Biliary Anatomy Visualization and Surgeon Satisfaction Using Standard Cholangiography versus Indocyanine Green Fluorescent Cholangiography during Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Background: Intraoperative biliary anatomy recognition is crucial for safety during laparoscopic cholecystectomy, since iatrogenic bile duct injuries represent a fatal complication, occurring in up to 0.9% of patients. Indocyanine green fluorescence cholangiography (ICG-FC) is a safe and cost-effective procedure for achieving a critical view of safety and recognizing early biliary injuries. The aim of this study is to compare the perioperative outcomes, usefulness and safety of standard intraoperative cholangiography (IOC) with ICG-FC with intravenous ICG. Methods: Between 1 June 2021 and 31 December 2022, 160 patients undergoing elective LC were randomized into two equal groups: Group A (standard IOC) and group B (ICG-FC with intravenous ICG). Results: No significant difference was found between the two groups regarding demographics, surgery indication or surgery duration. No significant difference was found regarding the visualization of critical biliary structures. However, the surgeon satisfaction and cholangiography duration presented significant differences in favor of ICG-FC. Regarding the inflammatory response, a significant difference between the two groups was found only in postoperative WBC levels. Hepatic and renal function test results were not significantly different between the two groups on the first postoperative day, except for direct bilirubin. No statistically significant difference was noted regarding 30-day postoperative complications, while none of the complications noted included bile duct injury events. Conclusions: ICG-FC presents equivalent results to IOC regarding extrahepatic biliary visualization and postoperative complications. However, more studies need to be performed in order to standardize the optimal dose, timing and mode of administration.

The Efficacy of Probiotics, Prebiotics, and Synbiotics in Patients Who Have Undergone Abdominal Operation, in Terms of Bowel Function Post-Operatively: A Network Meta-Analysis.

BACKGROUND: Abdominal operations may lead to post-operative bowel dysfunction, while administration of probiotics, prebiotics and synbiotics may limit its manifestation. Τhe study aimed to assess the efficacy of probiotics, prebiotics and synbiotics in patients who undergone abdominal operation, in terms of bowel function post-operatively. METHODS: PubMed, Scopus, Cochrane Central Register of Controlled Trials (Central), Embase, US Registry of clinical trials, and sources of grey literature were searched. The relative effect sizes were estimated, and we obtained the relative ranking of the interventions using cumulative ranking curves. RESULTS: In total, 30 studies were included in the analysis. For the outcome of post-operative ileus, probiotics was superior to placebo/no intervention (relative risk, RR: 0.38; 95%CI: 0.14-0.98) with the highest SUCRA (surface under the cumulative ranking) value (92.1%). For time to first flatus, probiotics (MD: -0.47; 95%CI: -0.78 to -0.17) and synbiotics (MD: -0.53; 95%CI: -0.96 to -0.09) were superior to placebo/no intervention. For time to first defecation and for post-operative abdominal distension probiotics were superior to placebo/no intervention. For post-operative hospitalization days, synbiotics were superior to placebo/no intervention (MD: -3.07; 95%CI: -4.80 to -1.34). CONCLUSIONS: Administration of probiotics in patients who had undergone abdominal surgery reduced the prevalence of post-operative ileus, time to first flatus, time to first defecation, and prevalence of post-operative abdominal distension. Synbiotics reduce time to first flatus and post-operative hospitalization days.

Anaplastic testicular seminoma presenting as a hydrocele, in a 36-year-old patient with a family history of anaplastic seminoma.

