An uncommon problem: Overcoming the challenges of rectal foreign bodies-A case series and literature review.

Key Clinical Message: Although rectal foreign bodies are rare presentations, this condition should be considered in patients with preanal pain, lower pelvic pain, or rectal bleeding.Rectal foreign bodies are a rare occurrence and can pose a therapeutic challenge for surgeons. These objects may be inserted through the anus or ingested orally. This study presents a retrospective review of all cases of trapped rectal foreign bodies at a single university hospital. From 2001 to 2020, twelve cases of rectal foreign bodies were diagnosed and treated at Ghaem Hospital in Mashhad. Demographic information, type of foreign body, clinical presentation, and removal method were collected retrospectively. All cases of rectal foreign bodies entered through the anus. Twelve cases involved male patients, with a mean age of 47.5 years (ranging from 24 to 70 years), and two cases involved female patients, with a mean age of 29.5 years (ranging from 29 to 30 years). Patients' main complaint was defecation disorder, accounting for 57% of cases. The types of rectal foreign bodies included two body sprays, two wood pieces, two glass bottles, glasses, eggplants, cucumbers, squash, and anal dilators. One case involved surgical gas. In five cases, rectal foreign bodies were removed under general anesthesia through the rectum by dilatation. Rectal foreign bodies were removed by rectosigmoidoscopy in three cases, forceps in two cases, and abdominal maneuvers in one case. Only one case required laparotomy. Minor complications such as scratches or small mucosal tears were observed in some cases after removal of the foreign body, but no deaths were reported. Although rectal foreign bodies are rare, this condition should be considered in patients with preanal pain, lower pelvic pain, or rectal bleeding when no justification for recent endoscopic examinations is found. Most rectal foreign bodies are removed through the anus under appropriate anesthesia. Rectosigmoidoscopy is a good alternative if needed. Surgical measures are necessary for cases that lead to peritonitis or are likely to cause serious injury.

Analysis of Th22, Th17 and CD4+cells co-producing IL-17/IL-22 at different stages of human colon cancer.

T-helper (Th) 22 cells are involved in the immunopathogenesis of inflammatory diseases, but their specific role in the immunopathogenesis of cancer is unknown. In this study, we examined the profile of circulating and intratumoral Th17, Th22 and CD4+ cells co-producing IL-17/IL-22 in colon cancer (CC) patients in relation to tumor staging. Thirty newly diagnosed colon cancer (CC) patients participated in this study. The percentage of Th1 (CD4+IFN-γ+IL-17-IL-22-), Th17 (CD4+IFN-γ-IL-17+IL-22-), Th22 (CD4+IFN-γ-IL-17-IL-22+) and CD4+ cells co-producing IL-17/IL-22 (CD4+IFN-γ-IL-17+IL-22+) in the peripheral blood, tumor and paratumor tissues was assessed by multicolor flow cytometry. The percentage of circulating Th17 and Th22 cells was significantly increased in CC patients compared to that in healthy controls (HCs). In addition, the percentage of infiltrating Th1, Th17, Th22 and CD4+ cells co-producing IL-17/IL-22 was significantly increased in the tumor tissues compared to that in the parartumor tissues. Furthermore, we also found that the percentage of circulating and intratumoral Th17, Th22 and CD4+ cells co-producing IL-17/IL-22 was higher in advanced stages than in early stages. Our findings revealed that Th17, Th22 and CD4+ cells co-producing IL-17/IL-22 were accumulated in colon cancer tissues and may be involved in the tumor development and progression. A better comprehension of the immunopathogenesis of Th17, Th22 and CD4+ cells co-producing IL-17/IL-22 in colon cancer patients would help in the development of novel therapies.

Efficacy and Safety of Pleurodesis Using Platelet-Rich Plasma and Fibrin Glue in Management of Postoperative Chylothorax After Esophagectomy.

