BACKGROUND: Fournier's gangrene (FG) is a rapidly progressive, life-threatening necrotizing fasciitis of the perineal and genital region. Despite advances in surgical and medical management, morbidity remains high. Early identification of disease severity and prognosis is essential for timely intervention. This study aimed to evaluate the prognostic value of routinely available inflammatory and metabolic markers-particularly C-reactive protein (CRP) and white blood cell (WBC) count-and to establish clinically applicable admission cut-off values for predicting clinical outcomes, including prolonged hospitalization and surgical burden. METHODS: This retrospective single-center study included 40 patients diagnosed with and treated for FG at Nigde Omer Halisdemir University Training and Research Hospital between 2022 and 2025. Demographic, laboratory, and clinical data were reviewed. Laboratory parameters, including WBC count, CRP, glucose, and derived indices such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were recorded at three time points: admission, post-first debridement, and pre-discharge. Patients were stratified according to diabetes mellitus (DM) status, antibiotic regimen, and surgical complexity. The primary outcome was prolonged hospitalization (>14 days), and the secondary outcome was the need for multiple debridements (>= 3 procedures). Statistical analyses included the Friedman test for repeated measures, Spearman correlation analysis, logistic regression, and receiver operating characteristic (ROC) analysis. RESULTS: The mean age was 56.8 +/- 17.9 years, and 40% of patients had DM. The most common etiology was scrotal abscess (57.5%). Serial laboratory assessment demonstrated significant reductions in WBC count (median: 13.1 -> 8.2 & times;10(3)/& micro;L, p<0.001) and CRP level (median: 90.4 -> 34.6 mg/L, p<0.001) following serial debridements. Admission CRP and WBC levels showed positive correlations with both length of hospital stay (rho=+0.46 and +0.41, respectively) and number of debridements (rho=+0.39 and +0.36, respectively). In multivariate regression analysis, CRP was the only independent predictor of prolonged hospitalization (odds ratio=1.07, 95% confidence interval: 1.02-1.14; p=0.009). ROC analysis identified a CRP threshold of >= 128 mg/L (area under the curve=0.86) as the optimal cut-off value for predicting prolonged hospitalization. No mortality occurred during the study period. CONCLUSION: CRP and WBC count are practical, inexpensive, and reproducible markers of disease severity and treatment response in patients with Fournier's gangrene. Serial monitoring of these parameters may facilitate early risk stratification, guide decisions regarding repeat debridement, and support optimization of antibiotic and surgical management. Incorporation of these readily available inflammatory markers into standardized treatment protocols may improve clinical decision-making and patient outcomes in FG.
BACKGROUND: This study aimed to evaluate the diagnostic approaches, treatment modalities, and clinical outcomes of patients presenting to the emergency department following razor blade ingestion. METHODS: Hospital records of patients who presented to the emergency department with razor blade ingestion and were referred to the General Surgery Clinic between 2021 and 2024 were retrospectively reviewed. Data collected included demographics, presenting symptoms, time to presentation, number of ingested razor blades, imaging findings, treatment approaches, complications, and clinical outcomes. RESULTS: A total of 72 patients with complete medical records were included. All patients were male and incarcerated. The mean age was 31.2 years, and the mean time to presentation was 8 hours. The mean number of ingested razor blades was 1.4. Endoscopic intervention was performed in seven patients (10%) in whom imaging localized the razor blade to the stomach; all presented within 6 hours of ingestion. Successful endoscopic removal was achieved in two patients, while no razor blade was visualized in the stomach in five patients. Surgical intervention was required in two patients (3%). A total of 63 patients (87%) recovered without intervention with outpatient conservative management and follow-up. Successful endoscopic removal was achieved in patients who presented within the first 2 hours. No morbidity or mortality was observed. CONCLUSION: A conservative management is safe and effective in most cases of razor blade ingestion. Early endoscopy may decrease the likelihood of surgical intervention.
