve mortalite nedenidir. Bu yazımızda HCC'nin risk faktörleri, epidemiyolojisi, klinik seyri, tanısı ve tedavisi ile ilgili son literatür bilgilerini şekil ve tablolar eşliğinde vermeye çalıştık. En önemli risk faktörleri hepatit B ve C'ye bağlı siroz ve non-alkolik yağlı karaciğer hastalığıdır. HCC kanser hücresinde p53 tümör süpresör geni, retinoblastoma (Rb) geni, AXINI tümör süpresör geni ile ilişkili mutasyonlar görülür. Tümör belirteçlerinden alfafetoprotein (AFP) yükselir. Hastalarda sıklıkla takipleri sırasında radyolojik görüntülemeler ile kitle tespit edilir ve araştırılır. Ultrasonografi, bilgisayarlı tomografi, manyetik rezonans ile ön tanı konur. Rutin biyopsiye gerek yoktur. Hastalar Child, MELD, Barselona, Milan gibi çeşitli skorlama sistemlerine göre değerlendirilir. Cerrahi kararı verilen hastalar ameliyat öncesi önemli bir hazırlık aşamasından geçer. Hasta kliniğinden, kalacak karaciğer miktarına, segmenter ve damarsal anatomisine kadar değerlendirilir. R0 rezeksiyon, transplantasyon, radyofrekans ablasyon, transarteryel kemoembolizasyon, portal ven embolizasyonu gibi tedavi yöntemleri uygun şekilde seçilmelidir. Ameliyat sonrası en önemli morbidite nedeni karaciğer yetmezliğidir. Haseki Eğitim ve Araştırma Hastanesi Genel Cerrahi kliniği olarak bu tür ameliyatları son dört yıldır gerçekleştirmekteyiz. Yedisi sağ-sol hepatektomi olmak üzere ameliyat edilen toplam 25 olgumuzun mortalite oranı %0, morbidite oranı %16'dır.

Research paper thumbnail of Comparison of ERCP and MRCP Findings in Patients with Mechanical Jaundice

Haseki Tıp Bülteni, 2014

Amaç: Mekanik ikterli hastalarda tanı ve tedavi yöntemi olarak kullanılan Endoskopik Retrograd Ko... more Amaç: Mekanik ikterli hastalarda tanı ve tedavi yöntemi olarak kullanılan Endoskopik Retrograd Kolanjiyopankreatografi'nin (ERKP) invaziv bir işlem olması ve komplikasyonları nedeniyle, Manyetik Rezonans Kolanjiyopankreatografi (MRKP) ile desteklenmesi gerekir. MRKP ile yönlendirilmiş ERKP'nin tanı koymadaki yerini değerlendirmeyi amaçladık. Yöntemler: Çalışmada 2010-2013 yılları arasında kliniğimize başvuran mekanik ikterli hastalardan ERKP öncesinde MRKP çekilmiş 120 hasta değerlendirilerek bulgular karşılaştırıldı. MRKP bulgularına göre hastalar üç gruba ayrıldı: 1. grupta safra yolları içinde kalkül, çamur ve dilatasyon tespit edilen hastalar, 2. grupta koledok dış basısı, koledok tümörü, koledokta striktür ve dilatasyon tespit edilen hastalar, 3. grupta bulguları normal olan hastalar. Bulgular gruplara göre değerlendirildi ve sonuçlar ki kare testi ile karşılaştırıldı. Bulgular: Çalışmayı oluşturan 120 hastanın (73 kadın, 47 erkek) yaş ortalaması 62 yıl idi. MRKP ile ERKP korelasyonu; 1. grupta 56 hastanın 53'ünde, 2. grupta 45 hastanın 44'ünde, 3. grupta 19 hastanın 4'ünde mevcuttu. Ayrıca; 3. grupta MRKP ile daha önce tanı konamayan 15 hastada ERKP ile altta yatan patoloji tespit edilebilmiştir. Hastaların tamamında MRKP ile ERKP uyumu %84 olup sonuçlar istatistiksel olarak anlamlıdır (p=0,015).

