IntroductionPelvic actinomycosis constitutes 3% of all human actinomycosis infections. It is usually insidious, and is often mistaken for other conditions such as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge pre-operatively; it is identified post-operatively in most cases. Here we present a case that presented as pelvic malignancy and was diagnosed as pelvic actinomycosis post-operatively.Case presentationA 48-year-old Caucasian Turkish woman presented to our clinic with a three-month history of abdominal pain, weight loss and difficulty in defecation. She had used an intra-uterine device for 16 years, however it had recently been removed. The rectosigmoidoscopy revealed narrowing of the lumen at 12 cm due to a mass lesion either in the wall or due to an extrinsic lesion that prevented the passage of the endoscope. On examination, there was no gynecological pathology. Magnetic resonance imaging showed a mass, measuring 5.5 × 4 cm attached to the rectum posterior to the uterus. The ureter on that side was dilated. Surgically there was a pelvic mass adhered to the rectum and uterine adnexes, measuring 10 × 12 cm. It originated from uterine adnexes, particularly ones from the left side and formed a conglomerated mass with the uterus and nearby organs; the left ureter was also dilated due to the pelvic mass. Because of concomitant tubal abscess formation and difficulty in dissection planes, total abdominal hysterectomy and bilateral salphingo-oophorectomy was performed (our patient was 48 years old and had completed her childbearing period). The cytology revealed inflammatory cells with aggregates of Actinomyces. Penicillin therapy was given for six months without any complication.ConclusionsPelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intra-uterine devices, and who have a history of appendectomy, tonsillectomy or dental infection. Surgeons should be aware of this infection in order to avoid excessive surgical procedures.

Beslenme jejunostomi tüpü oral yoldan beslenmenin yetersiz veya imkans›z oldu¤u durumlarda enteral nütrisyon deste¤inin sa¤-

Serum PGRN levels increase significantly in women with PE as an indirect sign of placental dysfunction. This increase is even more prominent in women with EOPE. The serum PGRN in the third trimester is positively correlated with gestational age at birth and birth weight.

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Objective:This study was conducted to present the preliminary results of seven patients treated with sphinctero-vagino-perineoplasty for secondary repair of obstetric anal sphincter injuries.Materials and Methods:This retrospective study was conducted on the records of seven patients who underwent secondary repair of obstetric anal sphincter injuries at the colorectal surgery unit of a tertiary care center between February 2015 and December 2017.Results:All patients with solid stool incontinence were fully recovered at postoperative month 3. The Wexner incontinence score was significantly improved (decreased from 14.12 [range: 8-20] to 2.28 [range: 1-4]). The complication rate was 85.7% (wound infection, abscess, hematoma, detachment).Conclusion:Combined repair of anal sphinchters, perineal body, superficial transverse perineal muscles, and bulbospongious muscles, which contribute to anal continence, may improve surgical outcomes in patients with obstetric anal sphincter injuries.

This study was performed to compare the clinical findings and identify differences in risk factors between early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE). Materials and Methods: This retrospective study included 516 women with singleton pregnancies and preeclampsia (none of them had superimposed preeclampsia on chronic hypertension) who delivered in a tertiary care center. Clinical findings, and maternal and perinatal outcomes were compared between early (< 34 weeks' gestation) and late (≥ 34 weeks' gestation) onset of the disease. Results: Incidences of nulliparity, previous preterm births, stillbirths, and first trimester abortions were significantly higher in women with EO-PE (p < 0.05). History of disease other than chronic hypertension (especially diabetes mellitus) and previous term births were significantly higher in women with late-onset disease (p < 0.05). The mean gestational week at delivery and mean birth weight were significantly lower in early-onset disease (p < 0.05). Stillbirths, early and late neonatal deaths, and cases where the mother's life at risk were significantly higher in women with early-onset disease (p < 0.05). Conclusions: EO-PE appears to be mediated by the placenta and associated with higher incidence of perinatal, neonatal and maternal deaths, and maternal nearmiss cases.

While the majority of fistulas in ano result from infection of the anal crypts, complex, recurrent, and/or nonhealing fistulas should always raise the suspicion of a chronic underlying condition. In this paper, we present a 30-year-old male patient with a diagnosis of a complex suprasphincteric fistula caused by a surgical thread left behind after an orthopedic hip operation performed sixteen years ago. Partial fistulectomy, extraction of the foreign material, and debridement procedures were performed. Few cases of such complex fistulas in ano due to foreign materials have been described in the literature. After careful history-taking, meticulous physical examination under general anesthesia should be done in order to deal with this rare type of fistula.

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