Introduction and importance Foreign body (FB) ingestion is a common challenge for pediatric health care providers globally. Although endoscopic approach for FB extraction is recommended, surgery remains life giving specifically in developing countries. We presented a novel surgical approach called ‘Gilan maneuver’ for removal of FB which lodged in duodenal loop. Case presentation An eighteen months old male infant referred to emergency department while he lied on his mother's arm. Parents stated their son has ingested a sharp metallic pointy thick needle which applies for cattle injection. On examination mid epigastric tenderness was remarkable. Laboratory finding was normal. Plain thoracoabdominal radiologic study confirmed the diagnosis. Patient underwent explorative laparotomy and the needle was removed through ‘Gilan maneuver’ in which mucosal unfolding of duodenal loop facilitated dislodgement of the FB and it was extracted on the jujenal side. Clinical discussion Duodenal lodge of sharp FB is rare and could be masked by gastric deposition diagnosis. Mucosal folding, narrow luminal diameter, retroperitoneal adherence, and hard surgical anatomy of the duodenal loop make both sharp and large FBs spontaneous dislodgement and favorable surgical outcome relatively unanticipated. Conclusion Despite rarity of duodenal deposition of FB it is possible and could be harmful due to adjacent unforgiving organs. Although endoscopic extraction of FB is generally recommended in guidelines, surgical approach is safe and could be considered.

Hospital‐acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross‐sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro–Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ2 and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD = 14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P < 0.001), and interns responsible for changing dressings (P = 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre‐ and postoperative antibiotic use. Gram‐positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase‐negative staphylococci. In addition, the most common Gram‐negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection‐associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.

Recurrent congenial diaphragmatic hernia (CDH) causes challenging conditions. In spite of several advantageous of laparoscopic surgery, this method is associated with the higher risk of recurrence. We described a three-month infant with a recurrent CDH following a successful laparoscopic repair. First, he did not have any specific symptoms and was at a high risk of misdiagnosis. He underwent an emergency surgery with proper surgical and anesthesia management. In order to achieve desired goals in CDH recurrence cases, an early diagnosis, urgent intervention, and a constant communication between the surgeon and the anesthesiologist are crucial. The parents should also be informed about the potential risks of recurrence after even a successful surgical repair.