No abstract

Primary carcinomas of the small intestine are extremely rare neoplasms. Most of these are adenocarcinomas. Primary squamous cell carcinoma (SCC) of small intestine is exceptionally rare with only occasional case reports in the literature. We report here a surgically treated patient with squamous cell carcinoma arising from duodenal diverticula in the third part of the duodenum.

Statistical AnalysisThe rates and distributions in this case series were indicated as percentages and frequencies. RESULTSThe physicians were found to be faulty in all the cases that were examined. The reason for physician fault was failure to show the necessary professional care and attention in one (4.7%) file, whereas the Objective: The aim was to evaluate the parameters that were considered by Forensic Medicine in bile duct injury as well as the issues that the physicians were found to be faulty. Material and Methods:The following parameters were investigated in 21 files that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012; expert decisions, patient's age, gender, written patient consent, diagnosis, type of first surgery, surgical complications, timing of complication diagnosis within the scope of complication management, patient's referral timing, troubleshooting procedures and mortality rate.Results: Physicians were found to be faulty in all files. The reason for physician fault was failure to show the necessary professional care and attention in one (4.7%) file, late recognition of injury and late transfer of the patient in 20 (95.3%) files. Written consent had not been obtained in any of the files. Thirteen patients were female (61.9%) and 8 (30.1%) were male, with a mean age of 43.3 years. Nineteen patients had cholelithiasis (90.4%), and two patients (9.5%) had a mass in the head of the pancreas. Cholecystectomy was performed laparoscopically in 15 patients (78.9%), and with open surgery in 4 patients (21.1%). The Whipple procedure was performed in two patients. The diagnosis was made during the operation in one patient (4.7%), and in the post-operative period in 20 patients (95.3%). The time to diagnosis after surgery was between 3-6 days. All of the patients had been referred to third level health care facilities. The timing of transfer was 1 day in the patient who was diagnosed during the operation, and ranged between 4-10 days in those who were diagnosed postoperatively. Reasons for late referral were delays related to pending test results in 12 patients, vague signs in 3 patients, and following-up patients with the thought that the biliary fistula will heal by itself in 5 patients. Mortality was not observed in any of the examined files. Conclusion:The issues where physicians were most frequently found to be faulty were failure to obtain written patient consent, late recognition of injury and late transfer of the patient.