Research paper thumbnail of The importance of follow-up gastroscopy in patients with perforated peptic ulcer

Medeniyet Medical Journal, 2018

Aim: Peptic ulcer disease arises from the imbalance between the mucosal defense factors and the d... more Aim: Peptic ulcer disease arises from the imbalance between the mucosal defense factors and the destructive properties of acid pepsin. The prevalance is around 5-10% of the population but only 2-10% of the patients with the disease are complicated with perforation. What is adviced is a follow up gastroscopy 6-8 weeks after the operation. We aimed to investigate gastric malignancy and helicobacter pylori prevalence in the follow-up gastroscopy. Method: The follow-up gastroscopy notes of the patients who went under operation for perforated peptic ulcer were reviewed. The demographic properties, the operation notes, the follow-up gastroscopy notes and pathology reports were reviewed for the presence of helicobacter pylori and gastric malignancy. Results: Between June 2014 and June 2017 a total of 132 patients were operated for peptic ulcer perforation. The average age of the patients was 43.46±18.78 (15-93). In the study group 73.5%(36/49) were found to be positive for Helicobater pylori. The gastric cancer diagnosis was confirmed in 5.6% (3/53) patients in the follow-up gastroscopy. Conclusion: Helicobater pylori is an important factor in ethiology as well but one must be alert about the potential presence of a gastric cancer. There is also a potential malignancy presence in the perforations which are thought to be duodenal.

Research paper thumbnail of Isolated Hydatid Cyst of the Spleen: A Case Report

Research paper thumbnail of A Fast and Reliable Method to Interpret Short-Term Mortality in Perforated Peptic Ulcer: Red Cell Distribution Width is Sensitive and Specific

Surgery Research and Practice, 2021

Introduction. Peptic ulcer is an important health problem worldwide with a prevalence of around 5... more Introduction. Peptic ulcer is an important health problem worldwide with a prevalence of around 5%. Peptic ulcer perforation is a potentially mortal complication of peptic ulcer disease. We aimed to investigate the potential use of red cell distribution width as a prognostic marker in peptic ulcer perforation. Methods. The files, operation notes, biochemical and hematological parameters, and prognosis of patients who were operated for a peptic ulcer perforation were reviewed in a retrospective cohort study. The relation of red cell distribution width (RDW) to main outcome in-hospital mortality was assessed. Results. The mean age of the 172 patients was 40 ± 17.89. There were 158 (92%) males and 14 (8%) females. The in-hospital mortality was 8.7% (15/172). The median RDW in the group with mortality was 15.00 (interquartile range (IQR): 14.30–17.20) compared with the median RDW in the group with no mortality as 13.2 (IQR: 12.80–14.00, p ≤ 0.001 ). Receiver operator characteristic curv...

Research paper thumbnail of Elevated serum bilirubin levels may predict perforation of the appendix

Annali italiani di chirurgia, 2019

AIM Acute appendicitis is one of the most common pathology requiring emergency operations, and if... more AIM Acute appendicitis is one of the most common pathology requiring emergency operations, and if perforated, can cause morbidity and mortality. The serum bilirubin levels were studied to see whether an elevation predicted perforation. MATERIAL AND METHODS In a retrospective cohort study the medical files of 221 patients who were operated for acute appendicitis were reviewed. RESULTS Total and indirect bilirubin levels were significantly higher in patients with a perforated appendicitis compared with patients with simple appendicitis. Elevated serum bilirubin had a sensitivity of 50.00 (95% CI 29.93 to 70.07) and a specificity of 80.73 (95% CI 74.43 to 86.05) when predicting a perforated appendicitis. CONCLUSIONS Appendiceal perforation may be accompanied with elevated serum bilirubin level. Assessment of bilirubin levels must be a part of the initial evaluation of a suspected appendicitis in the emergency room. KEY WORDS Acute appendicitis, Gangrenous appendicitis, Perforated appen...

