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Introduction Colorectal cancer is among the most commonly occurring malignancies and it is often associated with a high morbidity and mortality rate. Although significant advances have been made in ostomy surgery since the late 1800s, early postoperative complications may still occur. This study aimed to determine the prevalence of early stoma complication in our surgery clinic. Methods In this paper, we studied 314 consecutive patients who were admitted to the hospital for stoma creation, as emergency or elective procedures. Results The most common indication for stoma creation was colorectal carcinoma. The more frequently used surgical interventions were low anterior resection with diverting (loop) ileostomy (161 patients, 51.2%) followed by proximal defunctioning colostomy (54 patients, 17.2%) and abdominal perineal resection with end colostomy (52 patients, 16.6%). Ostomy-related complications developed in 121 patients (38.5%). Conclusion Our findings indicated that early stoma complication rates were higher in patients with malignancies and permanent stomas.

Introduction: Nasopharyngeal carcinoma (NPC) has the propensity to develop distant metastases at a high rate and with poor prognosis. The metastatic sites are usually multifocal and involve the bones, lungs, liver and distant lymph nodes. The management of metastatic disease is essentially palliative and is based on radiochemotherapy. Methods: A 50-year old man with a huge hematoma in the liver derived from a diagnosed NPC was treated with intermittent drainage of the hepatic hematoma for abdominal decompression, and the cavity was packed with omentum. In addition, 2 suspected metastatic lesions were excised. Neoadjuvant radiochemotherapy followed by concurrent chemotherapy was administered. Results: After surgical treatment of the huge hematoma, the suspect sites in the liver were diagnosed as metastatic carcinoma, similar to the primary tumor. Several months later, bone metastatic lesions in the vertebra and ossiliaca dextra were detected due to distant metastasis. Conclusion: Treatment of metastatic NPC is essentially palliative and survival is usually poor.

Introduction: Verneuil disease, or perianal hidradenitis suppurativa (HS), is a chronic suppurative disease with a tendency to develop sinus formation, fibrosis, and sclerosis, having a great impact on quality of life. HS affect the apocrine sweat glands or sebaceous glands and may arise in each of the regions where the apocrine glands are prominent: the axilla, breast aureole, umbilicus, perineum, groin, and buttocks. We present here moderate and extensive HS cases, with their respective treatment methods and outcomes. Methods: A retrospective re-view of 6 patients’ medical records from January 2001 to December 2010. Results: The 6 patients underwent treatment for HS in the gluteal and perianal regions with surgical excision. Five of the patients were male (83%). The median age was 42.5 years. We performed a total of 8 operations on these patients. In 3 patients, the wound was left open for secondary healing, and the mean time for complete wound healing was 11.3 weeks (range: 9.5-19 weeks). Delayed skin grafting was used for 2 patients in whom the wounds had been left open after the first operation. In this group, complete wound healing took 2 months in total. One patient underwent primary wound closure using rotation flaps, with a complete healing time of 2 weeks. Successful treatment without recurrence was accomplished in 5 (83.3%) of the patients. Conclusion: The conservative treatment methods had little effect, particularly on gluteal and perianal/perineal HS. The only successful treatment was wide surgical excision. Management of the wound after wide excision should be tailored to the individual patient.

Purpose. Diagnostic hysteroscopy has become a well-established modality for evaluating the uterine cavity, but provides no information regarding tubal patency. The aim of the present study was to investigate the diagnostic value of transvaginal sonography (TVS), performed directly after diagnostic hysteroscopy, for assessing tubal patency in infertile women, and to compare the findings with those obtained by means of laparoscopic chromopertubation. Methods. A total of 56 infertile patients were referred to our endoscopic unit for laparoscopic chromopertubation in the period from September 2008 to January 2010. Diagnostic hysteroscopy, followed by TVS, was carried out prior to laparoscopic chromopertubation. The collection of free fluid in the pouch of Douglas was accepted as evidence of tubal patency. The findings of TVS and laparoscopic chromopertubation were compared. The data were analyzed for the sensitivity, specificity, accuracy, positive-predictivevalue, and negative-predictive value of the combination of hysteroscopy and TVS in detecting unilateral or bilateral tubal patency. Results. The presence of fluid in the pouch of Douglas was observed in 37 of the 56 cases. In 36 of these cases, unilateral or bilateral tubal patency was confirmed by laparoscopic chromopertubation. In 17 of the remaining 19 cases (without fluid in the pouch of Douglas during ultrasound), bilateral tubal occlusion was confirmed by laparoscopic chromopertubation. Diagnostic hysteroscopy followed by TVS showed a high sensitivity and specificity for the assessment of tubal patency. Conclusions. TVS performed directly after diagnostic hysteroscopy in infertile patients provides additional nformation regarding tubal patency. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound 40:68–73, 2012

