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The importance of preoperative tumor site marking has increased over the years, as the method of intraoperative primary lesion identification and determination of resection margins is one factor determining whether oncological safety and function-preserving gastrectomy are possible during surgery. We hypothesize that preoperative placement of the near-infrared fluorescent (NIRF) clip, ZEOCLIP FS, near the oral incision line of the gastric tumor will allow for Firefly recognition of the NIRF clip on da Vinci during surgery and easy determination of the tumor location and incision line. Hence, we report on two cases in which the procedure was performed. Case 1: A 62-year-old woman was diagnosed with early gastric cancer of 35 mm in size located in the greater curvature of the gastric angle and underwent robot-assisted distal gastrectomy. NIRF clips were placed around the negative biopsy-confirmed area on the tumor's oral side by endoscopy on the day before surgery. The clips were identified intraoperatively in Firefly mode, and we performed gastrectomy without using an intraoperative endoscope. Case 2: A 60-year-old man was diagnosed with early gastric cancer 40 mm in size on the anterior wall of the gastric angle and underwent robot-assisted distal gastrectomy. Similarly, NIRF clips were placed around the site of negative biopsy confirmation the day before surgery. NIRF clips were identified, and we performed gastrectomy. The time taken to mark the gastric resection line after activating the Firefly imaging system was 120 and 154 s, respectively, and intraoperative endoscopy was not required. The advantage of our two-step method is that a surgeon can mark the clips the day before the surgery, even if they are not endoscopists. Increasing the recognition rate of fluorescent clips and preventing their remains are future issues. Based on the results of the above two cases, ZEOCLIP FS is influential in determining the tumor's location and the resection line. • Identifying the tumor and resection line in robot-assisted gastrectomy is challenging, but ZWOCLIP FS® can mark the resection line in minutes. [ABSTRACT FROM AUTHOR]

Cranioplasty is an elective neurosurgical procedure following decompressive craniectomy, often associated with post-operative complications such as hemorrhage, seizures, infection, hydrocephalus, and bone resorption. While seizures post-cranioplasty is not uncommon, Intractable seizures are rare but a dreadful complication following cranioplasty. A 23 and 17-year-old male underwent decompression craniectomy for traumatic brain injury and subsequently underwent titanium mesh and acrylic cranioplasty respectively, During the post-operative period both patients developed intractable seizures. Initially seizures were refractory to multiple anti-epileptic drugs and benzodiazepine induced coma. Intractable seizures were controlled gradually with few anti-epileptic drugs after the removal of cranioplasty. During 2 years' follow-up, there was no new episode of seizures complained by patients. Elective cranioplasty following decompressive craniectomy after traumatic head injury is one of the commonest surgical modality carried out globally as a life saving measure. But post-operative complications following cranioplasty such as wound infection, implant displacement, bone resorption, hydrocephalus, epidural hematoma are the commonest observed complications whereas post-operative seizure is the most dreadful complication needing immediate intervention. Along with it intractable seizure is rarer during post- operative period. Intractable seizures post-cranioplasty, though rare, are serious and often linked to cerebral edema from negative pressure drainage and dysregulation of cerebral blood flow. Removing the cranioplasty can restore blood flow regulation, stabilize brain tissue, and resolve seizures. Care providers should be aware of this rare complication and to be counselled the patient and the family before the surgery. • Seizures are the common post-operative complication following cranioplasty which has varied incidence rate • Intractable seizures are rare and dreadful complication following either cranioplasties • The exact mechanism of post-cranioplasty seizures are not known [ABSTRACT FROM AUTHOR]

Axillary artery aneurysms are rare vascular conditions that can present with various clinical manifestations, including neurological deficits and vascular compromise. While the underlying pathophysiology remains complex and multifactorial, potential associations with trauma, arteriovenous fistula formation, and atherosclerosis have been reported. Presentation Of Case. Two male patients, aged 33 and 38, with a history of kidney transplantation and previous arteriovenous fistula (AVF) presented with symptoms of upper limb ischemia and neurological compromise. Imaging revealed large axillary artery aneurysms. Open surgical repair was performed for both cases. Two weeks after discharge, one patient showed good pronation and supination with mildly limited extension. The other patient's wrist drop gradually improved with physiotherapy. Multifactorial pathophysiology encompassed altered blood flow dynamics, inflammation, and the underlying vascular pathology. Chief complaints and prior vascular interventions contributed. Open surgical repair was preferred to endovascular approaches, achieving favorable outcomes. Axillary artery aneurysms in patients with a history of AVF are rare but potentially serious complications. The cases highlight the complexity of axillary artery aneurysms and the need for careful evaluation and surgical intervention This strategy is crucial to prevent potential complications and optimize patient outcomes. Further research is needed to elucidate the precise pathophysiology and the potential association between AVF and the subsequent development of axillary artery aneurysms. Increasing awareness among surgeons could enable earlier detection of aneurysms, thereby reducing the risk of complications. • A report of axillary artery aneurysms in patients with brachiocephalic arteriovenous fistulas (AVFs). • The study identifies a potential link between AVF and the subsequent development of proximal aneurysms. • The pathophysiology is complex and involves alterations in blood flow dynamics and other contributing factors. • Successful surgical treatment of axillary artery aneurysms through open methods is reported. [ABSTRACT FROM AUTHOR]

Mesenteric cysts are rare, non-cancerous tumors found mainly in children. The symptoms can vary depending on the size and location of the cyst. While the exact cause is unknown, complete surgical removal is the main and most effective treatment for mesenteric cysts. Three cases involving young boys were presented. They primarily complained of abdominal swelling without pain. Radiological tests revealed mesenteric cysts near the jejunum and transverse colon, and another near the sigmoid colon, which were both successfully removed. Despite being uncommon, mesenteric cysts should be considered when diagnosing abdominal masses in children. Surgical intervention is crucial for patients with mesenteric cysts. Complete surgical removal leads to a positive prognosis, even for large or complex cases. This stresses the importance of considering. Environmental factors are potential causes for the formation and development of these tumors. • Mesenteric cysts are rare, non-malignant tumors. • Accurate diagnosis and surgical management are essential for successful treatment. • Complete surgical excision is the gold standard treatment approach. • Histological examination confirms the definitive diagnosis. • Recurrence typically occurs early, making long-term follow-up for recurrence less beneficial. [ABSTRACT FROM AUTHOR]

Brown tumors are non-neoplastic reactive tissue with osteoclasts multinucleated giant cells, and vascular and proliferative fibrous tissue. Hemorrhage results in significant bone resorption caused by hyperparathyroidism. This study provides information about the diagnosis challenge for brown tumor cases. We report four cases that experience pathological fractures with moderate pain, multiple lytic lesions, severe hypercalcemia, increased ALP (Alkaline Phosphatase), and PTH (Parathyroid Hormone). Abnormal parathyroid mass was found in ultrasound. A bone scan described increasing radio uptake in various bones, a whole body scan, or parathyroid scintigraphy with 99mTc- MIBI. Eventually, in all cases, the diagnosis of the brown tumor was confirmed through histopathological examination, which showed multiple nucleated giant cells with a deposit of hemosiderin pathognomonic for the brown tumor, and the diagnosis of primary hyperparathyroidism (PHPT) was confirmed in all cases. These cases show that initial misdiagnosis of brown tumors as other bone tumors. A definitive diagnosis of brown tumors requires more than just histological confirmation. A comprehensive evaluation encompassing laboratory tests, imaging studies, clinical symptoms, and a multidisciplinary orthopedic-oncology board discussion is essential. Observations show that treating hyperparathyroidism alleviates the osteolytic lesions caused by brown tumors, despite the lack of clinical guidelines. Based on a review of the literature and our clinical experience, we recommend screening serum calcium, phosphorus, and PTH levels in patients presenting with multiple lesions and widespread bone pain. This screening aims to rule out multiple bone lesions caused by PHPT. • Misdiagnosis of multiple lytic lesions • The diagnostic challenge of brown tumors • MIBI scan still useful to diagnose brown tumors [ABSTRACT FROM AUTHOR]

The increasing incidence of obstetric complications, such as post-partum hemorrhage in the case of placenta accreta spectrum, calls for innovative and adapted therapeutic approaches. This presentation highlights the effectiveness of arterial embolization of the hypogastric artery, properly known as the internal iliac artery, in managing obstetric bleeding, even after initial surgical ligation. An approach never described in the literature. 1st Case: A 38-year-old patient, in her fourth pregnancy with two previous caesarean sections, was admitted for moderate metrorrhagia at 19 weeks gestation. Ultrasound showed a monofetal pregnancy at 17 WG with a 6 cm placental abruption and an anterior placenta with accretion signs. An emergency subtotal hysterectomy with triple Tsirulsikov arterial ligation was performed after transfusion. Due to persistent bleeding, bilateral hypogastric artery ligation and abdominal packing were added, but without improvement. The patient was referred for embolization after hemodynamic stabilization. The procedure was carried out successfully and no complications were reported. 2nd Case: A 35-year-old patient with vaginal bleeding from placenta accreta at 25 WG required hemostasis hysterectomy. Despite the procedure, bleeding continued, leading to bilateral hypogastric artery ligation and pelvic packing. The patient was hemodynamically stabilized and transferred for hypogastric artery ligation, which was successfully performed without complication. The role of interventional radiology in managing postpartum hemorrhage (PPH) is well established, with substantial literature supporting the benefits of uterine artery embolization as a lifesaving and often uterine-sparing procedure in PPH. While its indication for prevention is well-known, what about post-operatively? Our experience indicates that consulting a radiologist specializing in pelvic embolization can yield satisfactory outcomes despite technical difficulties. Embolization of the hypogastric arteries as well as embolization followed by surgical ligation of these arteries have been well described in the literature, the originality in our case reports is the embolization performed after surgical ligation which has not been described before according to our knowledge and which despite its technical difficulty can be a satisfactory alternative for the control of post-partum hemorrhage. • Successful embolization after surgical ligation in two obstetric hemorrhage cases. • Arterial embolization controls bleeding post-surgery, even with technical challenges. • Femoral artery puncture and hyper-selective embolization used for hemostasis. • Case 1: Subtotal hysterectomy failed; embolization stopped persistent bleeding. • Case 2: Placenta accreta required hysterectomy; embolization stabilized bleeding. [ABSTRACT FROM AUTHOR]