INTRODUCTION: Chylothorax is by definition a collection of lymphatic fluids in the pleural cavity because of leakage from main thoracic duct or its tributaries. It is an uncommon but serious postoperative complication in esophageal cancer patients. There is no standard therapeutic algorithm for chylothorax because no prospective or randomized trials have yet been performed to evaluate the available treatment options. The aim of this study was to evaluate the efficacy of pleurodesis with a combination of platelet-rich plasma (PRP) and fibrin glue to the treatment of chylothorax after trans-hiatal esophagectomy. MATERIALS AND METHODS: We randomly allocated 52 consecutive esophageal cancer patients with postoperative chylothorax who did not respond to conservative management to either PRP fibrin glue pleurodesis or surgical thoracic duct ligation. 26 patients in each group were treated with PRP fibrin glue pleurodesis or surgical thoracic duct ligation in order to control chylothorax. Perioperative data, including success rate and complications of both interventions, were analyzed. RESULTS: Two groups were similar in terms of patients' demographics and tumor characteristics. All 26 patients in pleurodesis group (100%) and 20 patients in surgery group (76.9%) were successfully treated (p = 0.009). Seven patients (26.92%) in pleurodesis group required a second application of PRP fibrin glue after a week. The mean length of hospital stay was 53.50 ± 16.662 days in surgery group and 36.04 ± 8.224 days in pleurodesis group (p < 0.001). Although mortality rate in surgery group was higher than pleurodesis group, it was not statistically significant (p = 0.1621). There was no significant difference in complications between two groups either. No serious side effect occurred with PRP fibrin glue application. CONCLUSION: In conclusion, pleurodesis using PRP and fibrin glue for chylothorax after trans-hiatal esophagectomy was associated with significantly increased success rate, decreased ICU stay, decreased overall hospital stay, and decreased mortality compared with surgical thoracic duct ligation. No patient after PRFG required additional intervention including surgery. Thus, given the improved outcomes with PRFG pleurodesis, this technique may be considered in all patients with postoperative chylothorax after or during conservative management and before proceeding to more invasive interventions.

Iatrogenic injuries of the extrahepatic biliary system.

BACKGROUND: Iatrogenic traumatic extrahepatic biliary tract injuries though rarely occur; they can lead to exceedingly morbid complications. The aim of this study was to evaluate the management strategies and outcomes of patients presented with iatrogenic bile duct injuries. METHODS: This is a retrospective study. Over 19 y, 124 patients were managed for iatrogenic biliary injuries at our institution. The data related to the etiology of biliary tract injury, symptoms of injury, laboratory and radiologic studies, injury-to-diagnosis time, type of biliary tract injury, injury management, hospitalization time, and postoperative complications were reviewed. RESULTS: The main clinical presentations were jaundice or recurrent cholangitis in 64 (51.61%) patients, followed by bile peritonitis in 34 (56.67%) and biliary fistula in 26 (43.33%) patients. Only in 23 (18.54%) cases, the injury was recognized intraoperatively. The most frequent surgical procedure was open cholecystectomy in 81 (65.32%) of 124 patients. The remaining patients were operated on laparoscopically. Good results were achieved in 99 of 101 patients with direct suture repair including hepaticojejunostomy, choledocoduodenostomy, and choledochocholedochostomy (98.02% success rate) at the first attempt. Three cases (2.97%) of biliary strictures after direct suture technique and four (3.96%) cases of postoperative mortalities were detected. The mortality rate was mostly affected by male gender, advanced age, and existence of bile peritonitis. Totally, 111 (89.52%) patients are still alive with a mean follow-up time of 78 ± 38 (2-230) mo. CONCLUSIONS: Biliary injuries can be sometimes life-threatening complications. A successful repair may provide patients with a lifelong relief from symptoms, whereas a failed repair may result in recurrent biliary obstruction, reoperation, and even death.

Arteriovenous malformations of the colon: A report of two cases and review of the literature.

BACKGROUND: Arteriovenous malformations are one of the most common vascular disorders of the colon. Vascular disorders present as painless, high-volume rectal bleeding. CASE PRESENTATION: This study elucidates two rare cases of vascular disorders that are diagnosed as angiodysplasia of the left colon and cavernous hemangioma of the colon and rectum. The chief complaint in two patients was rectorrhagia. The patients who were diagnosed of ulcerative colitis were treated with sulfadiazine and prednisone. Due to continuous bleeding, the patients were referred to the surgery department for operation. The patients underwent total proctocolectomy. CONCLUSION: We discuss the faults in the diagnosis and management of vascular disorders of the intestine.