Research paper thumbnail of Endoscopic Retrograde Cholangiopancreatography Related Bleeding Complication and Easy Management

Medical Bulletin of Haseki, 2020

Research paper thumbnail of Practices in Obstructive Jaundice as An Emergency: A Training and Research Hospital Experience

İstanbul Kanuni Sultan Süleyman Tıp Dergisi, 2020

Objective: Management of emergency obstructive jaundice is quite complicated. It is important to ... more Objective: Management of emergency obstructive jaundice is quite complicated. It is important to select appropriate imaging methods to make differential diagnosis of a large number of causes. Providing proper biliary drainage is important in patient stabilization. Our aim is to reveal practical points in diagnosis and treatment. Method: A total of 173 patients with obstructive jaundice, who were hospitalized from emergency department, were analyzed retrospectively in the context of clinical, laboratory, imaging and biliary drainage methods. Results: The average age was 57,2. While, 105 (60,7%) patients were female and 68 (39,3%) were male. USG was performed on all patients. CT was performed in 91 (52,6%) patients immediately in the emergency department. The correct diagnostic guidance of these two imaging modalities were 56,6% and 61,5%, respectively. After transfer of the patients to General surgery ward, using additional imaging methods, accurate diagnosis was achieved in respective proportions of patients when only MRCP (93.8%), MR-MRCP (91.6%), CT and MR-MRPC (94.5, and EUS (96%) were performed. The benign causes of obstructive jaundice were seen at a rate of78%, and the most common cause was choledocholithiasis (54.9%), while the malignant causes were seen at a rate of 22%, and the most common one being pancreatic tumor (12.7%). Conclusion: The first imaging method to be performed after USG is MRCP. There are a lot of unnecessary imaging modalities performed. The diagnostic significance of EUS is increasing, and it is the method with the highest disgnostic yield. Choosing PTC or ERCP for drainage is important for the progression of the disease.

Research paper thumbnail of Delayed Gastric Emptying as a Complication of Whipple’s Procedure: Could it be Much Less Frequent than Anticipated? Could the Definition Be Revised? A Single Center Experience

Medeniyet Medical Journal, 2020

Objective: Whipple's procedure for periampullary tumors has significant risks and complications. ... more Objective: Whipple's procedure for periampullary tumors has significant risks and complications. Delayed gastric emptying has the highest rate. Although the International Study Group of Pancreatic Surgery defined (ISGPS) this entity, multiple definitions still exist among authors. This study aims to revise the definition. Method: Seventy-three consecutive patients were analyzed for complications, particularly delayed gastric emptying. All patients underwent a standardized surgery. Procedures used for total pancreatectomies and benign diseases were excluded. Results: A total of 73 patients were included in the study. Intra-abdominal complications were observed in 15 (20.6%) patients. Grade C delayed gastric emptying was observed in only one (1.4%) patient. Grade A and B disease were observed in three (4.1%) patients. However, they responded well to conservative methods, causing no extra morbidity. Conclusion: Grade A and B delayed gastric emptying can be observed after any gastrointestinal surgery. These patients respond well to simple conservative methods with nasogastric intubation. Drainage of the intra-abdominal collection resolves the emptying problem (if any). Only grade C disease without other intra-abdominal complications can be accepted as a complication of this procedure. ISGPS definition does not include the cause. Thus, the definition and grading can be revised.