Introduction and Importance: Laparoscopic cholecystectomy has become the gold standard for treating symptomatic gallstones in recent years due to its minimally invasive nature, which results in less pain, scarring, and a faster recovery time compared to traditional open surgery. Port site infection is a rare complication of laparoscopic surgery, sometimes occurring early after the procedure or developing later and the cause of these infections can vary. Port site tuberculosis (TB) is a particularly uncommon type of port site infection and represents a rare form of extra pulmonary TB., Case Presentation: Three patients (a 63-year-old diabetic male, a 62-year-old hypertensive female, and a 34-year-old female) presented with port site discharge and pain after undergoing laparoscopic cholecystectomy at the same center during the same campaign. All patients initially received antibiotics for suspected port site infections, but these failed to resolve the symptoms. Subsequent fine needle aspiration cytology revealed port site tuberculosis (TB) in all three cases. After initiating anti-tuberculosis treatment, all patients showed significant improvement., Clinical Discussion: Port site tuberculosis, a rare and often overlooked extra pulmonary manifestation of tuberculosis, can present as a port site infection following laparoscopic procedures. It is characterized by prolonged wound healing and persistent discharge, can pose diagnostic challenges, often requiring careful evaluation and appropriate investigations to ensure timely and effective treatment. Port site tuberculosis can be transmitted to patients through two main routes: exogenous or endogenous ways. Once a diagnosis of port site tuberculosis is confirmed; the next step involves treatment with a standard anti-tuberculosis regimen., Conclusion: Port site tuberculosis (TB) after undergoing laparoscopic cholecystectomy at the same facility, suggesting inadequate instrument sterilization as a likely cause. This case underscores the importance of considering port site TB in post-laparoscopic patients, particularly in areas with high TB prevalence, after ruling out bacterial infections. Prompt and appropriate treatment is crucial for successful outcomes., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Cloacal exstrophy (CE) is defined as a complex anomaly that affects the urogenital and intestinal tracts. It is the most serious form of anomaly that is described within the so-called exstrophy-epispadias complex. These malformations usually present a challenge in the management of particular conditions, as most of these forms require multiple surgeries, resulting in the use of multidisciplinary approaches, including reconstructive urologists, pediatric surgeons, orthopedic surgeons, endocrinologists, pediatricians, psychologists and nutritionists. Additionally, these patients present with ambiguous genitalia, which is another aspect that needs to be taken into consideration during the management of this condition., Case Presentation: The first patient, a baby who was 8 days of life and referred from a peripheral hospital, presented with classic features of cloaca exstrophy. He underwent first-stage cloacal exstrophy repair. The intraoperative findings included a bi-halved bladder and phallus, and the ureters were not appreciated, but there was continuous urine leakage from the bi-halved bladder and no uterus or ovaries. Poorly formed cecum, cecal-cutaneous fistula with an everted part of the terminal ileum protruding outside (mucosa-out), no transverse, no descending colon, collapsing small bowel, left undescended testis in the inguinal region, and right abdominal undescended testis. He first underwent surgery, which involved ileostomy, omphalocele closure and proper bladder exstrophy construction. The second patient, a 6-day-old female, had a similar presentation and physical findings as the first patient did, except that she had elephantoid trunk deformity with a cecal fistula, bifid clitoris, two cervical orifices, and two uteri completely separated with ovaries. Mobilization of the hindgut, closure of the cecal fistula, and proper bladder exstrophy after repair of the posterior wall were performed. The third patient was a 10-day-old female, similar to the second patient, but this patient presented with a left leg deformity with wide diastasis. In this case, the urinary bladder was not bivalved, and the cecal fistula had perforated just below the posterior wall of the urinary bladder. A mild omphalocele, bifid clitoris and vagina, one cervical orifice, and two uteri completely separated, with ovaries observed. Mobilization of the hindgut, closure of the cecal fistula, and proper bladder exstrophy after repair of the posterior wall were performed. The postoperative period was uneventful., Clinical Discussion: Surgical management of cloacal exstrophy is typically undertaken in the newborn period (48-72 h) as a combined effort between pediatric surgery and urology. In the setting of associated spinal dysraphism, neurosurgical consultation and closure should be undertaken as soon as the infant becomes medically stable. Early operation minimizes bacterial colonization of exposed viscera and may decrease the need for pelvic osteotomy. The goals of treatment include securing the abdominal wall and bladder closure, preserving renal function, preventing short bowel syndrome, creating functional and cosmetically acceptable genitalia, and attaining acceptable urinary and fecal continence., Conclusion: Cloacal exstrophy remains a rare and complex congenital anomaly characterized by an array of anatomical defects affecting multiple organ systems. With respect to the approach of this congenital malformation, it is therefore important that these individuals and their families remain under the care of a multidisciplinary team of providers who can offer medical care, counseling and life-long follow-up., Competing Interests: Conflict of interest statement The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Nutcracker syndrome (NCS) is a rare condition characterized by left renal vein compression and presents with diverse clinical manifestations. This case series study aims to evaluate the clinical presentations and outcomes of patients with NCS and varicocele., Case Presentation: We reviewed the cases of four male patients, aged 15 to 19 years, who presented with recurrent and grade 3 varicocele after varicocelectomy. All patients reported pain in the hypogastric, flank, or groin areas. Despite the absence of hematuria, NCS was diagnosed based on duplex ultrasound and contrast-enhanced computed tomography (CT) scans. Patients underwent open surgical interventions, including gonadal vein transposition or saphenous vein bypass., Clinical Discussion: The absence of hematuria in these cases poses a diagnostic challenge, as current diagnostic criteria for NCS relies on its presence. Our findings underscore the need to consider NCS in patients with varicocele, even in the absence of hematuria. Surgical interventions were effective in resolving the symptoms. After NCS surgery, the varicocele in one patient resolved, and three patients underwent varicocelectomy successfully without recurrence throughout the recovery period., Conclusion: This case series highlights the diagnosis of NCS presenting with varicocele and local pain without hematuria, emphasizing the need for improved diagnostic and management approaches., Competing Interests: Conflict of interest Authors declare they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: The cervical spine is a dynamic structure that protects adjacent nervous innervation and maintains the range of motion (ROM) of the head and neck. Fractures in this area can lead to high mortality and morbidity, with bone fractures accounting for 56 % of cervical spinal cord injuries. This case series presents a series of cervical pathologies treated with posterior decompression and stabilization using laminar and lateral mass screw fixation., Methods: This research is a case series of four patients treated with laminar and lateral mass screw technique. All patients received a surgical procedure, including posterior compression and stabilization, which included the use of a laminar and lateral mass screw. We followed the patient for 12 months. During follow up, outcome measures consisting of VAS, range of motion, neurological status, ODI Score, SF-12 Score and any complications related to the surgical procedure was recorded and calculated every 3 months., Outcomes: This series examines four distinct cases. The initial case pertained to a female patient, aged 72, who exhibited tetraparesis resulting from a burst fracture occurring in the C3-C5 vertebrae. The underlying etiology of this pathology is considered to be mineral bone disease associated with thyroid hormone imbalance due to thyroid cancer. The second instance was a 14-year-old child experiencing neck pain due to spondylitis tuberculosis in the C1-C2 region, accompanied by a retropharyngeal abscess and occipitocervical dissociation (OCD) with basilar invagination. The third example pertained to a patient who is 9 years old and presented with weakness in all extremities due to C1 fracture-dislocation. The fourth case was a 14-year-old patient who experienced a fall from a bunk bed. This patient was diagnosed with Traumatic Atlantoaxial dislocation with odontoid fracture Type II. All patients showed improved cervical curvature and range of motion with the advantages of reduction of intraoperative haemorrhage, as well as a decrease in postoperative rehabilitation duration. Overall, the data shows a general trend of improvement in VAS and ODI scores over time, with SF-12 scores stabilizing or slightly decreasing by 12 months post-operation., Conclusion: The use of a lateral mass screw for subaxial cervical injuries can be employed to manage cervical spine pathologies like fractures and infections, including spondylitis TB. However, more research is required to evaluate the long-term complications and success rates of this technique., Competing Interests: Conflict of interest statement The authors have no financial or proprietary interests in any material discussed in this manuscript., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The diagnostics and treatment management in conditions of massive sanitary losses with the use of staged treatment have their own specifics and require a multidisciplinary approach with the involvement of a wide range of specialists and the use of modern technologies. The number of sources covering the ultrasound diagnostics and clinical course of hepatic artery pseudoaneurysm as a complication of gunshot wounds is quite limited in world literature. We present the experience of the observation and management of the right hepatic artery pseudoaneurysm in case of the blast injury of liver in two patients: the example of successful resolution with spontaneous occlusion and the example with the occurrence of internal bleeding as a result of pseudoaneurysm rupture. Clinical cases presented here belong to the category of severe injuries caused by high-energy weapons, which are characterized by a syndrome of mutual aggravation and need for simultaneous treatment of several damaged organs. The use of contrast methods in severely injured patients requires instrumental justification, and results of daily ultrasound monitoring with the use of color Doppler program can be the one. Pseudoaneurysm of hepatic arteries is a dangerous complication of severe liver wounds and injuries, which occurs in 3·2 % of patients according to our data. The method of ultrasound examination with the use of color Doppler mapping program allows to visualize pseudoaneurysms and monitor their progress. When identifying patients with pseudoaneurysm of hepatic arteries at the level II–III medical care (Role II–III), their further evacuation should be carried out to medical institutions equipped with endovascular correction technologies. • Pseudoaneurysm of hepatic arteries is a dangerous complication of severe liver wounds and injuries • Cases of the spontaneous thrombosis and cases of pseudoaneurysm rupture with a massive bleeding are seen • Sonography method with the use of color Doppler mapping allows to visualize pseudoaneurysms and monitor their progress. • Patients with pseudoaneurysm of hepatic arteries should be evacuated to medical institutions with endovascular technologies. [ABSTRACT FROM AUTHOR]