Testicular cancer is the solid tumor with the greatest incidence in men between 15 and 44 years old. Its main histological type is germ cell tumor, that is divided into seminomatous and non-seminomatous tumors. Seminoma, consisting 55% of testicular cancer, manifests in the fourth decade of men's life and a rare type of it is the anaplastic seminoma (5% to 15% of testicular seminoma). Diagnosis is based on clinical examination, testicular ultrasound, magnetic resonance imaging, tumor markers measurement and pathological examination, while treatment of choice is radical orchiectomy, with or without retroperitoneal lymphadenectomy, potentially followed by radiotherapy or chemotherapy. We present the case of a 36-year-old male patient, whose father suffered from anaplastic seminoma and visited the hospital due to a painless hydrocele. The testicle was swollen and hard on palpation, while cytological examination of the drained fluid detected neoplasm, potentially seminoma. Tumor markers measurement, as well as abdominal and pelvic computerized tomography scans, were evaluated and the patient was staged as IIA, according to the American Joint Commission on Cancer. Radical orchiectomy with high ligation of the seminal vesicle was performed and the pathological examination showed anaplastic testicular seminoma. Postoperatively, four cycles of chemotherapy with bleomycin, etoposide and platinum (BEP) were performed and no signs of recurrence were present after 1 year. In conclusion, anaplastic seminoma has a good prognosis and is suggested to be treated with radical orchiectomy, with or without retroperitoneal lymphadenectomy, potentially followed by radiotherapy or chemotherapy.

Amyand's Hernia as a Random Finding in Acute Abdominal Pain and the Role of Thorough Investigation: a Case Report.

Objective:Amyand's hernia is a rare clinical entity, in which the sac of an inguinal hernia contains the appendix. Its incidence is less than 1% of all inguinal hernia cases. Clinical presentation is not specific and can mislead clinical suspicion towards inguinal hernia incarceration. Different classifications have been proposed, with significant importance for the surgical management plan. The main factors to take into consideration include hernia sac content and macroscopic appearance of the appendix, intra-abdominal inflammation, the possibility of hernia recurrence, and patient's general situation and comorbidities. Materials and methods: A 60-year-old male patient with previous history of tension-free right inguinal hernia repair with mesh and cholelithiasis presented to the Emergency Department complaining of acute abdominal pain localized at the right lumbar and right iliac region and a right groin easily reducible mass. The patient had an abdominal CT performed 48 hours ago that revealed cholelithiasis and a recurrent right inguinal hernia containing the appendix. Because of the consistent pain in the right abdomen despite the easily reducible hernia, a high suspicion of a coexisting pathology was raised and a new abdominal CT scan with intravenous and per os contrast agent was ordered. The latter showed an Amyand's hernia and cholelithiasis, but also detected lithiasis of the right ureter with upstream dilatation as the main cause of abdominal pain. Results:The patient was subsequently treated with ureteral stent placement and the following day laparoscopic hernia repair with a transabdominal preperitoneal (TAPP) approach and cholecystectomy were performed. The patient was discharged from hospital on the second postoperative day without complications. Conclusion:Surgeons should be aware of different types of Amyand's hernia and have to include this entity in the differential diagnosis of right iliac fossa abdominal pain combined with a groin mass to avoid intraoperative complications and suboptimal management. It is equally important, though, to exclude other causes of abdominal pain. This case report reviews a rare entity of right inguinal hernia recurrence presenting as Amyand's hernia during the investigation of right abdominal and iliac fossa pain, that was finally attributed to ureteric colic. Special attention should be given to the thorough investigation of abdominal pain causes.

Hemobilia Caused by Arterioportal Fistula Following Percutaneous Liver Biopsy Complicated by Acute Cholecystitis and Review of the Literature.

We present a case of a 44-year-old male with chronic hepatitis B that visited the Emergency Department due to epigastric pain after a liver biopsy. The ultrasonography revealed signs of bleeding in the bile ducts. and angiography visualized an arterioportal fistula. Selective right hepatic artery branch embolization was performed, and the bleeding was controlled. Although, the clinical picture was initially improved, the patient presented later with acute abdomen, obstructive jaundice and fever. The patient underwent cholecystectomy with bile duct exploration and placement of a Kehr's T tube in the common bile duct. The postoperative course was uneventful. We also review the relevant literature concerning arterioportal fistula manifested as hemobilia as well as acute cholecystitis occurring after hemobilia.

Abdominal Wall Defect Reconstruction with Use of Biological Mesh and Negative Pressure Wound Therapy: a Case Report.

