World Congress on Surgeons November 22-23, 2018 Bucharest, Romania

Atahan has completed his Graduation from Medical School of Ankara University. He has completed General Surgery Residency at Ministry of Health, Ankara Numune Education and Research Hospital, Ankara, Turkey. He has served as a General Surgeon at Cankiri Ilgaz State Hospital and as a Surgeon and Head Physician at Burhaniye and Edremit State Hospitals at Balikesir Province. He is working as a Specialist at The First Department of Surgery, Izmir Katip Celebi University Ataturk Education and Research Hospital. He has received certificate of Fellowship in minimal access surgery at World Laparoscopy Hospital at Gurgaon, Haryana, India.

Male Breast Cancer (MBC) is a very rare disease with a rising incidence in recent years. Although there are many similarities with breast cancer in women, some obvious differences has been shown. This oral presentation is aimed to draw attention with the current information of this rare entity. MBC is a rare disease, accounting for less than 1% of all malignancies in men and for less than 1% of all incidents of breast carcinoma. Factors which have been associated with an increased risk are aging, family history of breast cancer, inherited gene mutations, Klinefelter syndrome, radiation exposure, alcoholic beverages intake, liver disease, estrogen treatment, obesity, physical inactivity, testicular conditions, certain occupations. Although these factors may increase a man’s risks of developing breast cancer, the cause of most BMC is unknown. Most information on causes, prevention and treatment of breast cancer from clinical trials and research throughout the world were done in women. Recent studies focus on genetic testing mostly on BRCA1 and BRCA2 mutations and also some other genes that contribute to breast cancer risk are also being identified. Findings reveal that the effects of genetic variations on the risk of breast cancer in men and women are different. New laboratory test as circulating tumor cells and also the effect of environment have also received more attention in recent years. More convenient ways of radiation therapy and innovations in chemotherapy strategies by PARP (Poly ADP Ribose Polymerase) inhibitors and targeted therapies are quite popular. 2,470 newly diagnosed cases of invasive MBC were estimated by The American Cancer Society at the beginning of 2017 and also it was estimated that 460 of them would die. All these improvements of this orphan disease may be will able to save patients children from being orphans.

Alexandra Maria Santos Soares has completed her PhD from University of Beira Interior, Portugal and Postdoctoral studies from Hospital Amato Lusitano-Castelo

Branco. She is in the 3rd year Resident of General Surgery at Hospital Amato Lusitano.

Intussusception or intestinal invagination is usually manifested by intestinal occlusion. Although relatively common in the pediatric age, it is a rare condition in adults accounting for 1-5% of cases of intestinal occlusion. 60% of the cases of colonic intussusception are of malignant etiology. Insidious onset abdominal pain is the most frequent complaint and it may be associated with nausea, vomiting, constipation and occlusion. The examination is often normal. Computed tomography(CT) is the gold-standard for the diagnosis of intussusception, with the target pathognomic image. A 77-year-old man, with a history of hypertension and DM, who appealed to the attending physician for constipation with an insidious period of several months. The examination revealed mild abdominal distension. A colonoscopy revealed at the 22 cms a stenotic, vegetative and infiltrative lesion. Biopsies did not confirm malignancy. Staging CT showed an invaginated tumor of the sigmoid colon.

The patient underwent laparoscopic sigmoidectomy. Histology confirmed stenotic adenocarcinoma with a low grade sigmoid invasion (pT2N0M0). The diagnosis and treatment of intussusception is surgical and resection is the treatment of choice in adults due to the high risk of associated malignancy.

Seelamanthula V has completed his Graduation from Kathmandu Medical College, Nepal. He has his experience in General and Pediatric surgery and General surgery in India. He has also experience in Vascular Surgery and HPB surgery and Emergency Medicine, UK. He has obtained Membership from the Royal College of Surgeons; Edinburgh MRCS. He is currently working as Registrar in General Surgery, Australia.

Jejunal diverticula are uncommon entities which usually come to light incidentally via imaging or laparotomies performed for alternative indications. We present an unusual case of jejunal diverticulitis presenting as acute abdomen secondary to spontaneous perforation. A 69 year old Caucasian gentleman presented with one day history of acute onset left upper quadrant pain, fever and had localized peritonitis, on examination with marginal leukocytosis and neutrophil on bloods. Abdominal computerized tomographic scan was suspicious for a localized jejunal perforation. Emergency laparoscopy confirmed a perforated jejunal diverticulum with a mesenteric abscess. Immediate laparotomy for partial resection of jejunum was performed with jejunojejunostomy. Patient made excellent post-operative recovery and was discharged six days post-surgery. Histology revealed perforated diverticular abscess with acute fecal peritonitis. This case highlights the need for considering jejunal diverticulitis as a differential diagnosis of left upper quadrant pain. Jejunoileal diverticula can be rarely associated with potentially serious complications like mesenteric abscess, perforation, obstruction and hemorrhage. Cases reported so far occurred over the age of 70 and uncomplicated presentations settled with conservative management. In a multicenter study of 33 patients with jejunoileal diverticulitis, 24% of patients required emergency laparotomy. Overall post-operative recovery was uneventful and was associated with a short duration of hospital stay. Diagnostic laparoscopy may play a role when radiographic findings are unreliable and may be a therapeutic option in non-perforated jejunal diverticulitis that does not require bowel resection.

