Amniotic fluid sludge (AFS) is defined as the presence of particulate matter in the amniotic fluid in close proximity to the cervix. Although its prevalence is known to correlate with the risk of preterm delivery, initial reports describe a strong association between AFS and microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis. However, AFS is also present in uncomplicated pregnancies, and its prevalence appears to increase with gestational age. Recent evidence debates the usefulness of AFS as a marker of early preterm delivery risk. We present four cases with AFS diagnosed by transvaginal ultrasound at admission for cervical insufficiency between 20 and 24 weeks of gestation, with confirmed lower genital tract and intra-amniotic infections by amniocentesis and histological chorioamnionitis and funisitis. Our findings reinforce the presence of AFS as a useful marker of MIAC, chorioamnionitis and funisitis that increase the likelihood of preterm delivery at an extreme gestational age.
Introduction: Giant colonic diverticulum (GCD) is a rare complication of colonic diverticulosis. Patients have often non-specific symptoms, and complication is exceptional. Case Report: We report a case of an 87-year-old man with several admissions in the last year due to episodes of acute diverticulitis and CT scan image compatible with GCD that presents with pain and a palpable abdominal mass. In urgent CT scan GCD shows increased size reaching 12 cm. Laparoscopic sigmoidectomy with primary colorectal anastomosis was performed urgently. His postoperative course was plain and the patient was discharged after 5 days. Pathology reported a diverticular formation of 12 cm in diameter. Discussion: Location and simultaneous acute diverticular disease are the main criteria for deciding the surgical approach. Colonic resection with primary anastomosis is the gold standard and, if possible, should be performed by laparoscopy, even in emergency cases.
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