Traditional surgical treatment of widespread purulent peritonitis has some disadvantages that emphasizes the need for new approaches to postoperative care. The authors present successful treatment of diffuse purulent peritonitis using a combination of \'open abdomen\' technology and VAC therapy. This approach reduces abdominal inflammation and intra-abdominal pressure. Combination of \'open abdomen\' technology and VAC therapy provides effective control of inflammation and stabilization of patients with purulent peritonitis.
Широко используемый традиционный метод хирургического лечения пациентов с распространенным гнойным перитонитом имеет ряд значительных недостатков, что подчеркивает необходимость внедрения новых подходов к послеоперационному уходу. В статье представлено описание клинического случая, наглядно демонстрирующего успешное лечение разлитого гнойного перитонита с помощью комплексного метода, объединяющего технологию «открытый живот» и VAC-терапию. Этот подход способствует устойчивому снижению воспалительных процессов в брюшной полости и улучшению показателей внутрибрюшного давления. Комбинация метода «открытый живот» и VAC-терапии обеспечивает эффективное управление воспалением и стабилизацию пациентов с гнойным перитонитом.

UNASSIGNED: Primary pancreatic hydatid cysts are exceptionally rare as they have an incidence rate ranging from 0.14 % to 2 %. Due to their extreme rarity, the patient\'s clinical manifestations are nonspecific. This leads to misdiagnosis and delay in treatment. Therefore, a multidisciplinary approach is necessary for the proper treatment of this pathology.
METHODS: Herewith, we present the rare case of a 46-year-old Middle Eastern female who sought medical attention at our surgical clinic complaining of an acute on-top-of chronic epigastric pain that radiated to the back. It was associated with a reported dark and pale discoloration of the urine and stool, respectively. The preoperative investigative radiological analysis identified a primary pancreatic body mass formation.
UNASSIGNED: A meticulous surgical resection of the pancreatic body, tail, and the spleen was performed. Subsequent histopathological analysis of the excised specimens decisively established the diagnosis of a primary pancreatic body hydatid cyst.
CONCLUSIONS: Primary pancreatic hydatid cysts are profoundly rare, and their occurrence in the pancreatic body is even rarer. The profound scarcity of published literature on primary pancreatic body hydatid cysts highlights the imperative need for documentation, epidemiological studies, and the development of crucial interventional protocols. After a meticulous review of the published literature, we deduced that ours is the third documented case from our country of a primary pancreatic body hydatid cyst. Furthermore, no other cases beyond these three have been published from our country involving primary pancreatic hydatid cysts.

UNASSIGNED: Thoracoabdominal duplication and intestinal malrotation are extremely rare congenital alimentary tract anomalies that can manifest in any segment of the gastrointestinal tract. Still, tubular duplications are an even rarer subset of alimentary tract duplications. Misdiagnosis could occur and this will yield devastating ramifications. Therefore, consideration in the clinical settings is warranted to aid in conducting timely therapeutic interventions.
UNASSIGNED: In this article, we illustrate the overwhelmingly rare occurrence of thoracoabdominal duplication coexistent with intestinal malrotation in a 7-month-old male whose primary complaint was chronic dyspnoea since birth that progressed to involve cough and fever. Imaging analysis revealed a significant intrathoracic fluid-filled cyst.
UNASSIGNED: The intestinal malrotation was treated through Ladd\'s procedure, and surgical excision of the duplicated segments was accomplished. The subsequent analysis of the resected specimens via means of histopathology utilizing Hematoxylin and Eosin dyes established the definitive diagnosis of a foregut duplication cyst.
UNASSIGNED: Thoracoabdominal duplication is one of the most crucial topics in the field of Paediatric Surgery. It is exceptionally rare in occurrence, and the scarcity of available resources that document and describe this topic is evident in the published literature. The authors must opt to document, study, and broaden awareness regarding this life-threatening pathology so that they can circumvent the resultant complications by means of early detection and the performance of apt surgical interventions. Upon careful review of the available literature, we can state that ours is the first-ever case documented from their country regarding this topic and this co-incidence.

