Perianal abscess and fistula are 2 distinct entities that share a common pathology. A horseshoe fistulous abscess, a complex type of these conditions, occurs when the suppurative inflammation spreads through the deep anal space to the bilateral ischiorectal fossae. Following the intersphincteric plane, this infection may extend to the pararectal space, forming a supralevator abscess. We present a very rare case involving a 52-year-old male patient who was admitted to our surgical department with an extraperitoneal purulent inflammation as a complication following multiple drainage procedures for a posterior horseshoe abscess. Emphasis is given to the anatomical and technical considerations of eradication of anorectal sepsis and the management of complex fistula-in-ano along with a concise review of the literature.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. They constitute a distinct group of mesenchymal tumors, presenting different histological aspects in comparison to other types, such as tumors of neural origin (schwannoma and paraganglioma), smooth muscle cell origin (leiomyoma and leiomyosarcoma), fibroblastic tumors, and vascular tumors (angiosarcoma), among others. Gastrointestinal autonomic nerve tumors (GANTs) are rare tumors, probably developing from the myenteric plexus of Auerbach. They are considered as a subgroup of GISTs with specific ultrastructural appearance. Although cytological, immunohistochemical, and ultrastructural characteristics of GIST and GANT appear to be relatively heterogeneous, similarities in pathology may complicate the diagnosis (1).

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Background Central pancreatectomy (CP), a partial resection of the pancreas, is indicated for the excision of neuroendocrine tumors (NETs) of the pancreas, when located at the neck or the proximal body. Specifically, CP is preferable in functional NET and in nonfunctional sized 1 to 2 cm or/with proliferation marker Ki67 < 20% (Grade I/II). Postoperative leakage from the remaining pancreas constitutes the most frequent complication of CP (up to 63%). The aim of our study was to share the experience of our center in CP for NET, with pancreaticojejunal anastomosis. Methods In 1 year, we performed CP in two patients, following the aforementioned criteria. They presented with tumor of the body of the pancreas, which was found in random check with computed tomography, with negative hormonal blood tests and they underwent magnetic resonance imaging and endoscopic ultrasound/fine-needle biopsy/pathological examination. Results The patients underwent CP with Roux-en-Y pancreaticojejunal anastomosis of the distal pancreatic stump and jejunal patch of the proximal pancreatic stump. Histological exam revealed NET sized 2.8 cm and 1.45 cm, Grade I and II, respectively. Postoperatively both patients developed small pancreatic leakage, which did not affect their physical condition and stopped after 20 and 30 days. No one needed pancreatic enzymes supplements or developed new-onset diabetes mellitus. Conclusion CP provided adequate, functional remaining pancreatic tissue in both patients. Small leakages were treated conservatively and retreated without septic complications. As a result, CP might be considered as safe and effective technique for pancreatic neck/proximal body NET.

HighlightsAccessory right hepatic duct, that merged to the common bile duct.The accessory right hepatic duct drains the posterior segments of the right hepatic lobe.A detailed mapping of the bile tree is essential especially before major procedures.