Persistent organ failure early in the course of acute pancreatitis is a major determinant of outcome. In combination with pancreatic necrosis, survival rate is strongly compromised.

Objective This study aimed to review and evaluate our experience in 750 patients, who underwent transhiatal esophagectomy (THE) and analyze our data. Special attention was paid to some strategies, which we developed in the course of time, regarding the postoperative management of these patients and formulation of improved guidelines. Patients and methods This is a retrospective analysis of all THE operations performed between January 1981 until May 2007 in 750 patients: 60 patients (8%) had benign lesions, while 690 (92%) had malignant ones (5.2% of malignancies were located in the upper esophagus, 7.4% in the middle esophagus, 19% in the lower esophagus, and 68.4% at the cardioesophageal junction). THE and esophageal reconstruction were performed at the same operation in all patients. The stomach was our esophageal substitute of first choice with the colon and jejunum being acceptable alternatives in patients with prior gastric surgery and those necessitating synchronous gastrectomy for cancer invasion. A gastric tube was used as an esophageal substitute in 624 patients (83.2%), the whole stomach in 70 (9.4%), the colon in 43 (5.73%), and a jejunal loop in 13 (1.73%). Results The overall in-hospital mortality rate was 2.93% (22 patients). There was no intraoperative death. Major complications included atelectasis or pneumonia (4.8%), pleural effusion (22.7%), myocardial infarction (0.5%), recurrent laryngeal nerve paralysis (1.33%), and three tracheal lacerations (0.4%). The anastomotic leak rate decreased gradually over time from 29.4% to 11.1% in the last 6 years. The average intraoperative blood loss was 315 ml and 82% of the patients did not receive any blood transfusion. Late functional results were good or excellent in 93%. The average length of hospital stay was 11 days and intensive care unit stay was 2.3 days. The actuarial 5-year survival rate after THE for carcinoma was 21%. Conclusion THE is a safe and effective method of esophageal resection with low morbidity and mortality rates and good functional results when performed by experienced surgeons. We believe that our strategies concerning the way of dissecting the cervical esophagus, avoidance of performing pyloromyotomy, the delayed removal of the cervical drain and the delayed advance to oral feeding have reduced, noticeably, morbidity and mortality in our series.

Although the extent of necrosis as defined on contrast-enhanced CT examinations is considered as a risk factor for a negative prognosis, our findings suggest that the initially documented disease severity according only to imaging parameters is not highly important for the final patient outcome.

Fibrovascular polyps of the esophagus are rare benign lesions that arise from the cervical esophagus and can reach very big size before they become symptomatic. Surgical excision is the treatment of choice, since endoscopic removal is not always feasible.We present this case in order to emphasize the significance of localizing, preoperatively, the exact origin of the pedicle in planning the way of surgical approach. We consider the accurate pre-operative assessment of the origin of the pedicle essential for the proper surgical treatment of such a polyp. In respect to this, imaging provides important information concerning the exact location of the pedicle, the vascularity of the polyp and even tissue elements of the mass.

INTRODUCTIONPrimary neuroendocrine breast carcinoma (NEBC) is a rare entity of breast cancer.PRESENTATION OF CASEWe herein report a case of right hepatectomy for a NEBC liver metastasis.DISCUSSIONLittle is known about its evolution, bilologic behavior and optimal treatment. Its malignant potential has been addressed in few reports, with cases of metachronous metastases in diverse sites, even years following treatment of the breast primarily.CONCLUSIONTreating this kind of cancer implies both breast and hepatic surgery.Primary neuroendocrine breast carcinoma (NEBC) is a rare entity of breast cancer. Little is known about its evolution, biologic behavior and optimal treatment. Its malignant potential has been addressed in few reports, with cases of metachronous metastases in diverse sites, even years following treatment of the breast primarily. We herein report a case of right hepatectomy for a NEBC liver metastasis.

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Introduction: Schistosomal cholecystitis is remarkably uncommon. Almost all of the reported cases in literature, less than eleven universally, are associated with concomitant gallstone disease. It is unclear whether the extensive fibrocalcific reaction of the bladder`s wall and the cystic duct, seen in all cases, predisposes to cholelithiasis, or gallstones coexist. Case report: We report a Greek patient who developed schistosomal granulomatous lithiasic cholecystitis, which is unique in Greek medical chronicles. Performing a safe cholecystectomy in this patient was extremely difficult due to badly inflamed gallbladder. Conclusion: Schistosoma infection is associated with chronic granulomatous inflammation making cholecystectomy difficult and unsafe. In this article, we focus especially on prevention of bile duct injury by being prepared that a patient with a possible schistosomal cholecystitis will present with a complicated case.

A 65-year-old woman with a long surgical history was referred to our hospital’s Colorectal Unit for ileostomy management. The patient retained an ileostomy for almost a decade after a series of complicated operations she had undergone, which had several side effects such as electrolyte imbalances, high output, weight loss, and a parastomal hernia. Our hospital’s colorectal surgeon proposed to replace the ileostomy with a permanent sigmoidostomy and asked for an imaging evaluation of the parastomal hernia content before the surgery. A computed tomography of the abdomen was performed using our Computed Tomography Department’s 64-detector row CT scanner after oral administration of contrast media, without intravenous contrast media injection due to allergy. Concerning the parastomal ileostomal hernia, besides small bowel loops with intraluminal gastrografin, inside the parastomal hernial sac, there also was an almost rounded cystic lesion. Absence of the gallbladder at its typical position and no record of cholecystectomy raised suspicion for gallbladder projection inside the sac. Our suspicion was confirmed during the surgery. Nonexisting acute cholecystitis allowed easy reduction of the gallbladder along with the small bowel loops inside the peritoneal cavity, without proceeding to cholecystectomy at the same time. Finally, ileostomy was annulated and an end colostomy was established. Four days after the surgery, the patient was discharged from the hospital and was happy to live an almost normal life thereafter.