An ectopic spleen refers to splenic tissue or lobules located outside the normal anatomical position of the spleen and is most commonly found near the splenic hilum. Ectopic splenic tissue is typically found in characteristic anatomical locations but may rarely occur in atypical sites. Owing to its unusual localization, it can be radiologically mistaken for a variety of tumors. This case is notable because a large retroperitoneal mass requiring emergency laparotomy was ultimately diagnosed as ectopic splenic tissue. A 44-year-old man underwent emergency diagnostic laparotomy for acute abdominal symptoms. Preoperative imaging revealed a heterogeneous lesion medial to the left psoas muscle that was radiologically suggestive of a soft tissue tumor. Intraoperative frozen section examination demonstrated lymphoid tissue suggestive of splenic origin, and the diagnosis was subsequently confirmed on paraffin sections. Histopathological evaluation revealed a well-circumscribed nodular lesion composed of follicle-like lymphoid structures and sinusoidal vascular channels, consistent with ectopic splenic tissue. Unlike most reported cases, which typically occur in women aged 20-40 years and involve lesions measuring 1-3 cm, our patient was male and presented with a retroperitoneal lesion measuring 6.5×3×2.5 cm, an uncommon presentation. The unusual location and relatively large size of the lesion led to its initial radiological interpretation as a soft tissue tumor, highlighting the importance of comprehensive radiologic evaluation and histopathological examination for accurate diagnosis.
ROUND:This study aimed to evaluate the effects of silibinin, a compound with demonstrated therapeutic effects in various liver diseases, on liver healing in a rat model of blunt liver trauma. METHODS:Twenty-four Wistar albino rats weighing 250-300 g were randomly assigned to three equal groups. Group I served as the control group (CG) and received standard nutrition without trauma induction. Under general anesthesia, rats in Groups II and III underwent a blunt trauma procedure applied to the right upper abdominal quadrant. Group II, designated as the trauma group (TG), received standard nutrition only. Group III, designated as the trauma-silibinin group (T-SG), received silibinin at a dose of 100 mg/kg/day via gastric gavage for five days in addition to standard nutrition. Following the five-day observation period, blood samples were collected from inferior vena cava. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured in the collected blood specimens. Histopathological examination of liver tissue was performed to assess the degree of inflammation. RESULTS:Mean AST and ALT levels differed significantly among the groups (p<0.001). Although no statistically significant difference was observed in inflammation scores between the TG and T-SG groups (p=0.115), inflammation scores tended to be higher in the TG, with a moderate effect size (r=0.41). Furthermore, the risk of a high injury score was 11.7 times greater in the TG than in the T-SG. CONCLUSION:To our knowledge, this is the priority study to evaluate the effects of silibinin in a rat model of blunt liver trauma. Silibinin may represent a promising therapeutic agent for reducing inflammation following liver trauma and promoting liver healing.
BACKGROUND:This study aimed to evaluate patients who presented to the emergency department with non-traumatic back or lumbar pain, without new-onset neurological deficits or cauda equina syndrome. Because of inadequate response to medical treatment, patients underwent imaging of the affected region and subsequently required emergency neurosurgical intervention. METHODS:We included patients aged ≥18 years who presented to the emergency department with back or lumbar pain, experienced no pain relief despite analgesic treatment, underwent imaging of the affected region, and were referred for emergency surgical treatment by the neurosurgery department based on imaging findings. Patients presenting with trauma, new-onset neurological defi-cits, or a history of prior spinal surgery were excluded. RESULTS:The study included 35 patients with a mean age of 65.51 years (range: 42-82). Among them, 11.4% (n=4) had chronic kidney disease, 37.14% (n=13) had diabetes mellitus, 22.8% (n=8) had a history of cancer, and 22.8% (n=8) had a family history of cancer. No red flag findings other than cancer-related risk factors were identified. The primary clinical indicator of underlying pathology was persistent pain despite analgesic treatment. Advanced diagnostic evaluation revealed pathological fractures in 77.1% of patients (n=27), spinal abscesses in 14.2% (n=5), and spondylodiscitis in 8.5% (n=3); all patients underwent emergency surgical treatment. Among patients with pathological fractures, histopathological examination demonstrated osteoporotic fractures in 59.2% (n=16) and metastatic fractures in 40.8% (n=11). Notably, all spinal metastases led to the initial diagnosis of cancer, and only two of these patients presented with red flag symptoms. CONCLUSION:Patients without spinal emergencies or red flag symptoms may still require emergency surgical intervention. Therefore, diagnostic and evaluation algorithms should be developed for this patient population. We believe that pain severity scores may play an important role in such algorithms.
