BackgroundEncapsulating Peritoneal Sclerosis (EPS) describes a variety of diseases that are frequently confused with different names and different etiopathogeneses. The aim of this article is to report personal experience of focusing on correct classification and the status of current diagnosis and treatment.MethodsA retrospective analysis was performed. Age, sex, ethnic origin, past medical history, symptoms and their duration, radiological tools and signs, laboratory tests, preoperative diagnosis, surgical approach, intraoperative findings, pathological findings, hospital stay, morbidity and mortality were studied.ResultsA total of seven patients, including six males and one female, aged from 24 to 72 years were observed. Four patients had recurrent abdominal colic pain for 3 months, 1, 2 and 9 years; two patients also reported recurrent attacks but without any specification of the duration. All seven patients presented at the emergency department with abdominal pain that was mainly diffused over the entire abdomen. Six patients were submitted to a CT scan. Only in two patients was the diagnosis of EPS made preoperatively. All seven patients were submitted to open surgery. The hospital stay was between 4 and 60 days. One patient had morbidity, and one patient died of MOF.ConclusionsCurrently, the correct identification of EPS is more easily possible than in the past, but the diagnosis is still a challenge. Surgery must be performed as soon as possible to avoid a poorer quality of life.

BackgroundAnal metastases from lung cancer are infrequent, and there are only 10 published cases. Life expectancy is no longer than 1 year after diagnosis because of the typically advanced stage of disease. Treatment, which is typically inefficient, is administered with the intent to cure or avoid local complications.Case presentationWe report a case of a patient with non-small cell lung cancer presenting with perianal metastasis mimicking an abscess.ConclusionsBecause perianal masses may be misdiagnosed, patients with lung and other cancers should be evaluated for metastatic disease.

Introduction: Of the common complications of gallstones, acute cholangitis (AC) is the most rapidly lethal entity, making accurate diagnosis and early treatment imperative. Studies that report on the risk factors for the development of AC secondary to bile duct stones are rare. The aim of the present study is to identify clinical, laboratory and radiological factors that can predict which patients may develop cholangitis. Patients and methods: The study is a retrospective case–control study based on patients admitted to Hamad General Hospital from June 2008 to November 2012 with a diagnosis of AC secondary to CBD stones. The control subjects were patients admitted during the same period with obstructive lithiasic jaundice, but not complicated by cholangitis. Countries of origin, age, sex, history of diabetes mellitus, hypertension, chronic liver disease, previous similar attack, previous cholecystectomy, previous bariatric surgery procedure, small bowel resection, significant weight loss and Crohn's disease were studied. Also, complete blood count (CBC), prothrombin time (PT), liver enzymes (ALT and AST), bilirubin, alkaline phosphatase, albumin, amylase creatinine and blood urea nitrogen (BUN) were studied. Finally the diagnostic investigations and the surgical and endoscopic procedures have been reported. Statistical analysis was performed. Results: A total of 112 patients of 24 different nationalities (70 men and 42 women) were included in this study. Fifty-three patients (43.4%) presented with AC (cases group), and 59 (56.6%) were admitted for management of obstructive jaundice. Although Asians had a greater prevalence of cholangitis (57.4%) compared to Middle Easterners (35.7%) and Africans (33.3%), this was not statistically significant (P = 0.066). Laboratory tests significantly correlated to AC were leukocytosis (P < 0.001), elevated Bilirubin (P = 0.005), prolonged prothrombin time (P = 0.001), elevated INR (P = 0.001), elevated serum Creatinine (P = 0.001) and BUN (P = 0.001). In univariate analysis, the logistic regression model showed that dark urine, fever, elevated WBC and BUN were strongly associated with cholangitis. Conclusions: Typical clinical signs of acute cholangitis, history of chronic liver disease, together with certain biochemical criteria are strongly associated with occurrence of acute lithiasic cholangitis. Further study on a larger sample of patients is required to confirm these findings and as an attempt to create a reproducible and simple scoring system able to predict and consequently facilitate early intervention in such cases. Highlights:

