AMAÇ: Deneysel kafa travmasý modelinde etanerceptin antiödem, antienflamatuvar ve nöroprotektif etkinliðinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Bu çalýþmada aðýrlýklarý 250–300 g arasýnda deðiþen 40 adet erkek eriþkin Spraque-Dawley sýçaný kullanýldý. Sýçanlar kontrol; travma uygulanmayan; travma+SF; travma sonrasý serum fizyolojik, travma+D; travma sonrasý deksametazon ve tarvma+E: travma sonrasý etanercept verilen gruplara ayrýldý. Tüm ilaçlar periton içine verildi. Travma ve ilaç uygulamasý sonrasý 24. saatte sýçanlar dekapite edildi, örnekler histopatolojik olarak incelendi.
BULGULAR: Çalýþmamýzda ödem ve enflamasyon deðiþkenlerine göre travma+SF ve travma+deksametazon gruplarý arasýnda istatistiksel olarak anlamlý bir farklýlýk tespit edildi, nöronal hasar, astrositik hasar ve glial apoptoz deðiþkenlerine göre ise anlamý bir farklýlýk tespit edilmedi. Travma+SF ile travma+etanercept gruplarý arasýnda ve travma+deksametazon ile travma+etanercept gruplarý arasýnda tüm deðiþkenlere göre istatistiksel olarak anlamlý bir farklýlýk izlendi.
TARTIÞMA: Travma sonrasý beyin hasarý oluþturulan sýçanlarda etanercept uygulamasýnýn antiödem, antienflamatuvar ve nöroprotektif etkisinin olduðu saptanmýþtýr.

BACKGROUND: To study the anti-edematous, anti-inflammatory, and neuroprotective effect of etanercept in the model of experimental head injury.
METHODS: In this study, 40 male-adult Spraque-Dawley rats, with weight ranging from 250g to 300g, were used. The rats are divided into groups as control; non-penetrating trauma; trauma +NS; post-traumatic normal saline; trauma + D; post-traumatic dexamethasone and trauma + E. All medicines were given into peritoneum. After applying trauma and medicine, rats were decapitated in the 24th hour and the samples were studied histopathologically.
RESULTS: In the study, a statistically significant difference was observed between the groups of trauma + NS and trauma dexamethasone according to the variables of edema and inflammation, but no difference was observed according to the variables of neuronal damage, astrocytic damage, and glial apoptosis. Moreover, a significant difference was observed between groups of Trauma + NS and trauma+etanercept and between the groups of trauma + dexamethasone and trauma + etanercept in terms of all variables.
CONCLUSION: It was observed that etanercept has anti-edematous, anti-inflammatory, and neuroprotective effect on the rats which experienced traumatic brain injury.

AMAÇ: Özellikle geliþmekte olan ülkelerde daha yaygýn görülen korozif özefagus yanýklarý farklý yaþ gruplarýnda farklý problemlere yol açarlar. Korozif maddelerin yutulmasý özefagus striktürlerinden perforasyona hatta ölüme kadar birçok problem neden olabilir. Striktür oluþmasý ilk hasarýn þiddeti ile iliþkili olduðundan striktür geliþiminin önlenmesi tedavinin asýl amacýdýr. Bu çalýþmada, korozif özefagus yanýðýnda sarýmsak yaðýnýn (Allium Sativum) koruyucu ve antienflamatuvar etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Yirmi sekiz sýçan rastgele dört eþit gruba ayrýldý; 1. grup (Sham), 2. grup (kontrol), 3. grup (topikal tedavi) ve 4. grup (topikal ve sistemik tedavi). Sham grubu hariç diðer gruplarda abdominal özefagusun 1.5 cm’lik distal kýsmýna NaOH uygulanarak korozif özefagus yanýðý oluþturuldu. Ýkinci gruba normal salin, 3. gruba topikal sarýmsak yaðý ve 4. gruba topikal ve sistemik sarýmsak yaðý verildi.
BULGULAR: Hidroksiprolin seviyeleri topikal tedavi grubunda kontrol grubundan daha düþüktü (p=0.023). Sistemik tedavi grubu ile kontrol grubu arasýnda tümör nekrozis faktör alfa (TNF-α) seviyelerine göre farklýlýk mevcuttu (p=0.044). Sarýmsak yaðý ile tedavinin stenoz indeksini (SI) ve histopatolojik hasar skorunu (HDS) azalttýðý görüldü. Kontrol grubu ile karþýlaþtýrýldýðýnda topikal tedavi grubunda SI belirgin olarak daha düþüktü (p=0.016). Histopatolojik hasar skoru kontrol grubuna göre sistemik tedavi grubunda anlamlý olarak düþüktü (p=0.019).
TARTIÞMA: Sarýmsak yaðý korozif özefagus yanýðýna baðlý oluþan doku hasarýnýn ve özefagial stenozun azaltýlmasýnda etkili bir ajandýr. Sarýmsak yaðý topikal uygulandýðýnda doku hasarý üzerine koruyucu etkisi daha belirgin iken, sistemik uygulandýðýnda antienflamatuvar etkilerinin daha ön plandaydý. Bundan dolayý, korozif özefagus yanýðý olan hastalarda sarýmsak yaðý uygulamasýnýn komplikasyon oranlarýný azaltacaðýna inanýyoruz.
Anahtar sözcükler: Hidroksiprolin; korozif özefagus yanýðý; sarýmsak yaðý; stenoz indeksi; TNF-α.

BACKGROUND: Corrosive esophageal burns, particularly common in developing countries, lead to different problems in different age groups. The ingestion of corrosive substances can cause such problems as stricture of the esophagus, to acute perforation, and even death. Because stricture formation is related to the severity of the initial injury, the prevention of stricture constitutes a main goal of treatment. The aim of this study was to investigate the protective and anti-inflammatory effects of garlic (Allium sativum) oil in corrosive esophageal burn.
METHODS: Twenty-eight rats were randomly divided into 4 equal groups: group 1 (sham), group 2 (control), group 3 (topical treatment), and group 4 (topical and systemic treatment). In groups 2, 3, and 4, corrosive esophageal burns were generated by applying sodium hydroxide to a 1.5-cm segment of the abdominal esophagus. Normal saline was applied to group 2, topical garlic oil to group 3, and topical and systemic garlic oil were used in group 4.
RESULTS: The level of hydroxyproline was lower in the topical treatment groups than in the control group (p=0.023). There was difference in tumor necrosis factor alpha level between the systemic treatment groups and the control group (p=0.044). Treatment with garlic oil decreased stenosis index (SI) and histopathological damage score (HDS) in corrosive esophageal burn rats. The SI in the topical treatment group was significantly lower than that of the control group (p=0.016). The HDS was significantly lower in group 4 when compared with the control group (p=0.019).
CONCLUSION: Garlic oil is an effective agent in promoting the regression of esophageal stenosis and tissue damage caused by corrosive burns. While the protective effect of garlic oil on tissue damage is more significant when applied topically, the anti-inflammatory effect is more pronounced when applied systemically. Therefore, we believe that the application of garlic oil in patients with corrosive esophageal burns can reduce complication rates.

