Anatomical variations of the hepatic artery are important in the planning and performance of abdominal surgical procedures. Normal hepatic anatomy occurs in approximately 80% of cases, for the remaining 20% multiple variations have been described. The purpose of this study was to review the existing literature on the hepatic anatomy and to stress out its importance in surgical practice. Two main databases were searched for eligible articles during the period 2000 - 2015, and results concerning more than 19,000 patients were included in the study. The most common variation was the replaced right hepatic artery (type III according to Michels classification) which is the chief source of blood supply to the bile duct.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Anatomical variations or anomalies of the pancreatic ducts are important in the planning and performance of endoscopic retrograde cholangiopancreatography (ERCP) and surgical procedures of the pancreas. Normal pancreatic duct anatomy occurs in approximately 94.3% of cases, and multiple variations have been described for the remaining 5.7%. The purpose of this study was to review the literature on the pancreatic duct anatomy and to underline its importance in daily invasive endoscopic and surgical practice. Two main databases were searched for suitable articles published from 2000 to 2017, and results concerning more than 8,200 patients were included in the review. The most common anatomical variation was that of pancreas divisum, which appeared in approximately 4.5% of cases.

Low molecular weight heparins (LMWHs) are the standard agents used for antithrombotic therapy and prophylaxis. Despite their widespread use, reports about adverse effects from LMWHs are very scarce. Heparin-induced skin necrosis at the injection site is a rare adverse effect, more commonly associated with unfractionated heparin (UFH) rather than with LMWH, while its mechanism remains unclear. This paper deals with the enoxaparin induced skin necrosis.

Patient: Female, 27Final Diagnosis: Invasive thyroglossal duct cyst papillary carcinomaSymptoms: Painless cervical enlargementMedication: —Clinical Procedure: Sistrunk’s procedureSpecialty: SurgeryObjective:Rare diseaseBackground:Thyroglossal duct cyst is a common congenital anomaly of the thyroid gland, usually found centrally. The presence of malignancy occurring in a thyroglossal duct cyst is a rare condition, accounting only for 1% of all cases of thyroglossal duct cyst. This report is of a rare case of papillary carcinoma arising in a thyroglossal duct cyst and includes a review of the literature.Case Report:A 27-year-old female patient was referred to our department with a painless cystic mass in the neck. After initial physical examination and endocrinology investigations, a fine needle aspiration (FNA) of the cyst was performed. Cytology showed a papillary neoplasm. The patient underwent total thyroidectomy and surgical excision of the thyroglossal duct cyst (the Sistrunk’s procedure). Histopathology of the surgical excision specimen showed a thyroglossal duct cyst with a maximum diameter of 7.5 cm containing a primary invasive papillary carcinoma, measuring 1.5 cm in diameter that infiltrated into the cyst wall. The remaining thyroid gland was normal.Conclusions:Thyroglossal duct carcinoma, most commonly papillary carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Surgery and complete excision is the main treatment and the optimal patient management includes multidisciplinary consultation in order to improve survival. The diagnosis of malignancy is made postoperatively, as in the present case.

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We present a case of small bowel stricture and obstruction with delayed and subtle presentation 3 months after a car accident. Such a presentation is a rare clinical entity. The most likely cause, supported by most authors, implicates an injury to the mesentery. Post-traumatic ischaemic bowel stenosis may result from even small tears and contusions. These lesions may cause partial thickness ischaemia of the bowel wall, with mucosal ulceration and submucosal inflammation and fibrosis, or may cause full-thickness ischaemia with fibrosis of all layers. Mesenteric tears or intramural haematomas have been found on close inspection of the specimens. Our case supports the mesenteric injury theory since there is the initial CT-scan proof of retroperitoneal and consequently, mesenteric haematomas. Regardless of the pathophysiology of this clinical entity, it is very important that the condition of post-traumatic small bowel stricture should be suspected when a patient experiences bowel obstruction weeks, or even years, after sustaining abdominal injury, especially in connection with a seat-belt injury.

Background: Thyroidectomy is a quite common daily operation in general surgery. However, the anatomical structures of the region, mainly the relationship of recurrent laryngeal nerve (RLN) and inferior thyroid artery (ITA) makes the procedure challenging. The current review of the literature aims to report the anatomical variations of this relationship. Methods: The preferred reporting items for systemic reviews and meta-analyses (PRISMA) guidelines were used for the systematic review of the articles found after an extensive research through Pub-Med, Science Direct, EMBASE and Web of Science. A total of 16 studies were included for the statistical analysis. Results: The results showed that the most common type of RLN was posterior to the ITA. However, according to Higgins I 2 statistics the heterogeneity of the studies was quite high. Conclusions: The relationship between the RLN and the ITA is quite variable. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the nerve during thyroidectomy.