Surgical management of grade III gynecomastia with excess redundant skin is challenging. The choice of the surgical technique is mainly decided upon the size of the gynecomastia, the skin redundancy and correction of nipple position. We report our experience in the use of the circular incision bi-pedicled vertical flap based mastectomy for grade III gynecomastia according to Simon classification. This is a retrospective study conducted between January 2022 and April 2023 at two selected units in Sri Lanka. A total of 7 patients with bilateral grade III gynecomastia were included in this study with a median age of 24 years (range: 18–42 years). The mean BMI was 23.2 kg/m 2 . All patients exhibited near symmetrical breasts and large areolar diameters. All patients complained of physical and psychological dissatisfaction with their condition and sought an aesthetic correction. Two patients were diagnosed with Klinefelter syndrome and others were apparently healthy. The main complication was seroma formation (7/7). No patients developed haematoma. Nipple hypothesia was noted in two patients which improved on follow up. The mean follow- up duration was 4–9 months. The survey of patient satisfaction showed 9 for contour, 8.6 for wound scars, 9.2 for overall satisfaction and 9.6 for improvement in self-confidence. The above surgical technique achieved satisfactory aesthetic results while avoiding unsightly scars or serious complications and can be considered in the surgical decision making for grade III gynecomastia. • Surgical management of grade 3 gynecomastia is challenging. • This article describes the experience in the use of the circular incision bi-pedicled vertical flap based mastectomy for grade 111 gynecomastia. • This surgical technique achieves satisfactory aesthetic results while avoiding unsightly scars. [ABSTRACT FROM AUTHOR]

Peutz-Jeghers syndrome (PJS) is a rare hereditary disorder characterized by gastrointestinal hamartomatous polyps, due to mutation of the STK11/LKB1 gene located on chromosome 19p. The polyps are most commonly found in the small bowel followed by colon. Our case series includes 4 patients, three being male and one female. Each of them either presented with abdominal pain and other associated symptoms. Oral cavity and lip melanin pigmentation were common. CT abdomen revealed multiple large jejunal, ileal, gastric and colon polyps. Cancer was found in one patient. Different surgical approaches were adopted. All recovered well. PJS is an autosomal dominant disorder with an estimated incidence of 1:50,000 to 1:200,000 cases with a significant family history. Mostly found in small bowel followed by colon, it can also occur in a rare organ like gall bladder as evident in our case. PJS carries a substantial risk for gastrointestinal cancer. The treatment modality depends on the site of polyp, mode of presentation and availability of the expertise. PJS is a common disease in our part which is usually observed in teen age groups male. They have a varied presentation, from intestinal obstruction (due to intussusception) to GI bleeding. Colonic malignancy at young age may be the first presentation of the disease. Observation of melanin pigmentations on lips helps diagnose the disease; and one should always look at this findings in a young patient with pain abdomen or in intestinal obstruction to confirm/exclude the disease. • Peutz-Jeghers syndrome (PJS) presents with gastrointestinal hamartomatous polyps. • The polyps are most commonly found in the small bowel followed by colon and rarely gallbladder. • PJS is a common disease in our part which is usually observed in teen age groups male. • They have a varied presentation, from intestinal obstruction (due to intussusception) to GI bleeding. • Colonic malignancy at young age may be the first presentation of the disease. [ABSTRACT FROM AUTHOR]

Congenital pulmonary airway malformations (CPAM) are a spectrum of cystic and non-cystic anomalies arising from abnormal airway development in utero, with an incidence of 1 in 25,000 to 35,000 births. CPAM can present prenatally or postnatally with respiratory distress, recurrent infections, or occasionally as an incidental finding. This case series aims to highlight the clinical, radiological, and histopathological characteristics of CPAM through three pediatric cases, which include types 1, 2, and 3 CPAM. Case 1: A four-month-old male presented with cough, cold, and respiratory distress. Imaging revealed hypoattenuation and overinflation of the left upper lobe with mediastinal shift. Left upper lobectomy confirmed CPAM type 2. Case 2: A one-month-old female presented with recurrent respiratory distress and infections. Imaging showed a large cystic lesion in the right middle lobe. Right middle lobectomy confirmed CPAM type 3. Case 3: A two-month-old male presented with dyspnea. Imaging showed a large bullae in the right chest with mediastinal shift. Right upper lobectomy confirmed CPAM type 1. CPAM is a rare congenital lung malformation characterized by abnormal bronchial development and localized glandular overgrowth. Management involves surgical resection, with the timing of surgery dependent on symptomatology. Early identification and intervention are crucial for preventing complications such as pulmonary hypoplasia and recurrent infections. Histopathological examination post-resection is essential for accurate classification and management of CPAM. This case series provides valuable insights into the clinical, radiological, and histopathological features of CPAM, including the types encountered in each case. It underscores the importance of early diagnosis and timely surgical intervention, advocating for routine prenatal and postnatal screenings to effectively identify and manage CPAM. • This case series provides valuable clinical, radiological, and histopathological insights into CPAM, enhancing the understanding of its varied presentations and management approaches. • By detailing the cases, it underscores the importance of early diagnosis and timely surgical intervention, advocating for routine prenatal and postnatal screenings to identify and manage CPAM effectively. [ABSTRACT FROM AUTHOR]

Adult Head and neck Rhabdomyosarcomas (HNRMS) are exceedingly rare and remain challenging for pathologists. Five cases of adult HNRMS (≥19 years) were retrieved from the archives of the Department of Pathology of Hospital of Specialities in Rabat (HSR) in Morocco, over 5 years. Clinical and pathologic findings from hematoxylin and eosin slides and immunohistochemistry for Desmin and Myogenin were reviewed. The median age was 33, with a men's predominance (3 M/2F). Histological analysis revealed three cases of Alveolar Rhabdomyosarcoma (RMS), one Pleomorphic RMS, and one spindle cell/sclerosing RMS. In addition to the typical histology observed in each RMS, we found tricky growth patterns that could be a source of misdiagnosis. All five cases demonstrated variable positivity for Desmin and Myogenin. HNRMS cases have different pathological features than pediatric RMS cases. We identified rare subtypes such as pleomorphic and spindle cell/sclerotic RMS, which exhibit unusual morphological patterns. • Adult head and neck rhabdomyosarcomas are rare. • Atypical morphological patterns are identified when compared to pediatric rhabdomyosarcomas. • Age could play a significant role in determining survival outcomes. [ABSTRACT FROM AUTHOR]

Primary urethral carcinoma (PUC) is exceedingly uncommon and accounts for 0.02 % of all female cancers and <1 % of female genitourinary tract malignancy. PUC in female usually presents late with a higher disease stage and, hence, has higher cancer-specific mortality. Due to its rarity, the current recommendation for the management of PUC is still unclear. This study reports two rare cases of 59-year-old and 65-year-old women with PUC, presenting with chief complaint of hematuria. Urethrocystoscopy and biopsy were performed. Pathology results revealed mucinous adenocarcinoma (AC) and urothelial carcinoma (UC) of the urethra, respectively. Radiological imaging was conducted for staging. Both were diagnosed with cT4N2M0. The first patient underwent anterior pelvic exenteration with bilateral ureterocutaneoustomy (UCS), while the second patient received cisplatin-based chemotherapy before the surgery. Radiological follow-up was planned 3 months after the surgery. Both mucinous AC and UC are considered incredibly unusual subtypes, with no defined treatment guidelines. Anterior exenteration with or without neoadjuvant chemotherapy may be opted for advanced PUC affecting the proximal urethra and adjacent organs. Following the previous studies, in this case series, both patients (locally advanced) underwent anterior exenteration. Additionally, the UC subtype received multimodal treatment with neoadjuvant chemotherapy which was shown to improve overall survival. In conclusion, PUC is extremely rare, and the choice of management remained various. Long-term follow-up for these patients is mandatory to improve understanding of this incredibly uncommon disease. • PUC is very scarce, accounting for 0.02 % of all female cancers. • The current treatment for primary urethral carcinoma is still uncertain. • Multimodal treatment is preferred in locally-advanced since it increases OS. • In this case, both underwent anterior exenteration and neoadjuvant chemotherapy. • Long-term follow-up is necessary to better understanding of this rare cancer. [ABSTRACT FROM AUTHOR]

Caecal volvulus is a form of intestinal obstruction with life-threatening potential. While rare, it represents a perilous aetiology of intestinal blockage, with clinical manifestations spanning from abdominal discomfort to mortality. We report the cases of three young adults (two males and one female) who presented to the emergency department with different manifestations of severe abdominal pain. All occurred within one month in a tertiary referral centre. Radiological evaluations confirmed the diagnosis of caecal volvulus in all. Subsequently, these individuals underwent right hemicolectomies with end-to-end anastomosis. All experienced an uncomplicated perioperative course. Caecal volvulus is uncommon, but its yearly incidence is increasing. Early detection and a heightened level of suspicion lead to a timely diagnosis, reducing morbidity and mortality rates. We report a case series of caecal volvulus, emphasizing its variable presentation and highlighting the critical importance of an early diagnosis. Typically, patients have a history of similar episodes that resolve without any medical intervention. Definitive treatment involves right hemicolectomy while conservative management is associated with very high recurrence rates. Early detection allows for prompt intervention, resulting in reduced morbidity and mortality rates. • Patients with caecal volvulus typically have a history of similar episodes that resolved spontaneously. • Outdated statistical data can lead physicians not to consider a particular diagnosis in their clinical assessments. • Early detection allows for prompt intervention, resulting in reduced morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Rosai-Dorfman disease was first described in the 1960s and is characterized by hyperproliferation of histiocytes, which presents as painless lymphadenopathy with fever, night sweats, and weight loss. This disease often affects young adults and children of African descent. Different types of RDD exist, including familial, classical (nodal), extranodal, neoplasia-associated, and immune-associated. While this disease can cause significant pain, there is currently no consensus on treatment. This case series outlines three cases of bony involvement of histiocytic neoplasms and our technique for intralesionoal steroid injections. Two cases were successfully treated with intralesional steroid injections and one patient was treated with oral steroids. Histiocytic neoplasms can cause significant pain for patients and there is no standardized treatment as of yet. An interesting finding on MRI was a characteristic peripheral edema we termed the "Halo Sign". Steroids are believed to exert their benefit in treating this disease by apoptosis and reducing tumoral swelling. This case series demonstrates the successful management of bony involvement of RDD with intralesional steroids similar to eosinophilic granuloma. While intralesional steroid injection has previously been described for other types of RDD, this is the first description of bony RDD treated with this technique to our knowledge. • Histiocytic neoplasms represent a wide array of pathology. • Treatment for these neoplasms can vary as well. • Intralesional steroid injections for these neoplasms can be beneficial. [ABSTRACT FROM AUTHOR]