A Novel Approach to Minimally Invasive Management of Sigmoid Volvulus.

Resection is the most common treatment choice for sigmoid volvulus, a common complication in our region. A new minimally invasive technique for sigmoid resection with local anesthesia was done in this study. This method is invented to avoid general on regional anesthesia in high-risk patients. Nineteen patients were evaluated and then 14 were enrolled in this study. Sigmoidectomy with a left lower quadrant incision was performed and demographic data, the length of hospital stay, complications and procedure time were recorded. The mean age of participants was 65.68, and the male to female ratio was 1:2.7. The mean duration of the operation was 91.42 min. Complications include one case each of wound hematoma and wound infection. The intraoperative pain score was 1.2/10 and postoperative pain score was 2.35/10. The mean hospital staying was 8.3 days. By meticulous patient selection, sigmoidectomy under local anesthesia for sigmoid volvulus could be a surgeons' armamentarium in special situations.

Problems in Diagnosis and Treatment of Retrorectal Tumors: Our Experience in 50 Patients.

Retrorectal tumors are rare lesions in adults, which remains a difficult diagnostic and management problem. The purpose of this study was to evaluate the results of surgical management of retrorectal tumors in our institution. In a retrospective study, a consecutive series of patients who underwent surgical excision of a retrorectal tumor were identified from a database. Medical records, radiology, pathology reports and surgical approach were checked retrospectively. The data was analyzed using SPSS statistical software (version 18). From 50 patients, 24 were male, and 26 were female with the mean age of 41.7 years. The origin of mass was congenital in 46% (23 cases) and neurogenic in 14% (7 patients), bone origin in 12% (6 cases) and miscellaneous in 24% (12 cases). In total, 56.7% (21 cases) were malignant. Surgical approaches included laparotomy in 11 cases, the sacral approach in 17 cases, the anterior-posterior approach in 14 cases and one case through abdomino-sacral approach. The mean follow-up was 56.7 (10-277) month. Ten patients died due to extensive metastases with a mean survival of 46.6 (1-158) months. Primary urethrorectal tumors are very rare. Successful treatment of these tumors requires careful clinical evaluation and expertise in pelvic surgery.

Splenic cysts: Analysis of 16 cases.

BACKGROUND: Splenic cysts are known as rare clinical encounter. Classifying into primary (true) and secondary cysts (pseudocysts), true cysts contain cellular epithelial lining and subdivided into parasitic and non-parasitic cysts. This study aimed to determine the outcome of treatment in patients with splenic cyst. METHODS: All patients with splenic cyst who had been treated in Department of General Surgery of Ghaem and Omid teaching hospitals over a 24-year period were identified. The medical records of these 16 patients were reviewed. RESULTS: The study patients included 11 females (68.75%) and 5 males (31.25%) with average age of 39.8 years. Fifteen cases had true cyst including 11 parasitic cysts (hydatid) and only one pseudocyst. 37.5% of the splenic cysts had coexistent cysts in liver, pelvis, omentum and paracolic regions. Nine patients underwent total splenectomy and 5 cases partial splenectomy and 2 remaining cases received conservative medical treatment. The size of the cysts varied from 6 to 25 centimeter with average size of 14.3 centimeter. All patients with hydatid cysts received albendazole postoperative medical treatment with albendazole for 6 months. All patients recovered after treatment. CONCLUSION: Open splenectomy whether total or partial is effective and safe in patients with splenec cysts with or without hydatidosis. The outcome of treatment is good without recurrences.

Iatrogenic Seeding of Tumor Cells in Thigh Soft Tissue Upon Surgical Removal of Intracranial Meningioma.

INTRODUCTION: Meningioma is a benign and slowly-growing tumor that is responsible for 20% of brain neoplasms. It can be accompanied by some genetic disorders such as neurofibromatosis type 2 and is more common among women. As a space occupying lesion, it produces a wide range of signs and symptoms by compressing the adjacent and underlying tissues in the brain. Trauma and viruses are possible etiologies for meningioma. The ideal treatment of benign meningioma is surgical resection. CASE PRESENTATION: In this case report, we present a middle-aged man with a seeding metastasis of the cranial meningioma (after its removal) in the left thigh. During the removal operation, fascia lata had been used to repair the dura mater and the skin defect was repaired primarily. CONCLUSION: We believe that the occurrence of meningioma at the site of incision in the thigh is related to using the same surgical instruments for the removal of the brain tumor.

