Ertan BEYATLI*, MD., PhD.
* General Surgery Department, M.D. Medical Center, İzmir, Turkey
Background: Chronic abdominal pain is one of the most challenging conditions in the parctical medicine requiring appropriate diagnosis and treatment. Nearly all patients with chronic abdominal pain have had a prior medical evaluation that did not yield a diagnosis after history, physical, and basic testing. Materials and Methods: A total of 467 patient suffering from chronic abdominal pain were included in this study. Surgery was performed in all patients under general or spinal anesthesia. All pathological conditions were treated according to intraoperative findings.
Results: Disappearance of signs and symptoms of chronic abdominal pain was determined in 442 patients (94.6%) out of a total of 467 patient who underwent surgery.
Discussion: According to the phrase commonly used for these patient in the Middle East blog as “Drop Belly” we desired to use the original public term used in Turkey which is “Göbek Düşmesi” as nearly half of these patient were turkish origin and adding the word “BEYATLI” according to operating surgeon’s name. We decided to descibe chronic abdominal pain patients included in this study as “Drop Belly-Göbek Düşmesi BEYATLI syndrome”. Despite that all Pre-operative laboratory tests were normal in 424 patient (90.7%), a pathological factor was determined and treated intra-operatively in all patients who underwent surgery with the improvment of 442 patients (94.6%) suffering from chronic abdominal pain (or what we can shotly name it as “BEYATLI Syndrome” according to operating surgeon’s name). This factor alone might indicates the importance of this issue.
Conclusion: Chronic abdominal pain as phrased as “Drop Belly-Göbek Düşmesi BEYATLI syndrome” may be a starting point for some common known diseases of anterior abdominal wall like umbilical and periumbilical hernia and rectus diastasis.
Keywords: Chronic abdominal pain, Göbek Düşmesi, Drop Belly, Belly fall, Ertan BEYATLI, Drop Belly-Göbek Düşmesi BEYATLI syndrome
Chronic Abdominal Pain (CAP) (1) is one of the most challenging conditions in parctical medicine requiring appropriate diagnosis and treatment. The reason unkown yet but this condition is more common in the Middle East blog. In this study we tried to focus light on 467 patient presented with this condition and meanwhile to offer the ways for diagnosis and ultimate management strategies.
In the Middle East, peoples for thousands of years have been complaining of a vague and chronic abdominal or exactly umbilical pain with various conventional methods developed for appeasing symptoms. Examples from some of these methods are umbilical masaage with different objects like soap, onion, egg , olive oil and spices, wrapping umblicus with stone, onion, garlic, placing broomstick in the umblicus, even some cheating elderly methods like talisman and amulets. All these methods may have some physical and/or pcychological impress in abating symptoms but the vicious circle that the sufferer entered continues for many years without complete improvement. In addition, these traditional applications as it provides a temporary relief on the other hand it provides further progression of complaint at a time and is in the final stages the famous public phrase “belly have placed in” is used. In public, many different phrases were used worldwidely to descibe vague and chronic abdominal pain according to demographic location, for expamle belly fall, belly slip, drop belly, belly escape, swollen belly, belly up. But the most commonly used phrase is ‘Drop Belly’ that is why we are going to describe this condition shortly as “Drop Belly” in this study. We combined the main symptoms and signs of the condition under the term “BEYATLI Syndrome”. Symptoms and signs includes:
B – Belly pain and a feeling of heaviness in and around umbilicus
E – Escape of belly to one side while tilting on
Y – Yammering, to make a complaint loudly or persistently
A – Anorexia
T – Tumidity, bloating after meals
L – Laxity and carelessness
I – Indigestion
Although these patient’s complaints are serious but nearly all laboratory tests are normal including blood tests, X-ray, ultrasound, computed tomography and MRI films, endoscopy and colonoscopy. Every thing is normal!
Nearly all patients with chronic abdominal pain have had a prior medical evaluation that did not yield a diagnosis after history, physical, and basic testing(1). According to our observation based on detail physical abdominal examination the following signs were determined in 443 patients (95%) included in this study:
Umbilical rigidity and thickened peri-umbilical tissues
Eventration of umbilical dimple upon rising from a sleeping position
Umbilical fascia defect varing from 3-20 mm in diameter.