AMAÇ: Akut apandisit ani baþlangýçlý karýn aðrýsý nedeni ile acil servis baþvurularýnda en sýk karþýlaþýlan nedenlerden birisidir. Hekimler için akut apandisit tanýsýnýn zamanýnda ve doðru olarak konulmasý kritiktir. Bu çalýþmanýn amacý akut apandisit tanýlý hastalarda Doppler ultrasonografinin (USG)tanýsal deðerliliðini deðerlendirmek ve bu yeni tanýsal metodu diðer sýk kullanýlan tanýsal metotlarla karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Ekim 2012 ile Nisan 2013 arasýnda Keçiören Eðitim ve Araþtýrma Hastanesi’ne baþvuran ve akut apandisit tanýsý alan sonrasýnda ise apendektomiye alýnan hastalar çalýþmaya dahil edildi. Ýleriye yönelik olan çalýþmaya baþlanmadan önce lokal etik kuruldan izin alýndý. Hastalarýn demografik verileri, fizik muayene bulgularý, vital bulgularý, Alvarado skorlarý, radyoloji ve laboratuvar sonuçlarý kayýt edildi.
BULGULAR: Toplamda 60 hasta çalýþmaya dahil edildi. Kýrk altý hasta yapýlan cerrahi sonrasý patolojik olarak apendisit tanýsý doðrulanýrken 14 hasta patolojik sonuçlarla doðrulanmadý. Doppler USG 46 hastanýn 43’ünü doðru pozitif olarak saptayabilirken iki hastayý yanlýþ pozitif olarak yorumladý. Doppler USG duyarlýlýðý 0.93, özgüllüðü 0.85, doðruluk 0.91, pozitif likelihood ratio (PLR) 6.5 ve negatif likelihood ratio 0.08 olarak bulundu.
TARTIÞMA: Doppler USG akut apandisit hastalarýnýn taný sürecinde yüksek seviyede baþarýlý gibi görünmektedir. Hýzlý ve kolay uygulanabilmesi, hastaya kontrast madde verilmemesi nedenleri ile klasik USG ve bilgisayarlý tomografiye üstün gibi görünmektedir. Biz bundan dolayý Doppler USG’nin akut apandisit tanýsýnda öncelikle kullanýlmasý gerektiðini önermekteyiz.

BACKGROUND: Acute appendicitis is one of the most common causes of acute abdominal pain prompting emergency department (ED) visits. It is critical for the physicians to promptly and accurately diagnose acute appendicitis. The present study aimed to evaluate the diagnostic efficacy of Doppler ultrasonography (USG) in patients with acute appendicitis and compare this new method with other commonly used radio-diagnostic tools.
METHODS: All patients who were diagnosed with acute appendicitis at the Kecioren Training and Research Hospital ED and later underwent appendectomy between October 2012 and April 2013 were included in the study. Approval from the ethics committee was obtained for this prospective study. The patients’ demographic information, physical examination findings, vital signs, Alvarado scores, and laboratory and radiological exam results were recorded.
RESULTS: A total of 60 patients were enrolled in the study. In 46 of the 60 patients, diagnosis of acute appendicitis was confirmed by histopathology results, whereas 14 patients, diagnoses was not confirmed by lab tests. Doppler USG could detect 43 of the 46 patients as true positives, and it detected 2 of the 14 patients with negative lab results as false positives. For diagnosis of acute appendicitis, sensitivity of appendicular Doppler USG was 93%, specificity was 85%, accuracy was 91%, positive likelihood ratio was 6.5, and negative likelihood ratio was 0.08.
CONCLUSION: Doppler imaging can offer a high level of diagnostic success in patients with acute appendicitis. Appendicular Doppler USG offers a rapid and easy application without the need to expose patients to contrast medium and is superior to both USG and computed tomography. Therefore, we recommend the use of appendicular Doppler imaging as the primary radiological exam in diagnosing acute appendicitis.

BACKGROUND: The role of migration inhibitory factor (MIF) is best understood in septic shock and septic disease; however, the role of MIF in a secondary infection after trauma has not yet been completely studied. This study aimed to evaluate the role of MIF in trauma patients.
METHODS: The patients in the study population were divided into two groups according to the results of their MIF levels. The initial MIF levels, trauma mechanism, revised trauma score, survival rate, length of stay (LOS) in the intensive care unit (ICU), level of leukocytes, and level of C-reactive protein (CRP) were compared between the groups.
RESULTS: Overall, 116 patients were enrolled from August 1, 2014 to July 31, 2015. LOS in ICU in the elevated MIF group was 5.67±7.54 days compared with 2.09±2.26 days in the normal MIF group. Further, CRP level in the elevated MIF group was higher than that in the normal MIF group.
CONCLUSION: In a place such as the department of emergency medicine, it is critical and important for emergency physicians to make a proper judgment and to prepare for the worst scenario. Therefore, the utilization of MIF level in trauma patients has a possibility for assisting emergency physicians.