• Patients infected with the COVID-19 virus are at a higher risk of developing post-operative complications. • COVID-19 patients undergoing surgical procedures pose a transmission risk to the operating room team. • Augmented reality technology can be used to safeguard the surgical team while ensuring real-time multi-displinary expert input during the course of the procedure. • Augmented reality technologies may form the basis of a robust infection control strategy in the post-COVID era. COVID-19 has presented the surgical community with a multitude of challenges. Patients requiring surgical intervention who are positive for COVID-19 are not only more likely to develop complications post-operatively, but also pose an increased infection risk to the surgical team involved in their care. The infection control concerns raised at the peak of the pandemic persist in the post-pandemic era as patients continue to test positive for COVID-19 and the risk of a 'second wave' looms. We present a case series (compliant with SCARE 4 and PROCESS 5 criteria) to demonstrate the effective use of an AR technology platform during the intraoperative treatment of two complex COVID positive patients diagnosed with Fournier's gangrene. Retrospective review of prospectively collected data of all patients that required surgery involving multiple specialties during the COVID-19 pandemic at Jaber AlAhmad hospital in Kuwait between March 2020 to October 2020. We present two cases to highlight the use of an augmented reality (AR) platform during the treatment of COVID-19 positive patients with Fournier's gangrene in order to safeguard surgical teams whilst simultaneously enabling these complex cases to benefit from multi-specialty input intraoperatively. Augmented reality is a feasible option to minimize surgeons' exposure during surgery without compromising the patients safety. This case series demonstrates how AR solutions can be employed to bolster infection control measures and may be useful in the treatment of surgical patients who test positive for COVID-19. AR solutions could be considered as an infection control strategy to safeguard surgical teams operating on COVID-19 positive patients. [ABSTRACT FROM AUTHOR]

• SSCD and EH are two uncommon inner ear disorders. • UCLA is a high-volume otologic referral center with the most SSCD cases worldwide. • Three patients presented with both SSCD and EH, which have overlapping symptoms. • Post-surgical persistence of shared symptoms may prompt an investigation for EH. • Concurrent SSCD and EH is a rare but treatable entity. Superior semicircular canal dehiscence (SSCD) is characterized by CT-confirmed bony erosion over the superior semicircular canal, creating vestibular and auditory symptoms. Endolymphatic hydrops (EH) is characterized by an MRI-confirmed excess of endolymph within the scala media that distorts the membranous labyrinth. While there is overlap in symptoms, the two diseases result from different pathophysiologies and require different interventions. A retrospective chart review was conducted at the University of California, Los Angeles on a database of 270 adult SSCD patients, gathered between March 2011 and February 2020. A review of clinical notes, post-operative findings, and imaging was performed for 16 patients who had both CT-confirmed SSCD and an MRI of the internal auditory canal (IAC). Three cases of concurrent SSCD and EH were identified. Medical and surgical history, symptom progression pre- and post-operatively, and treatment outcomes were gathered. One patient's symptoms were resolved via mycophenolate mofetil, another's via hydrochlorothiazide, and the third's via hydrochlorothiazide and bilateral hearing aids. Post-surgical persistence of SSCD symptoms that are mutually shared with EH is the strongest indicator that a physician should investigate for concurrent EH. VEMP and audiogram testing in these cases can be misleading and should not be relied on as rule-in or rule-out tests. Concurrent SSCD and EH is a rare but treatable entity. Physicians should consider ordering an MRI of the IAC if SSCD patients' symptoms persist or recur after a successful surgery. [ABSTRACT FROM AUTHOR]

• 43 cases of death in Indonesian patients with ovarian cancer. • Most of Indonesian patients with ovarian cancer have received treatment. • The treatment given to Indonesian patients with ovarian cancer are in the form of chemotherapy and surgical procedures. • Diagnosis of ovarian cancer is mostly identified in stage III. Ovarian cancer is a gynecological cancer with a higher mortality than other gynecological cancers. There were 43 cases of Indonesian women who died of ovarian cancer in 2015–2017. Patients were first diagnosed at the age of 40–59 years (65.11%), of which had normal BMI (62.72%) and mostly in stage III (39.53%). The histology was 88.3% epithelial ovarian cancer with the most subtypes of mucinous carcinoma (25.5%). The majority were referral patients (62.7%), but due to its malignancy, many died before receiving ovarian cancer treatment (40.74%). Of the 43 patients, 17 patients received chemotherapy, and 10 patients received a combination of surgical therapy and chemotherapy. Most of the deaths were caused by primary disease (69.77%). Patients with stages III and IV, as well as patients receiving surgery or chemotherapy alone had shorter survival times. Most ovarian cancer patients are first diagnosed at stage III with the mucinous carcinoma subtype. Most deaths are caused by primary ovarian cancer. The therapy that provides the longest survival is a combination of surgery and chemotherapy. [ABSTRACT FROM AUTHOR]

• Now that laparoscopic surgery is widespread, minimally invasive surgery is desired. • Natural orifice specimen extraction is minimally invasive surgery. • Transanal specimen extraction and transvaginal specimen extraction. • Natural orifice specimen extraction appears to be feasible and safe. In recent years, natural orifice specimen extraction (NOSE) has been attracting attention as a further minimally invasive operation for colorectal cancer, and not only improvement of appearance, but also reduction of pain and wound-related complications due to abdominal wall destruction has been reported. However, NOSE is technically complicated and difficult, and it has not yet been widely used. The aim of this study was to confirm the feasibility, safety, and short-term outcomes of total laparoscopic colon cancer surgery with NOSE. From May 2018 to October 2019, eight patients with stage 0 or I colon cancer underwent NOSE surgery in our hospital. Transanal specimen extraction was performed in six cases, and transvaginal specimen extraction was performed in two cases. All operations were successfully accomplished without conversion to open surgery. The anastomosis method was double stapling technique in three cases and overlap method in five cases. The median operative time was 224 min. The median blood loss was 10 mL. The median time to first flatus was 1 day, and the median time to first stool was 2 days. The median postoperative observation period was 18 months, but there was no recurrence. There were no postoperative complications in these cases. Total laparoscopic colon cancer surgery with NOSE appears to be feasible, safe, and show promising efficacy for selected patients. [ABSTRACT FROM AUTHOR]

• There are yet any evidence regarding effects of emergency surgery on COVID-19 spread and benefits in delaying it. • Emergency orthopaedic surgery was not associated with increased COVID-19 cases. • We suggest performing PCR-RT swab examination for etiological diagnosis in pre-operative settings in future studies. Every emergency surgery performed is aimed at saving lives; however, during COVID-19 pandemic, surgeries are often postponed. Many existing recommendations take into account postponing surgery during a pandemic. How these surgeries can lead to increasing infection rates has not been widely published. This study aims to investigate the relationship of emergency orthopaedic surgery and the incidence rate of COVID-19. This was a case series of 14 patients. The study was performed at the emergency department unit at a national tertiary hospital in Jakarta, Indonesia. A total of 14 patients underwent orthopaedic surgery in the emergency room of our institution. The mean age of the subjects was 40.07 ± 20.5 years. Twelve (85.7%) were male patients and 2 (14.3%) were female patients. The average duration of surgery was 125 minutes. The most used type of anaesthesia was general anaesthesia for 6 operations (50%). Patients were hospitalized for an average length of 4 days. Three patients had infiltrates found on plain x-ray examination, which required further examination to determine whether the cause was COVID-19 infection or not. There was no ground glass appearance (GGO) in the three patients in further follow-up examination. We found that emergency orthopaedic surgery was not associated with increasing number of COVID-19 cases. Factors including duration of surgery, length of stay, types of anaesthesia and comorbidities were also not associated with COVID-19 cases in this study. [ABSTRACT FROM AUTHOR]

• Iatrogenic recto-urogenital fistulae rarely heal without surgical treatment. • The major challenge in pelvic redo surgery is to achieve adequate exposure. • A minimally invasive perineal approach using a SILS port seems a good treatment. Iatrogenic recto-urogenital fistulae are refractory complications that rarely heal without surgical intervention. The ongoing local infection causes pain, discomfort and substantially impacts quality of life. Surgical repair requires adequate exposure and space to fill with healthy tissue, which is a major challenge in pelvic redo surgery. An abdominal approach to repair the fistula is associated with major morbidity and often fails to expose the deep pelvis. In our experience a novel transperineal minimally invasive approach a utilizing single incision laparoscopic surgery (SILS) technique could offer improved results. In the present study, three cases of patients with recto-urogenital fistulae after pelvic surgery are described. Two patients were diagnosed with a rectovesical fistula and one patient with a rectovaginal fistula. In all three cases, a minimally invasive perineal approach, using a SILS port, was used to perform surgical repair. The closure of the fistulae involved: a separate repair of the urethra/bladder or vaginal defect and the rectal defect, followed by interposition of vascularized tissue by either a pudendal thigh fasciocutaneous flap or omentoplasty. This study is the first to report on a minimally invasive perineal approach, utilizing a SILS technique for recto-urogenital fistulae repair after previous pelvic surgery. The current approach improves exposure, creates surgical space, optimizes view and allows the interposition of vascularized tissue, without causing substantial blood loss and avoiding major abdominal surgery. [ABSTRACT FROM AUTHOR]