Difficulties in the diagnosis and management of alveolar hydatid disease: A case series.

BACKGROUND: Alveolar echinococcosis (AE) is a chronic, rare and sometimes lethal parasitic infection in humans, caused by the larval stage of the fox tapeworm Echinococcus multilocularis. This study aimed to investigate the clinical aspects and treatment outcomes of patients with alveolar hydatid disease. METHODS: The medical records of patients with alveolar echinococcosis admitted between 1997 and 2012 were reviewed. Diagnosis was confirmed by physical examination, ultrasonography and CT scanning and MRI. Various treatment techniques were used such as complete liver resection in seven (38.89%) patients, biliary bypass in two (11.11%) patients, laparotomy and tumor biopsy in eight (44.44%) patients and long term medical treatment in one (5.56%) patient. After discharge, all patients were followed to determine the effect of treatment, complications, recurrences and survival. RESULTS: A total of 18 patients with mean age of 46.11±15.14 years (range 23-74 years) were studied. The disease was more prevalent in women than men (78.9% vs 4, 21.1%, P=0.021). Fourteen (77.78%) patients live in Chenaran, a town located in Khorasan, Iran). Death occurred in (22.22%) patients after an average period of 45.70±7.50 months after disease onset. 14 remaining patients survived after a mean follow-up duration of 54.60±29.17 months. CONCLUSION: Diagnosis of alveolar echinococcosis should be considered in endemic area. Early diagnosis and treatment is associated with excellent outcome.

Uterocutaneous Fistula Following Cesarean Section: Successful Management of a Case.

A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation - she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months' postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management.

Early Post Operative Enteral Versus Parenteral Feeding after Esophageal Cancer Surgery.

INTRODUCTION: The incidence of malnutrition in hospitalized patients is reported to be high. In particular, patients with esophageal cancer are prone to malnutrition, due to preoperative digestive system dysfunctions and short-term non-oral feeding postoperatively. Selection of an appropriate method for feeding in the postoperative period is important in these patients. MATERIALS AND METHODS: In this randomized clinical trial, 40 patients with esophageal cancer who had undergone esophagectomy between September 2008 and October 2009 were randomly assigned into either enteral feeding or parenteral feeding groups, with the same calorie intake in each group. The level of serum total protein, albumin, prealbumin, transferrin, C3, C4 and hs-C-reactive protein (hs-CRP), as well as the rate of surgical complications, restoration of bowel movements and cost was assessed in each group. RESULTS: Our results showed that there was no significant difference between the groups in terms of serum albumin, prealbumin or transferrin. However, C3 and C4 levels were significantly higher in the enteral feeding group compared with the parenteral group, while hs-CRP level was significantly lower in the enteral feeding group. Bowel movements were restored sooner and costs of treatment were lower in the enteral group. Postoperative complications did not differ significantly between the groups. There was one death in the parenteral group 10 days after surgery due to myocardial infarction. CONCLUSION: The results of our study showed that enteral feeding can be used effectively in the first days after surgery, with few early complications and similar nutritional outcomes compared with the parenteral method. Enteral feeding was associated with reduced inflammation and was associated with an improvement in immunological responses, quicker return of bowel movements, and reduced costs in comparison with parenteral feeding.

Hemosuccus pancreaticus as a rare cause of gastrointestinal bleeding: a report of two cases.

Pancreatic diseases are known to be associated with complications such as pseudocyst and abscess. A pseudoaneurysm associated with pancreatitis may develop as well. The pseudoaneurysm may rupture into various parts of the gastrointestinal tract; the peritoneal cavity, or the retroperitoneum. We report two cases of Hemosuccus pancreaticus admitted to our center in the past five years. One case was associated with acute pancreatitis, and another case was associated with chronic pancreatitis. A pseudocyst was found in two cases. Both were successfully managed by emergency surgery. So, Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding with difficult diagnosis, and surgery is the effective treatment for the patient with severe bleeding. However in cases with no life-threatening bleeding angiography and embolization can be performed.