AMAÇ: Savaþlar sýrasýnda çok sayýda sivil, sýklýkla yüksek kinetik enerjili ateþli silahlar, bomba ve þarapnel etkisiyle ciddi yaralanmalarla karþý karþýya kalmýþlardýr. Savaþ yaralýsý olgularýn triyajý, cerrahi prosedürleri ve yoðun bakým takipleri oldukça zor ve karmaþýk süreçleri içerir. Biz bu çalýþmada, Suriye Ýç Savaþý sýrasýnda yaralanan ve acil operasyon gerektiren olgularýn demografik ve travmatik özelliklerini inceledik.
GEREÇ VE YÖNTEM: Türkiye’nin güneyindeki Suriye sýnýrýndan Mart 2012 ve Ocak 2013 arasýnda Kilis Devlet Hastanesi’ne getirilen 8318 Suriyeli yaralý sýðýnmacý arasýndan acil olarak operasyona alýnan 707 olgunun travmatik, cerrahi ve yoðun bakým takip özellikleri, elektronik datalar üzerinden geriye dönük olarak incelendi.
BULGULAR: Olgulardaki en sýk yaralanma nedeni yüksek kinetik enerjili ateþli silahlar (%83.75) idi. Acil servisten direkt olarak operasyon odasýna alýnan 707 olgunun %93.2’si erkek cinsiyetinde yaþ ortalamasý 26.1±12.1 ve çocuk olgularýn yaþ ortalamasý ise 11.7±3.41 olarak saptandý. En sýk yaralanan vücut bölgesi baþ-boyun idi (%52.7). New Injury Severity Score (NISS): 42.5±11.2 ve American Society of Anesthesiologists (ASA) Score: 3.2±0.7 olarak bulundu. Ameliyatta hayatýný kaybeden olgu sayýsý yedi, hasar kontrol cerrahisi uygulanan olgu sayýsý 204 ve ameliyat sonrasý periyotta yoðun bakýma yatýrýlan olgu sayýsý ise 233 olarak bulundu.Yoðun bakýmda yatýþ süresi 4.67±1.32 idi.Yaþayan hastalarda ilk 24 saatte bakýlan invaziv ölçümler (pH, hemoglobin, vücut ýsýsý, ortalama arteriyal kan basýncý) ve International Normalized Ratio (INR) daha yüksek bulundu. Yaþayabilen hastalar için kullanýlan kan ürünü miktarlarý daha azdý ve bu hastalarda NISS 29.7±10.1 olarak bulundu. Acil operasyon sonrasý yoðun bakýmda takip edilen tüm hastalardaki mortalite oraný %45 ve en düþük sað kalým oraný nöroþirürji olgularýna aitti (%24.1).
TARTIÞMA: Bu çalýþmanýn verileri, Suriye Ýç Savaþý sýrasýnda tahrip gücü yüksek olan savaþ silahlarý ile yaralanarak Türkiye’ye getirilen ve acil operasyona alýnan Suriyeli sivillerde baþ-boyun, göðüs-abdomen ve çoklu vücut yaralanmalarýnýn sýk görüldüðüne, acil cerrahi operasyon sayýlarýnýn fazla ve yoðun bakým takip sürelerinin uzun olduðuna, mortal olgularda ise NISS ve ASA skorlarýnýn anlamlý bir þekilde yüksek olduðuna iþaret etmektedir.

BACKGROUND: During a war, many civilians are severely injured by firearms, bombs, and shrapnel. The triage of war injuries involves difficult and complicated processes requiring surgical procedures and patient monitoring in the Intensive Care Unit (ICU) of hospitals. In this study, we examine the demographic, traumatic, and critical care characteristics of cases injured during the civil war in Syria and requiring emergency surgery.
METHODS: Electronic data of the traumatic, surgical, and ICU monitoring features of 707 patients admitted to Kilis Public Hospital between March 2012 and January 2013 were analyzed retrospectively
RESULTS: Most of the patients reported having been injured due to firearms (83.75%). Of the 707 cases studied in this work, 93.2% was male. Male patients reported a mean age of 26.1±12.1 years, while pediatric cases reported a mean age of 11.7±3.41 years. The most frequently injured region of the body was the head–neck region (52.7%). The New Injury Severity Score (NISS) of the cases was 42.5±11.2 and their American Society of Anesthesiologists (ASA) score was 3.2±0.7. The number of cases with intraoperative exitus was 7, while the number of cases who had undergone damage control surgery was 204. The number of cases hospitalized in the ICU during the postoperative period was 233, and the average hospitalization duration in the ICU was 4.67±1.32 days. Among survivor patients, the first 24-hour invasive measurements (i.e., pH, hemoglobin, body temperature, and mean arterial blood pressure) and international normalized ratio were found to be high. The number of blood products used for surviving patients was fewer relative to that used for non-surviving patients, and these NISS of these patients was 29.7±10.1. The mortality rate of all patients followed up in the ICU after emergency surgery was 45%, and neurosurgical cases showed the lowest level of survival (24.1%).
CONCLUSION: The results of this study indicated that head–neck, chest–abdomen, and multiple body injuries are the most widely seen among civilians brought to Turkey because of gunshot injuries sustained during the Civil War in Syria. The number of emergency operations performed in the study sample was high, and critical care follow-up durations were long. In addition, the NISS and ASA scores of mortal cases were fairly high.

AMAÇ: Acil müdahale ekibi koordinasyonu hastanelerde savaþa baðlý ateþli silah yaralanmalarýnda hýzlý ve etkin tedavinin önemli bir belirleyicisidir. Yazarlar akýllý telefonlar için anlýk mesajlaþma uygulamalarýnýn, acil müdahale ekip üyelerinin iletiþimi için etkin bir araç olarak kullanýlabileceðini düþünmektedir. Bu çalýþmada, seviye 1 travma merkezinde acil ekibi iletiþim aracý olarak ticari bir anlýk mesajlaþma uygulamasýnýn (WhatsApp, Mountain View, CA) etkinliði araþtýldý.
GEREÇ VE YÖNTEM: Sekiz haftalýk süre içinde helikopter ile hastanemize sevk edilen savaþa baðlý ateþli silah yaralanmalarý ile ilgili anlýk mesajlaþma uygulamasý mesaj grubu kuruldu ve bu gruba ait mesajlar deðerlendirildi. Acil ekip lideri tarafýndan yaralý ile ilgili gönderilen ilk bilgi mesajýna acil ekip üyesi olan doktorlar, hemþireler ve teknisyenler tarafýndan verilen ortalama yanýt süreleri ve mesai içi veya mesai dýþýnda ortalama yanýt süreleri deðerlendirildi.
BULGULAR: On yedi çatýþmaya baðlý ateþli silah yaralanmasý olgusuna ile ilgili 510 acil çaðrý mesajý bulunmaktadýr. Ekip üyesi doktor, hemþire ve teknisyenler tarafýndan ilk bilgi mesajýna verilen ortalama yanýt süreleri sýrasýyla 4.1 dakika, 6 dakika ve 5.3 dakika idi. Gruplar arasýnda yanýt süreleri farký (p=0.03) istatistiksel olarak anlamlý idi. Alt grup analizinde ise doktorlar ve hemþireler (p=0.038) arasýnda istatistiksel olarak anlamlý fark mevcuttu. Ancak, doktorlar ve teknisyenler (p=0.19), ya da hemþire ve teknisyenler (p=1.0) arasýnda istatistiksel olarak anlamlý fark saptanmadý. Acil travma ekip liderleri açýsýndan bakýldýðýnda, bu uygulamanýn kullanýmý ile iletiþim için zaman kaybý ve ekip liderinin iþ yükü azaltýlabilmiþtir.
TARTIÞMA: Akýllý telefonlar için anlýk mesajlaþma uygulamalarý, týbbi bilgi transferi ve hastanelerde acil müdahale ekibi üyelerinin koordinasyonu için etkin, kullanýmý kolay ve zaman tasarrufu saðlayan bir iletiþim aracý olabilir.

