Comparison of Fenestrating and Reconstituting Subtotal Cholecystectomy Techniques in Difficult Cholecystectomy.

Purpose Cholecystectomy is one of the most frequently performed surgeries. Although laparoscopy is considered the gold standard approach, it cannot prevent biliary injuries. Subtotal cholecystectomy has been performed mainly to prevent biliary injuries during difficult cholecystectomies. This study aimed to analyse our subtotal cholecystectomy results for difficult cholecystectomy cases and to evaluate the fenestrating and reconstituting techniques. Methods Retrospective data were collected and analysed statistically for cases that underwent subtotal cholecystectomy in a single referral centre between 2015 and 2020. Comparisons were made of the patients' age, gender, preoperative American Society of Anaesthesiologists (ASA) score, comorbidities, surgical timing, surgical procedure choice, postoperative complications, and mortality. Results The number of patients who underwent subtotal cholecystectomy was 46; 30.4% underwent emergent surgery and 69.6% underwent elective surgery. Twelve patients had subtotal fenestrating cholecystectomy and 34 had subtotal reconstituting cholecystectomy. Wound issues were noted in 17.4% of the patients, while 10.9% had temporary biliary fistulas that resolved spontaneously. Reoperation was performed in one patient due to high-output biliary drainage. Patients with postoperative complications had significantly higher co-morbid conditions (p=0.000), but surgery timing (p=0.192) and type of subtotal cholecystectomy (p=0.409) had no statistically significant effect on complications. Mortality showed a statistically significant correlation with patient comorbidities, surgery timing, and the type of procedure (p<0.05). Postoperative complications showed a statistically significant correlation with mortality (p<0.05). Conclusion Subtotal cholecystectomy prevents major biliary complications after cholecystectomy. Yet, the frequency of postoperative complications after subtotal cholecystectomy is incontrovertible. Intraoperative characteristics and the surgeon's expertise decide the optimal choice of the subtotal cholecystectomy technique.

Percutaneous drainage as an rapid procedure for deep pelvic abscess in the emergency department.

BACKGROUND: Drainage of pelvic abscesses is interventional procedures that should be well planned due to organ contiguity. There are not enough publications in the literature evaluating the treatment methods of pelvic abscess drainage and comparing success rates. METHODS: In this study, 15 patients who underwent pelvic abscess drainage in our interventional radiology unit between June 2017 and December 2019 were retrospectively included. Abscess size, abscess characteristics, the method of access to abscess (transrectal, transvaginal, transgluteal), and drainage treatment procedure (needle aspiration, catheter treatment) were evaluated statistically in terms of effects on the success of treatment. RESULTS: Of the 15 patients included in the study, 6 (40%) were male and 9 (60%) were female, with a mean age of 31.6 years.In 2 of the patients treated with needle aspiration alone, the abscess collection was repeated and the second procedure was performed. In our study, the technical success was 100% and the complete clinical success was 80%. None of the patients underwent open surgery due to abscess after drainage treatment. CONCLUSION: In conclusion, endocavitary and percutaneous drainage treatments of pelvic abscesses are safe and effective treatment methods. The success of needle aspiration treatment is lower than catheter treatment and it should be considered that the abscess collection may recur.

Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis: Percutaneous cholecystostomy.

