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Highlights • Esophageal perforation due to tuberculosis should be considered in countries with high prevalence of Tuberculosis. • Antibiosis for tuberculosis coverage should be initiated in appropriate group of patients with esophageal perforation with no response to conventional antibiotics and adequate surgical source control. • In patient with perforation and sepsis due to acute mediastinitis, surgical intervention should be considered., Introduction Tuberculosis is a multisystematic disease and is the most common cause of infectious disease–related mortality worldwide. Gastrointestinal tract is an uncommon site for extrapulmonary tuberculosis (TB). Esophageal TB is exceedingly rare. Presentation of case We report a 22-years-old male with esophageal TB that presented in septic shock from esophageal perforation. Despite all measures including surgical intervention and aggressive support in the intensive care unit, patient passed away. Discussion The most common mechanism for esophageal involvement is secondary to direct spread from mediastinal structures and/or spreading the inoculation of swallowed sputum, or hematogenous or lymphatic spread. Once the diagnosis of TB is established, antibiosis is the cornerstone of treatment. Surgery is reserved only for complications of TB such as fistula, abscess, strictures or perforation. Less than 50% of cases are diagnosed within 24 h, and delay in diagnosis lead to significant increases in the mortality. Conclusion In countries with high prevalence of TB, this diagnosis should be considered in those with esophageal perforation with no underlying etiology and medical treatment for TB should be initiated in addition to conventional treatment in appropriate group of patients.

One-hundred years after the 1918-19 H1N1 flu pandemic and 10 years after the 2009 H1N1 flu pandemic, another respiratory virus has now inserted itself into the human population. Severe acute respiratory syndrome coronavirus has become a critical challenge to global health with immense economic and social disruption. In this article we review salient aspects of the coronavirus disease 2019 (COVID-19) outbreak that are relevant to surgical practice. The emphasis is on considerations during the pre-operative and post-operative periods as well as the utility and limitations of COVID-19 testing. The focus of the media during this pandemic is centered on predictive epidemiologic curves and models. While epidemiologists and infectious disease physicians are at the forefront in the fight against COVID-19, this pandemic is also a "stress test" to evaluate the capacity and resilience of our surgical community in dealing with the challenges imposed to our health system and society. As recently pointed out by Dr. Anthony Fauci, the virus decides the timelines in the models. However, the models can also change based on our decisions and behavior. It is our role as surgeons, to make every effort to bend the curves against the virus' will.

Backgrounds Without proper use of prophylactic antibiotics, the chance of infection at the site of surgery after appendectomy is around 10 to 30%. Although, in the case of nonperforated appendicitis, the therapeutic use of antibiotic prophylaxis is still contentious. Cephalosporins and Metronidazole has been shown to be effective against anaerobe micro-organisms, and its bioavailability after oral and parenteral administration is comparable. The aim of this research is to compare the incidence of infection-related complications following open appendectomy for nonperforated appendicitis in patients who were given prophylactic antibiotics (Metronidazole and Cephalosporins) either intravenously or orally. Materials & Methods In this randomized clinical trial, the open appendectomy was performed on 200 non-perforated appendicitis cases; 87 females and 113 males, with a mean age of 26 years. Of all the enrolled, 100 cases were given single-dose metronidazole and Cefixime orally (study group), and 100 cases were given single-dose intravenous metronidazole and Ceftriaxone (control group). Results The wound infection incidence did not vary substantially between the two groups. (5% and 7% in the control and case group, respectively, P = 0.552). In addition, the length of hospitalization was also similar between both groups (2.4 and 2.6 days in the in the case and control group, respectively, P = 168). Conclusion All in all, it has been concluded that a single-dose metronidazole and Cefixime taken orally before surgery could bestow impactful prophylactic effects for nonperforated appendicitis cases. Therefore, it could be used instead of the parenteral antibiotics (Intravenous Metronidazole and Ceftriaxone).

Background: Diagnostic Peritoneal Lavage (DPL) is a routine method for evaluating internal organ damage in patients with blunt or penetrating torso trauma. Internal organ damage can lead to elevated alkaline phosphatase (ALP) levels in the DPL fluid. In this study, the researchers aimed to assess the prognostic value of elevated alkaline phosphatase levels and the need for laparotomy. Methods: In this study, the researchers evaluated 42 patients with torso trauma (18 penetrating and 24 blunt traumas). The ALP was positive for all the patients in DPL (2 IU/mL

Peritoneal dialysis (PD) as an equivalent to hemodialysis (HD) is one renal replacement therapy (RRT), which has several advantages compared to hemodialysis. However, most nephrologists are reluctant to apply this method. The purpose of this study is to assess the catheter efficiency, survival rate and complications of PD catheter placement in end-stage renal disease (ESRD) patients.From September 2002 to September 2003, 21 patients were operated by PD catheter placement in Imam Hossein Hospital, Tehran, Iran. The kind of catheter and surgical technique were identical in all patients. After surgery, patients were observed for 6 months.Out of the 21 patients, 13 (61%) were males and 8 (39%) were females. Diabetes and hypertension were the most common cause of nephropathy, mean age was 51.2 years and mean time between operation and from the beginning of PD was 9 days (range 1-14 days). In 8 (38%) patients, the 2 weeks break-in period was ignored. Complications observed were as follows: peritonitis in 2 (9.5%), leak of dialysate in 2 (9.5%), abdominal wall hernia in 2 (9.5%), catheter malfunction in 2 (9.5%) and abdominal wall hematoma in 2 cases (9.5%). The catheter lasted 6 months in all cases. However, 12 patients who previously received hemodialysis were more satisfied with PD.From the point of prevalence, our complications were not significantly different from previous studies. The 6-month survival rate and efficiency of catheter was very high. In addition, the rate of satisfaction of patients who received PD was also high. We suggest that more accurate studies on ESRD patients should be carried out to evaluate the use of PD in the primary stage of ESRD instead of HD.

Pancreaticoduodenectomy is commonly used for the surgical treatment of malignancies of the ampulla of Vater, duodenum, head of pancreas, and distal common bile duct (CBD). Pancreatic fistula and anastomotic leakage are the common fatal complications of the procedure. Management of the remaining stump is the most important part of pancreaticoduodenectomy in preventing fistula and leakage. We describe a non-anastomotic procedure that has fewer complications.Wirsung's duct was ligated with interrupted sutures after pancreaticoduodenectomy. Cut edge of pancreatic stump was then sutured. Drainage of the stump field was performed with a Petzer drain.Of 6 patients who were studied 3 were men and 3 were woman. The mean age was 59.19 years. There was no pancreatic fistula, anastomotic leakage, significant weight loss, far elevation in serum amylase, pancreatitis and oral intake serious problems within the follow-up months (median=7 months, min=2 months, max=20 months).Non-anastomotic options such as this necessitate the use of pancreatic enzyme supplementation, but low rate of complications and simplicity of the procedure make it an operation of choice.

Airway trauma is rare but morbid. It is encountered with increasing frequency because of improvements in prehospital care and early initiation of the Advanced Trauma Life Support. This study aims to give a description of patients with airway trauma, to help provide data for better emergency services and delayed managements of this type of trauma.