Adult intussusception is an unusual and challenging condition that represents a preoperative diagnostic difficulty. We think that colonic intussusceptions should be resected in an en-bloc manner without reduction due to the risk of perforation and spillage of micro-organisms and malignant cells, whereas cases of small intestinal intussusception can be reduced without complications unless there is strangulation.

Background: Retrorectal cyst are rare lesions. Their clinical presentation is nonspecific, thus hampering their detection and frequently leading to misdiagnosis. According to their origin and histopathologic features, rectorectal cysts are classified as epidermoid, dermoid, enteric (tailgut cysts and cystic rectal duplication), and neurenteric cysts. Here we present the clinical, radiological and surgical findings in a case with a retrorectal dermoid cyst. Case Report: A 47-year-old male patient presented with rectal fullness and pain. MRI and CT studies revealed a noncalcified, unilocular, cystic mass lesion with well-defined borders. On MRI, self-contained fat spheres were detected inside the cyst. The cyst was excised completely by laparotomy. Pathological assessment revealed a dermoid cyst. The patient’s postoperative period was uneventful, and there was no recurrence during a 2-year follow-up. Conclusion: Complete surgical excision is indicated to establish the diagnosis and avoid complications of retrorectal cysts.

Background: Situs inversus totalis (SIT) is a rare condition with an autosomal recessive genetic predisposition. In abdominal surgery this condition can be associated with substantial difficulties. Here we report diagnostic pitfalls and technical details of two patients with SIT and bile stone diseases who were treated by endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and laparoscopic cholecystectomy (LC). Patients and Methods: The patients were evaluated according to age, symptom as well as radiological, ERCP and surgical findings. Results: One of the patient is 41-yearold woman with known SIT having previous laparoscopy for infertility. Her abdominal ultrasound showed microlithiasis in the left sided gallbladder, and laboratory findings were within normal limits. The second patient was 37-year-old man with signs and symptoms of cholangitis. He had an icterus. Abdominal ultrasound, magnetic resonance cholangiopancreatography and ERCP investigations showed microlithiasis in the gallbladder and also a dilatation of the biliary ducts. Sphincterotomy and extraction of the stones were done. In both patients LC was successfully performed. Conclusion: Although it is time-consuming and difficult to demonstrate mirror image anatomy, minimal invasive treatment by ERCP, sphincterotomy and LC can be safely and effectively applied in patients with SIT suffering from bile stone disease, and iatrogenic injuries can be reliably prevented.

BackgroundFamilial Mediterranean Fever (FMF) is the most common periodic fever syndrome, characterized by recurrent fever and serositis attacks. It has been shown that there might be an ongoing subclinical inflammation between attacks. Adrenomedullin (ADM) is synthesized in endothelium, and has been shown to have high levels in patients with inflammation such as FMF. Colchicine is the treatment of choice and given once or twice daily depending on expert opinion.ObjectivesIn this study, it was aimed to investigate ADM as a marker for inflammation in pediatric patients with FMF who are using colchicine in different dosage schemaMethodsPediatric patients with FMF diagnosed clinically and genetically confirmed were included in the study. The colchicine was started in one or two doses randomly. The clinical and laboratory parameters were assessed on six clinical visits made every two months. After the third visit the dosing schema was changed to twice or once depending on the schema at the beginning.ResultsA total of 37 patients (female/male ratio: 0.94) were included in the study. Mean age of patients, age at disease onset, and age at diagnosis were 7.78±2.00, 5.05±3.04, and 7.51±2.66 years, respectively. Twenty patients received colchicine in once daily dosage while 17 patients had in twice-daily dosage at the beginning of the study. There were 10 patients with heterozygote and 27 with homozygote MEFV mutations. After the treatment was started all patients demonstrated improvement in clinical and laboratory findings such as erythrocyte sedimentation rate and C-reactive protein. However, ADM levels did not show any correlation with ESR and CRP levels. Mean ADM levels in six consecutive visits were as follows, first 322.19±161.92 ng/L; second 330.50±189.63 ng/L; third 339.54±168.03 ng/L; forth 378.11±177.63 ng/L; fifth 328.91±172.30 ng/L and sixth 326.25±165.87 ng/L. ADM levels were similar in all visits (p=0.954) and did not show any difference between the first and second three visits i.e. before and after changing the dosage schema (p=0.593).ConclusionsThe results indicated that patients using colchicine in once or twice daily doses did not show any significant difference according to the clinical and laboratory findings and had similar effects in controlling disease manifestations. ADM levels did not demonstrate any alterations in all visits that may suggest the continuation of subclinical inflammation in these patients.Disclosure of InterestNone declared