• Mean major coronal correction rate was 67%. • Pedicle screws provide three-dimensional deformity correction. • Posterior spinal fusion alone (PSF) obtains a good and stable correction for severe scoliosis. Adolescent idiopathic scoliosis (AIS) can lead to severe deformity. However, early detection and treatment can prevent its progression. Surgical instrumentation for scoliosis treatment has evolved from Harrington instrumentation to pedicle screws. However, there are still some concerns about the efficacy and long-term effects of pedicle screw fixation, and the clinical and radiographic outcomes of surgical treatment for severe AIS (>90°) by posterior spinal fusion alone need to be established. Eight patients with severe and rigid idiopathic scoliosis were recruited for this study. All surgeries were performed by one senior spine surgeon between 2015 and 2018. Free hand technique, intraoperative neurophysiologic monitoring (IONM), and intraoperative fluoroscopy to assess the screw position was performed. Severe scoliosis results in a complex three-dimensional spinal deformity that often requires correction in multiple planes. Mean major coronal correction rate was 67% (45–80%). No major complications occurred during the perioperative period and after one year follow up. Pedicle screws provide three-dimensional deformity correction. There were no complications other than the low-grade late implant-associated infections. Posterior spinal fusion with pedicle screw-only instrumentation obtains a good and stable correction for severe scoliosis. [ABSTRACT FROM AUTHOR]

• The incidence of ventral hernias varies from 4 to 10% depending on the type of surgery. • Careful patient selection is one of the main methods of choice. • Laparoscopic ventral hernia repair with Ventralight ST/Sorbafix is a safe and effective technique with low postoperative morbidity and low reoperation rate. A meta-analysis of studies has shown that the incidence of ventral hernias varies from 4 to 10%. During the last twenty years, the use of laparoscopic repair of ventral and other hernias of the abdominal wall has rapidly increased. From January 2011 to March 2020 101 patients underwent laparoscopic ventral hernia repair (LVHR). The diameter of the hernial defect intraoperatively was in average 6.22 ± 5.17 cm (SD) (range 2–30 cm). The difference with the defect diameter measured in CT is small (average 0.77 ± 2.21 cm). The mean operative time was 96.20 min. We used Physiomesh and Secure strap in 37 cases and Ventralight ST plus Sorbafix in 58 cases. The conversion rate was 6.93%. The mean hospital stay was 6.03 days. The 30-day mortality was 0%. The overall morbidity was 11.88%. LVHR indications are debated. The IEHS guidelines and the EAES/EHS Consensus conference of 2015 discussed the main indications, contraindications, and features of laparoscopic techniques. Laparoscopic approach seemed to have some benefits: absence of intraparietal dissection, of postoperative immobilization, lower risk of bronchopulmonary complications and lesser abdominal pain. We compared our case series with other similar studies, and we revealed our short-term outcomes are in line with literature. Our case series revealed that the LVHR with Ventralight ST/Sorbafix is a safe and effective technique with low postoperative morbidity and low reoperation rate. Careful patient selection is one of the main methods of choice. Studies with higher level of evidence are needed. [ABSTRACT FROM AUTHOR]

• Transanal total mesorectum excision is feasible for mid and low rectal cancer. • Good quality of the mesorectum specimen is obtain after TaTME surgery. • TaTME with intersphincteric resection is a feasible option for selected cases of very low rectal cancer. • Surgical complication rates after intersphincteric TaTME with hand-sewn coloanal anastomosis could be higher. Describe and demonstrate the feasibility and safety of TaTME in short term outcomes in the Instituto Nacional de Enfermedades Neoplásicas (INEN) in Peru. Case series with retrospective and prospective data collection of patients with middle and inferior rectal cancer who underwent TaTME between January 2015 and March 2020. Patients and tumor characteristics, operative details, postoperative complications and pathological results were analyzed. Nineteen patients were included. The median age was 56 years old (range 40–69). Ten were female. The median distance from the anal verge was 4 cm (range 3–6) and 17 cases were located in the inferior rectum. Eleven patients with clinical stage III. Thirteen (68.4%) patients received neoadjuvant treatment. There was no conversion to open surgery reported. Ten (52.6%) cases had intersphincteric resection and 18 (94.7%) had primary coloanal anastomosis, 13 (72.2%) of them with hand-sewn. All patients had a diversion with ileostomy. The median operative time was 330 min (range 270–480). Median postoperative hospital stay of 5 days (range 3–18). The overall rate of postoperative complication was 21.1%, two cases (10.5%) had anastomotic leakage and mortality was present in one (5.3%) patient. 94.5% had an optimal TME specimen, only one case (5.3%) had positive circumferential resection margin and positive distal margin. The median tumor size in the specimen was 4 cm (range 2–11) and nine (47.4%) patients had ypT3 on pathology. TaTME is a safe and feasible technique with good pathological results. [ABSTRACT FROM AUTHOR]

• Child sexual abuse is a reality in black Africa. • Detection of anogenital lesions during a paediatric consultation must evoke the possibility of sexual abuse. • In such cases, it's important to "listening to the child's voice". Child sexual abuse (CSA) remains a big taboo in black Africa with an underestimated prevalence. In our context, the majority of cases are known by revelations of the child at least one year after the facts. We report three cases of CSA revealed by an anal/anogenital lesion requiring surgery. All of these patients were female with ages ranging from 20 months to 8 years. The lesions encountered were: an anal abscess, a fissure-in-ano with permanent anal mucosal eversion and a complex perineal tear including partial anal sphincter rupture with partial section of the rectovaginal septum. The outcome was favorable in all cases after surgery. The abuser was subsequently able to be identified after the statements of two of these three children. Detection of anogenital lesions during a pediatric consultation should make practitioners aware of the possibility of sexual abuse. Surgical repair of these lesions can be simple or complex, requiring major reconstructions. In such cases, it's important to listening to the child's voice. Anogenital lesions discovered during pediatric consultation must evoke sexual abuse. The silence and the taboo surrounding these abuses in Africa must be break down. [ABSTRACT FROM AUTHOR]

• Neuroendocrine tumors (NET) of the colon and sigmoid colon are uncommon compared to colorectal adenocarcinoma. • The incidence of NETs has increased, probably due to improved diagnosis and the availability of very specific and sensitive modalities. • Here, we report a serial case of Gastrointestinal NET (GI-NET) found in the descending colon and sigmoid colon. Neuroendocrine tumors (NET) of the colon and sigmoid colon are uncommon compared to colorectal adenocarcinoma. Few reports have been made of NET of the colon and sigmoid colon that presents with peritonitis and large bowel obstruction. Here, we report two cases of NET of the colon and sigmoid colon, which were diagnosed and treated at our institution. In our first case, a 66-year-old man with a history of abdominal distension was diagnosed with NET via histopathology of the sigmoid colon. The second case involved a 45-year-old woman with the chief complaints of abdominal distention and inability to defecate; specimen histopathology of the descending colon showed neuroendocrine carcinoma features. Clinical outcome was very poor in our patients: eight months after the resection, the second patient demonstrated a sign of metastasis on the liver. An uncommon case of colon and sigmoid colon carcinoma with neuroendocrine and diagnostic difficulties precludes an exact description of the initial diagnostic criteria and management. Thus, our case series offers an overview of initial symptoms, radiological and histopathological features for early diagnosis, and proper management of NET. [ABSTRACT FROM AUTHOR]

• Infected monofilament, large-pore polypropylene hernia mesh can be salvaged. • Instillation of topical antiseptics provides recovery from hernia mesh infection. • An enclosed space provides a sufficient concentration of the antiseptic. • Povidone-iodine is effective on hernia mesh infection. The aim of the presentation is to demonstrate a new conservative approach for the salvage treatment of the infected hernia mesh. Three patients with polypropylene mesh infection following an open umbilical and incisional hernia repair performed by placing the mesh in the onlay position are presented. The infection manifested itself with a systemic inflammatory response and an infected fluid collection surrounding the mesh. All patients were treated conservatively by a minimally invasive technique according to the stepwise protocol. An effective, rapid response to the conservative treatment was observed. A total of five to six procedures were necessary in a period of up to twenty days. Mesh salvage was achieved, and the long-term outcome demonstrates neither the recurrence of infection nor hernia. An enclosed space at the infection site is the main precondition for providing a sufficient concentration of the antiseptic for a long enough time to act effectively at the infection site. The fast killing effect on the mesh infection and a good long-term outcome in all presented patients prove that this technique is superior to the the current techniques in appropriately selected patients from the point of treatment duration. An effective mesh salvaging conservative treatment is possible when the infection manifests itself as an infected fluid collection surrounding the monofilament, large-pore polypropylene mesh and should be the first-line option. Open surgical approach should be reserved as a second-line option if the first fails. [ABSTRACT FROM AUTHOR]

• Intestinal perforation in patients on peritonitis dialysis (PD) has high mortality. • Perforative peritonitis in PD patients and PD-associated peritonitis patients have similar signs. • Rapid diagnosis can help exclude perforation in cases of refractory peritonitis. Perforative peritonitis in patients on peritoneal dialysis (PD) is a serious adverse event associated with significant mortality. The signs and symptoms of perforative peritonitis in patients on PD are often confused with those of PD-related peritonitis; therefore, early diagnosis is often difficult. In all three cases, antibiotic therapy was started for peritonitis. Although contrast-enhanced computed tomography (CT) was not performed, perforative peritonitis was suspected due to severe cloudiness of PD effluents, and emergency surgeries were performed 8, 5, and 6 days after therapy onset in cases 1, 2, and 3, respectively. In case 1, the ileum was perforated owing to ischemia, and partial ileal resection and divided ileostomy were performed. The patient died 18 days postoperatively. In case 2, partial ileal resection and divided ileostomy were performed for an incarcerated obturator hernia and perforated ileum. The patient was transferred for hemodialysis (HD) and discharged 117 days postoperatively. In case 3, lavage drainage was performed for peritonitis because of mesenteric penetration of a sigmoid colon diverticulum. The patient was then transferred for HD, and colostomy was subsequently performed. He was discharged 159 days postoperatively. Early diagnosis between PD-related peritonitis and perforative peritonitis is often difficult since the washing effect of the peritoneal dialysate might relieve peritoneal irritation. In PD patients with refractory peritonitis, it is necessary to keep in mind the possibility of perforative peritonitis, and the differential diagnosis should be performed using contrast-enhanced CT within at least 5 days after antibiotic therapy. [ABSTRACT FROM AUTHOR]

