IntroductionPilonidal sinus disease (PSD) is a highly debatable disorder regarding its surgical management, despite an assortment of surgical techniques described in the medical literature. The aim of this report is to provide an alternate semi-closed surgical method for treatment of PSD, with early recovery and a satisfactory cosmetic result.MethodsIn this retrospective study, 34 patients underwent surgical treatment for primary PSD; 32 male and 2 female. Patients were suffering from primary PSD, with the cyst located in the gluteal midline. Total excision of the cyst was performed, while the skin flaps were fixed on the postsacral fascia using absorbable sutures, leaving the wound semi-closed.ResultsTechnical success was 100%, with an average operation time of 48.7 ± 3.8 min. No wound dehiscence or infections were recorded postoperatively. One reoperation was performed due to hemorrhage. All patients were discharged on the day after surgery, with a VAS pain score of 1.3 ± 1. Two incidents of late wound dehiscence were recorded at 4th and 6th postoperative day due to strenuous exercise. Patients resumed their work after the 5th postoperative day with no complications. The 6 month follow up was completed in 29 patients, with a VAS cosmetic score of 8.1 ± 0.9. No recurrences were observed during the follow up period.ConclusionThe presented semi-closed technique is a viable alternative for surgical management of PSD. It provides patients with a satisfying cosmetic result, while it allows for early and safe return to everyday activities with less pain experienced.

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Intussusception of the small bowel is an uncommon condition, with the majority of cases being observed during infancy. A number of points are responsible, with benign and malignant lesions of the small intestine being the most common. Herein, we present the case of a 75-year-old male patient with vague abdominal pain and black stool during defecation, who underwent surgery due to jejunal intussusception. Pathology report demonstrated a neuroendocrine carcinoma as the underlying cause for his condition, with no additional metastases during the initial diagnosis. Although a conservative approach for management of intussusception is viable, the possibility of gastric outlet obstruction and the presence of malignancy as the primary point usually lead to urgent surgery. In the case of malignancy, adjuvant chemotherapy or additional symptomatic therapy with close follow-up may be required depending on tumor’s grade and aggressiveness.

HighlightsMorgagni hernias represents a rare subtype of diaphragmatic congenital hernias manifesting usually during early childhood.An innocuous or asymptomatic presentation render diagnosis of Morgagni hernias a challenging procedure.In our case, an adult female patient presented with a giant Morgagni hernia, initially diagnosed as a paraesophageal hernia.Early treatment of such cases is advised due to potential fatal complications. Laparoscopic surgery is considered the best approach.

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