Εισαγωγή: Ο Pierre Fredet (1870-1946) ήταν Γάλλος χειρουργός από τον οποίο πήρε το όνομά της η προ-δωδεκαδάκτυλο-παγκρεατική περιτονία. Ωστόσο η ονομασία «περιτονία του Fredet» σχεδόν εκλείπει από την καθημερινή χειρουργική πρακτική και επικοινωνία. Η χειρουργική θεραπεία του καρκίνου του δεξιού κόλου πραγματοποιείται όλο και περισσότερο λαπαροσκοπικά, και η γνώση της ανατομίας είναι απαραίτητη για μια άρτια χειρουργική αντιμετώπιση. Κυρίως κείμενο – Συζήτηση: Μια από τις αρχικές και πιο δημοφιλείς περιγραφές του μεσοκόλου δόθηκε από τον Treves το 1885, μέχρι τη στιγμή που ο Culligan περιέγραψε την ανατομία του μεσοκόλου και παρουσίασε σημαντικά ευρήματα. Η περιτονία του Fredet βρίσκεται μπροστά από το δωδεκαδάκτυλο, το πάγκρεας και το σημείο έκφυσης της άνω μεσεντερίου αρτηρίας. Το περιτόναιο συντήκεται με τις παραπάνω ανατομικές δομές και εκτείνεται κρανιακά και ουραία. Η κινητοποίηση της ηπατικής καμπής και του δεξιού ημίσεος του εγκαρσίου κόλου επιτρέπει την πρόσβαση στην περιτονία του Fredet και την αποκάλυψη της πρόσθιας επιφάνειας του παγκρέατος και της δεύτερης μοίρας του δωδεκαδακτύλου. Συμπέρασμα: Η περιτονία του Fredet είναι χρήσιμη στην επίτευξη της ολικής εκτομής του μεσοκόλου και της D3-λεμφαδενεκτομής στον καρκίνο του δεξιού κόλου με μειωμένο κίνδυνο εμφάνισης διεγχειρητικών επιπλοκών.

Introduction: Hemangiomas are tumors that have the ability to grow, potentially causing abdominal complaints, most often presenting as pain. Against the background of the underlying complaints, there is controversy as to whether liver surgery is warranted. With the exclusion of these symptoms, there is a lack of consensus, contact additional indications for performing the operation in this benign tumor. Aim: We present a large series of surgically removed hemangiomas in an attempt to better define the indications, safety, and outcomes associated with LH surgery, and we propose an algorithm for the management of LH patients based on our experience and data from a literature review. Materials and methods. The study included 101 patients with cavernous hemangioma who were radically operated on in the Surgery Clinics of the Military Medical Academy for the period 2010-2023. Results: The proposed treatment algorithm is based on the results obtained from the present study and the conclusions after a thorough analysis of the data from the literature review. The developed algorithms take into account the size, localization, symptoms and indications for surgical treatment, as well as the patient’s desire for surgery or for alternative treatment. Discussion: Although surgical resection is the most effective treatment for symptomatic enlarging LH, it is a highly invasive procedure associated with morbidity and mortality of up to 27% and 3%, respectively. Alternatively, minimally invasive procedures such as transcatheter arterial embolization or radiofrequency ablation can be used, but these methods are not radical. Conclusion: An adequate differentiated approach in each individual patient with LH is the most direct way to his successful treatment. Knowledge of the factors increasing the frequency of postoperative complications determines the choice of operative procedure. The occurrence of serious complications related to non-operative treatment remains a rare phenomenon, which nevertheless causes the need for additional surgical indications for the removal of hemangioma.