BACKGROUND: The main cause of acute cholecystitis (AC) is gallstones, and the incidence of gallstones in elderly patients is high. METHODS: In this study, we aimed to investigate the efficacy of percutaneous cholecystostomy (PC) before early cholecystectomy in geriatric patients with AC. This retrospective study included 85 patients undergoing laparoscopic or conventional cholecystectomy during early stage of calculous AC. RESULTS: All patients were over 65 years old and were divided into two groups: Group I, PC plus early cholecystectomy and Group II, only cholecystectomy without PC. Data on age, sex, status of PC before surgery, postoperative complications, postoperative mortality, surgical method, and postoperative hospitalization duration were recorded in our study. The average age in the groups I and II was 75.7±7.5 and 73.7±7.2 years, respectively, indicating insignificant difference (p=0.223). Although postoperative complication rate was two fold in the non-PC group, the PC plus cholecystectomy group has a few complications (p=0.032). Postoperative mortality was evidently lower in patients who first underwent PC and followed by cholecystectomy (p=0.017). The average hospitalization duration in groups I and II were 5.6±2.4 days and 11.2±7.7 days, respectively (p<0.001). CONCLUSION: Urgent laparoscopic cholecystectomy is still the best surgical treatment modality for calculous AC. Further, our study results showed that in geriatric patients, bridge treatment, such as PC, can be useful for reducing postoperative complication rates.

Prolidase activity and oxidative stress in patients with breast carcinoma A prospective randomized case-controlled study.

INTRODUCTION: Oxidative stress plays an important role in the pathogenesis of malign diseases. Prolidase is a member of the matrix metalloproteinase family, plays a major role in collagen metabolism, cell growth, and matrix remodeling. Elevated serum prolidase activity have beendemonstrated in several types of carcinoma. The aim of this study is to investigate the serum prolidase activity, total oxidant status (TOS), total antioxidant status (TAS) and to evaluate their relationship with tumor stage, lymph node metastasis, and tumor size in patients with breast carcinoma. METHODS: Thirty-five patients with breast carcinoma and forty healthy controls were enrolled to this study.Serum TAS, TOS levels, and prolidase activities were measured and oxidative stress indices (OSI) were calculated. RESULTS: TOS, OSI levels and prolidase activities were significantly higher in the patients with breast carcinoma compared to the control group (P < 0.001, P < 0.001, P = 0.002, respectively).TAS levels were significantly lower in the in the patients with breast carcinoma compared to the control group (P = 0.016).Positive correlations were found between prolidase activity, TOS, OSI levels and tumor stage, lymph node metastasis, and tumor size. A negative correlation was found between TAS levels and tumor size,hovewer there were no correlationsbetween tas levels and stage of the tumor,as well as lymph node infiltration. CONCLUSION: We conclude that elevatedserum prolidase activity and oxidative stress may be associated with breast carcinoma. Increased serum prolidase activity may be related to stage and prognosis of breast carcinoma. KEY WORDS: Breast carcinoma, Oxidative stress, Proline dipeptidase.

Appendix adenocarcinoma in an elderly patient from a nursing home.

Appendiceal malignancies are rare clinic entities. The clinical presentation of appendiceal malignancies is often atypical. Acute abdominal pain and acute appendicitis, which requires early surgical intervention, are the most common clinical presentations of appendiceal malignancies. In this case report, an adenocarcinoma of the appendix in a 64-year-old male from a nursing home has been presented. He had right lower quadrant pain for the last 5 days. On physical examination, he had significant guarding. Intravenous contrast-enhanced abdominopelvic tomography revealed no pathological features. Laparotomy under general anesthesia was scheduled. During exploration, a perforated appendicitis was observed. Formal appendectomy was performed. The patient was lost due to pneumonia and septic shock 5 days after surgical intervention. In addition, the natural history of the disease and its basic diagnostic and therapeutic aspects are discussed. Preoperative or intraoperative diagnosis may not be available for some patients. Thus, routine histopathological examination is essential for adequate diagnosis and treatment.

DOES NEUTROPHIL TO LYMPHOCYTE RATIO PREDICT HOSPITAL STAY IN APPENDECTOMY PATIENTS?

