UARs that are performed following complicated abdominal surgeries have high mortality rates. In particular, UARs have higher mortality rates following GIS surgeries or when infectious complications occur. The possibility of efficiently lowering these high rates depends on the success of the first operations that the patient had received.

A VAC system can be successfully used for wound management in the control of fistula effluent in patients with an EAF in an open abdomen until spontaneous fistula closure occurs or definitive fistula surgery can be performed.

Background:Extra-gastrointestinal stromal tumor is defined as a mesenchymal neoplasm arising from soft tissues outside the gastrointestinal tract. Prostatic extra-gastrointestinal stromal tumor has rarely been noted.Case Report:A 56 year-old man presented with pain in the anal region. A digital rectal examination revealed that the prostate was markedly enlarged with a smooth, bulging surface. Computerized tomography images showed a 6 cm heterogeneous, infiltrative tumor within the prostate gland extending to the trigon of the bladder, left seminal vesicle and rectum. The tru-cut biopsy of the prostate was reported as leiomyoma. It was decided to perform surgery and the masses were easily and completely removed from the adjacent structures. The case was reported as extra-gastrointestinal stromal tumor within the intermediate- risk category with free surgical margins. Four years after the surgery, a locoregional failure was observed and treated with imatinib.Conclusion:Stromal tumor, although rare, should be considered in the differential diagnosis in patients with an enlarged prostate.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is an infrequent complication. It is associated with significant morbidity and mortality. The present study is an evaluation of experience with management and outcomes of ERCP-related perforations and a review of relevant literature.

Background Cholecystectomy is one of the most commonly performed surgical procedures. However, it may result in some unpleasant conditions such as bile duct injury (BDI), bile leak, and vessel injury. Subtotal cholecystectomy (SC), which has been introduced as an alternative method for reducing the complication rates, has been reported to have lower risk of BDI when compared to total cholecystectomy. This study aimed to evaluate the indications for SC, its early and late complications and their management, and the risk factors affecting the bile leak. Methods Fifty‐seven patients who underwent SC were included in the study, and their medical records were retrospectively reviewed. Results Thirty‐three patients were male (57.9%) and the mean age was 64.84 ± 11.35 (range: 29‐86). All patients had at least one episode of cholecystitis. Forty‐seven (82.5%) patients underwent surgery under emergency conditions. Postoperative bile leak/fistula, surgical site infection, and fluid collection were developed in 12 (21.1%), eight (14%), and six (10.5%) patients, respectively. Leaving the remnant tissue pouch open, presence of comorbidity and emergency operative condition were found to increase the risk of leak development (P < .001). During the average follow‐up of 49 months (range: 13‐98), symptomatic choledocholithiasis, symptomatic gallstones in the remnant tissue, and incisional hernia were detected within the first year of surgery in three (5.3%), four (7%), and seven (12.3%) patients, respectively. Conclusions Although SC is not an equivalent to total cholecystectomy, its vital benefit of lowering the risk of BDI should be considered in difficult cases.

Peutz-Jeghers syndrome is an autosomal dominant disorder characterized by mucocutaneous hyperpigmentation, and intestinal and extraintestinal multiple hamartomatous polyps. Development of gastrointestinal and extragastrointestinal cancer risk is markedly increased in patients with Peutz-Jeghers syndrome. We analyzed five patients from two families diagnosed with Peutz-Jeghers syndrome between 1999 and 2012. This study confirms the actual malignancy potency of PJS. Therefore, we suggest a close follow-up of patients with Peutz-Jeghers syndrome for the risk of malignancy.Keywords: Peutz-Jeghers syndrome, hamartomatous polyp, intussusception INTRODUCTIONPeutz-Jeghers syndrome (PJS) is an autosomal dominant disorder that is characterized by mucocutaneous hyperpigmentation, and intestinal and extraintestinal multiple hamartomatous polyps. It usually occurs in infancy and late adolescence. Although most of the polyps are encountered in the jejunum, they can occur in any other part of digestive system. Development of gastrointestinal and extragastrointestinal cancer risk is markedly increased in patients with PJS (1, 2). We analyzed five patients from two families diagnosed with PJS between 1999 and 2012. There were three male and two female patients, and their ages at the initial diagnosis ranged from 2 to 38 years. At the time of diagnosis, all patients had characteristic mucocutaneous hyperpigmentations and multiple polyps in the digestive system. Gastrointestinal cancer occurred in four of the five patients, three of whom developed colon cancer and one of whom developed small intestinal cancer at 32 years of age. One female patient with colon cancer also developed bilateral breast cancer. Three of these patients died within one month to one year after being diagnosed with colorectal cancer. Thus, we aim to present some new clinical features of PJS that have not previously been described in the literature and to discuss again the relationship between PJS and the development of cancer. CASE PRESENTATIONS Case 1:The male patient was born in 1970. He was 32 years old when colon cancer was first diagnosed. His father had been diagnosed with colon cancer at 54 years of age, and he died two years later. The patient had four siblings, two of whom were males at 14 and 22 years of age who do not show any signs or symptoms of PJS. The other two siblings described below, one male and one female, had PJS. The patient had undergone partial jejunectomy due to jejunal intussusception at the age of 17. He was admitted to our hospital in 2004 with subileus complaints and apparent perioral and oral hyperpigmentations on inspection. Detailed analysis revealed small intestinal intussusception at two locations and concomitant rectum cancer. The patient then underwent polyp excision (a total of 13 polyps were excised) and Miles operation in the same session. Histopathological examination of the resected specimen revealed signet ring carcinoma, regional lymph node metastasis (27/28), perinodal infiltration, and 13 hamartomatous pedunculat...

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