Background: periampullary malignancies have poor prognosis. Pancreaticoduodenectomy (PD) remains the treatment of choice for resectable periampullary malignancies. It is the only treatment that has a potential for cure. But PD has high morbidity and mortality rates (30-60% and 1-4% respectively). Postoperative pancreatic fistula (POPF) is the most feared and challenging cause of PD complications and mortality. Unfortunately, it still has a high incidence (11-47%). This study aimed to compare pancreaticogastrostomy with dunking (PG-D) to pancreaticojejunostomy with dunking (PJ-D) techniques after PD for resectable periampullary malignancies regarding feasibility and safety. Methods: This prospective randomized comparative study involved surgically fit patients, with resectable periampullary malignancies, who were admitted to surgery department, Assiut University Hospitals between January 1st 2022 and December 31st 2023. All patients had PD with dunking of the pancreatic stump into the stomach PG-D or into the Jejunum PJ-D. Randomly, patients were allocated into two equal groups; group A underwent PG-D, and group B underwent PJ-D. Results: according to this study PG-D when compared to PJ-D had significantly less operative time and operative blood loss but significantly more hospital stay time (P value = 0.03, 0.038, 0.011, respectively). But there was no significant difference between the two techniques regarding POPF and other operative morbidities or mortality. The two techniques can be considered feasible and safe, with low POPF (12,5% class A in all the 40 patients), accepted morbidity (18 of the 40 patients, 45%) and mortality (0%). Conclusions: Both PG and PJ with the dunking technique after PD for the treatment of resectable periampullary malignancies can be considered feasible and safe. The two techniques are comparable regarding morbidity and mortality.

Purpose: When both of the rectus abdominis muscles are unnaturally spaced by greater than two cm, the state is known as rectus abdominis diastasis (RAD). Suture repair of the hernia in such circumstances has a much greater rate of recurrence in contrast to non-RAD individuals. While not all RAD patients experience symptoms, those who do may experience abdominal discomfort and pain, musculoskeletal issues such as lumbar back pain and pelvic instability, uro-gynecological symptoms, fecal incontinence, and pelvic organ prolapse.Our study aimed at assessing effect of endoscopic assisted repair of RAD on post-operative pain and quality of life. Methods: Eighteen cases were involved in this study. Our technique provides anterior abdominal wall re-inforcement by putting a non-absorbable mesh in a pre-peritoneal space and assessing post operative pain and improvement in quality of life using Visual analogue score and 5 points Likert’s score. Results: All patients experienced mild pain on day 1 post-operative with mean of 1.8 on the visual analogue scale, none of them complained about the pain on the 2 weeks follow-up. Six (33.3%) patients were neutral regarding the outcome of the clinical bulge, while the rest (66.7%) were either satisfied or very satisfied. Conclusion: This technique has shown its effectiveness in improving quality of life with minimum post-operative pain.

Background: There are many management strategies of early gastric carcinoma as; endoscopic sub-mucosal dissection or endoscopic mucosal resection, open radical gastrectomy and laparoscopic radical gastrectomy. Each management strategies was found to have benefits and drawbacks with no consensus reached and there are only few comparative studies were reported in this topic. Aim of the current study was to compare between endoscopic submucosal dissection or endoscopic mucosal resection, open radical gastrectomy and laparoscopic radical gastrectomy as management strategies for early gastric carcinoma regarding advantages, operative, perioperative findings, short term and long term outcomes and patients prognosis. Patients and methods: We included a total of 350 patients with gastric carcinoma. We divided included patients into 3 groups according to used management approach, ESD/EMR group (100), LARG group (91), and ORG group (159). We followed patients for about 5 years with a median follow-up of 22 months for assessment of short term outcomes, long term postoperative complications, post-operative recurrence, 5-year overall survival (OS) rate and disease-free survival (DFS). Results: Patients with intra-mucosal carcinoma were more in the group of patients underwent ESD/EMR group than that in the other groups (P = 0.003). Duration of hospital stay, time of postoperative fluid intake, and antibiotic use in the group of patients underwent ESD/EMR were lower than those in patients underwent LARG group and ORG (P 0.05). 5-year survival rates in the group of patients underwent ESD/EMR were less than patients underwent LARG or ORG group. Absent lymphovascular invasion, conventional adenocarcinoma protect against recurrence after ESD/EMR. Conclusion: ESD/EMR is associated with less surgical trauma to tissues, rabid recovery, better life quality, and less cost, but it was associated with higher risk of lymph node metastasis. So, LARG/ORG is still superior to ESD/EMR for management of EGC patients regarding radicality of management, better survival rates and less risk of lymph nodes metastases.