Research paper thumbnail of Skolosidal Ajanlardan Kaynaklanan Sklerozan Kolanjitin Önlenmesinde Halofuginon ve Ursodeoksikolik Asidin Etkileri

Mustafa Kemal Üniversitesi Tıp Dergisi, 2020

Biliyer skleroz, otoimmünite, operatif travma, toksik ajanlar, kanser ve kronik inflamatuvar koşu... more Biliyer skleroz, otoimmünite, operatif travma, toksik ajanlar, kanser ve kronik inflamatuvar koşulların neden olduğu yaşamı tehdit eden durumdur. Karaciğer dokusu, fibrotik skar dokusunun ilerlemesi ile belirgin siroza doğru ilerleyebilir. Alkaloid febrifugine bitkisinin aktif bileşeni olan halofuginonun, fibrozisi inhibe ettiği gösterilmiştir. Gereç ve Yöntem: Elli sıçan, bir tanesi salin infüzyonu içeren bir kontrol grubu da içinde olmak üzere beş gruba randomize edilerek, koledoka skolosidal bir ajan olan povidon iyot (PI) enjeksiyonu ile bir biliyer skleroz modeli oluşturuldu. PI grupları (kontrol hariç tüm gruplar) daha sonra ya halofuginon, ya ursodeoksikolik asit (UDCA), ya ikisi beraber, ya da hiçbir madde verilmeyerek 90 gün takip edildi. Takip sonunda sıçanlar, intrahepatik ve hiler fibrozis tespiti için sakrifiye edildi. Karaciğer hasarının laboratuvar parametreleri ve kollajen degradasyonunu göstermek üzere hidroksiprolin düzeyleri serumda çalışıldı. Fibrotik değişikliklerin analizi için karaciğer ve koledokun histolojik incelemesi yapıldı. Bulgular: Ursodeoksikolik asit kullanılmış olsun veya olmasın, halofuginon kullanılan grupların histolojik analizinde diğer gruplara göre istatistiksel açıdan alamlı derecede az skleroz mevcut idi. SGOT, SGPT ve ALP'nin serum analizleri incelendiğinde; "sadece PI kullanılan grup" ve halofuginon grupları arasında anlamlı farklılıklar vardı. GGT sadece PI kullanılan grup için anlamlı derecede yüksekti. Bilirubin düzeyleri açısından gruplar arasında anlamlı fark yoktu. Hidroksiprolin serum düzeyleri "sadece PI kullanılan grup" için en yüksek olup, bunu sadece UDCA kulanılan grup ve ardından halofuginon grupları izledi. Sonuç: Halofuginon, sıçanlarda indüklenen bir sklerozan kolanjit modelinde UDCA'ya ek bir tıbbi tedavi olarak karaciğer ve safra yollarında fibrozun önlenmesinde etkili olmuştur.

Research paper thumbnail of Can elongation of the ileum by epiploic appendagitis result in acute abdomen?

The Turkish Journal of Gastroenterology, 2018

Epiploic appendagitis mimics acute abdomen or is a condition associated with acute abdomen, altho... more Epiploic appendagitis mimics acute abdomen or is a condition associated with acute abdomen, although it is usually not treated by emergent surgical intervention and has characteristic findings on computed tomography (1). Mechanical intestinal obstruction is not a real manifestation of the disease because those small appendages (inflamed or not) cannot easily obstruct the small or large intestines because of their small sizes. Epiploic or omental appendages are in fact visceral peritoneal pouches that arise from the serosal and antimesenteric surface of the large intestine. They may act as defending mechanisms, similar to the omentum (2). They can even be helpful in spontaneous healing of small perforations in the hollow viscera, and they can also be used as a patch during surgical interventions, such as in appendectomy, by the surgeon. Because of their roles in defending mechanisms, they can also be speculatively interpreted as dwarf omental structures. Consisting of fat tissue and vessels, they have a length of 0.5-5 cm. While epiploic appendages located near the sigmoid colon are the biggest, >100 such appendages may also occur. None of them are found at the rectal wall. Unfortunately, epiploic appendages are detected on computed tomography only when they are inflamed or surrounded by fluid accumulation. Torsion of epiploic appendages results in vascular occlusion that might lead to ischemia (3). Although there are rare reports about acute epiploic appendagitis, a condition resulting in mechanical obstruction of the ileum elongated like a horse by inflamed and fused epiploic appendagitis has not been reported previously. An 87-year-old female and obese patient with hypertension, diabetes mellitus, and Alzheimer disease was admitted to emergency service because of abdominal distention, nausea, vomiting, and subfebrile fever lasting