Objectives: Complex abdominal wall reconstruction cases constitute a challenging issue, with high morbidity and mortality rates. Materials and methods: A young trauma patient presented abdominal dehiscence after multiple laparotomies. The fascial defect was managed with the use of a biological mesh, while initially primary wound closure was attempted. Due to cutaneous dehiscence, the use of negative pressure wound therapy was decided. Results: Granulation tissue formation was noticed on the eighth day while complete wound closure was achieved after 57 days. Conclusions:In conclusion, the combined use of biological mesh and negative pressure wound therapy is feasible in the management of complicated abdominal defects.

Healing of colonic anastomosis in rats under obstructive ileus conditions.

BACKGROUND: The anastomosis leak in colon resections is a crucial post-operative complication with significant morbidity and mortality.  Methods: Forty (40) Wistar rats were allocated in two groups. In SHAM group only anastomosis was performed. In ILEUS group anastomosis was performed following one day of ileus. Animals in both groups were subdivided in two groups according to the day they were sacrificed, 4th or 8th post-operative day. A number of variables between the groups were estimated. RESULTS: Body weight loss was higher following obstructive ileus on both days. Adhesion score in 4th and 8th post-operative day was higher in ILEUS1, ILEUS2 groups compared to SHAM1, SHAM2 groups respectively (p<0.001 for both). Neovascularization decreased following obstructive ileus compared to control on the 4th day (ILEUS1 vs. SHAM1, p=0.038). Bursting pressure was lower in ILEUS2 group than SHAM2 group (p<0.001). The number of fibroblasts decreased following obstructive ileus compared to control on the 4th and 8th day (ILEUS1 vs. SHAM1, p=0.001, ILEUS2 vs SHAM2, p=0.016). Hydroxyproline concentration was decreased in ILEUS2 group compared to SHAM2 group (p<0.001). CONCLUSIONS: The balance of collagenolysis and collagenogenesis plays a decisive role in the healing of anastomoses following bowel obstruction. Under those circumstances, anastomosis' bursting pressure is reduced owning to decreased neovascularization, reduced fibroblast presence and lower hydroxyproline concertation. In our study, local inflammation, neocollagen concentration and collagenase activity were not associated with this adverse effect. However, further research should delineate the mechanisms of healing of colonic anastomoses and identify those factors that can improve our outcomes.

Oral administration of n-3 fatty acids positively affect the mucosal lesions after experimental ischemic enteritis in the rat.

AIM: The purpose of the study was to evaluate the effect of oral administration of n-3 polyunsaturated fatty acids in experimental ischemic enteritis in rats. METHODS: Forty Wistar rats were submitted to control narrowing of the superior mesenteric artery and were divided in two groups: N3 polyunsaturated fatty acids, which received a high-molecular polymer solution of artificial total enteral nutrition enriched with n-3 fatty acids and CONTROL which received a high-molecular polymer solution of artificial total enteral nutrition. RESULTS: Reduction of the animals' body weight was observed in both groups, but there was no difference between the two groups. Regarding the level of cytokines interleukin (IL)-1b, IL-6, and tumor necrosis factor a (TNF-a) there was no statistically significant difference between the two groups. Ischemic lesions to the small bowel mucosa were observed in both groups. A statistically significant difference in the extent of intestinal lesions was observed between the two groups with the animals that received enteral nutrition enriched with n-3 fatty acid developing fewer lesions. CONCLUSION: Enteral nutrition enriched with n-3 polyunsaturated fatty acids reduces the mucosal lesions caused by mesenteric ischemia compared to standard enteral nutrition, by modifying the local, but not the systemic, immune, and inflammatory response.