Background: The outcomes of laparoscopic rectal surgery are underreported in resource-limited countries such as South Africa (SA), and this knowledge is important if this approach is to be adopted in this setting. Our study compared the open (OS) and laparoscopic (LS) surgical approaches for CRC at a quaternary SA hospital. Methods: We conducted a retrospective analysis of data from a CRC patient registry at Inkosi Albert Luthuli Central Hospital, SA. The registry collected data on diagnosis, surgical approach, and perioperative outcomes for each patient undergoing CRC surgery. Patients who were recorded in the registry with a diagnosis of rectal cancer, Karnofsky score > 70, and who had surgery (OS or LS) between 2000 and 2020 were included in the analysis. Patients with incomplete datasets or irresectable tumours were excluded. Data was analysed with descriptive statistics and bivariate statistics. Results: Of 303 rectal cancer patients, 153 underwent LS (50.5%) and 150 underwent OS (49.5%). The rate of lower anterior resection was similar between groups (58% in LS vs. 65% in OS, p = 0.49). LS resulted in longer operative time (mean: 194.4 minutes for LS vs. 145.2 for OS, p = 0.023) but less blood loss (mean: 138.7 mL for LS vs 320.4 for OS, p = 0.01), shorter time to oral intake (mean: 60.1 for LS vs. 86.2 for OS, p = 0.002) and fewer complications (19% for LS vs. 36% for OS, p = 0.001). Conclusion: Overall, LS offered better outcomes than OS for rectal cancer. Further research in similar resource-limited settings is required to confirm the findings of this study.

Background: The number of papillary thyroid carcinoma is increasing worldwide compared to the other histopathologic types. There are several aggressive subtypes of Papillary thyroid carcinoma (PTC), where tall cell variant (TCV) is being one of them. TCV-PTC also has oncocytic cytoplasm histologically. We aim to characterize the clinicopathological features and to assess treatment results of tall cell variant papillary thyroid cancer. Material and methods: This is a retrospective analytical study. Clinicopathological characteristics, such as characteristics of the tumor, including tumor size, stage, pathological lymph node, metastasis, lymphovascular invasion, multifocality, peri thyroid invasion, muscle invasion, lymph node involvement, and extra-thyroidal extension; and procedures, such as surgeries, neck dissection, and radiotherapy treatment. The disease-free survival (DFS) and overall survival (OS) rates were calculated using the Kaplan-Meier method. Results: Recurrences are associated to older age, the presence of metastasis, the initial T stage, radioactive iodine therapy usage, and whether the patient received adequate treatment. Multifocality, lymphovascular space invasion, perithyroidal invasion, muscle invasion, lymph node involvement, and extra-thyroidal extension were observed in 21%, 14%, 17%, 9%, 40%, and 18% of the patients, respectively. The 5-year disease-free survival was 53.3%, and the overall survival was 85.8% at the time of study. Conclusions: In terms of clinicopathological features, the tall cell variety of papillary thyroid cancer has been proven to be aggressive. PTC-TCV has a female sex propensity and is most common in the fifth decade of life. Although the tall call variation has worse features, this does not always imply a poor prognosis.

Background: Obstructed defecation syndrome (ODS) is a type of constipation characterized by fragmented stools, need for straining at defecation, sense of incomplete evacuation, tenesmus, urgency, pelvic heaviness and self-digitation. Anorectal manometry has gained wide acceptance as a helpful method to objectively assess the apparatus of defecation provided by the anorectal sphincter. The standard manometric evaluation enables measurement of resting and squeeze pressures, as well as of the length of the functional anal canal high pressure zone [HPZ]. Purpose: the aim of this study is to access the rectosigmoid pressure together with the anal and rectal pressures in constipated patients in relation to their symptoms. Methods: our study is a case control study which included 30 patients with obstructed defecation underwent assessment of the rectosigmoid pressure by using anorectal manometry. Results: Evaluating the rectosigmoid junction pressure in 30 patients with obstructed defecation revealed statistically significant positive correlation with the severity of symptoms according to Cleveland clinic constipation score. Conclusion: high pressure in the recto sigmoid junction can be one of the causes of obstructed defecation, eliminating this high-pressure zone by sigmoidectomy can lead to improvement of symptoms.