BACKGROUND: Coordination of an emergency response team is an important determinant of prompt treatment for combat injuries in hospitals. The authors hypothesized that instant messaging applications for smartphones could be appropriate tools for notifying emergency response team members. The objective of this study was to investigate the efficiency of a commercial instant messaging application (WhatsApp, Mountain View, CA) as a communication tool for the emergency team in a level-I trauma center.
METHODS: We retrospectively evaluated the messages in the instant messaging application group that was formed to coordinate responses to patients who suffered from combat injuries and who were transported to our hospital via helicopter during an 8-week period. We evaluated the response times, response time periods during or outside of work hours, and the differences in the response times of doctors, nurses, and technicians among the members of the emergency team to the team leader’s initial message about the patients.
RESULTS: A total of 510 emergency call messages pertaining to 17 combat injury emergency cases were logged. The median time of emergency response was 4.1 minutes, 6 minutes, and 5.3 minutes for doctors, nurses, and the other team members, respectively. The differences in these response times between the groups were statistically significant (p=0.03), with subgroup analyses revealing significant differences between doctors and nurses (p=0.038). However, no statistically significant differences were observed between the doctors and the technicians (p=0.19) or the nurses and the technicians (p=1.0). From the team leader’s perspective, using this application reduced the workload and the time loss, and also encouraged the team.
CONCLUSION: Instant messaging applications for smartphones can be efficient, easy-to-operate, and time-saving communication tools in the transfer of medical information and the coordination of emergency response team members in hospitals.

AMAÇ: Ýnhalasyon yoluyla bütan gazý kötüye kullanýmý ergen ve genç eriþkinlerde giderek artan halk saðlýðý problemi halini almaktadýr. Çakmak gazý olarak kullanýlan bütan gazýnýn suistimali sýrasýnda oluþan patlama yanýklarý az sayýda bildirilmiþtir.
GEREÇ VE YÖNTEM: Son iki yýlda, kokusuz ve renksiz bir gaz olan bütan gazýnýn alev almasý sonucu oluþan parlamalarla yaralanmýþ 22 hastayý içeren geriye dönük bir çalýþma gerçekleþtirildi.
BULGULAR: Hastalarýn sosyo-demografik özellikleri, mevcut psikiyatrik hastalýklarý, alkol baðýmlýlýðý, yanýðýn derinliði, eþlik eden yaralanmalar, hastanede kalýþ süreleri ve yanýk yüzdesi kayýt edildi.
TARTIÞMA: Hastalarýn tamamý erkek ve çoðunun yanýklarý yüzeyel olarak görüldü. Hastalarýn hastanede kalýþ süreleri 0–11 gün arasýnda deðiþmekteydi. Hastalarýn tamamý konservatif yöntemlerle tedavi edildi.

BACKGROUND: Abusive inhalation of butane gas is becoming a serious public health problem among teenagers and young adult population; however, there has been little reporting on explosion burns associated with abuse of butane cigarette lighter fluid.
METHODS: Retrospective study was conducted of 22 patients who were burned in last 2 years in explosion of butane gas, a flammable, odorless, and colorless aliphatic hydrocarbon.
RESULTS: Details of sociodemographic profile of the patients, any underlying psychiatric illness, alcohol abuse, depth of burn injury, any associated injury, duration of hospitalization, and percentage of burned area were recorded and analyzed.
CONCLUSION: All of the patients were young men, and most had superficial burn injury. Hospital stay ranged from 0 to 11 days. All of the patients were treated with conservative management.

AMAÇ: Çocuklarda travma ya da giriþimsel iþlemlere baðlý olarak meydana gelen vasküler yaralanmalarýn birçoðu cerrahi müdahale gerektirir. Bu çalýþmada herhangi bir nedenle vasküler yaralanmaya maruz kalýnan çocuklarda uygulanan cerrahi iþlemler incelendi.
GEREÇ VE YÖNTEM: Ocak 2002–Aralýk 2012 yýllarý arasýnda vasküler yaralanma nedeniyle acil operasyona alýnan 18 yaþ altý 17 hasta geriye dönük olarak incelendi. Çalýþma verilerine hastane kayýtlarýndan ulaþýldý. Çalýþmaya alýnan hastalarýn ameliyat öncesi ve ameliyat sýrasýndaki verileri kaydedildi.
BULGULAR: Hastalarýn 11’i kýz (%64.7) ve yaþ ortalamasý 60.7±54.4 ay idi. Vasküler yaralanmalarýn 14’ü (%82.3) anjiyografik iþlemlere baðlý, biri (%5.9) eksternal travmaya, biri (%5.9) ameliyat sýrasýnda travmaya, biri (%5.9) ise yoðun bakým takibi sýrasýndaki invaziv arter takibine baðlý olarak meydana gelmiþtir. Bu yaralanmalarýn 11’i (%64.7) sað femoral arterde, üçü ise (%17.6) sol femoral arterde, ikisi (%11.8) sol barakiyal arterde ve biri (%5.9) sol eksternal iliak vende gerçekleþmiþtir. Anestezi yöntemi olarak beþ (%29.4) hastada lokal, 12 (%70.6) hastada ise genel anestezi kullanýldý. Yaralanmalarýn 15’i (%88.2) primer olarak tamir edilirken, birinde (%5.9) uç-uca anastomoz, birinde (%5.9) safen ven interpozisyonu gerekmiþtir. Ayrýca 16 (%94.1) olguda ilave olarak trombektomide uygulanmýþtýr. Hastanede yatýþ süresi ortalama 2.7±1.4 gün, yoðun bakým kalýþ süresi ise 1.1±0.4 gün olarak tespit edilmiþtir. Hiçbir hastada mortalite görülmemiþ olup ekstremite kaybý, yara yeri enfeksiyonu gibi herhangi bir komplikasyon da geliþmemiþtir.
TARTIÞMA: Pediatrik vasküler yaralanmalarýn etiyolojisinde sýklýkla giriþimsel iþlemlere baðlý iyatrojenik nedenler görülmektedir. Bu tip yaralanmalarda acil olarak uygulanan cerrahi iþlemlerin sonuçlarý oldukça iyidir.