• Acute appendicitis is the most common between the ages of 10 and 20 years. • Our centre performed a new technology of single-port laparoscopic appendectomy using a needle-type grasping forceps (SLAN). • SLAN has advantages of favourable cosmetic results, minimal trauma, and enhanced postoperative recovery. Single-port laparoscopy has been used in any areas of surgery, including appendectomy, to reduce the operative stress and enhance postoperative recovery procedure. This paper introduces our attempt to perform single-port laparoscopic appendectomy using conventional laparoscoopic instruments and a needle-type grasping forceps (SLAN), which has dominant advantage in cosmetic appearance. We report six pediatric patients who underwent SLAN for uncomplicated appendicitis from April to November 2019. SLAN was performed transumbilically, while conventional laparoscopic instruments and needle-type grasping forceps were both used. After routine intracorporeal appendectomy was completed, the pathological appendix was extracted through the single-port site, while a 10 mm trocar was used to avoid incision infectious. Clinical data and postoperative follow-up data were collected and analyzed to evaluate the feasibility, safety, and clinical outcomes of this novel technique. SLAN was successfully performed in all six pediatric patients. The median operative time, first exhaust time after surgery, pain score of postoperative day 1, and postoperative hospital stay were 69 (range, 50−85) min, 1.33 (range, 1–2) d, 0.83 (range, 0–3) score, 1.5 (range, 1–2) d, respectively. Neither intraoperative nor postoperative complications were noted, while no incision infectious, adhesive intestinal obstruction, and abdominal abscess were observed with 2–9 months follow up. Though there are many methods to perform single-port laparoscopic appendectomy, the use of needle grasping forceps in laparoscopic appendectomy has been confirmed a new choice for uncomplicated appendicitis in children. SLAN is a feasible and safe technique to treat acute uncomplicated appendicitis in children. To be emphasized, surgeons must strictly grasp the indications for this surgery. [ABSTRACT FROM AUTHOR]

• The radiographic measurements of the glenoid parameters may be helpful when the clinical diagnosis is difficult to attain. • These measurements can help in planning the management of cuff tears, especially in cases in which tears are resistant to treatment. • The importance of these findings is using an individualized approach in the management of the rotator cuff tears that can be based on gender, age, and the biomechanics of the patient. This study aims to investigate the presence of any differences between the normal population and patients with rotator cuff tears in term of glenoid morphological parameters. For the purpose of this study, 82 shoulder MRIs were evaluated. The individuals included in this study were divided into the patient group (cuff tear group, n = 41) and the control group (control group, n = 41) with respect to the inclusion and exclusion criteria. For the statistical analysis, SPSS software was used. Statistically significant difference was found between the patient group and the control group in terms of Glenoid Version Angle (GVA), Glenoid Axial Width (GAW), Glenoid Axial Depth (GAD), Glenoid Coronal Depth (GCD), and the Glenoid Inclination Angle (GIA). Age was found to have a positive linear correlation with the glenoid coronal height. Moreover, statistically significant difference was found between the males and females, between males with cuff tears and control males, and females with cuff tears and control females in terms of glenoid parameters. When gender was a covariate, statistically significant differences in glenoid parameters was still present between cuff tears patients and individuals with control shoulders. The results attained in this study are suggest that the GVA, GAW, GAD, GCD, and GIA in rotator cuff tear patients are different than those found in control patients. These measurements may be helpful in reaching the diagnosis in cases where the clinical diagnosis is equivocal. Moreover, these measurements may be helpful in planning tears management. The influence of gender on glenoid parameters and subsequent impact on shoulder pathology may help to better understand the biomechanism of rotator cuff tears and reach an individualized management for better patient care. [ABSTRACT FROM AUTHOR]

• 0.5 % of appendectomy specimens show neuroendocrine and 0.5 % show epithelial malignancy. • In 2 patients these two malignancies were in the same appendectomy specimen. • Patients peritoneal metastases occurred from the mucinous epithelial malignancy only. • Rather than routine right hemicolectomy, radical appendectomy is suggested. Although uncommon, neoplasms of the appendix do exist. The two most common types are neuroendocrine tumors and mucinous appendiceal neoplasms. In two patients unusual gross and microscopic findings in an appendectomy specimen were recorded. Special immunocytochemistry studies were used to determine the histologic type of the tumors in the appendix. The clinical features and histopathology of two patients who had both a neuroendocrine tumor and a low grade appendiceal mucinous neoplasm in the same appendectomy specimen were described. Possibilities for the causation and treatment of this unusual condition were discussed. The incidence of this double malignancy was estimated at 2.5 in 1000 appendectomy specimens. Although extremely unusual, a neuroendocrine tumor and a mucinous appendiceal neoplasm can exist in the same appendix. This condition is reported in two young patients. [ABSTRACT FROM AUTHOR]

• The differential diagnosis of superficial corneal opacities is challenging. • It includes 3 described overlapping entities: SND, PHSCD, and Acquired Corneal Sub-Epithelial Hypertrophy (ACSH). • Our case series match the newly proposed entity of ACSH. • ACSH should be accurately identified following keratoplasty to be successfully managed by simple surgical peeling without corneal re-grafting. Acquired Corneal Sub-Epithelial Hypertrophy (ACSH) has been described in patients with peripheral superficial corneal opacities following penetrating keratoplasty and might present similar to Salzmann's nodular degeneration (SND) or peripheral hypertrophic sub-epithelial corneal degeneration (PHSCD). We describe the clinical presentation, topographic findings and the surgical outcome of three cases, which fit the appearance and characteristics of ACSH. Three patients (3 eyes) with paracentral or peripheral corneal opacification were reviewed to describe their clinical examination (SL), morphology of the opacity (depth, diameter and density) and document their topographic changes before and after surgical intervention by peeling of the epithelium with or without superficial keratectomy under the microscope in addition to brief description of their histopathological examination. All 3 cases were secondary to corneal procedures [Penetrating keratoplasty (PKP) in 1 for pseudophakic bullous keratopathy and deep anterior lamellar keratoplasty (DLK) in 2 for advanced keratoconus]. All cases presented with reduced vision, astigmatic changes in topography or manifest refraction. The visual acuity, symptoms, and topographical findings all improved after treatment. Histopathologically, all cases fit the newly described entity of ACSH. Careful clinical judgement guided by corneal topography are needed for proper the diagnosis of acquired corneal opacification that results in reduction of vision to identify ACSH from other similar conditions (PHSCD and SND). Peeling of the thickened epithelial and sub-epithelial tissue is curative avoiding the need for corneal re-grafting. [ABSTRACT FROM AUTHOR]

• Unresponsive diabetic ulcer is ulcer that does not reduce in size within a month. • It is caused by senescent cells, absence of growth factors, and other cellular abnormalities. • To maximize wound healing, skin substitute can be used to prevent infection and dessication. • Amniotic membrane favoured healing of unresponsive and non-healing ulcers. Diabetic ulcer of the foot is a major cause of morbidity and is a leading cause of hospitalization in patients with diabetes, and causes productivity and financial losses that lower the quality of life of the patient. The wound is categorized as responsive and unresponsive wound, which occurs in debilitated patients as seen in diabetes mellitus. The delay in wound repair can be caused by senescent cells, absence of growth factors, and other cellular abnormalities. This is a retrospective, single-centre case series with non-consecutive cases. Patients with diabetic ulcer of the foot managed using gamma-treated placental amniotic membrane, with the minimum follow up of 1 month in academic practice setting were recruited. Three patients with 4 weeks period of oozing ulcers and signs of inflammation were included in this case series. Two layers of amniotic membrane dressing was applied weekly after cleaning and debridement for 3 weeks. Wound size and secretion were documented by taking photographs every week. At the end of the third week, the wound healed. Placental amniotic membranes are composed of cells, extra-cellular matrix (ECM), and a complex of regulatory cytokines which promote cell proliferation, cell modulation, and cytokine secretion by variety of cell types involved in wound healing. Our study showed that the treatment of diabetic ulcer wound using amniotic membrane was successful in achieving wound healing in unresponsive, chronic wound of diabetic ulcer of the foot. Our results clearly indicated the usefulness of the application of amniotic membranes in treatment of diabetic ulcer of the foot. Amniotic membrane favoured healing of unresponsive and non-healing ulcers. [ABSTRACT FROM AUTHOR]

• Cervical lymph node SmCC as a primary tumor's location, was never described in the literature according to what we know. • AC neuroendocrine carcinoma of the tonsil has never been described in the literature up to our knowledge. • A review of the literature was performed, indicating treatment and disease's prognosis. • In 2012, the 2005 WHO classification of neuroendocrine tumors of the head and neck region was modified by adding the ranges of the Ki-67 and suggested that LCNEC should be considered a distinct disease entity and be separated from AC. Primary neuroendocrine carcinomas are uncommon head and neck malignancies. Their classification is still debated. We report four cases of unusual primary locations of neuroendocrine carcinomas of head and neck region emphasizing two entities and rare sites that were never described in the literature to the best of our knowledge. We reported four different cases of neuroendocrine carcinomas (nasal cavity, larynx, lymph nodes and tonsil) treated in our institution. The diagnosis was made by biopsy and confirmed by Immunohistochemical study. We underscored 2 atypical and rare entities in their location and anatomo histopathological type. Chemotherapy and radiotherapy were proposed for patients with nasal's and laryngeal locations. This latter had also undergone surgery. For lymph node location, the patient received decompressive radiotherapy alone. The patient diagnosed with neuroendocrine carcinoma of the tonsil didn't get any treatment except initial tonsillectomy for diagnosis purposes. Regarding the evolution in our case series, 2 patients had a relapse with local and regional metastasis. Among the 4 patients, 50 % passed away, one is still alive with deterioration of his general status and one is lost to follow-up and refused undergoing further investigations. There is confusion in the literature regarding the classification of neuroendocrine carcinomas. According to the 2005 WHO, these lesions, can be subdivided into TC, AC (including LCNEC), SmCC, combined SmCC with nonsmall cell carcinoma, and paraganglioma. Their treatment is still debated. Through an overview of the literature, we have gathered the main studies and 2 meta-analysis summarizing the mainstay treatment and disease's outcome. Neuroendocrine carcinomas of head and neck region are aggressive tumors with poor prognosis, low incidence and their diagnosis is not obvious. The treatment protocol depends on the type, the site of the lesions, and metastasis status. It's still not well codified. [ABSTRACT FROM AUTHOR]