BACKGROUND: We aimed to investigate the relationship between the neutrophil to lymphocyte ratio (NLR) and postoperative length of hospital stay. In addition, the impact of radiological and histopathological findings on hospital stay was also evaluated. METHOD: This is a retrospective study. One hundred three patients with appendicitis were in-cluded. The diagnosis was confirmed by computed tomography (CT), ultrasonography and histopathological examination. Correlations between the length of hospital stay and age, gender, NLR, c-reactive peptide levels (CRP), the appendix diameter on CT or ultrasonogra-phy, appendix localisation and pathology reports were evaluated. RESULTS: The length of hospital stay was not related to age or gender. The length of hospital stay after appendectomy was correlated with appendix diameter on CT and phlegmonous appendicitis, but it was not associated with NLR, CRP levels or the appendix diameter on ultrasonography. CONCLUSION: To our knowledge, this is the first comprehensive study to evaluate the associa-tion between NLR levels and the length of hospital stay in patients with acute appendicitis. The NLR was not found to be associated with the length of hospital stay. The appendix di-ameter on CT and appendix pathology reports were correlated with the length of postopera-tive hospital stay in appendectomy patients.

Management of a Septic Open Abdomen Patient with Spontaneous Jejunal Perforation after Emergent C/S with Confounding Factor of Mild Acute Pancreatitis.

Introduction. We report the management of a septic Open Abdomen (OA) patient by the help of negative pressure therapy (NPT) and abdominal reapproximation anchor (ABRA) system in pregnant woman with spontaneous jejunal perforation after emergent cesarean section (C/S) with confounding factor of mild acute pancreatitis (AP). Presentation of Case. A 29-year-old and 34-week pregnant woman with AP underwent C/S. She was arrested after anesthesia induction and responded to cardiopulmonary resuscitation (CPR). There were only ash-colored serosanguinous fluid within abdomen during C/S. After C/S, she was transferred to intensive care unit (ICU) with vasopressor support. On postoperative 1st day, she underwent reoperation due to fecal fluid coming near the drainage. Leakage point could not be identified exactly and operation had to be deliberately abbreviated due to hemodynamic instability. NPT was applied. Two days later source control was provided by conversion of enteroatmospheric fistula (EAF) to jejunostomy. ABRA was added and OA was closed. No hernia developed at 10-month follow-up period. Conclusion. NPT application in septic OA patient may gain time to patient until adequate source control could be achieved. Using ABRA in conjunction with NPT increases the fascial closure rate in infected OA patient.

Adult midgut malrotation presented with acute bowel obstruction and ischemia.

INTRODUCTION: Intestinal malrotation refers to the partial or complete failure of rotation of midgut around the superior mesenteric vessels in embryonic life. Arrested midgut rotation results due to narrow-based mesentery and increases the risk of twisting midgut and subsequent obstruction and necrosis. PRESENTATION OF CASE: 40 years old female patient admitted to emergency service with acute abdomen and computerized tomography scan showed dilated large and small intestine segments with air-fluid levels and twisted mesentery around superior mesenteric artery and vein indicating "whirpool sign". DISCUSSION: Malrotation in adults is a rare cause of midgut volvulus as though it should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Even though clinical symptoms are obscure, adult patients usually present with vomiting and recurrent abdominal pain due to chronic partial obstruction. Contrast enhanced radiograph has been shown to be the most accurate method. Typical radiological signs are corkscrew sign, which is caused by the dilatation of various duodenal segments at different levels and the relocation of duodenojejunal junction due to jejunum folding. As malrotation commonly causes intestinal obstruction, patients deserve an elective laparotomy. CONCLUSION: Malrotation should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Surgical intervention should be prompt to limit morbidity and mortality.

Antiadhesive and anti-inflammatory effects of pirfenidone in postoperative intra-abdominal adhesion in an experimental rat model.