OBJETIVO: El propósito del estudio fue evaluar el efecto de la administración oral de ácidos grasos poliinsaturados n-3 en enteritis isquémica experimental en ratas. MÉTODOS: 40 ratas Wistar fueron sometidas a un estrechamiento controlado de la arteria mesentérica superior y se dividieron en dos grupos: N3PUFA, que recibieron una solución de polímero de alto peso molecular de nutrición enteral total artificial enriquecida con ácidos grasos n-3 y CONTROL que recibió un alto -Solución de polímero molecular de nutrición enteral total artificial. RESULTADOS: Se observó una reducción del peso corporal de los animales en ambos grupos, pero no hubo diferencias entre los dos grupos. Con respecto al nivel de citocinas IL-1b, IL-6 y TNF-a, no hubo diferencia estadísticamente significativa entre los dos grupos. Se observaron lesiones isquémicas de la mucosa del intestino delgado en ambos grupos. Se observó una diferencia estadísticamente significativa en la extensión de las lesiones intestinales entre los dos grupos y los animales que recibieron nutrición enteral enriquecida con ácido graso n-3 desarrollaron menos lesiones. CONCLUSIÓN: La nutrición enteral enriquecida con ácidos grasos poliinsaturados n-3 reduce las lesiones mucosas causadas por isquemia mesentérica en comparación con la nutrición enteral estándar, al modificar la respuesta local, pero no sistémica, inmunitaria e inflamatoria.

Conservative treatment of Boerhaave's syndrome in an octogenarian complicated with late distal esophageal stenosis and successfully treated by stent placement.

An 83-year-old female patient presented to the Emergency Department with shortness of breath, difficulty swallowing and left-sided chest pain following a vomiting attempt. A rupture in the left lower third of the esophagus, with hydropneumothorax, pneumomediastinum, and subcutaneous emphysema was revealed by chest X-ray, thoracic computed tomography scan, and contrast esophagography. The patient was successfully treated conservatively with closed thoracostomy, intravenous fluids, parenteral nutrition, and broad-spectrum antibiotics coverage. Following the successful conservative treatment, the patient developed a distal esophageal stenosis which was treated with an intra-esophageal self-expanding stent.

Una paciente de 83 años acudió al Servicio de Urgencias con disnea, dificultad para tragar y dolor en el lado izquierdo del pecho tras un intento de vómito. Una rotura en el tercio inferior izquierdo del esófago, con hidroneumotórax, neumomediastino y enfisema subcutáneo fue revelada por radiografía de tórax, tomografía computarizada de tórax y esofagografía con contraste. El paciente fue tratado con éxito de manera conservadora con toracostomía cerrada, líquidos intravenosos, nutrición parenteral y cobertura de antibióticos de amplio espectro. Tras el exitoso tratamiento conservador, el paciente desarrolló una estenosis esofágica distal que fue tratada con un stent autoexpandible intraesofágico.

The effects of growth hormone on the healing of colonic anastomoses in rats.

AIM: Growth hormone is known to affect healing on the postoperative patient. The aim of the present experimental study was to evaluate the effect of systematic infusion of growth hormone on the healing of colonic anastomoses in rats. METHODS: Fourty Albino-Wistar male rats were randomly divided into two groups, a control group (CONTROL) and a growth hormone (GH) group. In both groups, an end-to-end colonic anastomosis was performed after segmental resection. In the CONTROL group, 1 cc saline was administered subcutaneously in the experimental animals' necks in two equal doses daily until the sixth postoperative day. In the GH group, rats were administered a growth hormone solution (2 mg/kg b.w.) in an amount of 1 cc subcutaneously in their necks in two equal doses daily until the sixth postoperative day. Rats were sacrificed on the seventh postoperative day. Anastomoses were resected and macroscopically examined. Bursting pressures were calculated and histological features were graded and hydroxyproline was evaluated. RESULTS: No deaths or wound infections were observed until the sacrifice. Bodyweight was significantly increased in the GH group until the seventh postoperative day (p = 0.005). Bursting pressures (p = 0.0025), adhesion formation (p=0.0019), hydroxyproline concentrations (p = 0.007) were significantly higher in the GH group than in the control group. Also GH lead to decreased inflammation (p < 0.001), but increased neoangiogenesis (p < 0.001), fibroblast activity (p = 0.001) and collagen deposition (p < 0.001). CONCLUSION: Growth hormone, when applied systematically in rats with colonic anastomoses, promotes their healing in rats. Therefore, the application of growth hormone in colonic anastomoses leads to better outcomes. KEY WORDS: Adhesion, Bursting pressure, Collagen, Hydroxyproline, Inflammation, Neoangiogenesis.

Variations of plasma levels of insulin, glucagon, amylase and glucose and histopathological lesions of pancreatic tissue after complete elimination of exocrine pancreatic function with surgical ligation versus prolamine occlusion.

