The most common cause leading to primary constipation is obstructed defecation syndrome (ODS). Anatomical disorders in the pelvic floor region (rectocele, enterocoele, rectal intussusception, and rectal prolapse) result in ODS. However, it always occurs in combination with a functional defect of defecation. This review offers an in-depth look at ODS diagnosis and treatment. Conservative or surgical treatment options are available. Conservative treatment includes several approaches to defecation practice and regimen and dietary measures combined with pelvic floor rehabilitation and psychological support. However, some patients require surgical intervention as ODS symptoms might persist despite conservative treatment. Surgical approaches include transvaginal, transabdominal, and transanal procedures. The most widely used are the transanal procedures, which are associated with good short-term results and low complication rates. Nevertheless, the long-term complications are still unknown and being discussed. The underlying cause of ODS is a combination of functional and anatomical abnormalities; therefore, treatment should be focused on pelvic organ systems for several reasons. Accordingly, only a multidisciplinary approach and (multimodal) combination of different approaches can be used to avoid inferior results in this challenging area.

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Background: Postoperative pain and protracted recovery after open hemorrhoidectomy is a major concern for both patients and surgeons. This study aimed to assess the effect of draining the hemorrhoidectomy wound, on postoperative pain and healing. Patients and Methods: Four hundred and sixty patients with Grade III and IV piles were randomized into two groups, in this prospective randomized study. Group A: Received the conventional postoperative care (repeated sitz baths). And Group B: In which continuous wound drainage is achieved by placing a piece of dry, soft, adsorbent gauze, to be changed once it became wet. Both groups were compared regarding postoperative pain, postoperative complications, healing time, and time of return to daily activities and work. Results: The mean patients' age was 39.2 ± 15.7 years, with 53.6% of them were females. No significant differences between both groups regarding patients, and disease characteristics. The visual analogue scale score, at the first postoperative day, showed no significant difference in both groups: (P = 0.2024); however, it was significantly lower in postoperative day 4 and day 7: (0.001 and 0.001, respectively). Postoperative complications were similar in both groups; however, the meantime of return to normal daily activity, the meantime of return to work, and the meantime of complete wound healing were significantly shorter in Group B: (P = 0.003, 0.011 and 0.004, respectively). Conclusion: Continuous wound drainage after Milligan-Morgan hemorrhoidectomy significantly decreases pain, significantly facilitate wound healing resulting in significantly earlier return to normal daily activity and return to work.

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Introduction: An increasing number of patients are considered for surgical removal of adrenal tumors, including pheochromocytomas (PCC). This study evaluated the presentation and surgical outcomes of individuals with adrenal tumors including PCC. Methods: Data, including histological, radiological, and biochemical, were collected prospectively of all patients operated for adrenal tumors, via the computerized hospital information database, between 2006 and 2018. Statistical analysis was performed by STATA program, using the Student test or Kruskal–Wallis test being used for continuous variables. Chi-squared or Fisher tests were used to compare categorized variables. Results: In this study, there were 112 patients, of which 54 were males and 58 females, mean of 32 years, the minimum age of 23 days, and a maximum of 78 years. Hormonally active tumors accounted for 58.51% and inactive hormone was accounted for 41.49%. The mean (SD) of the tumor dimensions was 6.00 (3.82), 5.31 (3.16), and 5.91 (2.93) mm for length, height, and width, respectively. The mean (SD) for the duration of surgery for males was 183 (98.8) and for females was 188 (101.06) min, with a hospital stay of 9.9 (6.86) days for males and 7.11 (6.16) days for females. The most common etiology was neuroblastoma (29.5%), followed by adrenocortical adenoma (16.1%), and 7.1% were PCC. Conclusion: Our population may have a slower recovery and more complications after resection of adrenal tumors including PCC. However, most complications may be minor, surgery was equally feasible and may not result in mortality in this vulnerable group of patients. Meticulous preparation for surgery is crucial among our population and particular attention should be focused on maintaining balance between the adrenal disease and comorbidities.

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Acute Necrotizing Pancreatitis Is A Very Serious Disease That May Lead To Severe Systemic And Catastrophic Local Complications. One Of The Rare Local Complications Is Left Gastric Pseudoaneurysm, Another Even More Rare Complication Is Colonic Perforation. Here, We Present A Case Of Acute On Alcoholic Chronic Pancreatitis Complicated By Large Pseudocyst, Presented With Severe Lower Gastrointestinal Bleeding And Hemorrhagic Shock, Treated By Urgent Exploration Which Revealed The Presence Of Both Left Gastric Pseudoaneurysm And Colonic Perforation And Dealt With By Transfixing Ligation Of Bleeding Vessel And Loop Ileostomy.

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Background: Severe acute respiratory syndrome coronavirus-2 is a multisystemic inflammatory syndrome that has threatened the health of vulnerable populations worldwide. The most severe effects are seen in the elderly and in immunocompromised patients, leading to increased mortality and complications. Breast cancer is the most common type of cancer. With the availability and awareness of early breast screening, immediate therapy is possible once a patient is diagnosed; however, in the coronavirus disease-2019 (COVID-19) outbreak, breast cancer patients faced a unique situation where treatment was possibly delayed. To decrease the risk of infection and mortality in patients with solid organ tumors, strategies such as screening for COVID-19 and triaging of surgical patients have been implemented and international guidelines and vaccination guidelines have also been published. Methods: This case series descriptive, retrospective study of nine female patients aged 45–69 years was conducted from February 2020 to May 2021. Results: Herein, we highlight that it is possible to perform elective surgeries safely in breast cancer patients during a pandemic by implementing COVID-19 risk assessment strategies and using hospital facilities and precautions to avoid the spread of COVID-19. There was no transmission of COVID-19 in any of our patients during the preoperative, intraoperative, postoperative, and follow-up periods. Conclusion: The best method for reducing the risk of infection among breast cancer patients includes advocating for a safer standard care by implementing risk assessment strategies and following strict infection control procedures.

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