Background: Carbohydrate (CHO) drink is a new alternative concept of allowing some amount of calorised content drink during preoperative fasting period. The aim of the study was to compare the effect of CHO drink and plain water to residual gastric volume (RGV), gastric pH and serum glucose level. Methods: A total of 88 patients with American Society of Anesthesiologists class I-II, who underwent elective non-abdominal surgery under general anesthesia, were randomized into two groups; Group A: received 200 ml of CHO-rich drink (n = 44) and Group B: received 200 ml of plain water drink (n = 44) during fasting period at 3 hours before anesthesia. Both groups were measured for RGV by aspirating the gastric content via Ryle’s tube, gastric pH by using pH-indicator strips and serum glucose level. Results: The RGV were significantly lower for Group A than Group B [7.50 (8.69) vs. 13.59 (10.45) ml; p = 0.004)]. However, the pH level was comparable between the two groups [1.85 (0.77) vs. 1.75 (1.28); p = 0.672]. Preoperative and postoperative serum glucose level were comparable for both groups [6.31 (1.40) vs. 5.97 (1.25) mmol/l; p = 0.672] and [5.58 (1.09) vs. 5.54 (0.96) mmol/l; p = 0.235] respectively. RGV and gastric pH were weakly related to duration of fasting (r = 0.202, P 0.006, n = 88 and r = –0.089, P = 0.433, n = 80) respectively. Conclusion: Preoperative CHO drink up to 3 hours before anaesthesia reduced RGV but did not differ in term of gastric pH and serum blood glucose if compared to common practice of plain water drink.

Introduction: Intestinal stoma is a commonly performed procedure with a high rate of complications. This study was undertaken to compare the prevalence of stoma-related complication of patients with distal colorectal obstruction who underwent loop ileostomy and loop transverse colostomy. Patients and Methods: This is a study on 30 accrual patients between May 2021 to November 2021 attending the emergency department to determine the surgical outcome in patients with loop ileostomy (n = 15) in comparison to loop transverse colostomy (n = 15) including outcome of stoma creation and post-operative complication rates. Results: The study participants had a mean age of 53.5 SD10.9 years old. Men represented 56.7%. During stoma placement, peristomal skin complications occurred significantly more often in the loop ileostomy group than in the loop transverse colostomy (33.3% vs. 6.7%). Stoma retraction and wound infection occurred significantly more often in the loop transverse colostomy group than in the loop ileostomy (20.0% vs. 0% and 46.7% vs. 6.7% respectively). The need for further intervention was more commonly reported in the loop transverse colostomy group (20% versus 0%). Conclusion: Loop ileostomy is significantly associated with higher prevalence of peristomal skin irritations. Loop transverse colostomy was commonly associated with higher prevalence of wound infection, stomal retraction and need for surgical re-intervention. There was no significant difference between study groups in terms of hospital stay, mortality and intensive care unit admission.