OBJECTIVE: Pancreaticoduodenectomy has been established as the treatment of choice for the management of benign and malignant lesions of the pancreatic head, and pancreaticojejunal or pancreaticogastric anastomosis seems to be the safer choice for the management of the pancreatic duct. However, in certain seldom, but still existing circumstances, pancreatic duct ligation or occlusion with a chemical substance is a valuable and viable alternative. The aim of the current study is to compare these two methods of occlusion of the pancreatic duct regarding the endocrine and exocrine function of the pancreas and its histopathology. MATERIALS AND METHODS: 18 health mixed breed dog of both sexes were randomized in two groups: group A, in which the pancreatic duct was ligated and group B, in which the pancreatic duct was occluded with prolamine. RESULTS: None of the animals presented postoperatively steatorrhea and significant body weight changes. Peripancreatic inflammation at sacrifice, inflammatory cell infiltration and edema of the pancreas on the 15th postoperative day and 30th postoperative day were milder after occlusion with prolamine than after ligation. Ligation of pancreatic duct lead to significantly greater hyperamylasemia than prolamine occlusion every day until the 15th. Mild hyperglycemia presented from the first to the fourth day in both groups, which was associated with a significant drop in insulin. Glucagon remained within the normal values at all times during the experiment. None of glucose, insulin and glucagon differed between groups. CONCLUSION: Prolamine occlusion of the pancreatic duct causes milder hyperamylasemia and less extensive inflammation both macroscopically and microscopically than ligation. KEY WORDS: Pancreas, Pancreaticoduodenectomy, Hyperamylasemia.

The effect of chemotherapy with 5-fluorouracil, bleomycin and cisplatin in the healing of colonic anastomoses in rats.

PURPOSE: Chemotherapeutic factors are known to affect healing on the postoperative patient. The aim of the present experimental study was to evaluate the effect of intraperitoneal infusion of 5-fluorouracil, bleomycin and cisplatin on the healing of colonic anastomoses in rats. METHODS: Forty Albino-Wistar male rats were randomly divided into two groups, a control and a chemotherapy (CT) group. In both, an end-to-end colonic anastomosis was performed. collagen, In the control group, 2cc saline was administered intraperitoneally during the operation and daily postoperatively until the sacrifice. In the CT group, rats were administered a solution of 5-fluorouracil (20mg/kg b.w.), bleomycin (4mg/kg b.w.) and cisplatin (0.7 mg/kg b.w.) in an amount of 2cc intraperitoneal intraoperatively and afterwards daily postoperatively until the seventh postoperative day when they were sacrificed. At sacrifice, adhesion presence was calculated and the anastomoses were resected and macroscopically examined. Bursting pressures were calculated and histological features were graded. Hydroxyproline concentrations were evaluated. RESULTS: No deaths or wound infections were observed until sacrifice. Bodyweight was significantly decreased in the CT group (p=0.005). Bursting pressures (p=0.001) were significantly lower in the chemotherapy group, whereas adhesions were significantly increased (p=0.001). Hydroxyproline concentrations were not significantly different (p=0.401). All histological parameters appeared significantly decreased in the CT group: inflammation (p<0.008), neoangiogenesis (p<0.001), and fibroblast activity (p=0.001) and collagen deposition (p<0.001). CONCLUSION: The use of chemotherapeutic agents had negative effects on the healing process of colonic anastomosis in rats. The decreased inflammatory response depicts in more frequent anastomotic dehiscence, ruptures and bodyweight loss postoperatively. KEY WORDS: Adhesion, Bursting pressure, Collagen, Hydroxyproline, Inflammation, Neoangiogenesis.

The effect of hepatic ischemia in the liver of rats with obstructive jaundice.

