Murat Akici

A rare condition: Ectopic liver tissue with its unique blood supply encountered during laparoscopic cholecystectomy.

Highlights • Developmental abnormalities of liver including ectopic liver are rare conditions.• Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction.• Ectopic liver has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed.• The vascular anatomy of ectopic liver should be identified before the dissection of gallbladder in order to prevent hemorrhage from the liver parenchyma.

An atypical cause of rapidly progressing breast lump with abscess formation: Pure squamous cell carcinoma of the breast.

Squamous cell carcinoma (SCC) is a rare type of breast malignancy and little is known about long-term outcome. In the present report, the clinical features, histopathologic findings and postoperative course of a patient with squamous cell carcinoma are described. We have treated a 47-years-old woman who admitted for right breast mass without any discharge, bleeding and pain. The tumor was, 3 × 2 × 1.5 cm in size with central abscess formation. The result of surgical biopsy revealed large cell keratinizing type of SCC. The metastatic work-up studies ruled out any other probable sources of primary tumor. The patient was performed modified radical mastectomy and axillary dissection and received two cycles of chemotherapy. Squamous cell carcinoma of the breast (SCCB) is a rare entity and should be considered in patients with rapidly progressing breast mass. It should also be considered in breast lesions with abscess formation. The initial therapeutic approach should be surgical excision after histopathological diagnosis.

Internal herniation through the foramen of Winslow: a rare cause of bowel obstruction

An 80-year-old male patient was admitted with nausea, vomiting and abdominal pain persisting for 1 week. The patient’s medical history showed no malignancies, previous surgery, trauma or weight loss. The physical examination showed peritoneal tenderness and widespread abdominal distention. Laboratory examinations showed no sign of pathologies, except leukocytosis (14 000/mm). Abdominal computed tomography showed widespread small intestine dilation and intra-abdominal free air, and the patient underwent emergency surgery (Fig. 1). Intra-abdominal exploration showed that the terminal ileum and cecum (in part) were herniated into the bursa omentalis through the foramen of Winslow. Kocher’s manoeuvre was used to reduce herniated loops. Perforation foci secondary to ischaemia were detected in the 10-cm herniated small bowel loop (Fig. 2). Perforated intestinal loops were resected, and right colonic fixation was performed. The patient did not have any complications in the post-operative period, and was discharged on day 8. Herniation through the foramen of Winslow (HFW) is a rare type of herniation, and is usually not considered in the differential diagnosis in the preoperative period; still, it causes significant morbidity and mortality. HFW constitutes 0.1% of all abdominal hernias, and 8% of all types of internal herniation. The rate of preoperative diagnosis is quite low, and the diagnosis is usually made intraoperatively. Because of delays in diagnosis and treatment, mortality rates up to 50% have been reported. HFW was described for the first time in 1834 by Blandin, and is an extremely rare type of internal herniation. To date, approximately 200 cases have been reported. Under normal conditions, the foramen of Winslow is closed due to intra-abdominal pressure. The predisposing factors in

Spontaneous postoperative choledochoduodenal fistula due to bile duct injury following laparoscopic cholecystectomy.

Highlights • Class E injuries are the most common major bile duct injuries and can cause serious clinical condition including bile leak.• Iatrogenic operative injuries may be a cause of spontaneous postoperative choledochoduodenal fistula even in transaction type complete injuries.• Spontaneous closure of a postoperative bile fistula doesn’t guarantee that it is not a transaction type injury.

Results of the open surgery after endoscopic basket impaction during ERCP procedure

AIM To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. METHODS Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. RESULTS Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13(th) day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

Topical folinic acid enhances wound healing in rat model

PURPOSE Folic acid is an essential vitamin participating in DNA synthesis and repair. Recently folic acid has been shown to stimulate DNA-repair capacity in dermal fibroblasts in response to injury. Thus, the present study aimed to investigate the effects of topical folinic acid, a 5-formyl derivative of tetrahydrofolic acid, on wound healing using rat wound model. MATERIALS AND METHODS A rat wound model was established, and the wound healing was evaluated by macroscopic and histological analyses among vehicle control, 2.5% folinic acid, 1% folinic acid, and dexpanthenol treatment groups. While an image-analysis program was used to evaluate macroscopic wound closure, connective tissue properties, mast cell numbers, and the expressions of matrix metalloproteinase 1 (MMP-1) and 9 (MMP-9) were evaluated by microscopy. RESULTS The 2.5% folinic acid-treated group exhibited enhanced wound healing by increased reepithelialization, neo-vessel formation, inflammatory cell migration, collagen deposition and progressive mast cell increase. Furthermore, 2.5% folinic acid induced higher expressions of MMP-1 and MMP-9. CONCLUSIONS Folinic acid enhances both macroscopic and microscopic wound healing in rat wound model.

Peripheral Radial Vessels: A Dermoscopic Finding in Annular Lichen Planus: Case Report

124 ichen planus is an idiopathic chronic inflammatory skin disease affecting skin, hair, nails and mucous membranes. Classic lichen planus is characterized with pruritic, small, and violaceous papules favoring the flexor surfaces of the extremities.1 Annular lichen planus is a rare clinical variant affecting about 10% of patients and it is characterized with annular lesions with hyperpigmented or skin-colored center and slightly raised purple to white peripheral borders.2 Annular lesions may be scattered among more typical lesions, or may be found as an isolated finding.2 Literature data about dermoscopic features of annular lichen planus is very Peripheral Radial Vessels: A Dermoscopic Finding in Annular Lichen Planus: Case Report