BACKGROUND: Surgical intervention is mandatory in many children who present with vascular trauma or in complicated cases after medical interventions. In this study, surgical interventions applied after vascular injuries in children were analyzed.
METHODS: Between January 2002 and December 2012, 17 patients (aged under 18) who were admitted to the emergency room with vascular injuries were retrospectively analyzed. The data was collected through hospital records. Preoperative and postoperative data of the patients were recorded and analyzed.
RESULTS: Of the total, 11 patients were female (64.7%) and 6 patients were male (35.3%) with a range of 4–192 months. In total, 14 (82.3%) injuries were due to angiographic interventions, 1 (5.9%) was due to external trauma, 1 (5.9%) was due to preoperative trauma, and 1 (5.9%) was due to a catheterization complication in the intensive care unit. Additionally, 11 (64.7%) injuries were located in the right femoral artery, 3 (17.6%) were located in the left femoral artery, 2 (11.8%) were located in the left brachial artery, and 1 (5.9%) was located in the left external iliac vein. Also, 5 (29.4%) patients were managed under local anesthesia and 12 (70.6%) patients were managed under general anesthesia. With respect to treatment, 15 (88.2%) injuries were repaired with primary sutures, 1 (5.9%) injury was repaired with an end-to-end anastomosis, and 1 (5.9%) injury was repaired with a saphenous vein graft interposition. In addition, 16 (94.1%) patients underwent a thrombectomy prior to the repair. The total hospital stay was calculated as 2.7±1.4 days. The intensive care unit stay was calculated as 1.1±0.4 days. There was no mortality, a loss of an injured extremity, or an infection. No other complication was detected.
CONCLUSION: Iatrogenic interventional procedures seem to be responsible for the majority of pediatric vascular injuries. The results of surgical repairs in these injuries are successful and efficient.

AMAÇ: Bu çalýþmanýn amacý elektrik yanýðý olan hastalarda mortalite oranlarýna etki eden faktörleri belirlemektir.
GEREÇ VE YÖNTEM: Elektrik yanýðý nedeniyle Derince Eðitim ve Araþtýrma Hastanesi Acil Servisi’ne kabul edilip yanýk tedavi merkezi veya yoðun bakýma (YB) yatýrýlan 115 hasta çalýþmaya dahil edildi.
BULGULAR: Ortalama yaþý 32.88±12.87 yýl olan toplam 115 hastanýn (4 kadýn, 111 erkek) çalýþmaya alýndý. Ortalama hastanede yatýþ süresi 25.03±20.50 gün ve yanan ortalama toplam vücut yüzey alaný (%TVYA) ise %22.83±15.54 idi. Bu hastalarýn 106’sý tedavi sonrasý taburcu edilirken, dokuzu (%8.5) hayatýný kaybetti. Lojistik regresyon analizinde, TVYA >%20 (p=0.02, odds ratio (OR): 11.7, confidence interval (CI): 1.38–99.16), YB gerekenler (p=0.005, OR: 1.28, CI: 1.08–1.58); eritrosit transferi gerekenler (p=0.02, OR: 12.48, CI: 1.44–107.83); Taze donmuþ plazma (TDP) gereksinimi olanlar (p=0.03, OR 10.23, CI: 1.18–88.17); albümin gereksinimi olanlar (p=0.02, OR: 12.60, CI: 1.44–109.85); kabulde serum albümin seviyesi <3.5 mg/dL (p=0.04, OR: 7.25, CI: 0.82–63.64); kabul hemoglobin seviyesi <12 mg/dL (p=0.01, OR: 8.29, CI: 1.57–43.61) hastalarda mortaliteyi belirleyen risk faktörleri olarak belirledik.
TARTIÞMA: Klinik uygulamada, elektrik yanýðý olan hastalarda bu faktörlerin analiz edilmesi mortalite oranýný belirlemede yararlý olabilir. Elektrik yanýðý olan hastalarda mortalite risk faktörlerini ve uzun dönem morbiditeleri belirlemek için daha geniþ çalýþmalara gereksinimi vardýr.

BACKGROUND: The aim of this study was to determine the factors affecting mortality rate among patients with an electrical burn.
METHODS: A total of 115 patients admitted to the emergency department and hospitalized in the Burn Treatment Center or Intensive Care Unit (ICU) due to the electrical burn, were included in the study.
RESULTS: A total of 115 patients (4 female and 111 male) with a mean age of 32.88±12.87 years were included in the study. The mean hospitalization period was 25.03±20.50 days, and the mean total body surface area burned (% TBSA) was 22.83±15.54%. Among those patients, 9 (8.5%) expired, and the remaining 106 were discharged after treatment. In a logistic regression analysis, TBSA >20% (p=0.02, OR: 11.7, CI: 1.38–99.16); ICU requirement (p=0.005, OR: 1.28, CI: 1.08–1.58); erythrocyte transfusion requirement (p=0.02, OR: 12.48, CI: 1.44–107.83); fresh frozen plasma (FFP) requirement (p=0.03, OR: 10.23, CI: 1.18–88.17); albumin requirement (p=0.02, OR: 12.60, CI: 1.44–109.85); admission serum albumin level <3.5 mg/dl (p=0.04, OR: 7.25, CI: 0.82–63.64); and admission hemoglobin level <12 mg/dl (p=0.01, OR: 8.29, CI: 1.57–43.61) were determined as risk factors for mortality in patients with electrical burns.
CONCLUSION: In clinical practice, defining a mortality risk analyzer using these factors may be helpful in the management of patients with electrical burns. Additional, more comprehensive studies are required to define the risk factors for mortality and long-term morbidities in patients with electrical burns.