Background: The WHO define Surgical Site Infections (SSIs) as infections occurring within 30 days of an operation and affecting either the incision or deep tissue at the operation site. It is a severe problem in the surgical specialties which can cause antimicrobial and spread of drug-resistant pathogens, increase in morbidity and mortality as well they form economic burden. The objectives of this study are to identify the bacterial causes of post-operative surgical site infections (SSI), with particular focus on bacteria producing extended-spectrum beta-lactamase (ESBL), and to analyze their susceptibility to various antibiotics as well as to essential oils derived from clove. Method: A cross-sectional study enrolled 119 patients who had undergone surgical procedures. Sociodemographic and clinical factors were assessed using a pre-tested structured questionnaire. Wound swabs and pus samples were collected and promptly transported to the bacteriology laboratory. Swabs were applied onto MacConkey and blood agar plates. Antibiotic susceptibility testing was performed using the disc diffusion method, while susceptibility to clove was evaluated using agar disc diffusion and agar well diffusion methods. Further susceptibility testing was conducted to confirm the presence of ESBL-producing bacteria. Results: The most frequently encountered bacterial species were Escherichia coli, Staphylococcus aureus, and Klebsiella spp., constituting 30.3%, 15.9%, and 13.1% of the isolates, respectively. Notably, a high level of resistance to third-generation cephalosporins was observed in both E. coli and Klebsiella spp. Specifically, resistance percentages were 90.3% for CFM, 83.9% for CTR, and 100% for CTX in E. coli, while for Klebsiella spp., resistance rates were 100%, 80%, and 100%, respectively. These findings strongly suggest the production of extended-spectrum beta-lactamases (ESBLs) by these bacteria. Conversely, both E. coli and Klebsiella spp. exhibited considerable sensitivity to clove oil extract, with percentages of 80.6% and 70%, respectively. Conclusion: A significant number of gram-negative bacilli were identified as producers of extended-spectrum beta-lactamases (ESBLs). Despite their resistance to conventional antibiotics, these strains showed susceptibility to specific plant essential oils, which acted as potent inhibitors against both E. coli and Klebsiella spp., albeit with varying degrees of effectiveness. Regular surveillance of antibiotic resistance is essential to track resistant patterns and facilitate the administration of appropriate antibiotic treatments.

Background: Inguinal hernia is one the most commonly performed operations worldwide. Laparoscopic approaches for repair are now commonly adopted as TAPP and TEP. After refinement of techniques, recurrence rates are now the same as open techniques but chronic pain still remains an issue. One of the main causes of chronic pain is mesh fixation. So, we aim to evaluate the need for mesh fixation by assessing actual mesh displacement in the post-operative period. Methods: From February 2022 to September 2023, 54 patients with inguinal hernias were initially included but only 46 completed the study. They were divided into 2 groups; Non-fixation group and Fixation group where the mesh was fixed by Tacks/sutures. The mesh was marked by 4 radio-opaque markers that were applied to the mesh before its insertion. Mesh displacement was assessed by comparing radio-opaque markers positions in an initial CT done on day 1 postoperatively and follow up CT done 3 months post-operatively. Results: The mean displacement of the mesh in Non-fixation group was 2.26 ± 1.75 mm horizontally and 2.87 ± 2.91 vertically, while in Fixation group it was 2.05 ± 1.64 mm horizontally and 2.63 ± 2.09 mm vertically. There was no significant difference between both groups regarding horizontal or vertical displacement. P 0.58 and 0.51. Conclusion: The current study demonstrates that TAPP without mesh fixation for inguinal hernias is safe and effective with no significant difference in mesh displacement when comparing to mechanical mesh fixation.

Background: Bile duct injury (BDI) following cholecystectomy is an iatrogenic catastrophe that is characterized by a poor quality of life, significant mortality, and morbidity. We aimed to evaluate post cholecystectomy BDI open surgical and Laparoscopic management. Methods: This randomized comparative prospective study was performed on 40 patients, both sexes, with bile duct injuries after cholecystectomy. Patients were randomly allocated into two equal groups: Group (A) patients had laparoscopic management of BDI, and group (B) patients had open surgical management of BDI. Results: There were significant differences between both groups regarding that laparoscopy was better in less operative blood loss (P-value: 0.001), less post-operative hospital stays (P-value: 0.001), less postoperative wound infection (P-value: 0.001), and less postoperative delayed gastric emptying (P-value: 0.001). Open surgery was significantly better in operative time (P-value: 0.001) and postoperative bile leak (P-value: 0.185). Conversion to open surgical management was done in 5 patients of group (A) due to severe adhesions and severe bleeding that obscured the field. Conclusions: Laparoscopic management of BDI post cholecystectomy is feasible and safe but conversion was in 25% of patients due to severe adhesions or severe bleeding. Moreover, laparoscopy provides multiple advantages like less blood loss, less post-operative pain, less post-operative hospital stays, and less post-operative wound infection.