UNASSIGNED: Angiosarcomas are an exceedingly rare and malignant form of soft tissue sarcoma that are derived from endothelial cells. Overall, they comprise <1 % of the total number of soft tissue sarcomas. Due to nonspecific and misleading symptoms, the subsequent clinical presentations can easily result in misdiagnosis. This leads to life-threatening complications for patients. Contemplating this tumor as a differential diagnosis during the preoperative phase allows for essential time-sensitive therapeutic interventions to be accomplished.
METHODS: Herein, we present the seldom precedented case of a 66-year-old Middle Eastern male who came to our surgical clinic chiefly complaining of an exacerbation of chronic left hypochondriac pain accompanied by gradual inexplicable abdominal distention. Our diagnostic radiological evaluation demonstrated two isolated abdominal mass formations.
UNASSIGNED: Sheer excision of the neoplastic masses with safety margins was successfully executed via open surgery. The stemming histopathological examination through Hematoxylin and Eosin and immunohistochemical staining established the definitive diagnosis of an Epithelioid Angiosarcoma.
CONCLUSIONS: Epithelioid Angiosarcomas belong to the category of profoundly rare tumors. The available published literature conveys this rarity through the scarcity of epidemiological parameters and studies. It necessitates being borne in mind when facing similar clinical scenarios so that apt therapeutic interventions can be achieved. Structured diagnostic methods, timely surgical interventions and proper techniques, and comprehensive follow-up patient surveillance protocols are, therefore, merited. After thorough review of the published literature, we reckon herewith that ours is the first documented case from our country of an Epithelioid Angiosarcoma.

A minimally invasive partial pancreatectomy was performed through a novel laparoscopic lateral flank approach in sternal-oblique recumbency in four clinical cases presented with an insulinoma. All four cases were female castrated dogs of older age (range 7-9 years) and different breeds (Wire haired dachshund, German shepherd, Jack Russel terrier, and Boxer), and all presented with episodic weakness, tremors, and/or seizures. The diagnosis was based on plasma glucose level below reference range with concomitant increased or normal insulin level. A laparoscopic approach was considered based on triple-phase contrast-enhanced computed tomography findings of the abdomen, revealing a pancreatic mass situated in the right pancreatic limb or left pancreatic limb without suspicion of metastasis. Laparoscopic procedures were performed without any major complications, and peri-operative glycemia increased to (supra-)normal levels in all cases. Histopathologic reports qualified the masses as neuroendocrine carcinomas, and in conjunction with the clinical picture, this neoplasia was further defined as insulinoma. Post-operative care in an intensive care unit was of short duration, and all animals were discharged being clinically normal and normoglycemic in between 1.5 and 2.5-day post-surgery. At short-term follow-up, no dogs showed clinical abnormalities, all recovered well from the surgical procedure, and blood glucose levels remained in the normal range. During long-term follow-up, 2 cases remained clinically normal at the time of writing, 564 and 1,211 days after surgery, 1 dog had recurrence of hypoglycemic episodes after 246 days and was euthanized after 673 days of surgery due to progressing disease, and 1 dog was euthanized after 1,028 days of surgery due to reasons unrelated to the insulinoma. Survival times ranged from 599 to 1,232 days after diagnosis. Considering the highly metastatic nature and difficulty of full laparoscopic staging of insulinoma patients, thorough pre-operative disease staging is warranted when considering a laparoscopic approach. This case series shows the feasibility of a novel laparoscopic flank approach for right and left partial pancreatectomy in dogs. Furthermore, proper case selection resulted in favorable outcome in these insulinoma patients.

UNASSIGNED: A primary congenital splenic epidermoid cyst is an immensely rare pathology with mostly unknown epidemiological parameters. Misdiagnosis can easily happen and this results in life-threatening ramifications for patients. Considering this pathology as a potential differential diagnosis allows for the required surgical intervention to be timely accomplished. In this case, the authors are documenting this pathology and presenting how it was successfully managed via proper and informed preoperative analysis and meticulous intraoperative technique.
UNASSIGNED: Hereby, we portray the exceptionally rare case of a 7-year-old male who presented to our surgical clinic complaining of a sudden left hypochondriac pain with early satiety for 1 month\'s duration. The preoperative radiological assessment displayed numerous splenic cystic lesions throughout the splenic parenchyma.
UNASSIGNED: Resection of the cysts was accomplished via total splenectomy. The ensuing histopathological analysis via Hematoxylin and Eosin of the resected specimens established the diagnosis of a congested hemorrhagic spleen with multiple primary congenital splenic epidermoid cysts.
UNASSIGNED: Primary congenital splenic epidermoid cysts are an extremely rare type of splenic pathology. There is profound scarcity amidst the published literature regarding it. This merits in-depth study and apt documentation to raise awareness regarding this pathology as a potential differential diagnosis in cases of abdominal pain. Documentation allows us to set up proper and innovative clinical and surgical protocols for these patients. Based on our conclusive review of the published literature, the authors conclude that ours is the first ever documented case from our country of a primary congenital splenic epidermoid cyst.