We present an unusual case of a 28-year-old woman who had termination of pregnancy at 18 weeks of gestation. She visited our clinic with a history of secondary infertility for 3 years. A transvaginal ultrasonography revealed a hyperechogenic image that suggested presence of an intrauterine contraceptive device (IUCD). Hysteroscopy revealed a foreign body in the uterine cavity. The foreign body was removed with a hysteroscope using additional instruments that were not designed for hysteroscopy. Histological examination of the foreign body revealed fragments of dead bone.

Dear Editor: Situs inversus totalis (SIT) is a rare congenital condition characterized by a mirror-image transposition of both the abdominal and thoracic viscera with an incidence of 1/8,000 to 1/25,000 in the normal population. First described in 1600 by Fabricius [1], SIT may complicate the diagnosis and therapeutic management of abdominal pathology. This congenital condition involves inverted positions of all of the thoracic and abdominal organs that represent mirror images of their normal locations. In the abdomen, the stomach, spleen, and pancreas are on the right side of the body; the liver and gallbladder are on the left side; and the colonic flexures are reversed [2]. Here, we report the case of a 32-year-old man with SIT, colon cancer in the cecum, and malformation of the inferior vena cava (IVC) who underwent a right hemicolectomy. A patient was examined in our hospital for SITand a tumor in the cecum. His only significant medical history was fatigue and weakness. His family history was essentially negative for SIT or familial and hereditary diseases. The patient’s clinical features at admission were as follows: blood pressure, 130/ 70 mmHg; pulse, 60 beats/min; and temperature, 36.5 °C. The palpebral conjunctivae were anemic. Breath sounds were normal. The abdomen was flat, soft, and non-tender. A decreased red blood cell count of 3.8 million (range, 4.5–6 million) and a hemoglobin level of 12.2 mg/dL (range, 13–18 mg/dL) were noted with no hepatic or renal dysfunction or electrolyte abnormalities. Computed tomography (CT) revealed dextrocardia, situs inversus in the colon in which a splenic flexure of the colon was on the right side of the abdomen with the ileocecal region on the left side. A 3.0×2.5-cm elevated lesion was present in the cecum that was associated with regional adenopathies. The remainder of the colon and upper gastrointestinal tract were unremarkable. CT revealed abnormalities including an anomaly of the IVC. The area from the origin of the IVC to the level of the renal vein was normal. At this level, an interruption and extensive vena azygos localized on the left side due to situs inversus was seen. CT also showed dilatation of the vena azygos in the upper part of the posterior mediastinum in the thoracic cavity where the diameter was the same as that of the thoracic aorta (2.5 cm). A big development shows too, and venous hemiazygos were also seen. The hemiazygos vein was less dilated than the azygos vein. A short segment of the IVC was seen prior to the entrance of the right atrium. Based on these findings, the patient was diagnosed with a tumor of the cecum, and, hence, resection of the cecum and ascending colon were performed. An end-to-end functional anastomosis between the ileum and the transverse colon was performed. Histopathologically, the primary lesion was cecum colon cancer with moderately differentiated adenocarcinoma. Situs inversus itself has no pathophysiological significance but poses diagnostic and surgical difficulties that arise from the inversion. SIT is frequently associated with other disorders including Kartagener’s syndrome, primary ciliary dyskinesia, and asplenia or polysplenia. Other authors have reported additional concurrent anomalies of the digestive system including a short pancreas, symmetric lobulation of the liver, S. Bilali (*) General Surgery Department, University Hospital Center “Mother Teresa”, Tirana, Albania e-mail: sbilali@hotmail.com