Isolated duodenal rupture due to blunt abdominal trauma

Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes

Combining Flexi-Seal and negative pressure wound therapy for wound management in Fournier's gangrene

WOS: 000354476800025PubMed ID: 23738767

A rare case of duodenal duplication treated surgically

Duodenal duplication, a rare congenital malformation, can also be observed in adulthood. Although it can be cystic or tubular, communicating or non-communicating, cystic and non-communicating forms are the most common. Several complications, such as obstruction, bleeding, perforation and pancreatitis, may result. Optimal treatment is total excision, although endoscopic procedures have also been described in appropriate cases. If total excision is not possible, subtotal excision and internal derivation can be performed. The 38-year-old woman presented here had occasional attacks of abdominal pain and obstruction, and we considered the diagnosis of duodenal duplication by abdominal computerized tomography. As we confirmed the diagnosis with operative findings and histopathological signs, we treated her with subtotal excision and intraduodenal cystoduodenostomy

Fournier's gangrene current approaches

WOS: 000387667600070PubMed ID: 25145578Fournier's gangrene is a rare but highlymortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41.6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomywas performed in six cases (50%), Flexi-Seal was used in two cases (16.6%). In four patients (33.4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33.4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi-Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi-Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients

Effects of montelukast on the healing of ischemic colon anastomoses

WOS: 000326510500010PubMed ID: 23809995BACKGROUND: The aim of this study was to examine whether treatment with montelukast, a selective leukotriene antagonist, would affect anastomotic healing in a reperfused colon rat model with remote ischemia/reperfusion injury. METHODS: Rats (n = 12 per group) were intraperitoneally administered normal saline or 10 mg/kg montelukast sodium 60 minutes before and for 5 days after surgery. Ischemia was induced for 45 minutes through superior mesenteric artery occlusion. A left colon anastomosis was made. Blood and peri-anastomotic tissue samples were obtained on postoperative day 5. RESULTS: Mean anastomotic bursting pressures of the control and montelukast groups were 159.17 +/- 29.99 and 216.67 +/- 26.40, respectively (P < .001). Compared with saline, montelukast treatment increased the mean tissue hydroxyproline level (2.46 +/- .30 vs 3.61 +/- .33 mu mol/L) and decreased tissue caspase-3 activity (36.06 +/- 5.72 vs 21.78 +/- 3.87) and malondialdehyde levels (3.43 +/- .34 vs 2.29 +/- .34 nmol/g) (P < .001 for all). Other plasma markers of injury also showed differences. CONCLUSIONS: Montelukast prevented ischemia/reperfusion-induced damage in a rat model of colonic anastomotic wound healing. (C) 2013 Elsevier Inc. All rights reserved