BACKGROUND: Pirfenidone (PF) is a potent antifibrotic and anti-inflammatory agent. We investigated the protective effect of PF against postoperative intra-abdominal adhesions. MATERIAL AND METHODS: Thirty male Sprague-Dawley rats were divided into three groups (n = 10 in each group). In group 1 (control), adhesion induction was performed by cecal abrasion, and no treatment was administered. In group 2 (vehicle), for 2 wk after adhesion induction, 0.4%-carboxymethylcellulose was administered by gavage. In group 3 (PF treatment), for 2 wk after adhesion induction, 500-mg/kg/d PF was administered by gavage. On the 15th postoperative day, the animals were killed, and cecal and peritoneal tissues were excised. The adhesions were graded macroscopically. The protein concentrations and mRNA expression levels of the following genes were measured in the tissues: matrix metallopeptidase-9 (MMP-9); tissue inhibitor of metalloproteinase-1 (TIMP-1); tumor necrosis factor-alpha (TNF-α); and transforming growth factor-beta 1 (TGF-ß1). The tissue samples were also evaluated histopathologically. RESULTS: Macroscopic and histopathologic evaluation showed that PF-reduced adhesion and inflammation (P < 0.001, P = 0.004, respectively). Pretreatment with PF-reduced TIMP-1, TNF-α, and TGF-ß1 protein concentrations (P < 0.001, P < 0.001, and P < 0.001, respectively) and mRNA expression levels (P = 0.030, P = 0.005, and P = 0.016, respectively) and increased MMP-9 protein concentrations (P < 0.001) and mRNA expression (P = 0.021). CONCLUSIONS: The findings of this study suggest that PF can be used as a protective agent to prevent the development of peritoneal adhesions and inflammation during the postoperative period.

Incidental signet ring cell carcinoma of the gallbladder in routine histopathology.

Cholecystectomy is a common surgical procedure for various indications. Preoperative imaging is the main stay in the management of the patients. Routine and/or selective histopathological examination of the cholecystectomy materials have been discussed previously. However, incidental findings may be only observed with routine histopathological examination. Here, we report an incidental gallbladder signet cell carcinoma in a 66 years old patient. This case underlines the importance of routine histopathological examination after cholecystectomy.

Relationship Between the Neutrophil to Lymphocyte Ratio and Parathyroid Adenoma Size in Patients With Primary Hyperparathyroidism.

The aim of our study was to evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and adenoma size in parathyroidectomized patients who underwent a parathyroidectomy. The neutrophil to lymphocyte ratio has recently become popular as a biomarker for malignant diseases or for estimating tumor size preoperatively. This study aimed to estimate the relationship between adenoma size and NLR. Furthermore, we assessed whether a higher level of NLR is correlated with the presence of parathyroid carcinoma. A retrospective chart review was performed for patients with parathyroid adenoma who underwent parathyroidectomy between January 2012 and August 2014. Data related to age, sex, NLR, parathyroid hormone level (PTH), preoperative calcium, phosphorus, adenoma size, and pathology reports were collected. The neutrophil to lymphocyte ratio was significantly correlated with calcium levels, PTH levels, parathyroid adenoma size, and the presence of cancer. However, there was no correlation between NLR and age, sex, and phosphorus levels. This study is the first to document a positive correlation between NLR and parathyroid adenoma size, as well as the presence of cancer, in patients who underwent surgery as a result of primary hyperparathyroidism.

Acute nontraumatic torticollis in a patient with right lower quadrant pain: case report.

Right lower quadrant pain is one of the most common symptoms of the emergency patients. For accurate diagnosis and treatment; the patients must be questioned and examined very well. Also accompanying conditions due to right lower quadrant pain may be noticed. In this case presentation, we discussed a patient who was presented with right lower quadrant pain and cervical dystonia. By limiting the usage of metoclopramide the patient was followed seamlessly. In this case presentation we want to accentuate that a patient who with abdominal pain may be presented with rare symptoms such of dystonia. In such conditions a detailed anamnesis and physical examination are the first steps of the evaluation to prevent potential hazardous outcomes. In particular, a surgeon must be always carefully while taking history and examining the patient.

The effect of methylprednisolone and tenoxicam on the protection of damage of the nerve physiomorphology caused by prolene mesh.

