Improved Biochemical Parameters in Patients Who Undergo Early Resection in Isolated Ileocaecal Crohn's Disease.

INTRODUCTION: The aim of this study is to evaluate the outcome of introduction of early surgery in the course of isolated ileocecal Crohn's disease, where there is no absolute indication of surgery. METHODS: Observational study involving patients with isolated ileocecal Crohn's disease who underwent early surgical resection (within one year of the presentation of the hospital). A complete blood count, ESR, and CRP were done and compared between the preoperative value, 1st postoperative visit (3-4 weeks), and last follow-up visit. Statistical analysis was done using Analysis of Variance (ANOVA) to compare the different figures. RESULTS: There was a statistically significant increase in the hemoglobin levels between preoperative, postoperative, and long-term follow-up and a significant decrease in leukocyte count between the pre- and postoperative values (F = 19.8, p < 0.001 and F = 8.9, p = 0.002, resp.). Similarly, the ESR and CRP values were decreased significantly at long-term follow-up (F = 8.5, p = 0.019 and F = 8.3, p = 0.013, resp.). CONCLUSION: Early surgical resection in isolated ileocaecal Crohn's disease achieved significant biochemical improvements. These successful results in this small number of patients indicate that early surgical intervention may provide better outcomes. These initial results encourage larger and comparative studies of long-term results versus long-term use of biological agents.

Actinomycosis presenting as an anterior abdominal mass after laparoscopic cholecystectomy.

Abdominal actinomycosis is a rare disease caused by different anaerobic Actinomyces species. We report the case of a 55-year-old woman who presented with a painless, slow growing, left upper abdominal mass that developed after a laparoscopic cholecystectomy. A CT scan and MRI of the abdomen revealed a desmoid tumour of the left rectus abdominis muscle.Surgical excision was performed with an uneventful postoperative course. The histological analysis of the specimen was inconsistent with a desmoid tumour and revealed an infection of Actinomyces israelii in the anterior abdominal wall that was confirmed with a microbiology culture. The surgical treatment was followed by a course of penicillin antibiotic therapy for 6 months. This treatment resulted in full recovery with no further complications. Although it is rare, the patient's history of laparoscopic cholecystectomy was identified as the likely source of infection.

Extraperitoneal abscess originating from an ischorectal abscess.

We describe a case which had ongoing sepsis, despite adequate incision and drainage performed for an ischorectal abscess. The patient was then noted to have an ascending infection reaching the extraperitoneal space of the abdominal cavity. The case reported required multiple episodes of drainage along with lower midline incision for deep-situated abscess. Postoperatively, the abdominal wound was treated with vacuum-assisted closure dressing and antibiotics. The patient was doing well and was discharged with an appointment at the surgical outpatient department. The report signifies the importance of investigating patients who have systemic inflammatory response syndrome despite treating local abscess.

Tibialis anterior muscle hernia: rare but not uncommon.

Muscular hernias in the lower limb are a rare entity that have seldom been described in the literature, to the extent that the seminal paper on the subject remains a case series from 1929. Here, we present a case of tibialis anterior muscle hernia and discuss the aetiology behind the same. Furthermore, we attempt to amalgamate existing knowledge to provide some guidance for investigation and management of this important diagnostic consideration.