AMAÇ: Mukosel apendiksin mukus tarafýndan týkanmasý sonrasý geniþlemesini tanýmlar. Nadir bir bozukluktur. Çoðu zaman semptomsuz olmakla beraber apandisit kliniðine sebep olabilir. Tüm apendektomilerin %0.2–0.3 ve apandiks tümörlerinin %8–10’unda görülür.
GEREÇ VE YÖNTEM: Yirmi altý hasta (14 kadýn–12 erkek) apandiks mukoseli nedeni ile ameliyat edildi. On altý hasta klasik apandisit bulgularý ile acil þartlarda ameliyat edildi. Acil ameliyat edilenlerin 14’üne apendektomi, ikisine sað hemikolektomi uygulandý. Elektif hastalarýn altýsýna apendektomi dördüne sað hemikolektomi uygulandý.
BULGULAR: Hastalarýn yaþý 27–81 arasýnda idi. On altý hastaya açýk, dört hastaya laparoskopik apendektomi uygulandý. Histopatolojik sonuçlara göre mukozal hiperplazi %23.1, müsinöz kistadenom %61.4 ve müsinöz kistadenokarsinom %15.5 oranýnda tespit edildi.
TARTIÞMA: Uzun süre sað alt kadran aðrýsý ile görülen hastalarda apandiks mukoseli ayýrýcý tanýda düþünülmelidir. Ameliyat öncesi radyolojik deðerlendirme doðru cerrahi tedavi için gereklidir.

BACKGROUND: The term mucocele refers to the dilatation of the appendix due to mucus, and it is an uncommon disorder with an estimated incidence of 0.2%–0.3% of all appendectomies performed and 8%–10% of all appendiceal tumors. It is often asymptomatic, but may manifest appendicitis-like symptoms.
METHODS: Twenty-six patients (14 females and 12 males) were operated on due to mucocele of the appendix. Sixteen patients exhibiting the characteristics of clinically acute appendicitis required an emergency operation. Appendectomy was performed on 14 patients, and right hemicolectomy was carried out on 2 patients. Of the remaining 10 patients who received surgery under elective conditions, 4 underwent a right hemicolectomy and 6 underwent an appendectomy.
RESULTS: The patients’ age ranged from 27 to 81 years. Sixteen open and 4 laparoscopic appendectomies were performed. An incidental appendiceal mucocele was identified in 2 patients who had undergone colonoscopy. According to the histopathological examination, the incidence rate of mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma was found to be 23.1%, 61.4%, and 15.5%, respectively.
CONCLUSION: In patients with long-term pain in the right lower quadrant of the abdomen, appendiceal mucocele should be considered, and the results of radiological imaging tests should be carefully analyzed before surgery.

AMAÇ: Yetiþkin önkol diafiz kýrýðý (radius, ulna veya her iki kemik kýrýðý) olan hastalarda uyguladýðýmýz intramedüller çivi tedavisi ile açýk redüksiyon internal fiksasyon tedavi yöntemlerini kaynama ve fonksiyonel sonuçlar açýsýndan karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Önkol diafiz kýrýðý nedeniyle cerrahi tedavi uyguladýðýmýz, iskelet sistemi matürasyonu tamamlanmýþ 90 hastayý geriye dönük olarak inceledik. Monteggia, Galeazzi, ipsilateral üst ekstremite fraktürü olan hastalar, epifiz hattý açýk hastalar, Tip 3 açýk kýrýðý olan hastalar, patolojik kýrýðý olan hastalar ve beyin travmasý olan hastalar çalýþmaya dahil edilmedi. Hastalarýn 42’sine açýk redüksiyon internal fiksasyon (plak grubu), 48’ine intramedüller çivi tedavisi (ÝM çivi grubu) uygulandý. Ýki tedavi grubu; kaynama zamaný, eklem hareket açýklýðý, ameliyat süresi, kavrama gücü, Grace-Eversman kriterleri ve komplikasyon sonuçlarýna göre karþýlaþtýrýldý.
BULGULAR: Ameliyat süresi plak grubunda 63.29 (40–100) dakika, intramedüller çivi grubunda 46.02 (17–85) dakika idi. Plak grubunda ortalama kaynama süresi 13.19 (10–20) hafta, ÝM çivi grubunda ortalama 10.85 (8–20) hafta deðerlendirildi. Ýstatistiksel olarak kaynama süresi ve ameliyat süreleri açýsýndan her iki grup arasýnda anlamlý fark saptanýrken Grace-Eversman deðerlendirme kriterleri, önkol supinasyon, pronasyon dereceleri ve kavrama gücü açýsýndan iki grup arasýnda fark saptanmadý.
TARTIÞMA: Ýntramedüller çivi tedavisinde kaynama süresi, ameliyat süresi ve kanama miktarý açýsýndan açýk redüksiyon internal fiksasyon tedavisine göre anlamlý fark saptandý. Ancak fonksiyonel deðerlendirme kriterlerine göre fark saptanmamýþtýr. Bu nedenle iskelet sistemi matürasyonu tamamlanmýþ önkol diafiz kýrýðý olan eriþkin hastalarda her iki tedavi metodu kabul edilebilir yöntemlerdir.

BACKGROUND: We compared the union and functional results of intramedullary nailing and open reduction internal fixation treatment applied to adults with a forearm diaphysis fracture (fracture of the radius and/or ulna).
METHODS: We retrospectively examined 90 patients with completed skeletal maturation who were surgically treated for a forearm diaphyseal fracture. Patients with a Monteggia Galeazzi and ipsilateral upper extremity fracture and those with an open epiphyseal line, Type 3 open fracture, pathological fracture, or brain trauma were excluded from the study. Open reduction and internal fixation (ORIF) was applied to 42 patients (plate group), and intramedullary nailing was performed in 48 patients (intramedullary nailing group). Both treatment groups were compared with respect to time to union, joint range of motion, operating time, grip strength, Grace-Eversman criteria, and complications.
RESULTS: The mean operating time was 63.29 (range, 40–100) min in the plate group and 46.02 (range, 17–85) min in the intramedullary nailing group. The mean time to union was 13.19 (range, 10–20) and 10.85 (range, 8–20) weeks, respectively. While a statistically significant difference was determined between groups with respect to operating time and time to union, no difference was determined in the Grace-Eversman evaluation criteria, forearm supination, pronation degrees, and grip strength.
CONCLUSION: The results of this study showed a significant difference in the intramedullary nailing treatment with respect to time to union, operating time, and amount of bleeding compared with the ORIF treatment. However, no difference was determined in the functional evaluation criteria. Thus, both treatment methods are acceptable in the treatment of forearm diaphyseal fractures in adults with skeletal maturation.