Corrosive injury of the upper gastrointestinal tract: review of surgical management and outcome in 14 adult cases.

INTRODUCTION: Caustic ingestion is responsible for a spectrum of upper gastrointestinal tract injury from self-limited to perforation. This study conducted to evaluate clinical characteristics as well as surgical outcomes in patients with caustic ingestion. MATERIALS AND METHODS: Between Nov1993 to march 2011, 14 adults with a clinical evidence of corrosive ingestion were admitted into our institutions (Omid and Ghaem hospitals). Patients evaluated for etiology of erosion, location, type of surgery, morbidity and mortality after surgery. RESULTS: 14 patients (10men and 4 women) with a age range between18-53 years were evaluated. In 6 patients, the injury was accidental and in 8 patients ingestion was a suicide attempt. Ingested agent included nitric acid in 4 patients, hydrochloric acid in 7 patients, sulfuric acid in 2 patients and strong alkali in one patient. The location and extent of lesion varied included esophagus in 13 cases, stomach in 7 cases and the pharynx in 3 cases. Acute abdomen was developed In 2 patients and a procedure of total gasterectomy and blunt esophagectomy was performed. In the remaining patients, substernal esophageal bypass in 2 patients, esophageal resection and replacement surgery in 9 patients and gastroenterostomy in one patient performed to relieve esophageal stricture. Two patients died of mediastinitis after esophageal replacement surgery. Postoperative strictures were developed in 2 survived patients with hypopharyngeal reconstruction that was managed by per oral bougienage in one patient and KTP Laser and stenting in the other patient. CONCLUSION: Esophageal resection with replacement was safe and good technique for severe corrosive esophageal stricture with low mortality and morbidity.

Temporary abdominal closure in the critically ill patients with an open abdomen.

The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags (Bogotá bag). The study population comprised of 11 (57.9%) male and 8 (42.1%) female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 (57.9%) patients, subjective judgment that the fascia closure is too tight in 6 (31.6%) patient's damage control surgery in one patient (5.3%) and development of abdominal compartment surgery in one patient (5.3%). Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 (47.4%) patients, post operative intestinal fistula in 4 (21.1%) patients, post traumatic intra abdominal bleeding in 3 (15.8%) patients and intestinal obstructions in 3 (15.8%) patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one (10.0%) patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 (%21.1) early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 (26.3%) late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 (range 2-54) months. Currently 10 patients (52.6%) are alive at a follow up of 45 (range 1-94) months. Only one (10.0%) patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. Bogotá bag technique is a rapid, simple and inexpensive technique for temporary abdominal coverage.

An unusual case of recurrent gastric cancer long after the first gastrectomy due to adenocarcinoma.

The postgastrectomy recurrence rate is as high as 30-65%, with 5-year overall survival rates of <20%. Local recurrence is very common which occurs in 38-45% of cases. The most common sites of locoregional recurrence are the gastric remnant at the anastomosis, the gastric bed, and the regional nodes. The recurrence may occur as early and late events after gastrectomy. Most recurrences are early, within three years of surgery. Numerous studies reported the late recurrences, but most of them having a survival time of less than ten years. This report elucidates a case of recurrent gastric cancer after 24 years postoperatively.

Esophageal diverticula: Analysis of 25 cases.

BACKGROUND: esophageal diverticula are classified as 2 types: true diverticula and pseudodiverticula. These disorders result in clinical manifestations such as dysphagia and esophageal reflux. In this study, we evaluated the results of surgical treatment for diverticula. METHODS: all patients suffering from symptomatic esophageal diverticulum, who underwent surgical treatment in Ghaem Hospital from 2000 to 2012 and were followed up for at least for one year, were included in the study. Age, sex, clinical manifestations, location, surgical approach, and mortality were evaluated. There were 25 patients (15 men and 10 women) with a mean age of 41 ± 8.3 years. RESULTS: the most common site of involvement was inferior (epiphrenic diverticulum). Barium swallow was diagnostic. After surgical treatment, complications occurred in 4 (16%) patients, comprising anastomosis site leakage, hoarseness, atelectasis, and wound infection; all were treated medically. There was no postoperative mortality. All patients experienced an improvement in symptoms during one year of follow-up. CONCLUSION: due to the good results and minimal complications postoperatively, surgical treatment is recommended for patients with symptomatic esophageal diverticulum.

