rare case of perforated Meckel's diverticulum presenting as a gatrointestinal stromal tumor

Meckel's diverticulum is located on the antimesentric border of the ileum, approximately 45 to 60 cm proximal to the ileocecal valve, and results from incomplete closure of the omphalomesentric or viteline duct. Common complications presenting in adults include bleeding, obstruction, diverticulitis, and perforation. Tumors within Meckel's diverticulum are a rare, but recognized complication. A 62year-old woman presented with peri-umbilical pain that had localized to the right iliac fossa. On examination, she was tender in the right iliac fossa, with localized peritonism. At surgery, a perforated Meckel's diverticulum was found that was associated with free intra-abdominal fluid and hemorrhage. A 25 mm nodule was found at the apex of Meckel's diverticulum.We resected 100 mm of the small bowel and a pri-mary anastamosis was performed.Histopathological examination of the resected lesion revealed a mesenchymal tumor categorized as a gastrointestinal stromal tumor [GISTs]. GISTs arising from Meckel's diverticulum are an extremely rare, but recognized complication. Surgery is considered the standard treatment for non-metastatic GISTs with enbloc resection and clear margins

use of fibrin glue in surgical treatment of pilonidal sinus disease: a prospective study in the limberg flap procedure

Different surgical techniques for pilonidal disease have been described in the literature. Limberg flap has low morbidity and recurrence rates. Fibrin sealant, a two-component tissue adhesive composed of fibrinogen and thrombin, has been used in a number of surgical procedures to achieve hemostasis and to seal tissues. The purpose of this study was to investigate the effect of fibrin sealant on the Limberg flap procedure. 132 male patients with pilonidal sinus who underwent Limberg flap operation were evaluated prospectively. The patients were assigned randomly into two groups [group 1; with suction drain, group 2; fibrin glue]. Seroma was encountered in 5 of 132 patients [3.78%]; Flap oedema occurred 4[6.06%] patients in group 1. Wound infection occurred in one patient [1.5%] in group 1. Most patients in group 2 were mobilized on the first postoperative day, and the median time to first mobilization was earlier in group 2 than in group 1 [1 [1-1] versus 2 [1-2] days respectively; P<0001]. The median duration of incapacity for work was 17 [15-20] days in group 1 and 8 [6-12] days in group 2 [P< 0.001]. Total wound dehiscence and flap necrosis did not occur in any patient. There has been no recurrence in any of the patients during the follow-up period. The mean time for complete healing of wound after rhomboid excision and Limberg flap plus fibrin sealant was 8.13 +/- 7.88 days [range 6-28 days]. This was markedly increased in group 1 patients [mean 22.08 +/- 8.59 days, and range 15-60][p < 0.001]. We recommend the use of fibrin sealant with Limberg flap technique. Our results suggest that drains may be avoided with fibrin sealant