We recommend routine colonoscopy after an attack of presumed left-sided diverticulitis in patients who have not had recent colonic luminal evaluation. The rate of occult carcinoma is substantial in this patient population, in particular, when abscess, local perforation, and fistula are observed.

Aim The aim of this paper was to provide a narrative review of surgical site infection after hernia surgery and the influence of perioperative preventative interventions. Methods The review was based on current national and international guidelines and a literature search. Results Mesh infection is a highly morbid complication after hernia surgery, and is associated with hospital re-admission, increased health care costs, re-operation, hernia recurrence, impaired quality of life and plaintiff litigation. The American College of Surgeons National Surgical Quality Improvement Program is a particularly useful resource for the study and evidence-based practise of abdominal wall hernia repair. Discussion The three major modifiable patient comorbidities significantly associated with postoperative surgical site infection in hernia surgery are obesity, tobacco smoking and diabetes mellitus. Preoperative optimization includes weight loss, cessation of smoking, and control of diabetes. Intraoperative interventions relate, in particular, to the control of fomite mediated transmission in the operating theatre and prevention of mesh contamination with S. aureus CFUs. Risk management strategies should also target the niche ecological conditions which enable bacterial survival and subsequent biofilm formation on an implanted mesh. Outcomes of mesh infection after hernia surgery are closely related to mesh type and porosity, patient smoking status, presence of MRSA, bacterial adhesion and biofilm production. The use of suction drains and the timing of drain removal are controversial and discussed in detail. Finally, the utility of the ACS-NSQIP Surgical Risk Calculator in predicting complications and outcomes in individual patients and the importance of quality improvement initiatives in surgical units are emphasized.

Acute liver failure (ALF) is characterised by severe liver injury with the onset of coagulopathy (INR ≥1.5) and encephalopathy in the absence of pre-existing liver disease. It is associated with a high mortality rate of 10-57%, which is largely driven by multi-organ failure, sepsis and cardiac arrhythmia. Current management focuses on identifying and treating the aetiology, providing supportive care and monitoring liver function. The use of N-acetylcysteine (NAC) therapy is well-studied in the treatment of paracetamol toxicity but is controversial in other causes of ALF. We reported the first case of ischaemic hepatic failure secondary to prolonged portal vein occlusion treated with 72 hours of NAC therapy. Although ischaemic hepatopathy is a relatively uncommon cause of ALF, it is associated with a high mortality rate. The case highlights how early use of NAC therapy may improve hepatic serology biomarkers and should warrant consideration in ALF secondary to ischaemic hepatopathy.

Univariate and multivariate analysis of several preoperative and intraoperative variables were done to detect risk factors and predictor of morbidity and early mortality. Results: Between the first of January 2008 and the end of June 2013, 102 patients underwent pancreaticoduodenectomy at the National Liver Institute, Menoufiya University. As regard univariate analysis, the patient's age is the only preoperative variable found to be statistically significant with the incidence of delayed gastric emptying (P value > 0.05). As regard the univariate analysis of the intraoperative variables, the consistency of the pancreas, pancreatic duct size, operative time and blood loss were statistically significant with the incidence of pancreatic leak. The Blood loss was significant with the incidence of bile leak. The type of pancreaticoenteric anastomosis, pancreatic duct size and tumor size were significant with the incidence of delayed gastric emptying. The operative time, blood loss and blood transfusion were significant with the incidence of wound infection. As regard multivariate analysis, the origin of the tumor and blood loss was significant with the incidence of postoperative bile leak. The blood loss was significant with the postoperative wound infection. Conclusions: The patient's age, consistency of the pancreas, pancreatic duct size, operative time, blood loss Type of pancreaticoenteric anastomosis, and tumor size were risk factors with the incidence of major postoperative complications. In multivariate analysis, the origin of the tumor and intraoperative blood loss were significant with the incidence of postoperative bile leak and wound infection.

Candida peritonitis is associated with high mortality and multiple organ failure. With an evolving epidemiology of candidaemia indicating an increasing prevalence of rare Candida species worldwide, consideration of multidrug-resistant fungal pathogens as a cause of abdominal sepsis is paramount. We report three cases of Candida krusei as a cause of secondary and tertiary peritonitis. These cases highlight that the early use of an echinocandin class antifungal in patients not responding to standard regimens warrants consideration.

Fig 2. (a) Axial view: progress computed tomography scan demonstrating complete resolution of intrahepatic pancreatic pseudocyst. Resolution of intrahepatic bile duct dilatation. (b) Coronal view.

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