BackgroundLaparoscopic cholecystectomy is one of the most frequently performed surgical interventions nowadays in developed countries. While lost gallstones during the procedure represent a commonly encountered issue, there is an ongoing debate whether split gallstones imperatively need to be extracted during the same procedure. The reported case of a wall abscess several years after follow-up lights up this debate.Case presentationA 75-year-old male Caucasian with a history of rheumatoid arthritis and congestive heart failure presented with a recurrent subcutaneous abdominal wall abscess with occasional, spontaneous drainage of pus. He underwent laparoscopic cholecystectomy for acute calculous cholecystitis 3 years ago with uneventful and prompt recovery. A computed tomography scan showed a cavity in the periumbilical abdominal wall with peripheral contrast-enhancing, next to a calcified foreign body between the rectus muscle sheets. Wound exploration under general anaesthesia was performed with drainage of the cavity, extraction of the foreign body and closure of the anterior rectus sheet over a drainage catheter. The foreign body turned out to be a gallstone lost in the periumbilical port site during the procedure. Antibiotic treatment with co-amoxiclav was continued for 14 days. The patient was discharged 9 days postoperatively with a clean wound.ConclusionThis case and short review of the literature is a reminder of the importance of careful extraction of split gallstones during cholecystectomy in order to avoid early or late complications. This is especially important in the light of one of the most commonly performed surgical procedures in developed countries with generally low morbidity.

Unusual clinical course Background:The incidence of neuroendocrine tumors (NETs) has increased in recent years. They can affect every area of the human body that presents cells with a secretory function. In this report, we focus on gastrointestinal NETs. The small bowel (SI) is the most affected area and SI-NETs have recently become more common than adenocarcinomas. Inside the small intestine, the appendix suffers from this pathology more than other organs. Case Report:Our case report deals with a 70 years-old man with extensive abdominal pain due to ingestion of an apricot kernel. A CT abdominal scan showed, around the kernel, a mechanical ileus with inflammation of the distal ileum and thickening of the intestinal wall. During the operation, we replaced laparoscopy with mini-laparotomy, performing an ileocecectomy due to suspicion of a tumor lesion. The histopathological exam revealed a welldifferentiated neuroendocrine tumor (NET G1) of the distal ileum. Conclusions:This case report shows that SI-NETs can be found in cases of small bowel occlusion. Depending on the size and distinction, such patients can have good survival rates.

Background: Chronic post-lobectomy empyema is rare but may require space obliteration for infection contrai.We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection contrai and functional outcome. Patients and Methods:We retrospectively analysed 17 patients ( 11 men, 6 women) with chronic post-lobectomy empyema and treated by thoracomyoplasty in our institution between 2000 and 2011. Ali patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). In 5 patients, branchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior -rhomboid myoplasty which also served to close a broncho-pleural fistula, ifpresent. The first rib was resected in 11/17 patients. Resu!ts:The 90-day mortality was 11.7%. Thoracomyoplasty was successful in ail surviving patients with respect to infection contrai, space obliteration and definitive closure of broncho-pleural fistula, irrespective of the type of infection, the presence of a broncho-pleural fistula and whether a 1 ' 1 rib resection was performed .Post-lobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEY l of 63.0±8.5% and 51.5±4.2% (p=0.01), and a mean predicted DLCO of59.8±11.6% and 54.5±12.5%, respectively.Postoperative shoulder girdle dysfunction and scoliosis were prevented in patients willing to undergo intense physiotherapy. Conclusions AbstractBackground: Chronic post-lobectomy empyema is rare but may require space obliteration for infection contrai.We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection contrai and functional outcome. Patients and Methods:We retrospectively analysed 17 patients (11 men, 6 women) with chronic post-lobectomy empyema and treated by thoracomyoplasty in our institution between 2000 and 2011. Ali patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). ln 5 patients, branchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior -rhomboid myoplasty which also served to close a broncho-pleural fistula, ifpresent. The first rib was resected in 11/17 patients. Results:The 90-day mortality was 11.7%. Thoracomyoplasty was successful in ail surviving patients with respect to infection contrai, space obliteration and definitive closure of broncho-pleural fistula, irrespective of the type of infection, the presence of a broncho-pleural fistula and whether a 1 ' 1 rib resection was performed .Post-lobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEVI of 63.0±8.5% and 51.5±4.2% (p=0.01), and a mean predicted DLCO of59.8±11.6% and 54.5±12.5%, respectively.Postoperative shoulder girdle dysfunction and scolios...

Disclosure 19The authors have no conflict of interest to disclose. 20Written patient consent was obtained. 21 Funding 22No funding was received 23 24 M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Abstract 25A 61-year-old man received a living-donor kidney graft for an end-stage renal 26 disease. In the postoperative course the patient was oliguric and needed dialysis. 27The postoperative Doppler showed a normal peak systolic velocity and maintained 28 parenchymal perfusion associated with a parvus tardus signal. The patient was 29 operated and a kinked renal artery was found. To reposition the artery, the distal iliac 30 artery was clamped, sectioned, shortened and re-anastomosed after a 90° axial 31 rotation. This innovative technic allowed restoration of a normal flow in the 32 parenchyma and avoided an additional clamping, cooling, ischemia and re-33 anastomosis/reperfusion of the graft. Postoperative diuresis immediately raised >100 34 ml/h and creatinine durably returned to normal values. 35 36 Main text 37Introduction 38

Perforated diverticulitis is a rare but serious complication associated with a significant mortality rate. Although many cases of conservative treatment have been reported, surgery remains the mainstay for perforated duodenal diverticulitis.We report a rare case of a 55-year-old female who presented with epigastric pain without fever. Computed tomography revealed a 3 cm perforated duodenal diverticulum of the D2 part of the duodenum with a localized abscess. After the failure of conservative treatment, we performed a deriving intestinal patch completed by cholecystectomy and biliary decompression via a transcystic drain, as well as feeding jejunostomy. The patient was discharged on day 32. Removal of the transcystic drainage at eight weeks postoperatively was complicated by the appearance of an iatrogenic bilioperitoneum, which was effectively treated with percutaneous drainage. Surgery remains challenging; our experience suggests that perforation covering with a deriving jejunal patch offers an alternative to direct beach suturing when the latter is deemed precarious. Part of the treatment success lies in local drainage and duodenal exclusion that can be achieved by various surgical approaches.