AMAÇ: Cerrahi olarak tedavi edilmiþ kalça kýrýðýný takiben taburculuk sonrasý erken dönem hastane baþvurularý genellikle altta yatan önemli bir etiyolojik faktöre baðlýdýr ve saðlýk sisteminin yükünü artýrýr. Bu geriye dönük çalýþmanýn amaçlarý cerrahi olarak tedavi edilmiþ kalça kýrýðý hastalarýnda taburculuk sonrasý erken dönem hastane baþvuru oranlarýný, bu duruma yol açan sebepleri ve hastalarýn ameliyat sonrasý birinci yýl sonunda mortalite oranlarýnýn belirlenmesidir.
GEREÇ VE YÖNTEM: Ortalama yaþý 74 olan toplam 517 hasta çalýþmaya dahil edildi. Taburculuk sonrasý erken hastane baþvurusu, yaþ, cinsiyet, vücut kitle endeksi, kýrýk tipi, kýrýk öncesi mobilizasyon seviyesi, ameliyata kadar geçen süre, American Society of Anesthesiologists (ASA) skoru, implant tipi, ameliyat sonrasý yoðun bakýmda kalýþ, toplam hastanede yatýþ süresi, komorbid hastalýklar ve hastane baþvuru sebepleri veri toplama kriterleri olarak belirlendi. Çok deðiþkenli analiz ile majör belirleyici faktörler deðerlendirildi.
BULGULAR: Taburculuk sonrasý erken dönem hastane baþvurusu olan hastalarda kronik obstrüktif akciðer hastalýðý, kardiyak aritmi veya iskemik kalp hastalýðý, diyabet, demans veya Alzheimer hastalýðý prevalansý daha yüksek bulundu. Çok deðiþkenli analize göre hastane baþvurularýnýn ana belirleyicileri ileri yaþ, 3 veya üzeri ASA skoru, ameliyat sonrasý yoðun bakýmda kalma, kardiyak aritmi veya iskemik kalp hastalýðý olarak belirlendi. Ameliyat sonunda ilk yýl içinde ölüm oraný taburculuk sonrasý hastane baþvurusu olan hasta grubunda anlamlý olarak yüksek bulundu.
TARTIÞMA: Cerrahi olarak tedavi edilmiþ kalça kýrýðý hastalarýnda taburculuk sonrasý erken dönem hastane baþvurusu oraný %12 olarak tespit edilmiþtir. Bu durumun ana belirleyicileri ileri yaþ, yüksek ASA skoru, ameliyat sonrasý yoðun bakým yatýþý ve kardiyak aritmi ya da iskemik kalp hastalýðý varlýðýdýr.

BACKGROUND: Early hospital readmission after surgically treated hip fracture is a common entity, often involving an adverse event and causing strains on an already overburdened healthcare system. The main purposes of the present study were to determine the 30-day readmission rate, analyze the predictive factors for early hospital readmissions, and assess 1-year mortality following surgical treatment of hip fracture in elderly patients. Retrospective case-control study.
METHODS: In total, 517 patients with a mean age of 74 years were evaluated. The rate of early readmission, age, gender, body mass index, fracture type, pre-fracture mobility status, preoperative time to surgery, American Society of Anesthesiologists score, implant type, postoperative intensive care unit stay, total length of postoperative hospital stay, comorbidities, and the main reasons for readmission were the criteria for data collection. Multivariate analysis was performed to determine the main predictors of early hospital readmission. Mortality within the first year after surgery was also assessed.
RESULTS: A higher prevalence of chronic obstructive pulmonary disease, cardiac arrhythmia or ischemic heart disease, diabetes, and dementia or Parkinson’s disease was detected in readmitted patients. Advanced age, American Society of Anesthesiologists (ASA) grade ≥3, postoperative intensive care unit (ICU) stay, and pre-existing cardiac arrhythmia or ischemic heart disease were identified as the main predictors. The 1-year mortality rate for the readmitted group was 53.9%, whereas it was 24% for those patients who were not readmitted.
CONCLUSION: The readmission rate following surgical treatment of hip fracture in elder patients was 12%, and its main predictive factors were advanced age, ASA grade ≥3, postoperative ICU stay, and pre-existing cardiac arrhythmia or ischemic heart disease. Hospital readmission within the first 30-day period following initial discharge was significantly correlated with an increased 1-year mortality rate.

AMAÇ: Bu çalýþmanýn amacý dislokasyon olmuþ subkondiler kýrýklarýn redüksiyonunda uygulanan retromandibular transparotid yaklaþýmýn etkinliðinin ve komplikasyonlarýnýn deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Subkondiler mandibular kýrýk görülen 14 hasta deðerlendirildi (8 erkek, 6 kadýn, yaþ aralýðý: 21–56). Bu çalýþmada ameliyat öncesi ve sonrasýnda elde edilen sonuçlar karþýlaþtýrýldý. Birincil olarak deðerlendirilen sonuçlar iltihabi komplikasyon geliþimi, fasiyal sinir hasarý (House ve Brackmann sýnýflandýrmasýna göre) ve parotis fistül oluþumu idi. Ýkincil olarak deðerlendirilen sonuçlar oklüzyon bozukluklarý, maksimum aðýz açýklýðý ve temporomandibular eklemde görülen aðrýydý. (Görsel Analog Skalasý’na göre).
BULGULAR: Ameliyat sonrasý dönemde hatasýz bir oklüzyon ve fonksiyon gözlemlendi. Bir hastada parotis fistül oluþtu fakat üç hafta içerisinde kapandý. Hiçbir hastada iltihabi komplikasyon geliþmedi. Üç hastada 3. seviye, bir hastada 2. seviye fasiyal sinir hasarý geliþti, fakat bütün fasiyal sinir hasarlarýnýn altý hafta içerisinde iyileþti. Hiçbir hasta da aðrý veya oklüzyon bozukluðu olmadý. Altý ay sonraki maksimum aðýz açýklýðý 34–58 mm (ortalama 44.4 mm) olarak ölçüldü.
TARTIÞMA: Retromandibular transparotid yaklaþým kullanýþlý ve güvenli bir yaklaþýmdýr. Subkondiler kýrýklarýn redüksiyonunu ve fiksasyonunu kolaylaþlaþtýran bu yaklaþýmda komplikasyon oraný az olup fonksiyonel sonuçlar elde edilir.