• The pathogenesis of MRONJ is related to repression of osteoclast mediated bone remodeling. • rhBMP-2 can stimulate not only osteoblasts but also osteoclasts and induce new bone formation. • ACS has been proved to be a good carrier of rhBMP-2 with maximal efficacy. • Application of rhBMP-2/ACS can be a new approach to surgical treatment for MRONJ patients. The purpose of this study was to pursue, and to report the results of, mandibular reconstruction and rehabilitation of medication-related osteonecrosis of the jaw (MRONJ) patients having large critical-sized defects of the mandible using a combination of recombinant human bone morphogenetic protein-2 (rhBMP-2) and absorbable collagen sponge (ACS) with surgical miniplate without any grafting materials. Three (3) patients aged 67 and 86 (2 patients) presented due to discomfort on the mandible. They all had a medical history of bisphosphonate and steroids treatment orally or intravenously, and all had been diagnosed as MRONJ stage 3. Sequestrectomy and saucerization were performed, and then a surgical miniplate (Hansolmedical, Korea) was adapted and fixed on the sound portion of the mandible. rhBMP-2 was loaded onto an ACS at a dose of 1.5 mg/cc. Several rhBMP-2 (Cowellmedi, Korea)/ACS (Ateloplug, TRMkorea, Korea) were placed into the bony defect with a surgical miniplate. All 3 patients recovered without complications. They all exhibited radiographic evidence of bone formation by 3 months postoperatively in every case. All 3 patients were treated successfully with rhBMP-2/ACS and miniplate without any complications. This protocol reported herein represents a new approach to the surgical treatment of maxillofacial bone defects and deficiencies, especially in MRONJ patients. [ABSTRACT FROM AUTHOR]

Congenital hepatoblastoma is an exceedingly rare neoplasm, predominantly documented as isolated instances, with contentious aspects surrounding its therapeutic approaches and prognostic implications. This study aims to comprehensively summarize and evaluate the management experience of congenital hepatoblastoma (CHB). This cohort comprised five infants diagnosed with hepatoblastoma, confirmed through pathological examination, and with an onset of symptoms before 28 days of age. They were enrolled between November 2019 and May 2022. The treatment course they underwent has been summarized, and their prognosis has been subject to analysis. Distinguishing congenital hepatoblastoma from other medical conditions is typically necessary. Given the patient's tender age, the approach to treatment demands comprehensive assessment, particularly in cases involving unique tumor locations or substantial tumor sizes. The selection of treatment modalities, encompassing preoperative neoadjuvant chemotherapy and surgical techniques, becomes of paramount importance. Furthermore, determining the treatment's endpoint poses a notable challenge and often necessitates a comprehensive evaluation. For pediatric patients afflicted with CHB, the application of preoperative neoadjuvant chemotherapy mitigates surgical risks, while the incorporation of surgical procedures followed by postoperative chemotherapy significantly enhances the overall prognosis. Additionally, AFP-L3% levels may serve as a valuable adjunctive marker signifying the conclusion of treatment. • Congenital hepatoblastoma is primarily documented via case reports. with this study reporting a higher number of cases. • Neoadjuvant chemotherapy is safe and effective for patients with CHB when initial surgical removal is not possible. • Three-dimensional imaging, utilizing contrast-enhanced abdominal CT scans, can facilitate tumor resection. • AFP-L3 can serve as a valuable tool for determining the appropriate treatment endpoint. • In certain cases, tumor block resection may lead to an improved prognosis and obviate the need for liver transplantation. [ABSTRACT FROM AUTHOR]

Combat wounds can be difficult to manage and can lead to disfigurement and infection. The closure of these wounds is crucial, as delayed closure also increases the risk of further complications. Military medicine has introduced negative pressure wound therapy, which modulates wounds perfectly through the microscopic and macroscopic configurations of the wound environment. It is expensive and not available worldwide, and several modifications using low cast materials were mentioned in literature. We present a case series of four patients using the previously mentioned modified technique in combat wound management, and discuss the results, outcome, and justification for choosing this modality of treatment. All patients underwent a thorough debridement, followed by a modified negative pressure wound treatment for three weeks, employing readily available medical devices. All wounds healed successfully without complication and a simple closure was used to cover the resultant wound. Modified NPWT with limited resources is capable of promoting healing in conflict-related wounds through multifactorial properties and transforming reconstructive methods from complex to simple procedures in areas with a shortage of medical supplies and surgeons in addition to busy operating rooms. • Combat injuries are destructive and wound at high risk of infection and delayed reconstruction is advisable but open wound pose significant morbidities. • Negative pressure wound therapy was used since decades and proved it's effectiveness, but high cost and shortage of materials are drawbacks so modification was created to obtained advantages of NPWT with low case limited resources. • Modified NPWT can be uesd in military medicine and it provided optimal condition for wound healing. [ABSTRACT FROM AUTHOR]

Mediastinal teratoma is a rare extragonadal teratoma that frequently manifests with non-specific symptoms and is commonly misdiagnosed, particularly in Indonesia, where tuberculosis (TB) is endemic. Herein, we present two cases of children aged 19 months and 17 years old who were referred with chronic nonspecific symptoms of cough, tachypnea, chest pain, and hemoptysis. Both children were initially diagnosed with TB and both completed anti-tuberculosis treatment. After visiting several healthcare facilities, a mediastinal mass was finally diagnosed and they all underwent thoracotomy without any further complication. The histopathology findings revealed mature teratoma. All patients had satisfactory outcomes at follow-up visits. Patients presented with non-specific symptoms are often clinically diagnosed with TB. However, primary healthcare doctors should consider other differential diagnoses when a child has non-specific respiratory symptoms, especially when chest X-ray findings are nonspecific and TB workup is negative. The diagnosis of mediastinal masses is still challenging in Indonesia, as the diagnosis requires a vast array of work-up examinations, therefore, early recognition and referral are crucial for management. • Mediastinal teratoma often present with unspecific symptoms such as chronic cough and worsening dyspnea. • In resource limited countries, the diagnosis is challenging and it is often misdiagnosed or came with delayed presentation. • Raising awareness for vast differential diagnosis of such unspecific symptoms is crucial for primary physician. [ABSTRACT FROM AUTHOR]

Abdominal pregnancies, although rare, present unique challenges in both diagnosis and management. This case series reports on four cases of abdominal pregnancies diagnosed in a remote and underserved region of the Democratic Republic of Congo, highlighting the difficulties encountered in an under-equipped environment. The cases were documented in a remote village of DRC, which lacks specialized medical personnel and relies heavily on traditional healers. We report here 4 cases of abdominal pregnancies, their clinical presentations, diagnostic modalities, and surgical approaches. The cases varied in terms of clinical symptoms, gestational age, and placental implantation sites. Delayed diagnosis and presentation were common, resulting in significant hemoperitoneum and adverse fetal outcomes. All cases required laparotomy for both diagnosis and intervention. Abdominal pregnancies can go undetected until advanced gestational age, with common physical findings including abdominal tenderness, abnormal fetal lie, fetal body parts readily palpable, and a displaced cervix. Laboratory tests may raise suspicion, but treatment options depend on intraoperative findings and gestational age. Advanced abdominal pregnancies are associated with high mortality rates for both the mother and the fetus. Laparotomy is typically required for diagnosis and intervention, with variations in placental implantation sites. Management of the placenta remains a debated topic, with partial or complete removal both viable options. Abdominal pregnancies pose significant challenges in resource-poor settings, where limited healthcare resources and a shortage of specialized medical personnel can impede early diagnosis and appropriate management. Enhancing prenatal care, improving diagnostic capabilities, and increasing awareness among healthcare providers and communities are essential for optimizing outcomes in these complex obstetric cases. • Abdominal pregnancies are rare but present unique challenges in diagnosis and management. • The case series reports on four cases of abdominal pregnancies in a remote and underserved region of the D.R. Congo. • The lack of specialist and reliance on traditional healers in the area contributed to delayed diagnosis and presentation. • All cases required laparotomy for both diagnosis and intervention, highlighting the need for improved awareness of the disease. [ABSTRACT FROM AUTHOR]

A mucoid cyst is a benign lesion in the oral mucosa resulting from the rupture of a salivary gland duct and the subsequent discharge of mucin into the soft tissues. Mucoceles are more common in children and young adults, and the most common site is the lower inner lips. We describe 3 clinical cases managed in service between 2022 and 2023. Clinical cases are presented in order to detail their clinical history, paraclinical and treatment. In general, mucoceles tend to resolve spontaneously, but can sometimes interfere with swallowing or speech. Therefore, in such cases, these lesions must be promptly diagnosed and treated. There are various methods of managing these lesions, each with its own advantages and disadvantages. Surgical technique is preferable when the lesion is persistent, recurrent or symptomatic, and remains the most effective strategy, despite the existence of other, more modern techniques that are better tolerated by patients. But in all cases, follow-up is very important, especially when the mucocele is located in a particular area, such as the ventral side of the tongue, or in a younger population. • A mucoid cyst is a benign lesion in the oral mucosa resulting from the rupture of a salivary gland duct and the subsequent discharge of mucin into the soft tissues. • There are various methods of managing these lesions, each with its own advantages and disadvantages. • Surgical technique is preferable when the lesion is persistent, recurrent or symptomatic, and remains the most effective strategy. • Follow-up remains very important to avoid complications. [ABSTRACT FROM AUTHOR]

