The rupture of hydatid cysts into the peritoneal cavity should be included in the differential diagnosis of acute abdominal pain in endemic areas. Perforation in a young patient may be the first presentation of hydatid cyst. Multiple hydatid cysts may be a predisposing factor for perforation. Location of the cyst on segment VI of the liver may be a predisposing factor as well. Emergency surgery is the main treatment for intraperitoneal rupture of hydatid cysts and medical treatment should be given postoperatively.

Objective: To investigate wound healing rates and postoperative recovery of patients after a one-time phenol application for pilonidal disease. Subjects and Methods: A total 30 consecutive patients with chronic pilonidal disease ranging from midline to complex sinuses were enrolled in the study. No preoperative laboratory examinations or bowel preparation were required. No antibiotic prophylaxis or sedation was used. A small incision was made on the midline and hair/debris in the sinuses was removed. A cotton swab with saturated phenol was moved into the cavity and the phenol was left for 2 min. No special dressing was necessary and patients left the hospital immediately afterwards. Patients filled out a daily questionnaire for 7 days. We did not intervene in the wounds with a second phenol application or curettage during the observation period. Wounds were inspected at weekly intervals for 2 months. Results: At the end of the third day, 97% of the patients were pain-free and 100% of the patients were free from analgesics. Time off work was 2 days for most patients (93.3%). Twenty-eight (93.3%) patients were satisfied with the procedure, they found it easy and painless and suggested the procedure to other patients. Twenty-five (83%) patients were asymptomatic at the end of 2 months’ observation and the remaining 5 patients had unhealed sinuses. Mean time for wound healing was 25 days (range 10–63 days). There were 4 recurrences after a mean of 14 months’ follow-up and the overall success rate was 70%. Conclusions: A one-time phenol application was an effective treatment for pilonidal disease with acceptable wound healing rates, less postoperative pain and less time off work. Hence it can be an alternative treatment modality.

The outcome of the patients is associated with presence of hemorrhagic shock, a high injury severity score, and additional organ injury.

Introduction Amyand's hernia is defined as the herniation of the whole or a part of appendix vermiformis into an inguinal hernia sac. Amyand's hernia is very rare, constituting about 1% of all inguinal hernia patients and 0.1% of all acute appendicitis patients. In one-quarter of Amyand's hernia patients, inflammatory changes are detected in appendix vermiformis. Detecting an appendiceal tumor in an Amyand's hernia sac is extremely rare, with only eight cases having been reported so far in the English literature. Case presentation A 64-year-old man with an appendiceal carcinoid tumor inside an incarcerated Amyand's hernia sac. As the tumor was localized to the radix of the appendix, resection was carried out with the help of a linear-cutter stapler in a way to contain a part of the cecal wall. As the pathology examination revealed a carcinoid tumor infiltrating the periappendicular fatty tissue, right hemicolectomy was performed in a second session, in compliance with the oncological principles. No metastasis was present at the 24th month. Case reports published in the English literature regarding the Amyand's hernia with an appendiceal tumor were also analyzed in this study. Conclusion Amyand's hernia containing an appendiceal tumor is an extremely rare clinical entity. Clinical manifestations mostly mimic the incarcerated hernia and thus accurate diagnosis is made incidentally during hernia surgery. The basic oncological principles apply for the approach to tumors inside a hernia sac.

This study suggests that minimally invasive, laparoscopic techniques be considered for drainage of liver abscess before open exploration is performed.

Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient’s tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients.

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