Onychogryphosis.

BACKGROUND: Onychogryphosis is a nail disorder that can damage nail plates, usually caused by repeated minor trauma to the foot. Onychogryphosis of the toe is commonly seen in clinical practice; however, optimal treatment of the condition is still the subject of debate. The purpose of this study was to evaluate clinical outcomes of patients with toe onychogryphosis treated by subcutaneous flap coverage after total matricectomy. METHODS: In this article, we describe 12 patients who had onychogryphosis on the great toe treated by subcutaneous flap coverage after total matricectomy. There were eight men and four women, with a mean age of 63.8 years (range, 56-74 years). RESULTS: The follow-up period ranged from 4 to 108 months, with an average of 25.2 months. All of the flap reconstructions ultimately survived. CONCLUSIONS: The advantage of the described technique is the avoidance of tight closure of the skin and preservation of toe length. The possible limitation of the technique is poor blood circulation to the feet.

Incarcerated Spigelian hernia: A rare cause of abdominal wall tender mass.

In this study, we aimed to present that incarcerated Spigelian hernia is an important cause of acute abdomen although it is rare and accounts for 1-2% of all abdominal wall hernias. Spigelian hernia arises from a defect in the aponeurosis of the transversus abdominis muscle, also known as the Spiegel fascia. This case analysis aims to present a Spigelian hernia case in which the sigmoid colon is incarcerated. The patient was referred to our emergency surgery clinic complaining of severe abdominal pain and a palpable mass in the left quadrant of the abdomen, presenting tenderness on the front abdominal wall. The symptoms suddenly emerged approximately eight hours ago before the patient was admitted to the hospital. The patient was taken into surgery after the ultrasonography (US) and computed tomography (CT) results suggested a preliminary diagnosis of incarcerated Spigelian hernia for which polypropylene mesh repair was performed. No recurrence was identified in the patient's control examination performed 22 months later. Incarcerated Speigel hernia should be considered as a cause for patients developing sudden stomach ache and mass, causing tenderness on the front abdominal wall for which mesh repair should be performed.

Single-site multiport combined splenectomy and cholecystectomy with conventional laparoscopic instruments: Case series and review of literature.

INTRODUCTION: Conventional laparoscopic procedures have been used for splenic diseases and concomitant gallbladder stones, frequently in patients with hereditary spherocytosis since 1990's. The aim of this study is to evaluate the feasibility of single-site surgery with conventional instruments in combined procedures. PRESENTATION OF CASE SERIES: Six consecutive patients who scheduled for combined cholecystectomy and splenectomy because of hereditary spherocytosis or autoimmune hemolytic anemia were included this study. Both procedures were performed via trans-umbilical single-site multiport approach using conventional instruments. All procedures completed successfully without conversion to open surgery or conventional laparoscopic surgery. An additional trocar was required for only one patient. The mean operation time was 190min (150-275min). The mean blood loss was 185ml (70-300ml). Median postoperative hospital stay was two days. No perioperative mortality or major complications occurred in our series. Recurrent anemia, hernia formation or wound infection was not observed during the follow-up period. DISCUSSION: Nowadays, publications are arising about laparoscopic or single site surgery for combined diseases. Surgery for combined diseases has some difficulties owing to the placement of organs and position of the patient during laparoscopic surgery. Single site laparoscopic surgery has been proposed to have better cosmetic outcome, less postoperative pain, greater patient satisfaction and faster recovery compared to standard laparoscopy. CONCLUSION: We consider that single-site multiport laparoscopic approach for combined splenectomy and cholecystectomy is a safe and feasible technique, after gaining enough experience on single site surgery.

Imaging of malignancy-suspected pancreatic involvement of extrapulmonary tuberculosis.

Extrapulmonary tuberculosis has a poor reputation because of its manifestations. Diagnostic delays or misdiagnosis negatively impact treatment. It has a low incidence and can easily mimic other noninfectious abdominal diseases, which are therefore necessary in the differential diagnosis. We report a 45-year old male presenting with obstructive jaundice, night fever, and abdominal pain and we describe the repeated interesting imaging findings. Imaging techniques revealed an irregularly bordered retroperitoneal mass. Extrapulmonary tuberculosis involvement was diagnosed after laparotomy biopsies. In the case of retroperitoneal mass on imaging techniques, we believe that intraabdominal tuberculosis should be included in the differential diagnosis, especially in endemic areas, in order to avoid unnecessary serious surgical procedures. In this case, we studied serial phase contrast dynamic magnetic resonance imaging of the pancreatic head mass; the complications of hepatic abscess and cholangitis that developed after surgery have never been reported concomitant with tuberculosis disease.