MATERIALS AND METHODS
A total of 467 patient suffering from chronic abdominal pain (Drop Belly-Göbek Düşmesi BEYATLI syndrome) were included in this study. The mean age was 38 years, with a range of 17–59 years. Tow handred fourty eight (53.1%) patients were male and tow handred ninteen (46.9%) patients were female. Inclusion criteria were: the existence of at least three symptoms and one sign (3+1) mentioned above . Laboratory tests were all normal unless in 43 patient, 2 of them having peptic ulser, 16 of them with umbilical hernia, 15 patient with rectus diastasis and reminder 15 patients were complaining of accompanying pcychological disorders. All patients were asked for signed informed consent prior to surgery. Intra-operatively the following pathologies were encountered:
1. Retro-umbilical excessive fatty tissue in 261 patients (55.8%)
2. Retro-umbilical small (ranging from 3-20 mm in diameter) fascia defect (umbilical hernia) in 126 patients (26.9%)
3. Rectus diastasis in 19 patients (4%)
4. Retro-umbilical omental adhesion in 48 patients (10.2%)
5. Peri-umbilical pinpoint hernia in 4 patients (0.8)
6. Combination of 1,2,3,4 and 6 in 9 patients (1.9%)
Surgery was performed to all patients under general or spinal anesthesia. In 450 patient a standard infra-umbilical mini-transverse incision was used, in the remainder cases different incisions were applied like supra-umbilical transverse and longitudinal incision, para-umbilical incision, etc.. Fascial defects were primarly repaired using 1/0 prolene and 1/0 PDS. Subcutaneous tissue and skin were sutured by 2/0, 3/0 vicryl and 3/0 4/0 rapid vicryl. All pathological conditions were managed accordingly including removal of retro-umbilical excessive fatty tissue, primary hernia repair, primary rectus diastasis repair and liberalization of omental adhesions. All treatment strategies were decided intra-operatively and applied by the same surgeon. That is way we are going to combine them under the term “Ertan BEYATLI’s Method” in the management of Drop Belly-Göbek Düşmesi BEYATLI syndrome.
Disappearance of signs and syptoms of chronic abdominal pain (Drop Belly-Göbek Düşmesi BEYATLI syndrome) was determined in 442 patients (94.6%) , in 9 patients (1.92%) there were no improvement and other 6 patient (1.28%) were mentioned that they became worser after operation. Ten patients (2.14%) could not be followed up. The median follow-up for patients was 15 (range 6–24) months.
Chronic abdominal pain is one of the most challenging conditions in parctical medicine requiring appropiriate diagnosis and treatment. In this study a total of 467 patient suffering from chronic abdominal pain for many years (the mean was 18 years, with a range of 1–35 years) were included. According to the phrase commonly used for these patients in the Middle East blog as “Drop Belly” we desired to use the original public term used in Turkey which is “Göbek Düşmesi(2)” as nearly half of these patient were turkish origin. This term was used because we tried to focus light on a neglected group of patients suffering from similar signs and symptoms bu unfortunately beacause of the public use of the narrator word “Drop Belly-Göbek Düşmesi” finally leading to many paramedical traditional applications that might be life threatening at sometimes. The seconed aim was to find the appropriate medical management for these patient according to clinical researches.
Despite that all Pre-operative laboratory tests were normal in 424 patient (90.7%), a pathological factor was determined and treated intra-operatively in all patients who underwent surgery with the improvment of 442 patients (94.6%) suffering from chronic abdominal pain. This factor alone might indicates the importance of this issue.
The subject of finding a pathological factor like defect or anatomical abnormality in reto-umbilical space including fascia defect, hernia and rectus diastasis and excessive fatty tissue is also valuable. Because this condition might indicate that what is publicly called Drop Belly/Göbek Düşmesi may be a starting point to these diseases.
Chronic abdominal pain as phrased in public as Drop Belly/Göbek Düşmesi may be a starting point for some common known diseases of anterior abdominal wall like umbilical and periumbilical hernia and rectus diastasis. We hope that this clinical study also to be a starting point for further future researches on this topic and providing useful informations for our colleague worldwide.
Merck Manuals Professional Edition: http://www.merckmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gi-disorders/chronic-and-recurrent-abdominal-pain
Göbek Düşmesi (Kayması) Hastalığı: http://www.ertanbeyatli.com/gobek-dusmesi/