INTRODUCTION: Aim was to investigate the effect of methylprednisolone and tenoxicam on the protection of damage of the nerve physiomorphology caused by prolene mesh used in hernia repair. METHODS: Fifty male Wistar-albino rats weighing 250-350 gr, were randomly divided into 5 groups. Sciatic nerve was dissected in all rats after performing EMG on basal neural transport. In group 1, only sciatic nerve manipulation was performed. Other groups received a monofilament polypropylene cuff around the sciatic nerve. No additional procedure was performed in group 2. In group 3, 2 mg/kg single dose methylprednisolone was injected around the nerve and mesh. In group 4 and 5, 0.5 mg/kg/day methylprednisolone and 1 mg/kg tenoxicam was injected around the nerve and mesh for 4 weeks, respectively. Neural transport was evaluated by electromyography 4 weeks later and compared with pre-procedural values. Then the rats were sacrificed and, sciatic nerves including 1 cm around the mesh were excised. Inflammation and fibrosis were scored histopathologically. RESULTS: While basal latency was similar, postoperative latency was significantly different among groups. Latency was significantly longer in group 2 than the group 1. It was significantly shorter in group 3 when compared to group 2 (p = 0.007). Preoperative and postoperative amplitudes were similar among groups. Denervation was significantly different among groups (p < 0.05). Denervation was higher in group 2 than group 1. It was similar to group 2 in study groups. Inflammation and fibrosis was significantly different among groups (p < 0.05). Inflammation and fibrosis scores were significantly higher in group 2 than group 1. The highest inflammation and fibrosis scores were detected in repetitive drug administrated groups. Although it wasn't statistically significant, inflammation was lower in single dose steroid administrated group than group 2. Similarly, the highest fibrosis scores were detected in repetitive drug administrated groups. Single dose steroid administration didn't increase fibrosis when compared to group 2. CONCLUSIONS: Prolene mesh used in hernia repair caused increased inflammation and fibrosis and effected latency and denervation negatively. Single dose methylprednisolone administration decreased nerve damage and inflammation. On the other hand, daily administration of methylprednisolone and tenoxicam for 4 weeks caused increased inflammation and fibrosis and wasn't affective on protection of nerve physiomorphology.

Mean Platelet Volume as a Biomarker for Thyroid Carcinoma.

AbstractObjective: This study aimed to determine the relationship between MPV and thyroid malignancy by comparing patients who underwent surgery for benign or malignant thyroid diseases. BACKGROUND: Mean platelet volume (MPV) is a useful early indicator of platelet activation. Platelets differ in terms of functional activity and size. Large platelets are relatively new, more reactive and produce more thrombogenic factors. Therefore, in conditions that involve increased platelet activation, an increase in the proportion of young platelets and MPV is expected. PATIENTS AND METHODS: This study involved 146 patients who underwent total thyroidectomy because of benign (99 patients) or malignant (47 patients) diseases of the thyroid. Data on age, sex, MPV, white blood cell (WBC) count, hemoglobin level and platelet count were collected retrospectively. RESULTS: MPV was significantly higher in patients with malignant thyroid diseases than in those with benign thyroid diseases. Age, sex, hemoglobin level, WBC count and platelet count did not significantly differ between the two groups. CONCLUSION: MPV was significantly higher in patients with thyroid malignancies than in patients with benign thyroid diseases. We propose that MPV might be an important predictive factor for thyroid malignancies. Further prospective studies with a larger number of patients in high-volume endocrine surgery centers are required to confirm our findings.

Protective effects of simvastatin administered in the experimental hepatic ischemia-reperfusion injury rat model.