Atahan Acar is Graduated from Medical School of Ankara University. He has completed his General Surgery Residency at Ministry of Health, Ankara Numune Education and Research Hospital, Ankara, Turkey. He has worked as a General Surgeon at Cankırı Ilgaz State Hospital and also as a Surgeon and Head Physician at Burhaniye and Edremit State Hospitals at Balikesir Province, respectively. He finally started to work as a Specialist at The First Department of Surgery, Izmir Katip Celebi University Ataturk Education and Research Hospital. He has also received certificate of Fellowship in minimal access Surgery at World Laparoscopy Hospital at Gurgaon, Haryana, India.

Chitotriosidase is one of the most quantitative proteins secreted by activated macrophages, so its activity has been proposed as a biochemical marker of macrophage accumulation. The clinical importance of the chitotriosidase is still largely unknown. Our aim was to evaluate diagnostic accuracy of serum chitotriosidase activity in Acute Appendicitis (AA). A total of 34 patients with preoperative AA diagnosis (18 men and 16 women; mean age, 28.8±10.9 years) were enrolled in this study.The appendix specimens were classified as normal appendix (10 patients) and AA (24 patients). The serum chitotriosidase

activity was measured preoperatively. Diagnostic value of the preoperative chitotriosidase activity as assessed through the corresponding receiver operating characteristic curve was well (area under the curve, 0.771; 95% confidence interval, 0.647-0.877; P<0.05). Preoperative serum chitotriosidase activity may be a useful marker for diagnosis of AA and future studies are

required to confirm the results presented here.

Humera Naz Altaf has done her postgraduate training in General surgery at Holyfamily hospital.In January 2012 she joined Shifa College of Medicine as Senior Registrar and was promoted to post of Assistant Professor in 2014.

Breast cancer is the leading cause of death despite the continuous development of newer and more effective cancer treatment modalities. In Asia, Pakistan has the highest rate of breast cancer. Delay in diagnosis and non-availability of treatment are the major factors responsible for advanced stage and low survival. Breast cancer treatment shows better prognosis when it is diagnosed at an early stage but mortality increases significantly with delayed diagnosis and advanced stage of disease. The objective of our study was to identify the factors responsible for delayed presentation of patients with breast carcinoma. A cross-sectional study using a questionnaire method was conducted at the Foundation University Medical College affiliated with Fauji Foundation hospital Rawalpindi from January 2015 to December 2016. A total of 89 patients gave consent and were interviewed using a pre-structured questionnaire during the study. Age ranged from 25 years to 64 years. Majority of patients were in stage T3N1M0 (31.5%). Second most common stage was T4N0M0 (14.6%). 13 patients (12.4%) were in stage T3N0M0 and 10 patients (11.2%) were in T3N2M0. Delay ranged from 3 months to more than one year, 43.8% presented with delay of 3 to 6 months. The reasons for delay were lack of knowledge about breast cancer (41%), lack of availability of health care services (32.6%), purdah and religious reasons (6.7%) and fear of being diagnosed with cancer (10.1%). The main reasons for delay identified in our study were lack of knowledge and availability of appropriate health care facilities. In order to improve outcome of breast cancer more focus is needed on spreading awareness and improving health care services in rural areas.

Soares A has completed her PhD from Beira Interior University, Portugal and Postdoctoral studies from Hospital Amato Lusitano-Castelo Branco.She is in the 3rd year Resident of General Surgery at Hospital Amato Lusitano.

The TAMIS technique is currently one of the most effective methods for resection of mid-inferior rectus lesions, namely large polyps not amenable to endoscopic removal, as well as in the case of early stage neoplasms in patients with significant comorbidities. We describe the case of a 71-year-old male sent to the surgery consultation due to a flat lesion of the distal 1/3 of the rectum occupying half of the lumen, not acessible to complete excision by endoscopy, whose biopsies revealed a villous adenoma with a low-grade dysplasia. During patient’s evaluation there was disagreement between staging MRI, which revealed a malignant rectal neoplasm infiltrating the entire thickness of the rectal wall and multiple adenopathies (T3 long N2) and ano-rectal echo-endoscopy in which submucosal involvement was observed without apparent further infiltration (T1N0Mx). We chose resection of the lesion by TAMIS, delaying radical surgery if pathological anatomy confirms malignant neoplasia.

Anatomopathological examination revealed a tubal reticular adenoma of the rectum, with focal high-grade dysplasia and free resection margins. The patient maintains follow-up without recurrences.

