Volvulus of transverse colon is a rare cause of large bowel obstruction. Diagnosis can be challenging and the effective management remains controversial. We report a case of volvulus of the transverse colon in a 76-year-old woman. The literature regarding diagnosis and treatment of such pathology was also reviewed.

Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis.

c A S E R E P O R t SAn enteric fistula that occurs in an open abdomen is called an enteroatmospheric fistula (EAF) and is the most challenging complication for a surgical team to deal with. The treatment of EAF requires a multidisciplinary approach. First of all, sepsis has to be managed. Any fluid, electrolyte and metabolic disorders need to be corrected. Oral intake must be stopped and total parenteral nutrition introduced. The control and drainage of the effluent from the fistula is a separate issue. Since there are no fixed algorithms for the treatment of EAF, surgeons need to develop their own, often highly unconventional solutions. We present the case of a 24-year-old man who developed enteroatmospheric fistula after laparotomy and relaparotomy due to acute necrotic pancreatitis. Both the laparostomy and the fistula were successfully managed using modified negative pressure wound therapy. The literature regarding this issue was also reviewed.

Abstract-Surgical site infection (SSI) makes patient care more expensive by prolonging antibiotic usage and hospital stay. Negative pressure wound therapy (NPWT) has been recently reported as a preventive strategy to avoid SSI. We present a simple and low-cost vacuum dressing that may improve surgical wound healing and prevent high-risk wounds from complications.

IntroductionDuring laparoscopy, the monitor is usually placed near the operating table, at eye level, which significantly affects hand-eye coordination. First, it is impossible for the surgeon to simultaneously observe the operative field and hand movement. Second, the axis of view of the endoscope rarely matches the natural axis of the surgeon's sight: it resembles a direct view into the operative field. Finally, as the arms of the tools act as levers with a fulcrum at the site of the skin incision, the action of the tool handles is a mirror image of the movement of the tool tips seen on the monitor. Studies have shown that a neutral position with the head flexed at 15–45° is the most ergonomically suitable.AimTo evaluate whether the level of monitor placement exerts an influence on laparoscopic performance.Material and methodsA group of 52 students of medicine were asked to pass a thread through 9 holes of different sizes, placed at different levels and angles, using a self-made laparoscopic simulator. Each student performed the task four times in two monitor positions: at eye level, and placed on a simulator. The order of monitor placement was randomized.ResultsThe task was performed more quickly when the monitor was placed on the simulator and the sight was forced downwards. Lower placement was also found to be more beneficial for students with experience in laparoscopy.ConclusionsNew technologies which place the display on the patient, thus improving the ergonomics of the operation, should be developed.