Omer Alabaz

A New Seton Type for the Treatment of Anal Fistula

In this retrospective study, our aim was to introduce an industrial synthetic material that can be used as a seton and then to present the results of complicated anal fistula cases treated with this different sort of seton. Between 1997 and 2005, 32 patients (aged 27–63 years) with a high anal or rectal internal opening were treated with a cutting seton. In the postoperative period none of the patients had recurrence or solid stool incontinence. However, three of them had just flatus incontinence, and two had flatus and liquid stool incontinence. The new material we used as a new type of seton can be used efficiently; it can be inserted easily, is cheap and effective, and may give better therapeutic results and better patient satisfaction.

Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion

In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier’s gangrene patients. Fourty-eight patients with diagnosis of Fournier’s gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients’ relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients’ satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters.

Isolated Hepatic Tuberculosis Presenting as Cystic-Like and Tumour-Like Mass Lesions

Hepatic tuberculosis is a rare manifestation of extra-pulmonary tuberculosis. Hepatic tuberculous lesions are especially mimicking tumour-like mass or cystic lesions in the liver and so can be misdiagnosed with several diseases. Histopathological examination of the specimen is essential in the diagnosis for hepatic tuberculosis. In this report, two cases with hepatic tuberculosis having cystic solid mass and abscess liver lesions are described.

The Effectiveness of Nitric Oxide Derivates in Hydatid Disease

The purpose of this study was to assess the possible alterations of the levels of plasma NO derivates which are thought to reflect the immune status of the body against cystic echinococcus (CE). Materials and Methods: Plasma NO2 and NO3 levels of 95 patients with CE were analyzed before treatment and then after a 1 year. All patients were classified according to the WHOIWGE classification of cystic hydatid disease. The levels of NO2 and NO3 were detected from sera by using a photometric endpoint determination on the basis of absorbance in the visible range at 550 nm. Results: Pretreatment levels of plasma NO2 and NO3 of the CE group were significantly higher than those in the control group (p < 0.001). However, the posttreatment NO2 and NO3 levels of the CE group were significantly lower than the pretreatment levels (p < 0.001). Hence, a positive correlation was found between fertile capacity of CE and the levels of NO2 and NO3 (p < 0.05). Conclusion: The analysis of the levels of plasma NO derivates should be considered for the at preoperative detection of hydatid disease and postoperative follow-up in addition to radiological and serological methods.

Intestinal Behcet’s Disease with Perianal Abscess and Necrosis: A Case Report

Behçet’s disease (BD) is an inflammatory multisystem disorder, characterized by recurrent oral and genital ulcers, erythema nodosum-like lesions, papulopustular lesions, uveitis, large vessel thrombosis as well as neurologic and gastrointestinal manifestations. Case Report: A 55-year-old man with BD was admitted to the emergency room with perianal abscess and necrosis. One day after abscess drainage and débridement the patient developed peritonitis, and sepsis ensued. Histopathologic examination of the skin overlaying the débridement area revealed vasculitis and fibrinoid necrosis. Emergency laporatomy revealed multiple ‘punchedout’ perforations with 0.5-1 cm in diameter over the whole small intestine concentrating in the terminal ileum. Débridement - primary repair and partial ileal resection - of ileostomy was done. The patient died due to sepsis and multiple organ failure on the first postoperative day. Histopathologic examination revealed nonspecific inflammatory cell infiltrates surrounding capillaries and venules, especially in the submucosa and serosa (vasculitis) with no evidence of granulomatous inflammation. Conclusion: Anal abscess or necrosis in a patients with BD may be a clue to the presence of intestinal BD with imminent perforation, representing the widespread vasculitis of the gut in BD.