OBJECTIVE: The aim of the current study was to evaluate the effect of ischemia-reperfusion injury on the liver's function and morphology during the establishment and progress of obstructive jaundice. MATERIAL AND METHODS: 80 Wistar rats were used for the purposes of the study and were allocated in four groups: JAUNDICE (obstructive jaundice), JAUN-ISC (obstructive jaundice and ischemia reperfusion), CONTROL (laparotomy) and ISCHEMIA (ischemia reperfusion). RESULTS: Obstructive jaundice, and ischemia-reperfusion injury following obstructive jaundice led to increased mortality, while no mortality was noticed in the control and ischemia groups. In the JAUN-ISC group, SGOT was significantly increased on the 10th day and SGPT was significantly increased on the 1st day compared to JAUNDICE group. Moreover, in the JAUN-ISC group, sinusoid dilation was significantly increased on the 5th and 10th days and neutrophil infiltration was significantly increased on the 10th day compared to the JAUNDICE group. CONCLUSIONS: A mild ischemia-reperfusion injury that in the normal liver led only to slight increase of hepatic neutrophil infiltration in the presence of obstructive jaundice led to increased hepatic biochemical markers (SGOT, SGPT) and increased hepatic sinusoid dilatation and enhanced neutrophil infiltration. KEY WORDS: Dilatation of sinusoids, Granulocytes infiltration, Oxaloxate, Pyruvate transaminase, Transaminase reperfusion.

Duodenal Injuries During Laparoscopic Cholecystectomy: An Unusual But Serious Complication of a Routine Surgical Procedure.

Duodenal injury is an unusual complication of laparoscopic cholecystectomy, mostly caused by direct injury of the duodenum by laparoscopic instruments, either mechanical or thermal. The management is usually surgical, with satisfactory results, as long as the complication is detected early. We report two cases of duodenal perforations during laparoscopic cholecystectomy. One was treated with primary closure of the defect, while the other was managed conservatively with abdominal drainage and food deprivation. Both techniques proved successful in the management of that complication.

Klatskin tumors and "Klatskin-mimicking lesions": our 22-year experience

Background and study purpose: Hilar cholangiocarcinoma, also known as Altemeier-Klatskin tumor, is a rare malignancy that arises in the confluence of the hepatic ducts of the porta hepatis. The prognosis is rather poor. Several lesions mimic these tumors and lead to a misdiagnosis, resulting in radical hepatic resections. These lesions are known as Klatskin-mimicking lesions. We present our experience with the diagnosis and treatment of pathological lesions that can mimic a perihilar cholangiocarcinoma and establish an algorithm of treatment Methods: For the current retrospective study, a prospectively established bile-duct tumor database was analyzed by selecting patients with a preoperative diagnosis of perihilar cholangiocarcinoma. Results: In the last 22 years (from January 1, 1996, to December 31, 2017), 73 patients who were referred to our tertiary center with a primary diagnosis of a Klatskin tumor were treated. All patients underwent a thorough evaluation before deciding upon the treatment. However, only 58 cases had a confirmed preoperative diagnosis of hilar cholangiocarcinoma in the final histopathological examination. The final diagnosis in 15 patients differed from the primary cause for referral and the lesions were regarded as Klatskin-mimicking lesions. Conclusions: Clinicians should always highly suspect Klatskin-mimicking lesions when they evaluate a patient for a possible hilar cholangiocarcinoma in order to avoid a misdiagnosis and propose a proper treatment

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Klatskin tumors and "Klatskin-mimicking lesions": our 22-year experience.

Background and study purpose: Hilar cholangiocarcinoma, also known as Altemeier-Klatskin tumor, is a rare malignancy that arises in the confluence of the hepatic ducts of the porta hepatis. The prognosis is rather poor. Several lesions mimic these tumors and lead to a misdiagnosis, resulting in radical hepatic resections. These lesions are known as Klatskin-mimicking lesions. We present our experience with the diagnosis and treatment of pathological lesions that can mimic a perihilar cholangiocarcinoma and establish an algorithm of treatment Methods: For the current retrospective study, a prospectively established bile-duct tumor database was analyzed by selecting patients with a preoperative diagnosis of perihilar cholangiocarcinoma. Results: In the last 22 years (from January 1, 1996, to December 31, 2017), 73 patients who were referred to our tertiary center with a primary diagnosis of a Klatskin tumor were treated. All patients underwent a thorough evaluation before deciding upon the treatment. However, only 58 cases had a confirmed preoperative diagnosis of hilar cholangiocarcinoma in the final histopathological examination. The final diagnosis in 15 patients differed from the primary cause for referral and the lesions were regarded as Klatskin-mimicking lesions. Conclusions: Clinicians should always highly suspect Klatskin-mimicking lesions when they evaluate a patient for a possible hilar cholangiocarcinoma in order to avoid a misdiagnosis and propose a proper treatment.

