Search

Background: Cystic echinococcosis (CE) is a parasitic and zoonotic infection, recognized globally as aneglected disease, with significant morbidity and mortality rates, especially in low-advantaged countries. Weaimed to evaluate the recurrence rate after hydatid disease surgery in Fars Province, Iran.Methods: A retrospective design was used to examine the data collected from Nemazee and Shahid FaghihiHospitals, Shiraz, southern Iran, over eight years, from 2011 to 2019. The research was conducted in 2023.The study extracted the following data from hospital records: demographic characteristics, paraclinicalfindings (such as sonography and CT scan), organ involvement, cyst number and size, surgical procedure, cystcomplications, intraoperative or postoperative complications, and recurrence rate.Results: The study included 303 patients, of whom recurrence occurred in 36 (11.9%). Intra or postoperativecomplications were associated with recurrence (P=0.001). In the recurrent cases, the most common intraoperativecomplication was anaphylactic shock (P=0.001), and the most common postoperative complicationswere unresolved pneumothorax and empyema (P=0.001). There was a significant association betweenrecurrence and complicated cysts (P=0.001). There was no significant difference between the organ involvedand the complicated cyst in the recurrence (P=0.50). There was no association between increasing the cyst’ssize and the chance of the recurrence rate. There was a significant relationship between recurrence and thenumber of cysts in the affected organ (P=0.001). There was a significant association between using no scolicidalagents and recurrence (P=0.001), and no antiparasitic drugs were used in only one (2.7%) patient (P=0.3240).There was no significant association between recurrence and duration of admission (P=0.193).Conclusion: Intra or postoperative complications (anaphylactic shock, unresolved pneumothorax, andempyema), complicated cysts, the number of cysts in the affected organ, and injecting of no scolicidal agentswere significantly associated with recurrence. Recurrence may have many reasons, such as insufficient drainage(incomplete peri-cystectomy and minute spillage of cyst contents), missing hidden cysts (numbered cysts),rupture or spillage of the cysts, and inadequate medical treatment.

Background: Anastomotic leakage (AL) is the main complication of colorectal surgeries. Recent studies haveassessed the effects of the ghost ileostomy on preventing complications related to a defunctioning stoma (DS)in high-risk anastomoses. In this study, we aimed to review patients who underwent ghost ileostomy and assesstheir colon leakage score (CLS) and Dutch leakage score (DULK) to evaluate their preoperative AL risk andpost-operative AL diagnostic score, respectively. We examined whether the suggested cut-off points of thesescores (>11 for CLS and >4 for DULK) could be appropriate criteria for determining when to insert ghostileostomy and when to convert it to a DS.Methods: All patients from three referral hospitals in Shiraz, Iran who underwent colorectal surgery withghost ileostomy during 2019-2020 were enrolled in this retrospective case series. We calculated preoperativeCLS and post-operative DULK scores for all patients and assessed what diagnostic and therapeutic measureswere performed for them based on their scores.Results: AL was diagnosed in two of 34 patients. Eight patients had a total CLS score of 11 and above, butonly one of them experienced AL. The other case of AL had a CLS score of 10. The DULK score of these twopatients increased during hospitalization.Conclusion: Because of the importance of accurately identifying high-risk patients for ghost ileostomy, itis imperative to undertake additional research aimed at determining the optimal cut-off value for CLS ordevising alternative valid scoring systems. DULK score could be an appropriate post-operative monitoring toolto reduce morbidity.

Objective: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical procedure performed on patients with ulcerative colitis (UC) to avoid the need for permanent stoma. The objective of this study was to assess the quality of life and fecal incontinence in UC patients after IPAA and compare the quality of life among different subgroups. Patients and Methods: This cross-sectional study included all UC patients who had underwent IPAA between 2017 and 2021 at Shahid Faghihi Hospital, Iran. Data were collected from medical records and through direct contact with the patients. Fecal incontinence was evaluated using Wexner questionnaire, while quality of life was assessed using the inflammatory bowel disease questionnaire (IBDQ). Patients were categorized into groups based on the severity of their fecal incontinence, classified as no/mild (0-4) or moderate to severe (≥5), according to their Wexner scores. Results: A total of 138 patients completed the Wexner questionnaire, and 119 completed the IBDQ questionnaire. The mean age of participants at the time of questionnaire completion was 43.39 years (±11.16). Among the included patients, 19% experienced moderate to severe fecal incontinence. These patients had lower scores across all domains and the total score of IBDQ compared to patients with no/mild fecal incontinence. Additionally, those who underwent IPAA more than four years ago had significantly lower scores in the social function domain (P-value=0.047) and total score of IBDQ (P-value=0.027). Conclusions: Patients with fecal incontinence and those who have undergone IPAA for a longer duration have better quality of life scores.

Background: Cystic echinococcosis (CE) is a parasitic disease caused by the larval stages of taeniid cestodes of the genus Echinococcus which is considered a neglected disease of public health worldwide. CE primarily affects the liver and demonstrates distinctive radiological findings in computed tomography and ultrasonography. Surgery is considered the mainstay of CE treatment. Case presentation: The patient was a 17-year-old man who was admitted to the Emergency Department of Shahid Faghihi Hospital affiliated with the Shiraz University of Medical Science with dull right upper quadrant abdominal pain, loss of appetite, abdominal distention, and fullness. Abdominal computed tomography (CT) scan revealed a giant hepatic cyst measuring about 24 × 20 × 15 cm in the RHL with a pressure effect on the right kidney, pancreas, and bowel loops and another smaller one measuring 9× 8 × 8 cm in the left liver lobe. Semi-chevron incision was done and the patient underwent partial precystectomy with capitonnage and omentoplasty. Our case was the 5th rank according to the size of the recorded published cases in the literature.Conclusion: When dealing with a huge liver cyst, a high index of suspicion for echinococcal etiology becomes important in endemic areas like Iran. The choice of treatment for giant hepatic cysts substantially seems to be radical surgery by surgical ablation in general to mitigate the mortality and morbidity rate, because they are at risk of rupture, anaphylaxis, and so forth.

Context Colorectal cancer (CRC) is the third most prevalent cancer worldwide which is less common in the Middle East. It is also the second leading cause of cancer-related mortality and represents a major public health problem in developed countries. Objectives The present review aimed to explore the differences among the reports on number and age standardized incidences of CRC in both sexes in different areas of Iran to find the incidence trend of this cancer. Data Sources All the published reports citing the incidence of CRC in Iran were collected by conducting a literature search in international databases. Study Selection English articles were included where there was a clear definition of the population of patients under study and where the criteria for diagnosing CRC were well described. Data Extraction One author read each paper and extracted several studies and then the studies suitable for inclusion were reported in three categories. Results We identified 181 independent studies dating back to 2003; 168 full text articles were assessed for eligibility. However, 136 full text articles were excluded due to different reasons. Finally, 26 studies were suitable for inclusion in the analysis. The highest and lowest (age standardized rates) ASRs were respectively 3.4 and 2.6 in males and 11.42 and 10.56 in females. Time showed a slightly increasing trend in recent years. Conclusions Although Iran was expected to have a low incidence rate of CRC, recent studies revealed a slightly increasing trend for the incidence rate of CRC. This finding shows the necessity to consider CRC screening as an important issue in health policy priorities.