BACKGROUND: Hepatic ischemia-reperfusion (I/R) injury is a major complication in clinical practice. Previous studies suggest that statins have pleiotropic effects in addition to cholesterol-lowering effects. In this study, we aimed to investigate the hepatoprotective role of two different doses of simvastatin (SV) pretreatment in rats with experimental hepatic I/R injury. METHODS: Adult male Sprague-Dawley rats were divided into four groups (n = 7 in each group) :control, I/R, I/R with 2.5-mg/kg SV, and I/R with 5.0-mg/kg SV. Before hepatic I/R was induced, SV was injected intraperitoneally at doses of 2.5 and 5.0 mg/kg. After 45-min ischemia and a 60-min reperfusion period, the animals were euthanized, and liver tissues were excised. Tissue levels of malondialdehyde and nitric oxide, and activities of superoxide dismutase, glutathione peroxidase, and catalase were measured. Liver tissues were also evaluated histopathologically and immunohistochemically. RESULTS: Histopathologic evaluation showed that 5.0-mg/kg SV reduced hepatic damage and apoptosis. Pretreatment with 5.0-mg/kg SV reduced malondialdehyde and nitric oxide levels (P < 0.01) and increased superoxide dismutase, glutathione peroxidase, and catalase activities significantly (P < 0.001, P < 0.01) in I/R with 2.5-mg/kg SV compared with I/R group. In addition, SV decreased Kupffer cell activation, and hypoxia-inducible factor-1α and vascular endothelial growth factor protein levels. CONCLUSIONS: The results of this study suggest that 5.0-mg/kg SV pretreatment may be protective against hepatic I/R injury. This effect can be achieved by antioxidant and antiapoptotic activities.

Carcinosarcoma of the thyroid gland.

Introduction. Surgeon has significant role in the management of such rare and controversial clinical entities related to thyroid gland. In this case report we have presented an elderly patient with rapid enlargement in thyroid that was related to carcinosarcoma. Case Presentation. A 60-year-old lady was presented with rapid enlargement of the thyroid gland. A fine needle aspiration of the nodule in right lobe was performed several weeks before presentation to our clinic. End diagnosis was a papillary carcinoma of the thyroid with spindle cell component. Thus the nodule was recognized to be a carcinosarcoma. Conclusion. Thyroid surgery merits a multidisciplinary approach. Indeed the surgeon should make a conclusive decision in some controversial and rare clinical entities such as carcinosarcoma.

Advanced alveolar echinococcosis disease associated with Budd-Chiari syndrome.

INTRODUCTION: Alveolar echinococceal disease of the liver is rare. Echinococcus multilocularis is responsible for the development of the related clinical conditions. Advanced disease may result with serious complications such as end stage liver disease and Budd-Chiari syndrome. PRESENTATION OF CASE: In this presentation, a 28 years-old woman who was a case with advanced alveolar echinococcosis complicated with a Budd-Chiari syndrome and was performed successful living donor liver transplantation, has been demonstrated with clinical and radiological images. DISCUSSION: Initially there may be no clinical evidence of the disease in humans for years. Severity and fatality are the significant characteristics of the natural history. Extension to the surrounding tissues and metastasis of the parasitic mass may be observed. Prevention is essential in disease control. Serologic assay may identify the parasite. However, early diagnosis is rare. Staging is based on radiologic imaging. Some patients with advanced disease may require surgery. Hepatic resection and liver transplantation are accepted procedures in selected patients. CONCLUSION: The importance of early diagnosis to prevent advanced complications such as development of Budd-Chiari syndrome and metastasis has been underlined.

Cholesterolosis in routine histopathological examination after cholecystectomy: what should a surgeon behold in the reports?

