Bleeding hepatico-cutaneous fistula: Unusual complication of the percutaneous liver biopsy

Introduction. Arteriovenous fistula is one of the complications that can occur during percutaneous liver biopsy. Hepatic arterio-venous fistula with chronic bleeding from the puncture site on the skin is extremly rare complication following percutaneous liver biopsy. Case report. The case represents a 35-year-old woman with secondary anemia caused by chronic bleeding at the site of a granuloma caused by a previous liver biopsy done 7 years ago. The patient was examined and treated for several years due to anemic syndrome. The pathological communication between the right hepatic vein, the anterior sectional branch of the portal vein and the posterior arterial sectional branch was detected on a CT scan, and proven by fistulography. Due to the failed embolization, a laparotomy was performed, where a tumor mass was found in the VI and VII segment of the liver, which communicates with the skin. Tumor mass was removed by atypical resection of VI and VII liver segments. Due to hemorrhage, re-exploration was performed, where bleeding was found from the surface of the resected liver parenchyma. Two weeks after the last operation, the patient was released for home treatment. Conclusion. Although percutaneous liver biopsy is a safe procedure, the complication in the form of bleeding occurs in less than 25% of cases and with spontaneous cessation. In our presentation, there was a complicated intrahepatic arteriovenous-portal fistula with the formation of communication with the puncture site on the skin. This is the first case of complications of this type after percutaneous liver biopsy.

Small bowel perforation with iliac artery prosthesis stump

Aim: In this case we report an unusual complication after retroperitoneal formation of an iliac artery prosthesis-stump – a bowel perforation and sepsis. Case report: During the open urology surgery a right external iliac artery was iatrogenic injured and iliofemoral bypass grafting was performed. Eight months thereafter, due to an inguinal site graft infection and graft occlusion, the distal part of the prosthesis was transacted and removed, and the proximal, retroperitoneal part, was closed and over sewn in the zone without any sign of infection present. This prosthesis-stump caused a very unusual complication – a small bowel perforation three months thereafter. Conclusion: The whole retroperitoneal graft should always be removed with no stump formation to avoid this complication.

Clinical outcome of selective amygdalectomy in a series of patients with resistant temporal lobe epilepsy

Background: Selective amygdalohippocampectomy is one of the main approaches for treating medial temporal lobe epilepsy (TLE). We herewith describe seven cases of amygdala lesions treated with selective amygdalectomy with the hippocampus saving procedure. Furthermore, we explain the trans-middle temporal gyrus transventricular approach for selective amygdalectomy. Methods: We studied patients with TLE who underwent selective amygdalectomy with hippocampal saving procedure between March 2012 and July 2018. We preferred the trans-middle temporal gyrus transventricular approach. We adopted pterional craniotomy with extensive exposure of the base and posterior of the temporal lobe. The posterior margin of resection in the intraventricular part of the amygdala was considered the inferior choroidal point. Medially anterior part of the uncus was resected until reaching the ambient cistern. We applied the transcortical transventricular approach for selective amygdalectomy in all patients. Results: We present 11 cases having an amygdala lesion in our series, seven of whom underwent selective amygdalectomy with hippocampal sparing. Nine patients had neoplastic lesions, and in two of them, gliosis was evident. Total resection of the lesion was achieved in all cases based on postoperative magnetic resonance imaging. No unusual complication or surgically-related new neurological deficit occurred. Conclusion: We consider the resection of the amygdala until the inferior choroidal point sufficient for the disconnection of its circuits, which results in more effective control of seizures and reduction of surgery time and complications.

An unusual complication after augmentation genioplasty: odontogenic infection requiring implant removal

Augmentation genioplasty is a common surgical procedure with extremely low infection rates. We present the case of a healthy middle-aged woman who experienced years of chronic infection after chin implantation due to a fractured mandibular canine root, which is exceedingly rare. Awareness of this potential complication will reduce patient morbidity.