Research paper thumbnail of C-reactive protein and red cell distribution width as indicators of complications in patients with acute appendicitis

ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE, 2019

Aim: Acute appendicitis is one of the most common operations in general surgery. When complicated... more Aim: Acute appendicitis is one of the most common operations in general surgery. When complicated, mortality and morbidity increases. We aimed to find out whether use of C-reactive protein (CRP) and red cell distribution width (RDW) may help to find out development of complications with acute appendicitis at initial evaluation in an emergency department. Methods: Files of the patients who underwent operations for acute appendicitis between January 2017 and August 2017 were reviewed. Development of complications was recorded and the patients were grouped as with and without complications and were compared about age, sex RDW, CRP, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Diagnostic efficiency of CRP and RDW on the development of complications in acute appendicitis was investigated with regression analysis and by receiver operator characteristic curve analysis. Results: Age, CRP and RDW were found to be significantly related to perforation (p<0.001 for all) (Bonferoni correction), while white blood cell (WBC), AST and ALT were found to be insignificant (p=0.052, p=0.806 and p=0.804, respectively. There was a significant correlation between RDW and CRP in the Spearman nonparametric correlation analysis (correlation coefficient r=0.244 and p<0.001). There was no significant correlation of WBC to CRP and RDW. Conclusion: CRP and RDW are biochemical parameters that help us to identify the development of complications in acute appencitis. CRP may be elevated in acute appendicitis; however, it must be kept in mind to be cautious about a potentially complicated acute appendicitis after a certain level, RDW in our study has been found to be elevated in complicated appendicitis cases; but, it may not helpful to detect for perforated or gangrenous appendicitis.

Research paper thumbnail of A study to use hematological and biochemical parameters as a key in the diagnosis of acute mesenteric ischemia

ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE, 2018

Aim: Acute mesenteric ischemia is still fatal in 59-92% of cases. Delay in diagnosis of acute mes... more Aim: Acute mesenteric ischemia is still fatal in 59-92% of cases. Delay in diagnosis of acute mesenteric ischemia can cause dramatic increase in morbidity and mortality rates. However several diagnostic and disease related factors have been widely studied. Controversy still remains. In this study, we evaluated hematological and biochemical parameters in patients with acute mesenteric ischemia. Methods: 46 patients (study group) who underwent emergent surgery for acute mesenteric ischemia and 46 patients (control group) operated for acute abdomen with another etiology other than acute mesenteric ischemia and internalized to intensive care unit were included in this study. Medical records and clinical data of acute mesenteric ischemia patients between January 2008 and December 2014 were evaluated with regard to 8 parameters; age, amylase, white blood cell count, mean platelet volume, creatine kinase, lactate dehydrogenase, lactate and D-dimer. These parameters were selected for their increased levels in acute mesenteric ischemia patients according to many published medical studies. Control group was formed randomly from patients followed in intensive care unit for their co-morbidities after acute abdomen operation in the same period. Gender was included in the table but was not taken into account as a parameter for the study. Results: Mean values of age, white blood cell count, creatine kinase, lactate dehydrogenase, lactate and D-dimer were significantly higher in acute mesenteric ischemia group than the control group. Mean platelet volume was significantly lower in acute mesenteric ischemia group. The p values were for age (p=0.009), for amylase (0.475), for white blood cell (p=0.001) for mean platelet volume (0=0.001), for creatinine kinase (p=0.017), for lactate dehydrogenase (p=0.001), for lactate (p=0.001), for D-dimer (p=0.001) respectively. Conclusion: White blood cell count, creatine kinase, lactate dehydrogenase, lactate and D-dimer levels increase; mean platelet volume decrease in acute mesenteric ischemia patients significantly.

Research paper thumbnail of Is there any benefit of harmonic scalpel for hemorrhoidectomy versus conventional diathermy?

ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE, 2018

Aim: Symptomatic hemorrhoidal disease is among the most common surgical diseases and it may neces... more Aim: Symptomatic hemorrhoidal disease is among the most common surgical diseases and it may necessitate surgical intervention. The most common and effective approaches used for surgical treatment are harmonic scalpel hemorrhoidectomy and conventional diathermy excision. The aim of the study was to compare the outcomes of hemorrhoidectomy using harmonic scalpel and the conventional diathermy excision techniques. Methods: The files of 113 consecutively operated patients (26 females 23%, 87 males 77%), who were operated on for symptomatic Grade III-IV hemorrhoids, were retrospectively reviewed for length of operation and hospitalization, early and delayed bleeding, urinary retention, postoperative abscess and anal stenosis. Exclusion criteria were additional operations, recurrent cases and inflammatory bowel disease. Results: Conventional diathermy hemorrhoidectomy in 60 (53%) and harmonic scalpel hemorrhoidectomy were used in 53 patients (47%). There were significant differences between the operation and hospitalization times in favor of harmonic scalpel group (p<0.05 for both). The other parameters did not show any significant differences (p>0.05 for all). Conclusion: Harmonic scalpel hemorrhoidectomy is advantageous and superior to conventional diathermy hemorrhoidectomy in regard to shorter operation time and earlier discharge from the hospital with no additonal complications.

Research paper thumbnail of Is the use of intraoperative nerve monitoring an effective method to reduce the rate of permanent recurrent laryngeal nerve paralysis?

ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE, 2018

Aim: Recurrent laryngeal nerve (RLN) paralysis is a common complication of thyroid surgery. In re... more Aim: Recurrent laryngeal nerve (RLN) paralysis is a common complication of thyroid surgery. In recent years, intraoperative nerve monitoring (IONM) has been used to reduce the risk of RLN paralysis. The purpose of this study was to assess the role of IONM in reducing RLN paralysis. Methods: A retrospective clinical study was conducted between January 2015 and January 2017 in a two-centerclinical trial at Lutfiye Nuri Burat State and Haseki Teaching and Research Hospitals. Patients who underwent thyroidectomy using IONM (Group A, n=100) or direct visual technique (Group B, n=232) were included. Patients' files were reviewed for age, body mass index, gender, American Society of Anesthesiologists score, calcium levels, complications, duration of operation and follow-up. Postoperative complications were regarded as the main outcomes. Results: A total of 332 patients (52 male, 280 female) with a mean age of 46.4±12.9 years were enrolled. 30.1% of the patients were in Group A (IONM). Bilateral and unilateral thyroidectomies were performed in 70.8% and 29.2% of the operations, respectively. Operative time was shorter in Group A (76.9±12.0 minutes vs 97.7±27.6 minutes, p <0.001). There was no significant difference between the two groups in terms of preoperative and postoperative calcium levels (p=0.407).There was no statistically significant difference in early RLN paralysis rates between the two groups (for Group A and Group B, 10 (10%) and 34 (14%), respectively) (p=0.251) While it was not present in Group A, permanent RLN paralysis was found in 10 patients in Group B (4.3%) (p = 0.035). Conclusion: The use of IONM may be useful in reducing the rate of permanent RLN paralysis.

Research paper thumbnail of Adenocarsinoma Arising within a Cystic Duplication of the Ileum: A Case Report

Research paper thumbnail of Preperitoneal Mesh Placement with Anterior Approach in Incarcerated Femoral Hernia (Our Experiences with 23 Cases)