Background: Haemorrhoidectomy is a definitive treatment for severe haemorrhoids, but it can be associated with significant postoperative pain and delayed recovery. Lateral internal sphincterotomy has been proposed to alleviate these issues, though its efficacy and safety remain subjects of debate. Methods: This observational study involved 80 patients who were randomly assigned to undergo either haemorrhoidectomy alone (Group A, n = 40) or haemorrhoidectomy with lateral sphincterotomy (Group B, n = 40). Data on postoperative pain, recovery time, complications, recurrence of haemorrhoids, and patient satisfaction were collected and analysed. The primary outcomes were measured using the Visual Analog Scale (VAS) for pain and recurrence rates at 6-month follow-up. Results: Group B patients experienced significantly lower postoperative pain at 24 hours, 72 hours, and 1 week (p 0.001) compared to Group A. The time to return to normal activities was also shorter in Group B (10 ± 2 days vs. 14 ± 3 days, p 0.05). Complication rates were similar between the groups, but Group B had a slightly higher incidence of fecal incontinence (5% vs. 0%). Recurrence of haemorrhoids was less frequent in Group B (2.5% vs. 7.5%). Conclusion: Haemorrhoidectomy with lateral sphincterotomy reduces postoperative pain and accelerates recovery compared to haemorrhoidectomy alone. Despite the increased risk of fecal incontinence, the combined procedure may offer superior overall outcomes for patients with advanced haemorrhoids.

Background: Metabolomic approach, especially measuring amino acid levels to analyze the immunohistochemistry subtype in breast cancer, is a promising tool. Previous studies showed alteration of amino acid levels in breast cancer patients compared to healthy women, indicating an association between amino acid and breast cancer. Amino acids also can be used as a biomarker for determining cancer progression. This study aims to investigate the association of amino acids with immunohistochemistry subtypes in breast cancer. Methods: This is a cross-sectional study involving 51 breast cancer patients in Cipto Mangunkusumo General Hospital. Each blood sample was collected from patients and analyzed using High- Performance Liquid Chromatography (HPLC) methods to calculate the level of amino acid. The data are analyzed and tested statistically to investigate the association of amino acid alteration based on three categories of immunohistochemistry [Luminal A, Luminal B+HER2 dan Triple-Negative Breast Cancer (TNBC)]. Results: There were mostly no changes in amino acid levels among the three subtypes, except arginine, histidine, and ornithine. Arginine and histidine increased in Luminal A and Luminal B+HER2, whereas a decrease of ornithine level showed in TNBC group. Bivariate analysis showed significant associations between arginine and ornithine with breast cancer immunohistochemistry subtype (p 0.005). Conclusions: Arginine dan ornithine have significantly associations with immunohistochemistry subtype of breast cancer. Arginine tends to increase in Luminal A and Luminal B + HER2, while ornithine tends to decrease in TNBC.

Background: Acute appendicitis is the most common cause of an acute abdomen in young adults. A decision to operate based on clinical suspicion alone can lead to the removal of a normal appendix in 15-25% of cases. Several clinical and laboratory-based scoring systems have been devised to assist diagnosis. Aim: To compare the Diagnostic efficacy of Modified Alvarado score (MAS) and Tzanaki score for acute appendicitis in terms of Sensitivity, Specificity, Positive Predictive value (PPV) and Negative predictive value (NPV). Material and methods: It is a prospective observational study which was conducted at Kasturba hospital affiliated by Kasturba Medical College, Manipal. A total of 75 patients clinically diagnosed to have acute appendicitis were studied who underwent emergency open or Laparoscopic appendectomy from December 2020 to September 2022. Tzanaki and Modified Alvarado scores were obtained for all of them at the time of admission using a pre-prepared Performa and postoperatively specimen was sent for histopathological examination. Results: For MAS Sensitivity, Specificity, PPV, NPV, Diagnostic accuracy were 33%, 83%, 91%, 19%, 41% respectively. For Tzanaki score, Sensitivity, Specificity, PPV, NPV, Diagnostic accuracy were 89%, 58%, 92%, 50%, 84% respectively. Conclusion: Tzanaki scoring is a superior scoring system to decrease negative appendectomy rate when compared to MAS.