Management of sigmoid volvulus: options and prognosis.

OBJECTIVE: To describe the management of sigmoid volvulus with reference to the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Ghaem Hospital of Mashhad, University of Medical Sciences, Mashhad, Iran, from 1996 to 2008. METHODOLOGY: A total of 944 cases of colon obstruction were reviewed. Demographic, laboratory and treatment results, mortality and complications were recorded. The data was analyzed using descriptive statistics as frequency and percentage for the qualitative variables and mean and standard deviation values for the quantitative variables. Also chisquare and Fisher's exact test were used for the association between the qualitative variables. SPSS statistical software (version 18) was used for the data analysis. RESULTS: In all patients except those with symptoms or signs of gangrenous bowel, a long rectal tube was inserted via the rectosigmoidoscope which was successful in 80 (36.87%) cases. Rectosigmoidoscopic detorsion was unsuccessful in 137 (63.13%) patients, who underwent an emergent laparotomy. The surgical procedures performed in these cases were resection and primary anastomosis in 40 (29.1%), Mikulicz procedure in 9 (6.6%), laparotomy detorsion in 37 (27.01%), Hartmann procedure in 47 (34.3%), mesosigmoidoplasty in 3 (2.19%) patients and total colectomy in one (0.73%) case. The overall mortality was 9.8% (22) patients. CONCLUSION: In sigmoid volvulus, the most important determinant of patient outcome is bowel viability. The initial treatment of sigmoid colon volvulus is sigmoidoscopy with rectal tube placement.

Gastrointestinal anthrax: clinical experience in 5 cases.

BACKGROUND: Bacillus anthracis may usually cause three forms of anthrax: inhalation, gastrointestinal and cutaneous. The gastrointestinal (GI) anthrax develops after eating contaminated meat. Thus, in this paper were report 5 cases of intestinal anthrax. CASE PRESENTATION: We report a case series of intestinal anthrax, with history of consumption of raw or poorly cooked liver of sheep. One patient was female and 4 were males with the age range between 17 and 26 years. All patients were admitted with abdominal pain, nausea, and vomiting. Examination revealed abdominal distention on the right lower quadrant or diffuse tenderness. Laboratory examination in all patients showed leukocytosis with polymorphonuclear of >80%. Because of the unclear and questionable diagnosis, exploratory laparotomy was performed on several patients, invariably showing an abundant yellowish and thick ascitic fluid, soft hypertrophied mesenteric lymph nodes (3-5 cm) mostly in the ileocecal region, and substantial edema involving one segment of small bowel, cecum or ascending colon. Anthrax was diagnosed on the epidemiologic basis (ingestion history of half cooked liver of sheep) or microbiologic (microscopy with bacterial culture) and pathologic testing (post surgery in four patients or autopsy in one patient). With appropriate treatment, 4 survived and one patient died. CONCLUSION: Gastrointestinal anthrax is characterized by rapid onset, fever, ascitis and septicemia. The symptoms can mimic those seen in an acute surgical abdomen. Rapid diagnosis and prompt initiation of antibiotic therapy and then exploratory laparotomy (right hemicolectomy) are keys to survival.

Spontaneous transanal protrusion of ventriculoperitoneal catheter: a case report.

Ventriculoperitoneal (VP) shunt placement that diverts the cerebrospinal fluid (CSF) into the peritoneal cavity is the most common method of treatment of hydrocephalus. This shunt has a high incidence of malfunction mainly due to catheter obstruction or infection. About 20% of these complications are abdominal that may occur at any time after shunt placement from 1 week to several years. This study reports a case of 2.5-year old child with a history of hydrocephalus who had a VP shunt placed which was protruded from the anus on the day of referral. The patient was treated successfully after extrusion of the shunt through the anus, receiving antibiotics and being carefully observed. He was discharged from the hospital after one week.