Haseki Tıp Bülteni, 2015

To investigate the effectiveness of preperitoneal mesh placement with anterior approach in incarc... more To investigate the effectiveness of preperitoneal mesh placement with anterior approach in incarcerated femoral hernia and to reveal morbidity and recurrence rates. Methods: Twenty-three patients with incarcerated inguinal hernia, who were admitted to our emergency surgery clinic between the years 2009 and 2012 and found to have incarcerated femoral hernia during exploration, were included in the study. All patients underwent inguinal transverse incision suitable for anterior approach. By cutting transversalis fascia, polypropylene mesh was placed preperitoneally between Cooper's ligament and the conjoint tendon. Results:The mean age was 54.2 (39-85) years; 16 (69%) subjects were men, 7 (31%) were women. Five patients had no complaints related to hernia before being admitted to the hospital. Six (26%) patients underwent bowel resection and anastomosis. Small intestines or omentum incarcerated in the hernia sac were reduced into the abdomen in 17 (74%) patients. There was no complication during surgical interventions. Average length of hospital stay in patients with resection and anastomosis were 5.3 days, and 2.1 days in patients with no resection. In follow-up, 3 (13%) patients had hematoma-seroma and 2 (8%) patients had wound infection. In 2-4 years follow-up, no recurrence was detected. Chronic pain related to nerve damage was not observed. Conclusion:Preperitoneal mesh placement with anterior approach in incarcerated femoral hernia as an emergency is safe in terms of complications and recurrence either with or without intestinal resection.

Research paper thumbnail of Two pseudotumor cases mimicking liver malignant tumor

Turkish Journal of Surgery, 2017

Inflammatory pseudotumor of the liver is a rare benign tumor that can be confused with malignant ... more Inflammatory pseudotumor of the liver is a rare benign tumor that can be confused with malignant tumors of the liver. It is usually diagnosed after pathologic evaluation of the resected lesion. If a mass lesion in the liver is suspicious for malignancy on radiologic evaluation then surgical resection is planned for suitable patients rather than a biopsy. Inflammatory pseudotumors are similar to malignant tumors on macroscopic assessment, but microscopically they are characterized by the presence of inflammatory cells. In case of clinical or radiologic suspicion, the lesion is biopsied and once the diagnosis of inflammatory pseudotumor is made the lesion is managed by conservative-medical treatment. It must be kept in mind as part of differential diagnosis to avoid unnecessary surgery.

Research paper thumbnail of Hepatocellular Carcinoma-Liver Resections

Haseki Tıp Bülteni, 2015

Hepatoselüler karsinom (HCC) yılda 500,000 yeni olgu ile onkolojik cerrahide önemli bir morbidite... more Hepatoselüler karsinom (HCC) yılda 500,000 yeni olgu ile onkolojik cerrahide önemli bir morbidite ve mortalite nedenidir. Bu yazımızda HCC'nin risk faktörleri, epidemiyolojisi, klinik seyri, tanısı ve tedavisi ile ilgili son literatür bilgilerini şekil ve tablolar eşliğinde vermeye çalıştık. En önemli risk faktörleri hepatit B ve C'ye bağlı siroz ve non-alkolik yağlı karaciğer hastalığıdır. HCC kanser hücresinde p53 tümör süpresör geni, retinoblastoma (Rb) geni, AXINI tümör süpresör geni ile ilişkili mutasyonlar görülür. Tümör belirteçlerinden alfafetoprotein (AFP) yükselir. Hastalarda sıklıkla takipleri sırasında radyolojik görüntülemeler ile kitle tespit edilir ve araştırılır. Ultrasonografi, bilgisayarlı tomografi, manyetik rezonans ile ön tanı konur. Rutin biyopsiye gerek yoktur. Hastalar Child, MELD, Barselona, Milan gibi çeşitli skorlama sistemlerine göre değerlendirilir. Cerrahi kararı verilen hastalar ameliyat öncesi önemli bir hazırlık aşamasından geçer. Hasta kliniğinden, kalacak karaciğer miktarına, segmenter ve damarsal anatomisine kadar değerlendirilir. R0 rezeksiyon, transplantasyon, radyofrekans ablasyon, transarteryel kemoembolizasyon, portal ven embolizasyonu gibi tedavi yöntemleri uygun şekilde seçilmelidir. Ameliyat sonrası en önemli morbidite nedeni karaciğer yetmezliğidir. Haseki Eğitim ve Araştırma Hastanesi Genel Cerrahi kliniği olarak bu tür ameliyatları son dört yıldır gerçekleştirmekteyiz. Yedisi sağ-sol hepatektomi olmak üzere ameliyat edilen toplam 25 olgumuzun mortalite oranı %0, morbidite oranı %16'dır.

