Robert Mechera

Large ovarian cystadenofibroma causing large bowel obstruction in a patient with Klippel–Feil syndrome—A case report

Highlights • MR imaging may help to determine origin and dignity before surgery.• Explorative laparotomy is the appropriate surgical approach for masses of unclear origin and dignity.• Intraoperative frozen-sections can avoid extensive fertility impairing surgery.• Interdisciplinary management is mandatory in patients with Klippel–Feil syndrome.

Symptomatic giant peritoneal loose body in the pelvic cavity: A case report

Highlights • Giant peritoneal loose bodies occur rarely and have not often been described.• They can cause acute or chronic abdominal pain with changing localizations.• It is important to define its entity and to discern it from other manifestations.• Proper anamnesis, examination and preoperative investigations are crucial.

The association of surgical drains with surgical site infections – A prospective observational study

BACKGROUND Surgical drains are widely used despite limited evidence in their favor. This study describes the associations between drains and surgical site infections (SSI). METHODS This prospective observational double center study was performed in Switzerland between February 2013 and August 2015. RESULTS The odds of SSI in the presence of drains were increased in general (OR 2.41, 95%CI 1.32-4.30, p = 0.004), but less in vascular and not in orthopedic trauma surgery. In addition to the surgical division, the association between drains and SSI depended significantly on the duration of surgery (p = 0.01) and wound class (p = 0.034). Furthermore, the duration of drainage (OR 1.24, 95%CI 1.15-1.35, p < 0.001), the number (OR 1.74, 95%CI 1.09-2.74, p = 0.019) and type of drains (open versus closed: OR 3.68, 95%CI 1.88, 6.89, p < 0.001) as well as their location (overall p = 0.002) were significantly associated with SSI. CONCLUSIONS The general use of drains is discouraged. However, drains may be beneficial in specific surgical procedures.

Gallbladder perforation and massive intra-abdominal haemorrhage complicating acute cholecystitis in a patient with haemophilia A

We present an unusual case of a 32-year-old man with haemophilia A, who sustained massive, haemodynamically significant intra-abdominal bleeding from a perforated gallbladder wall and from the greater omentum as a complication of acute ulcerophlegmonous and haemorrhagic cholecystitis. Recombinant coagulation factor VIII was given and an emergency laparotomy was performed, with open cholecystectomy and haemostasis. Coagulation factor VIII was given for a further 2 weeks postoperatively, and the patient was discharged in good condition. In most published cases of haemorrhagic cholecystitis, the haemoperitoneum arises via transhepatic perforation; in this case, there was a free rupture into the peritoneal cavity. Patients with coagulopathies may have severe haemorrhagic complications and therefore need interdisciplinary management before, during and after surgery. Replacement therapy with factor concentrates should be initiated at once, and early surgery for gallbladder disease should be considered.