BACKGROUND: The aim was to evaluate the effectiveness and complications of retromandibular transparotid approach performed for the reduction of dislocated subcondylar fractures.
METHODS: Fourteen patients with subcondylar mandibular fractures were evaluated (8 male, 6 female, age range 19–43 years). The primary predictor variable in the present study was time (preoperative vs postoperative). The primary outcome variables were inflammatory complication, facial nerve deficit (House and Brackmann classification), and presence of parotid fistula. The secondary outcome variables were occlusal disturbances, maximal interincisal opening (MIO), and temporomandibular joint (TMJ) pain (VAS).
RESULTS: Excellent occlusion and function was observed postoperatively. One salivary fistula occurred after surgery but was healed after 3 weeks. No inflammatory complication was observed. Three patients had grade III and one patient had grade II facial nerve deficit, all recovered in 6 weeks. All patients were free of pain and no malocclusion was observed. MIO was ranging from 34 to 58 mm (mean 44.4 mm) after 6 months.
CONCLUSION: The retromandibular transparotid approach is feasible and safe. It facilitates reduction and fixation of subcondylar fractures with functional outcomes and rare complications.

Donuk hasarý, soðuða doðrudan ya da dolaylý yoldan maruz kalýnmasý sonucunda etkilenen dokuda geri dönüþümlü ya da dönüþümsüz harabiyete neden olan bir durumdur. Donuk hasarý oluþumuna yol açan farklý etiyolojik nedenler bulunmaktadýr. Bunlar arasýnda en sýk karþýlaþýlan nedenler; ev, araç ya da endüstriyel alanlarda kullanýlan LPG (liquefied-petroleum gases) temasýna baðlý hasarlardýr. LPG, yüksek basýnç altýnda tanklar içerisinde sývý halde depolanan bir yakýt türüdür. Ýçeriðinde propan ve bütan gazlarý karýþým halinde bulunur. Bu gazlarýn, dokularla direkt temas halinde metabolik, toksik ve solunumsal hasar oluþturma potansiyeli bulunmaktadýr. Bu çalýþmada, LPG tankýnýn kapakçýklarýndan likid formdaki gazýn yüksek basýnçla fýþkýrmasý sonucunda oluþan jet akýma baðlý olarak üst ekstremite ve yüzde donuk hasarý oluþmasýna neden olan dört olgu deðerlendirildi. Olgularda üst ekstremite ve yüzde büllöz lezyonlar, fibrotik ve nekrotik alanlar içeren ikinci ve üçüncü derece donuk hasarlarý mevcuttu. Yüzeyel defektler sekonder olarak yer yer minimal skar alanlarý býrakarak iyileþti, parmaklarda nekroz geliþen olguya amputasyon uygulandý. Çalýþmamýzdaki olgularda olduðu gibi, likit nitrojen içeriðinin yüksek basýnçla fýþkýrmasý ve deride donuk hasarý oluþturmasý sýk rastlanan bir durum deðildir. Olgularýmýz farklý bir donuk etiyolojisine sahip olmasý nedeniyle oldukça ilgi çekicidir.

Cold injury is a condition that causes reversible and irreversible damage when tissues are exposed to cold. This injury occurs due to various etiologies, and the most commonly observed ones include contact with liquefied petroleum gas (LPG) used in households, vehicles, and industry. LPG is a type of gas stored in liquid state under high pressure within cylinders. LPG contains a mixture of propane and butane gases. Direct contact of these gases with the tissues has the potential to cause metabolic, toxic, and respiratory damage. In this study, we present the cases of four patients with cold injury in the face and upper extremity caused by a pressurized jet stream of liquid gas that escaped out of the valves of the LPG cylinders. The patients had bullous lesions in the upper extremities and the face and second- and third-degree cold injuries with fibrotic and necrotic areas. The superficial defects secondarily healed with minimal scarring, while the necrotic finger had to be amputated. Cold injury on the skin caused by high-pressure jet streams of liquid gas as in our study is a rare occurrence. Our patients are important cases due to the rare etiology of cold injury.

A 50-year-old man experienced cardiac arrest. The patient underwent standard cardiopulmonary resuscitative measures for approximately 20 minutes before spontaneous circulation returned. He was diagnosed with variant angina, and subsequent imaging for evaluation of upper back pain revealed fractures of the fifth through eighth thoracic vertebrae. Multiple thoracic vertebral fractures are extremely rare. Here we report a case of multiple thoracic vertebral fractures as a complication of cardiopulmonary resuscitation.

Ectopic varices include all varices except esophageal or gastric varices and comprise large portosystemic venous collaterals that occur anywhere in the abdomen. Ectopic varices are relatively rare; however, approximately 5% are related to gastrointestinal bleeding. Ectopic varices usually occur in the rectum, duodenum, or colon, and portal hypertension is the most common cause. Hemodynamic profiles of ectopic varices remain unknown, and extensive bleeding from these structures occurs because diagnosis and treatment are difficult. Here we report a case of obscure gastrointestinal bleeding (GIB) due to ectopic varices in the small intestine that flowed into the inferior epigastric vein. Our observations suggest that when obscure GIB is detected in patients with either cirrhosis or post-surgical history including incisional hernia, it is essential to acquire multilanar reconstruction images and volume-rendered 3-dimensional reconstruction of computed tomography scans to investigate the complex venous supply and optimize decisions for therapy.

Rektosigmoidoskopi alt gastrointestinal sistemin hastalýklarýnýn teþhis ve takibinde sýk kullanýlan bir iþlemdir. Ýþlemin tecrübeli ellerde güvenilirliði ispatlanmýþtýr, ancak komplikasyon ortaya çýkma ihtimali vardýr. Rektosigmoidoskopi esnasýnda perforasyona baðlý tümü ayný anda ortaya çýkan iki taraflý pnömotoraks, pnömoperitoneum, pnömoretroperitoneum, pnömomediastinum ve pnömoderma olgusunu çok nadir görülmesi nedeniyle sunuyoruz. Bu olgu ile rektosigmoidoskopide nadir komplikasyonlarýn mümkün olduðunun altý çizilmektedir. Endoskopistin iþlem sýrasýnda perforasyon oluþmamasý için azami özen ve gayret göstermesi, sýklýðýndan baðýmsýz tüm olasý komplikasyonlar hakkýnda bilgi sahibi olmasý ve gerektiðinde süreçlerini yönetebilmesi gerekmektedir.

Rectosigmoidoscopy is a common procedure for diagnosis and follow-up of diseases of the lower gastrointestinal system. Although the procedure is proven to be safe in experienced hands, there is always risk of complications. We report a case of bilateral pneumothoraces, pneumoperitonium, pneumoretroperitoneum, pneumomediastinum, and pneumoderma due to perforation during a rectosigmoidoscopy. Co-occurrence of all these in 1 patient is a very rare clinical condition. This report underlines the possibility of even the rarest and unexpected complications related to rectosigmoidoscopy. Endoscopist should be careful to avoid perforation, be aware of the potential complications, and be able to manage them.