A rare case of a transabdominal impalement after a fall from a ladder.

INTRODUCTION: Impalement injuries are caused by objects that penetrate and remain inside the human body. They are rare and often lead to complex surgical problems, demanding immediate measures and intensive care. PRESENTATION OF CASE: We report a case of a 39 year old male who presented in our emergency department with a history of fall from a 3m high ladder, landing on a wooden stick that penetrated the patient from his left lumbar region, leading to a trans-abdominal impalement injury. DISCUSSION: Nowadays impalement injuries although rare, demonstrate a challenging presentation for emergency providers. Their complexity often raises concerns about the proper surgical approach and postoperative management. In many cases, they may cause severe morbidity or even be lethal. CONCLUSION: The article describes a case of a transabdominal impalement injury and pinpoints the strategies followed regarding the prehospital care, as well as the intra- and postoperative management.

Healing of colonic anastomoses after immediate postoperative intraperitoneal administration of oxaliplatin.

AIM: The aim of this experimental study was to investigate the effect of intraperitoneal administration of oxaliplatin on the healing of colonic anastomoses when injected immediately after colon resection. MATERIALS AND METHODS: Thirty male Wistar rats were used. During the operation, the rats were randomized to two groups of 15 rats each. Immediately after colonic anastomoses were performed, the rats were injected intraperitoneally with either 3 ml of 0.9% NaCl solution or oxaliplatin (2.4 mg/kg body weight) depending on their group. All rats were killed on the eighth postoperative day. The anastomoses were examined macroscopically. The anastomotic bursting pressures were recorded, the anastomoses graded histologically, and the hydroxyproline tissue contents determined. RESULTS: Anastomotic leakage was noted in four rats (26.7%) of the oxaliplatin group, whereas no anastomotic dehiscence was detected among rats of the control group (p = 0.016). The adhesion formation at the anastomotic sites and the inflammatory cell infiltration were significantly higher in the oxaliplatin group than in the control group (p = 0.001). The bursting pressures (p = 0.001), the hydroxyproline tissue content (p = 0.001), the neoangiogenesis (p = 0.033), the fibroblast activity (p = 0.001), and the collagen deposition (p = 0.001) were significantly lower in the oxaliplatin group in comparison to the control group. CONCLUSION: The immediate postoperative intraperitoneal administration of oxaliplatin seems to impair healing of colonic anastomoses in rats.

Retained gallbladder remnant after laparoscopic cholecystectomy.

BACKGROUND: Upper abdominal pain and other symptoms may recur after cholecystectomy, often presenting a diagnostic challenge. We will analyze 3 cases of gallbladder remnants, containing stones that presented with recurrent biliary symptoms. PATIENTS AND METHODS: Three patients have presented to our clinic with recurrent biliary symptoms, after laparoscopic cholecystectomy, over the last 5 years. All 3 had biliary pain similar to the symptoms that precede cholecystectomy; 1 of them also had associated mild jaundice. RESULTS: A cystic lesion containing stones was identified on transabdominal ultrasound in all 3 patients, suggesting the possibility of a gallbladder remnant. Magnetic resonance cholangiopancreatography confirmed the diagnosis of a gallbladder remnant in 2 of them. The 3 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) owing to jaundice. This revealed a dilated gallbladder remnant and sludge into the bile duct and was treated by sphincterotomy and cleansing of the duct. All 3 patients were treated successfully via laparoscopic "recholecystectomy." CONCLUSION: Gallbladder remnant, containing stones, can be the cause of otherwise unexplained postcholecystectomy pain. "Recholecystectomy" constitutes the definite treatment for any residual gallbladder remnant and can be performed laparoscopically.