INTRODUCTION: Cholecystectomy is one of the most common surgical procedures. Postoperative investigation of cholecystectomy specimen has a great value since histopathological reports may document some entities with significant clinical consequences. The aim of this study was to evaluate the association between cholesterolosis and the reports indicating some histopathological alterations in symptomatic cholecystitis. METHODS: This paper is based on a retrospective study. Histopathological reports of 432 cholecystectomy specimens between January 2011 and June 2013 were reviewed. Three reports were excluded due to perioperative diagnosis of cancer. Reports of 429 cholecystectomy specimens of the acute and symptomatic chronic cholecystitis patients were analyzed. Standardization of the reporting was questioned. Age, gender, histopathological wall thickness of gallbladder, reporting rates of acute inflammation, cholesterolosis, polypoid lesions, epithelial hyperplasia, gastric or intestinal metaplasia, dysplasia and incidental cancer were investigated and compared between patients with and without cholesterolosis. Reported rates of histopathological findings were comparable between patients under and over 60 years old and patients with and without reported cholesterolosis. RESULTS: Reported histopathological findings were presented as acute inflammation in 46 (10.7%), cholesterolosis in 79 (18.4%), gallbladder polypoid lesions in 7 (1.6%), epithelial hyperplasia in 16 (3.7%), metaplasia of any type in 34 (7.9%) of 429 patients. Dysplasia was excluded whereas one incidental gallbladder carcinoma was reported. Epithelial hyperplasia and metaplasia were found to be related to age. Gallbladder wall thickness was decreased with cholesterolosis. However, only a correlation between cholesterolosis and gender or metaplasia was noted. CONCLUSION: Recent study suggests that cholesterolosis is somehow associated with metaplasia. Thus, surgeons should carefully interpret the histopathology reports based on unusual or exceptional findings corresponding to the cholecystectomy specimens. Any abnormal finding in the reports should be investigated in terms of the progress of the pathology and also its clinical consequences.

Management of fistula of ileal conduit in open abdomen by intra-condoit negative pressure system.

INTRODUCTION: We aimed to present the management of a patient with fistula of ileal conduit in open abdomen by intra-condoid negative pressure in conjunction with VAC Therapy and dynamic wound closure system (ABRA). PRESENTATION OF CASE: 65-Year old man with bladder cancer underwent radical cystectomy and ileal conduit operation. Fistula from uretero-ileostomy anastomosis and ileus occurred. The APACHE II score was 23, Mannheim peritoneal index score was 38 and Björck score was 3. The patient was referred to our clinic with ileus, open abdomen and fistula of ileal conduit. Patient was treated with intra-conduid negative pressure, abdominal VAC therapy and ABRA. DISCUSSION: Management of urine fistula like EAF in the OA may be extremely challenging. Especially three different treatment modalities of EAF are established in recent literature. They are isolation of the enteric effluent from OA, sealing of EAF with fibrin glue or skin flep and resection of intestine including EAF and re-anastomosis. None of these systems were convenient to our case, since urinary fistula was deeply situated in this patient with generalized peritonitis and ileus. CONCLUSION: Application of intra-conduid negative pressure in conjunction with VAC therapy and ABRA is life saving strategies to manage open abdomen with fistula of ileal conduit.

Malignant peritoneal mesothelioma: clinicopathological characteristics of two cases.

Introduction. Peritoneal mesothelioma is a rare tumor, presenting difficulties in diagnosis and treatment. Peritoneum is the second most common area of the mesothelioma after pleura, and even synchronous pleural and peritoneal mesotheliomas are observed in 30-45% of all cases. The diagnosis may be difficult due to lack of specific symptoms and clinical findings. In addition, a delay in the diagnosis is not rare especially in the absence of previous asbestos exposure. Here we report two cases of malignant peritoneal mesotheliomas. The diagnostic and therapeutic approaches for these rare neoplasms are discussed. Case Presentation. The cases were two men (one aged 54 years old and the other 40 years old). Prolonged abdominal pain and swelling were the primary presentation symptoms and findings. The mesotheliomas were developed in the right upper quadrant of abdomen in both of the cases. Both cases were treated with surgical resection. Final diagnosis were possible with histological and immunohistochemical documentation of tumor characteristics, which were consistent with dictating a mesothelial origin. No history of asbestos exposure was reported. Conclusion. Peritoneal mesotheliomas are rare clinical entities. However, patients with prolonged abdominal pain and abdominal masses should be considered to have atypical pathologies such as peritoneal mesotheliomas.