Research paper thumbnail of Comparison of ERCP and MRCP Findings in Patients with Mechanical Jaundice

Haseki Tıp Bülteni, 2014

Amaç: Mekanik ikterli hastalarda tanı ve tedavi yöntemi olarak kullanılan Endoskopik Retrograd Ko... more Amaç: Mekanik ikterli hastalarda tanı ve tedavi yöntemi olarak kullanılan Endoskopik Retrograd Kolanjiyopankreatografi'nin (ERKP) invaziv bir işlem olması ve komplikasyonları nedeniyle, Manyetik Rezonans Kolanjiyopankreatografi (MRKP) ile desteklenmesi gerekir. MRKP ile yönlendirilmiş ERKP'nin tanı koymadaki yerini değerlendirmeyi amaçladık. Yöntemler: Çalışmada 2010-2013 yılları arasında kliniğimize başvuran mekanik ikterli hastalardan ERKP öncesinde MRKP çekilmiş 120 hasta değerlendirilerek bulgular karşılaştırıldı. MRKP bulgularına göre hastalar üç gruba ayrıldı: 1. grupta safra yolları içinde kalkül, çamur ve dilatasyon tespit edilen hastalar, 2. grupta koledok dış basısı, koledok tümörü, koledokta striktür ve dilatasyon tespit edilen hastalar, 3. grupta bulguları normal olan hastalar. Bulgular gruplara göre değerlendirildi ve sonuçlar ki kare testi ile karşılaştırıldı. Bulgular: Çalışmayı oluşturan 120 hastanın (73 kadın, 47 erkek) yaş ortalaması 62 yıl idi. MRKP ile ERKP korelasyonu; 1. grupta 56 hastanın 53'ünde, 2. grupta 45 hastanın 44'ünde, 3. grupta 19 hastanın 4'ünde mevcuttu. Ayrıca; 3. grupta MRKP ile daha önce tanı konamayan 15 hastada ERKP ile altta yatan patoloji tespit edilebilmiştir. Hastaların tamamında MRKP ile ERKP uyumu %84 olup sonuçlar istatistiksel olarak anlamlıdır (p=0,015).

Research paper thumbnail of The importance of follow-up gastroscopy in patients with perforated peptic ulcer

Medeniyet Medical Journal, 2018

Aim: Peptic ulcer disease arises from the imbalance between the mucosal defense factors and the d... more Aim: Peptic ulcer disease arises from the imbalance between the mucosal defense factors and the destructive properties of acid pepsin. The prevalance is around 5-10% of the population but only 2-10% of the patients with the disease are complicated with perforation. What is adviced is a follow up gastroscopy 6-8 weeks after the operation. We aimed to investigate gastric malignancy and helicobacter pylori prevalence in the follow-up gastroscopy. Method: The follow-up gastroscopy notes of the patients who went under operation for perforated peptic ulcer were reviewed. The demographic properties, the operation notes, the follow-up gastroscopy notes and pathology reports were reviewed for the presence of helicobacter pylori and gastric malignancy. Results: Between June 2014 and June 2017 a total of 132 patients were operated for peptic ulcer perforation. The average age of the patients was 43.46±18.78 (15-93). In the study group 73.5%(36/49) were found to be positive for Helicobater pylori. The gastric cancer diagnosis was confirmed in 5.6% (3/53) patients in the follow-up gastroscopy. Conclusion: Helicobater pylori is an important factor in ethiology as well but one must be alert about the potential presence of a gastric cancer. There is also a potential malignancy presence in the perforations which are thought to be duodenal.