Seelamanthula V has completed his Graduation from Kathmandu Medical School and has obtained MRCS from Royal College of Surgeons, Edinburgh. He is

currently working as a Registrar in General Surgery at Caboolture Hospital, Queensland, Australia. He is also Associate Lecturer at the University of Queensland.

Colonic metastasis from breast carcinoma is extremely rare. Bony, pulmonary, pleural, hepatic and cerebral metastases are common. Here we discuss rare colonic metastatic presentation of a primary breast malignancy. A 72 year old female presented with a left breast mass in 1991 treated with breast conserving surgery, axillary clearance and adjuvant radiotherapy.Six years later she developed bony metastases requiring endocrine therapy and bisphosphonates. Following this, she was diagnosed with ovarian metastases requiring total abdominal hysterectomy and bilateral salpingo-oophorectomy. New retroperitoneal disease was detected subsequently on surveillance imaging mandating Aromasin reinstitution. Routine bowel screening few years later revealed a sigmoid growth histologically consistent with metastatic breast cancer, PET scan confirmed a locally invading proximal sigmoid mass. Anterior resection of mass was performed. Tissue was immuno histochemically

consistent with metastatic breast primary with nodal involvement. We present a rare case of breast cancer metastases to sigmoid colon that was detected on routine surveillance colonoscopy for polypoid disease and herewith, emphasize the importance of biopsying bowel polyps in the context of prior breast cancer, providing the pathologist with this crucial information for timely diagnosis. There are emerging case reports of this uncommon occurrence, which can also present with symptoms of dyspepsia,anemia and bowel occlusion. Early investigation with PET scan may aid timely diagnosis. Indications for surgery should be based on the risk of intestinal occlusion or bleeding. Clinical management can be challenging. Holistic care should be delivered via multidisciplinary approach.

Mehreen Khan Bhettani is Graduated from Khyber Medical University.She had the Fellowship training in General Surgery at Pakistan Institute of Medical sciences Islamabad, under the supervision of Professor Rakhshanda Rashid.She also has the Membership of Royal College of Surgeons, Edinburgh. She is currently working as a Senior Registrar in General Surgery at Shifa International Hospital.

Introduction: Fibroadenomas despite being benign cause undue anxiety to patients and place an enormous burden on physicians. Relationship of Body Mass Index and benign breast diseases is quite controversial. Despite multiple publications on relation of fibroadenoma and BMI in international literature, there are a few studies in Pakistan. Therefore it is need to time to ascertain any co-relation in our set of population.

Method: This was a descriptive cross-sectional study, conducted at the Department of General Surgery, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan from 24-03-2016 to 23-09-2016. 300 patients having benign breast diseases were evaluated co-relation between fibroadenoma and BMI. The data was analyzed by SPSS software version 17. Univariate analysis was used to establish co-relation between BMI and fibroadenoma. A P value of less than 0.05 was considered as significant.

Result: The mean age was 23.05±4.17 years (13-35). The average size of fibroadenoma was 2.5±1.9 cm (1-5). The mean BMI was 21.8±1.3 (19-24.9). 60 (20%) had fibroadenoma, while 240 (80%) had other benign breast diseases. 42(30.8%) of patients with high BMI (136) had fibroadenoma. 8 (10.8%) of patients with low BMI (74), had fibroadenoma however 10 (11.1%) of patients with Normal BMI (90) had fibroadenoma. Our study population showed a statistically significant increased risk of fibroadenoma formation in adolescent age group with high BMI (P<0.001).

Conclusion: A high BMI seems to be a substantial risk factor for development of fibroadenoma particularly in young adolescent females. The most site of lesion in our population was the upper outer quadrant of breast. There was substantial association of body mass index with size and quantity of lesions.

Teffahi Sidahmed is a 3rd year Medical Resident in General Surgery at the University of Algiers’s. He is currently pursuing his Residency. He has completed his Residency subspeciality in Orthopedic Surgery and Traumatology, Pediatric Surgery, Thoracic Surgery , Urology and Plastic Surgery at the Teaching Hospital

Mustapha Pacha in Algiers.

Cutaneous squamous-Cell Carcinomas (SCC) are one of the main types of skin cancers, after basal cell carcinoma. Theoverall  cure rate for both types of skin cancer is related to the stage of the disease and the type of treatment employed.

This case involves a locally advanced cutaneous squamous cell carcinoma of the scalp with a deep invasion of the skull. A computed tomography showed full thickness scalp defect and occipital bone destruction. Gadolinium-enhanced MRI revealed no neoplastic invasion of the dura and both cerebral hemispheres. We performed a resection of the scalp craniectomy and dural resection followed by a reconstruction of the skin defect using a rotational flap closure, following the Orticochea’ method. The patient tolerated the procedure, recovered with minimal morbidity and good cosmetic result and addressed for radiotherapy.