Hydronephrosis occurs when the tubes connecting the kidneys and bladder become blocked. These tubes carry urine from the kidneys, where it is created, to the bladder, where it is stored until elimination. When one or both ureters get blocked, serious complications and symptoms might arise. These symptoms include urinary tract obstruction, urine backflow, kidney distension, increased intra-renal pressure, impaired kidney function, infection risk, urinary incontinence, which is the involuntary loss of urine, and discomfort in the side, abdomen, or groin. This case report describes the effective postoperative management of abdominal surgery with virtual reality therapy (VRT) combined with standard medical care as additional therapy and physical therapy for hydronephrosis in a 22-year-old male patient. After undergoing laparoscopic open pyeloplasty, the patient developed right-sided hydronephrosis due to ureteral stenosis. He had a ureteral stent inserted and received physical therapy, including pelvic floor muscle training, core strengthening, and diaphragmatic breathing exercises. After four weeks of physical therapy, the patient reported improvement in his symptoms, including reduced discomfort and increased urination. These findings imply that physical therapy, in addition to advanced treatment with the help of VRT for hydronephrosis following abdominal surgery, might be beneficial.

Persistent hiccups that occur after abdominal surgery seriously affect postoperative rehabilitation. Phrenic nerve block therapy has been recommended after failure of medication or physical maneuvers. However, the phrenic nerve is often difficult to accurately identify because of its small diameter and anatomic variations. We combined ultrasound with the use of a nerve stimulator to quickly and accurately identify and block the phrenic nerve in a patient with postoperative persistent hiccups. The ongoing hiccups were immediately terminated with no adverse effects. The patient reported no recurrence during the 2-week follow-up period. We conclude that the combined use of real-time ultrasound guidance and a nerve stimulator for singular phrenic nerve block might be an effective intervention for terminating postoperative persistent hiccups, although further studies are needed to evaluate the safety and efficacy of this technique. The findings in this case suggest a potential clinical application for this technique in managing persistent hiccups, thereby contributing to improved patient care and outcomes.

BACKGROUND: Retained foreign bodies have become very rare in countries where the safety rules in the operating theater are very rigorous and follow precise guidelines. Maintaining awareness of this issue among surgeons and radiologists is of paramount importance to minimize avoidable morbidity and facilitate the selection of the most suitable therapeutic strategy. This consideration is particularly relevant in the differential diagnosis of hydatid cysts. This study describes a case of intra-abdominal gossypiboma, which mimicked hydatid cyst on preoperative assessment.
METHODS: We report the case of a 63-year-old female who was referred to our department for the management of a hepatic hydatid cyst. She has history of open cholecystectomy and oophorocystectomy. During the intervention, we discovered a 10 cm mass located in the interhepatogastric region. Complete resection of the mass was performed, and pathology results were compatible with a piece of gauze surrounded by reactive changes (gossypiboma).
CONCLUSIONS: Gossypiboma is undeniably a source of concern for surgeons. It\'s a genuine and serious surgical complication which can potentially arise from any type of surgery and may manifest with diverse complaints. However, it is crucial to emphasize that this complication is preventable with the primary preventive measure being meticulous counting of surgical materials during the procedure.
CONCLUSIONS: The potential embarrassment experienced by the surgeon and the significant legal consequences associated with this iatrogenic complication are substantial. Hence, it becomes imperative to adopt all requisite preventive measures to avert such incidents, as there is no excuse that can justify their occurrence.

UNASSIGNED: Retroperitoneal neoplasia comprise less than 2% of all tumours. benign primary retroperitoneal mucinous cystadenoma (PRMC) is an extremely rare tumour. Their clinical course is overall silent unless the patient presents with a vague abdominal or pelvic pain, abdominal distention, or a palpable mass. Their aetiology remains theorized and since 1989, only 46 cases (excluding ours) worldwide were documented in the literature. The majority of cases were discovered in females but the overall tumour incidence rate is still undetermined due to its rarity. Well-timed recognition of this pathology permits the necessary curative surgical intervention to take place.
UNASSIGNED: We hereby illustrate the rare case of a 23-year-old female who presented to the surgical clinic complaining solely of an unexplained gradual increase of the abdominal contour. Their presurgical radiological analysis yielded an intraabdominal large-sized well-demarcated retroperitoneal mass.
UNASSIGNED: Thorough resection of the mass was accomplished via open surgery. The subsequent microscopic analysis of excised tumour yielded the diagnosis of primary retroperitoneal mucinous cystadenoma of benign nature.
UNASSIGNED: Primary retroperitoneal mucinous cystadenoma is a seldom seen tumour. The scarcity of its occurrence is further highlighted by the published data. Based on their conclusive review of the available published English-based literature, ours is the 47th documented case of a benign PRMC and it is the first documented case from our country; Syria. The impact of these findings warrants raising awareness on the subject and considering PRMC as a differential diagnosis when presented with a similar case in the clinical practice.