Knee arthroplasties as an effective intervention is primarily performed in patients with primary osteoarthritis and rheumatoid arthritis. Risk of hip fracture may be either decreased or increased in patients with Knee arthroplasties. There is conflicting evidence in this regard. Over the years, some studies have reported the occurrence of hip fractures following this operation as a rare but severe complication. The aim of the present case series was to report diagnosis and treatment of the mentioned five cases. During a period of two years, five patients with a diagnosis of a subtrochanteric fracture and history of total knee arthroplasty who referred to hospital were selected to include in the present case series. the presence of RA and treatment with glucocorticoids, a reduction of BMD following knee replacement surgery, and ultimately, an increase in physical activity and movement after the arthroplasty due to the improvement of preoperational pain, may all contribute in a complex manner to the observed outcome of increased fracture risk in the hip following TKA. In summary, special care including using medications to improve BMD should be taken to minimize the risk of such an event. • Knee arthroplasties as an effective intervention is performed in patients with primary osteoarthritis and rheumatoid arthritis • Risk of hip fracture may be either decreased or increased in patients with Knee arthroplasties • The presence of RA and treatment with glucocorticoids, a reduction of BMD following knee replacement surgery, and an increase in physical activity and movement after the arthroplasty due to the improvement of preoperational pain, may all contribute in a complex manner to the observed outcome of increased fracture risk in the hip following TKA • Using medications including alendronate to improve BMD, treatment of patients with RA with medications other than glucocorticoids, and application of some new types of knee prosthesis to attenuate decreasing BMD are among the most important strategies for reducing the risk of subtrochanteric fracture of the femur [ABSTRACT FROM AUTHOR]

A high-angle thoracolumbar kyphotic deformity (TLKD) may complicate surgical rectification of AS patients since one-stage two-level pedicle subtraction osteotomy (PSO), which provides high-angular correction, leads to excessive blood loss, neurological deficits and fixation failures. This case series presents the long-term results of one-stage single level PSO with Ponte osteotomy (PO) in the treatment of AS patients with high-angle TLKD. This case series presents two AS patients with high kyphotic angles (KAs) of 86.1o. We collected data retrospectively from our institution's database between 2019 and 2023. A sagittal axis imbalance was the only complaint initially, no neurological deficits or other problems. A PSO augmented by PO was performed with a decompression laminectomy. Intraoperative monitoring (IOM) during reduction was used to observe neurological deficits. Blood loss at the highest rate was 1000 cc. It corrected 57.8o of KA postoperatively without neurological deficits. We found consistent results over 36 months. A thorough analytical approach may help diagnose AS. One-stage single-level PSO may correct high-angle TLKD in AS patients effectively. To achieve greater angular correction, PO, a less risky osteotomy, must be added. Decompression laminectomy is vital before osteotomy and IOM is crucial during reduction to prevent nerve injury. Even with two osteotomies, there was less blood loss than previously reported. These impressive long-term results call for further research. Combined PSO and PO with IOM efficiently magnifies the angular correction without postoperative neurological deficits or excessive blood loss in AS patients with high-angle TLKD. • The combined technique yields high-angle correction. • No neurological deficit presents after surgery. • The intraoperative monitoring minimizes imminent complication. • The exceptional results were consistent in long-term evaluation. [ABSTRACT FROM AUTHOR]

• Two cases of laparoscopic splenectomy for solitary metastasis – patients after open surgery. • Operative time was 165–200 min, patients were discharged on POD 3–4. • Laparoscopic splenectomy is feasible after open surgery. Solitary splenic metastases are a rare entity. We report two consecutive cases of solitary splenic metastases from ovarian and rectal cancer which were completely removed by laparoscopic splenectomy in patients with previous open surgery. The operative time was 165–200 min. The blood loss was 25–100 ml. There were no intra- and postoperative complications. Laparoscopic splenectomy for solitary splenic metastases seems safe and feasible with short recovery period even in patients with previous open surgery. More research in the area is needed. [ABSTRACT FROM AUTHOR]

• Computed tomography scan is the best test to establish the diagnosis of EG. • Early recognition and initiation of therapy is crucial to prevent progression of EG. • Surgical exploration is indicated after failure of non-operative management. Emphysematous gastritis (EG) is a rare condition characterized by air within the gastric wall with signs of systemic toxicity. The optimal management for this condition and the role of surgery is still unclear. We here report three cases of EG successfully managed non-operatively. All three of our patients were elderly females with several co- morbidities. The chief presenting symptom was abdominal pain with signs of systemic toxicity ranging from tachycardia and hypotension to acute kidney injury. Computed tomography (CT) scan revealed gastric pneumatosis in all patients. One patient had extensive portal venous gas, and another had free intraperitoneal air. All patients were managed with nothing by mouth, proton pump inhibitors, intravenous fluid resuscitation, and antibiotics. Repeat CT scan in two patients in 3–4 days demonstrated resolution of the pneumatosis. They were all discharged home tolerating an oral diet. The presentation of EG is non-specific and the diagnosis is primarily established by findings of intramural air in the stomach on CT scan. The initial management of EG should be nothing by mouth, proton pump inhibitor, intravenous fluid resuscitation, and antibiotics with surgical exploration only reserved for cases that fail non-operative management, demonstrate clinical deterioration, or develop signs of peritonitis. Early recognition and initiation of appropriate therapy is crucial to prevent the progression of EG. EG, even in the presence of portal venous air or pneumoperitoneum, should not represent a sole indication for surgical exploration and trial of initial non-operative management should be attempted when clinically appropriate. [ABSTRACT FROM AUTHOR]

• Peritoneal carcinomatosis from unknown primary site must be a diagnosis of exclusion. • Peritoneal metastases in the absence of a primary site by definitive radiologic and endoscopic tests does occur. • An occult appendiceal adenocarcinoma may be the cause of the peritoneal carcinomatosis. • Visualization of a normal appendix by exploratory laparotomy or laparoscopy is a new requirement for the diagnosis. Peritoneal carcinomatosis is sometimes diagnosed by cytology or by biopsy, but routine radiologic and endoscopic workup may not reveal a primary site. This clinical condition is called adenocarcinoma of unknown primary site. The clinical findings of two patients with adenocarcinoma of unknown primary site were presented and the implications for management of similar patients were suggested. The patient had the diagnosis of adenocarcinoma of unknown primary site made when cancer was discovered at the time of umbilical hernia repair or laparoscopy. Radiologic and endoscopic tests were not definitive in providing the primary site for the malignancy. Exploratory laparotomy was performed which revealed an appendiceal mucinous adenocarcinoma as the cause of the peritoneal carcinomatosis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) were used at the time of the exploratory laparotomy to treat the appendiceal adenocarcinoma with peritoneal metastases. Peritoneal carcinomatosis of unknown primary site may be caused by an occult appendiceal adenocarcinoma. This error in diagnosis may lead to suboptimal treatment. Surgical exploration to visualize a normal appendix should occur prior to making a definitive diagnosis of peritoneal carcinomatosis of unknown primary site. [ABSTRACT FROM AUTHOR]

• Porto-mesenteric vein thrombosis is rare and fatal complication after laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients. • Most patients presented with vague abdominal symptoms, so the physician should has high index of suspicion to recommend CT abdomen. • Early diagnosis is of paramount importance for better outcome. • Prophylactic anticoagulant is essential after LSG to prevent PMVT. Portal vein thrombosis is a rare and a potentially lethal complication of Laparoscopic sleeve gastrectomy. In this series, we describe the presentation, treatment, and outcome of 5 cases of PMVT post-laparoscopic sleeve gastrectomy (LSG) treated successfully at our hospital. Five patients presented to our emergency department with diffuse abdominal pain associated with anorexia, nausea and vomiting after laparoscopic sleeve gastrectomy (LSG). Computed tomography (CT) scan showed evidence of portal, mesenteric and splenic vein thrombosis and small bowel ischemia in three patients. Two patients were treated only with anticoagulant and the other three patients were treated with surgery in the form of diagnostic laparoscopy converted to laparotomy with Small bowel resection. Portal and mesenteric venous thrombosis after laparoscopic sleeve gastrectomy is an unusual complication but it has life threatening consequences if it is not diagnosed early and treated adequately. The patients with porto-mesenteric venous thrombosis (PMVT) usually present themselves with vague abdominal symptoms. As so, the physicians should have high index of suspicion to recommend computed tomography (CT) abdomen to confirm diagnosis and start adequate treatment. [ABSTRACT FROM AUTHOR]

• Schwannomas are benign tumors that commonly occur in the head and neck, mediastinum and extremities. • Pelvic schwannomas are very rare. • Patients with pelvic schwannomas have different clinical presentations. • We reported 2 cases of schwannomas found at the presacral area. • The mass was found incidentally in one of the cases and the patient was completely asymptomatic. Schwannomas are benign tumors that arise from the Schwann cells of nerve fibers. They commonly occur in the head and neck, mediastinum and extremities. However, they are extremely rare to be found in the pelvis. We report two cases of pelvic presacral schwannomas found in our hospital. The first case is a 50 years old lady who was seen in the outpatient clinic complaining of pelvic heaviness. Investigations were done including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) which showed a solid mass in the presacral area. Biopsy was taken, and results came back as schwannoma. The patient underwent exploratory laparotomy and total tumor resection. The second case is a 19 years old gentleman who was referred from a local hospital to our hospital for further evaluation of an asymptomatic left retroperitoneal pelvic mass. The mass was found incidentally after a Road Traffic Accident. The patient underwent exploratory laparotomy and total tumor resection. In the two cases, specimen histopathology report came back positive for schwannoma and patients were doing fine in the post-operative period with no signs of recurrence till this date. Due to the few cases in the literature, the diagnosis of presacral schwannoma is challenging. Some patients presented with vague symptoms like pelvic heaviness as seen with the patient in the first case, and some presented completely asymptomatic as seen with the patient in the second case. In symptomatic and asymptomatic cases, surgical excision is the mainstay of treatment of these tumors. [ABSTRACT FROM AUTHOR]