A Novel Technique for the Management of Persistent Biliary Fistulas Developing After Liver Hydatid Cyst Surgeries: Drain Clamping Technique.

BACKGROUND: External biliary fistula, where the residual cyst is associated with the biliary tree, is one of the most common complications after liver hydatid cyst surgery. Surgical procedures become a consideration for patients in whom the biliary fistula persists despite all endoscopic procedures. However, reoperation for biliary fistula after hydatid cyst surgery leads to additional complications and increases morbidity and mortality. AIM: This study aims to treat persistent biliary fistulas that develop after liver hydatid cyst surgery using a simple noninvasive technique. MATERIALS AND METHODS: External drainage surgery was performed on 295 patients with liver hydatid cysts. Endoscopic treatment methods were used in patients who developed biliary fistula after surgery. Despite all endoscopic treatment methods, 14 patients developed persistent biliary fistulas. These patients were subsequently treated using the drain clamping technique. FINDINGS: All persistent fistulas occluded in 11.86 days (with a range of 8-20 days). No complications were observed in the one-year follow-up visits. CONCLUSION: Drain clamping, a novel approach to the treatment of persistent biliary fistulas developed despite all available endoscopic methods, can be safely used. This technique resulted in a complete recovery in patients without the need for surgical procedures.

Small bowel perforation after drawing a blood sample in the femoral artery: a case report.

Small bowel perforation is a rare complication of femoral artery access in cases of femoral hernia. A 48-year-old woman was admitted to the intensive care unit due to pulmonary insufficiency. After a routine femoral arterial blood gas analysis, severe abdominal pain and nausea began. She underwent emergency laparotomy due to acute abdomen. Laparotomy revealed small bowel perforation. Segmental resection and end-to-end anastomosis were performed. The femoral canal was closed using plaque mesh. Special attention is needed during femoral artery access to avoid accidental small bowel perforation. As seen in this case, a careful examination should be done in cases of femoral hernia.

Tandir burns in and around Diyarbakir, Turkey.

BACKGROUND: Tandir is the name given to a special oven used for baking bread in the eastern and southeastern part of Anatolia. Tandir burn is a unique trauma in that it involves primarily women and young children falling into the in-ground ovens and suffering deep extensive burns. In this study, we aimed to evaluate the tandir burns occurring in the Diyarbakir region. METHODS: The records of 21 patients with tandir burn who were treated in our Burn Center between May 2003 and February 2006 were reviewed. Patients with tandir burns accounted for 2.14% of all burned patients. The mean age was 10.7 years (1hyphen;47 years). Of the patients, 71.43% were female, and 61.90% were under six years old. The mean total body surface area (TBSA) burned was 22.33% (8-75), and 71.43% of the patients had third-degree burns. RESULTS: Three patients required amputation of an extremity. Eight patients had fasciotomies, 16 eschar excision, and 5 partial thickness skin grafts. The mean hospitalization period was 16.90 days (5-34 days). Five patients (23.81%) died. CONCLUSION: Tandir burn is a severe burn with a higher morbidity and mortality.

Falls from heights in and around the city of Batman.

BACKGROUND: We evaluated the demographic data, mortality rates, fall causes, and post-mortem findings of individuals who fell from heights. METHODS: Five hundred thirty-eight patients who sustained injuries after an accidental fall from heights were entered into the study. Our cases were collected prospectively in Batman over a seven- month period. RESULTS: The mean age was 12.4+/-3.22 years (3 months-98 years); 56.5% of patients were under 6 years old and 83.5% were under 20 years old. The mean fall height was 3.2+/-2.4 m. The mortality rate was 2.2%, and was highest among the patients who fell from flat-roofed houses. The most common injuries were to the head, and 100% of those who died had a head injury. Six patients were followed because of abdominal bleeding and 141 patients due to extremity fractures; 6.7% of patients were operated on and 83.8% of patients were treated in the emergency department. CONCLUSION: The results of this study were at variance with literature data with respect to the following: falls from heights were most common in the 0-5 years of age group. Craniocerebral trauma is the most common injury in fatal falls. Males had a higher rate of falls from height than females.

The handmade endoloop technique. A simple and cheap technique for laparoscopic appendectomy.

OBJECTIVE: To compare 2 laparoscopic appendectomy techniques. METHODS: We describe a modified technique, the handmade endoloop technique, for closing the base of the appendix. This prospective study was carried out at Harran University Medical Faculty, Sanliurfa, and Gulhane Military Medical Academy, Ankara, Turkey from September 2006 to February 2008. We evaluated the safety and efficacy of the procedure in 98 acute appendicitis cases: 57 patients handmade endoloop patients, and 41 endoloop technique patients. Operative time, postoperative complications, need for analgesics, and procedure cost were measured for both groups. The endoloops and sutures used to manage appendectomy were listed at current prices, summarized as number consumed per case, and compared. Data were analyzed by appropriate test. RESULTS: The average price of material used for closing the base of appendix was 81 American Dollars (USD) for laparoscopic appendectomy with endoloop, and 8 USD for the technique described by this article. Overall, postoperative complications, operative time, and the need for analgesia did not show a statistical difference in comparing both groups. CONCLUSION: This procedure is simple, safe, and cheap.

Spontaneous intestinal perforation due to non-Hodgkin's lymphoma: evaluation of eight cases.

Primary intestinal lymphoma with spontaneous perforation and after systemic chemotherapy is rare. The present study summarizes retrospectively the outcome of eight free intestinal perforated patients diagnosed with intestinal non-Hodgkin's lymphoma. Two patients had a history of systemic chemotherapy before perforation. The most common symptoms of the patients were abdominal pain, nausea, vomiting, weight loss, and fever. Sites of perforation were ileum in four, jejunum in two, cecum in one, and sigmoid colon in one patient. Synchronous lymphoma was present in three patients. The perforation was closed by primary closure in three patients. Resection/anastomosis was performed in four patients and sigmoid colostomy was performed in one patient. Three patients were lost due to leakage or septicemia. Intestinal lymphoma might be kept in mind as a cause in free intestinal perforations. Because of the high mortality rate early diagnosis and treatment are important to improve the prognosis of bowel perforation in patients with non-Hodgkin's lymphoma.