Purpose: This study investigates the influence of various factors, including defecation habits, age, gender, and obesity, on the recurrence of hemorrhoids after treatment with the LEONARDO laser technique. Hemorrhoids, a prevalent anorectal condition, often require intervention ranging from conservative management to surgical procedures. Traditional hemorrhoidectomy is associated with postoperative pain and high recurrence rates, whereas the LEONARDO laser technique promises a safer and less invasive alternative. Methods: A comprehensive analysis was conducted on patients who underwent hemorrhoidectomy using the LEONARDO laser technique. The study focused on assessing the impact of several risk factors, such as defecation habits (with a particular emphasis on obstructive defecation syndrome), age, gender, and obesity, on the recurrence of hemorrhoids. Data were collected over a two-year follow-up period post-surgery. Results: The findings revealed a significant correlation between certain defecation habits, notably obstructive defecation syndrome, and an increased rate of hemorrhoid recurrence, especially in older female patients. The study also observed that other factors like age, gender, and obesity played a role in the recurrence rates, although the impact of defecation habits was more pronounced. Conclusions: The results of this study highlight the critical importance of considering individual defecation patterns, particularly obstructive defecation syndrome, in the management and prognosis of hemorrhoids post-LEONARDO laser treatment. These insights can guide clinicians in tailoring postoperative care and counseling to reduce recurrence rates and improve patient outcomes.

Background/aim of study: Adhesions are the leading cause of intestinal obstruction. This affection provoke difficulties in decision-making as surgery might be deleterious in time of adhesiolysis but delaying surgery might deepen general and intestinal consequences of intestinal obstruction To reconciling these conflicts, we herein study factors associated to failure of non-operative treatment in small bowel obstruction due to adhesions. Patients and methods: We conducted a retrospective study between January 2022 and February 2024 and included records of intestinal obstruction in our general surgery department. We aimed to describe the epidemiological, clinical and therapeutic aspects of acute intestinal obstruction. We also determined identify factors associated with the failure of non-operative treatment of adhesions. Results: Among 82 enrolled patients, most occlusions were of small bowel origin (81.7%). Adhesions were at top of the list accounting of 48 cases. In the majority of cases, adhesions were caused postoperatively (84%), with almost all cases in laparatomized patients. On multivariate analysis, wall thickening in the affected intestinal segments was associated to non-resolution by medical treatment (p = 0.031; OR = 6.3). Conclusion: integrating this result could help surgeons in patient-selection to expedite necessary surgery and avert wasted time on observation.

Ischiorectal abscess occurs as an extension of suppurative inflammation of the deep anal space. This infection may extend to pararectal space, forming the supralevator abscess, following the intersphincteric plane, and cause life-threatening medical condition. We present a rare case of 57 years old HIV-positive male, with bilateral ischiorectal abscess, in which he underwent incision and drainage. After one week of the procedure, the patient presented again with suprapubic and scrotal painful swelling. Computed tomography (CT) of the pelvis revealed multiloculated collections at the bilateral ischioanal and ischiorectal fossa which extends anterolaterally into extraperitoneal fats superior to the urinary bladder and into bilateral inguinal canals and scrotal sacs. The patient underwent wound exploration, debridement of the ischiorectal space and scrotal exploration with multiple corrugated drains insertion. The patient completed several courses of intravenous antibiotics and repeated CT pelvis showed a significant reduction of the collection and patient able to be discharged home. This condition is an unusual clinical problem that often poses a significant diagnostic and therapeutic challenge due to complex anatomical planes and rarity of such sequelae of this ischiorectal abscess. We discuss the relevant anatomy, literature reviews and approach to the management of this unfamiliar complication of the disease.

Background: Peripheral nerve injuries, although common in robotic surgeries, may occur in open thyroidectomies. This can be due to improper patient positioning during surgery and long operative time, causing ischemic compression injury to the nerves. Case presentation: A case of thyroid adenoma in a 44-year-old woman planned for open thyroidectomy; complicated with post-operative weakness and numbness of the left upper limb, which upon further workup was proven to be an upper brachial plexus neuropraxia. Conclusion: Intraoperative awareness and monitoring of patient posture are critical in the prevention of such a complication. Neuropraxia can be managed conservatively, without the need for surgery, with full recovery potential.

