INTRODUCTIONRectal foreign bodies are rare colorectal emergencies. They are important for the complications that may occur. Delayed response causes a wide range of complications or may even result in death.PRESENTATION OF CASEA 22 years old male patient was seen at our hospital with anal pain, discharge, and complaining of incontinence. The patient stated that a bottle of beverage was placed into his anal canal in an inverted manner for sexual satisfaction 5 years previously.DISCUSSIONAfter clinical and radiological assessment under general anaesthesia in the lithotomy position the object was removed by a laparotomy. He was advised to seek legal help and he received psychiatric treatment in the postoperative period prior to his discharge.CONCLUSIONComplications such as abscess, perianal fistula complicated by severe pelvic sepsis and osteomyelitis were expected complications in this case. As in this case, a surgical approach may eliminate dissection planes, increasing morbidity and mortality related to the injuring of surrounding bodies during object extraction.

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In patients with hepatocellular carcinoma, hospital stay was longer after liver transplant, but morbidity and mortality rates for liver transplant versus hepatic resection were similar. However, overall and event-free survival rates were better after liver transplant than after hepatic resection. These results suggest that liver transplant should be considered as the primary treatment option for patients with hepatocellular carcinoma secondary to cirrhosis.

Although this technique exerts its effect primarily by reducing gastric volume, besides its metabolic and hormonal effects, it also improves serum lipid levels (decreasing TC, LDL cholesterol and TG levels, and increasing HDL cholesterol levels). It therefore contributes to decreasing cardiovascular diseases.

Sentinel lymph node biopsy is the standard application for evaluating the axilla in patients with breast cancer. The Z0011 trial conducted by The American College of Surgeons Oncology Group (ACOSOG) revealed that axillary dissection may be redundant in selected patients with positive sentinel node. This raises questions regarding the application of this result to ultrasoundpositive patients. This research therefore aimed to evaluate how accurate an ultrasound scan is for axillary node status in earlystage breast carcinoma. The study included 156 newly diagnosed clinical T1-T2, N0 breast cancer patients attending our breast clinic between January 2010 and February 2016. Sentinel lymph node biopsy and axillary lymph node clearance in the presence of sentinel lymph node metastasis was performed on all the breast cancer patients. Axillary ultrasound reports were reviewed retrospectively and the results compared with surgical pathology results. The sensitivity and specificity of axillary ultrasound for detecting axillary lymph node disease was 69.2% and 98%, respectively, with a negative predictive value of 86.4% and positive predictive value of 94.7%. Given the high sensitivity and specificity, and high positive predictive value and negative predictive value demonstrated in the present study, axillary ultrasound represents a potential alternative to sentinel lymph node biopsy for staging of the axilla in early breast cancer. Subsequent trials (SOUND) comparing axillary ultrasound alone with sentinel lymph node biopsy in early breast cancer patients will provide additional information about the subject.

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A 28−year−old female was referred for sur− gical management of acute cholecystitis 1 day after endoscopic retrograde cholan− giopancreatography (ERCP) and biliary sphincterotomy, because of the finding of a 15−mm−thick gallbladder wall on right upper quadrant ultrasonography (l " Figure 1). Pre−ERCP ultrasonography (l " Figure 2) and magnetic resonance cholangiopancreatography (l " Figure 3) demonstrated a 2.8−mm gallbladder wall and a patent cystic duct. The fluoroscopic images of the ERCP were reexamined and it was apparent that introduction of the guide wire had caused a dissection of the gallbladder wall which was visualized only after the injury had been exacerbat− ed by injection of contrast intramurally (l " Figure 4). In the absence of fever, leu− kocytosis, a positive Murphy's sign, or pericholecystic fluid on ultrasound imag− es, the gallbladder wall thickening was concluded to represent an iatrogenic in− jury. We monitored the patient with seri− al abdominal exams to rule out a perfora− tion and were able to discharge her with conservative management alone. Two months later she underwent an elective laparoscopic cholecystectomy for symp− toms attributed to cholecystitis. A mural hematoma was seen upon initial visuali− zation of the gallbladder (l " Figure 5) and confirmed by histopathology. The incidence of post−ERCP acute chole− cystitis is less than 1 % [1, 2]. The etiology has been postulated to be the presence of nonsterile contrast medium exacerbated by cystic duct obstruction and mechani− cal irritation [3 ± 5]. This case represents the first reported occurrence of an intra− mural dissection of the gallbladder wall during ERCP. The subsequent intramural hematoma caused gallbladder wall thick− ening that mimicked post−ERCP cholecys− titis on ultrasonography. While concur− rent development of localized tender− ness, fever, leukocytosis, and perichole− cystic fluid on ultrasonography would strongly suggest post−ERCP cholecystitis, an isolated and sudden increase in gall− bladder wall thickness after ERCP must be evaluated carefully for the possibility This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.of an iatrogenic injury with the attendant risk of perforation.

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