BackgroundIntraoperative cholangiography (IOC) may detect residual stones in the common bile duct (CBD) after acute biliary pancreatitis (ABP). The aim of the present study is to analyze the utility of IOC in detecting residual stones in patients undergoing cholecystectomy for ABP and if complications are related with this procedure.MethodsDemographic and clinical factors were assessed in patients with mild ABP who underwent IOC during laparoscopic cholecystectomy. Factors assessed included preoperative size of the CBD on ultrasonography, presence of stones in the gallbladder and the CBD, and IOC results. For the statistical analysis, χ 2 or Fisher’s exact tests to compare proportions and the nonparametric Mann–Whitney U test for analysis of values with abnormal distribution were used.ResultsThe study included 113 patients, 82 males (72.6%) and 31 females (27.4%), of mean age 46.9 ± 14.7 years (range 18–86 years). All preoperative laboratory indicators were elevated. The group of the patients with stones in the CBD diagnosed by IOC was divided in patients with diameters <0.8 mm and with diameters ≥0.8 mm of the CBD diagnosed preoperatively with ultrasound. The laboratory tests do not demonstrate difference statistically significative between these two groups. The group of the patients without stones in the CBD diagnosed by IOC was also divided in patients with diameters <0.8 mm and with diameters ≥0.8 mm of the CBD. Also in these two groups, the statistical analysis of the laboratory tests does not demonstrate significative difference. Most procedures were performed by specialists (64.6%), and all patients underwent IOC. IOC showed stones in 84/113 patients (74.3%). A comparison of patients with and without stones at IOC showed similar mean times from hospitalization to surgery (5.9 days [range 2–12 days] vs. 6.1 days [range 2–23 days]), from surgery until hospital discharge (2.0 days [range 0–4 days] vs. 2.2 days [range 0–11 days]), and overall length of stay (7.9 days [range 3–19 days] vs. 8.3 days [range 3–23 days]) (P > 0.001).ConclusionsIOC is useful to diagnose residual CBD stones, without increasing complications related to the procedure itself.

Background: Many ventral hernia repair methods have been described among surgeons. The traditional primary repair entails a laparotomy with suture approximation of strong fascial tissue on each side of the defect. However, recurrence rates after this procedure range from 12% to 24% during long-term follow-up. Laparoscopic ventral hernia repair (LVHR) is a well recognized minimally invasive surgical technique for repair of different types of abdominal wall ventral hernias. However, the best method of mesh fixation during LVHR is still a subject of debate. Patients & Methods: In the present study, 50 patients were presented with ventral hernia between June 2012 and October 2013. Demographics of the patients were recorded. All patients were submitted to LVHR with mesh fixation by "Double Crown" of tackers. The first crown was placed on the mesh periphery with 1 cm between each 2 successive tackers and the second crown around the edges of the defect. Operative complications, VAS scale, post-operative complications, and length of hospital stay were reported. Results: The mean age was 40.08 years. Female to male ratio was 3:2. The mean BMI was 32.3. The diameter of the hernial defect was <5 cm in 64%, while, the defects larger than 15 cm were excluded. LVHR was successfully completed in all the patients with no conversion. Only 1 patient had intra-operative bleeding from omental vessels that was successfully controlled. The mean operative time was 79 minutes. Post-operatively, the mean VAS was 3.96, 2.12, and 0.24 at 24 hours, 2 weeks, and 4 weeks, respectively. Two patients developed post-operative ileus that was treated conservatively and 1 patient developed persistent seroma that was treated by repeated aspiration. The mean length of hospital stay was 3.08 days. Conclusion: "Double Crown" tackers mesh fixation in LVHR seems to be a safe and effective surgical technique with favorable outcome. However, further randomized studies are needed on larger numbers of patients to validate these results.