Bowel ischaemia is a clinical condition that requires early diagnosis and may associated with poor outcome. Methamphetamine may cause bowel ischaemia due to its vasoconstriction effect on mesenteric vessels. We describe a case of 36 year-old man who presented with ischaemic bowel related to illicit use of methamphetamine. Exploratory surgery was done with concern for intestinal infarction, intra-operatively revealed long segment gangrenous small bowel which necessitate bowel resection with stoma creation. This case report highlights the importance of having high index of suspicion for non occlusion mesenteric ischaemia secondary to methamphetamine usage in these patients presenting with acute abdomen.

Background: Spontaneous perirenal hemorrhage is an uncommon condition characterized by non-specific symptoms such as abdominal pain and vomiting. Timely diagnosis is critical as misdiagnosis or delayed management can lead to life-threatening consequences. While the primary etiologies include tumors and vascular diseases like polyarteritis nodosa, spontaneous perirenal hemorrhage associated with systemic lupus erythematosus (SLE) is exceedingly rare. Case Presentation: A 38-year-old female with end-stage renal failure and SLE presented to the Emergency Department with sudden onset left-sided abdominal pain, dizziness, and vomiting. Physical examination revealed tenderness in the left upper quadrant. Initial laboratory findings indicated anemia and coagulopathy. Contrast-enhanced CT scan confirmed left renal subcapsular, pararenal, and retroperitoneal hematoma with contrast blush, consistent with spontaneous renal hemorrhage. The patient was initially managed conservatively with blood transfusion and antibiotics. Despite these measures, her hemoglobin continued to drop, and she developed worsening coagulopathy and thrombocytopenia. Due to the failure of conservative management and the absence of interventional radiology facilities, the decision was made to proceed with left nephrectomy to control ongoing bleeding and stabilize her condition. Conclusion: Diagnosis of spontaneous perirenal hemorrhage in SLE patients is challenging due to its rarity and varied presentation. This case underscores the importance of clinical suspicion and prompt imaging to achieve early diagnosis and intervention. Optimal management strategies should be tailored to patient individually, including underlying comorbidities such as renal failure and autoimmune diseases like SLE, to improve outcomes and prevent fatal complications.

Backround: Diverticulosis of the appendix and appendiceal diverticulitis are uncommon clinical conditions with a reported pathologic incidence of appendiceal diverticulosis that ranges approximately 0.014-1.9% [1]. We report a case of a 69-year-old man who presented at the emergency department with signs and symptoms typical of acute appendicitis. Case report: A 65-year-old man presented at the Emergency Department with a 24 hours history of right lower – quadrant abdominal pain which was associated with fever, vomiting and abdominal tenderness. Blood tests revealed mild leucocytosis and computed tomography (CT) scan of abdomen and pelvis revealed signs of acute appendicitis. The patient underwent an open appendectomy. During the operation the appendix was observed with diverticula and signs of inflammation and the histopathological examination confirmed appendiceal diverticulitis with a serrated sessile polyp of the appendiceal mucosa. Conclusions: Appendiceal diverticulitis, even though a separate clinical entity from acute appendicitis, often presents with a closely similar clinical image. The higher rates of complications and appendiceal neoplasms that are associated with this medical condition must raise clinical awareness when treating patients with signs and symptoms indicating acute appendicitis.

The pelvic cavity, one of the most dependent regions in the abdominopelvic cavity, is a common site for the accumulation of collection. The collection has various aetiologies, including residual peritoneal washout, inflammatory fluids and leakage of intestinal content. Drainage of pelvic collection, either percutaneous, transrectal or transvaginal route, typically requires image guidance due to the complexity of pelvic anatomy and to reduce procedure-related complications. We reported a case of a 35-year-old female who developed symptomatic significant pelvic collection following multiple laparotomies. Transrectal drainage was successfully performed without radiological guidance. We would like to highlight that this approach is safe and feasible with proper surgical technique.