Erratum to: Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

[This corrects the article DOI: 10.1186/s13017-016-0089-y.].

"Enteroatmospheric fistulae"--gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.

Collision tumor of the appendix: mucinous cystadenoma and carcinoid. A case report

INTRODUCTION

Mucinous cystadenoma is the most common of benign neoplasms of the appendix and carcinoid is the most common type of primary malignant lesions of the appendix.We report a rare case of a 57-year-old female with combined mucinous cystadenoma and carcinoid tumor of the appendix.Dual carcinoid and epithelial neoplasia is a rare occurrence in the appendix.

CASE REPORT

A 57-year-old Caucasian woman presented after incidentally palpating a mass on her right iliac fossa. Imaging modalities revealed a cystic tumor in the right iliac fossa with a diameter of about 8 cm, originating either from the right ovary or the appendix. She underwent laparoscopic surgical exploration, which revealed appendiceal mucocele and appendicectomy was finally performed as well as excision of a right ovarian cyst. Pathological examination showed acollision tumor consisting of mucinous cystadenoma and carcinoid tumor of the appendix. Because of the size and extension of the carcinoid tumor, which the pathology report revealed, she underwent re-exploration and laparoscopic right colectomy.

DISCUSSION

Mucinous cystadenoma is rare, but it is the commonest of benign appendiceal tumours accounting for 0.6% of appendectomy specimens. It can present as appendicitis,mucocele or if the tumour ruptures, as pseudomyxomaperitonei. On the other hand, carcinoid is the most common type of primary malignant lesion of the appendix and 0.3-0.9%of appendectomy specimens, with small predominance in female patients. Rare cases of mucinous cystadenomas of the appendix coexisting with carcinoid tumors were reported before, but in our case it was a collision tumor with no transitional zone between them. Also, the clinical presentation of our patient and the differential diagnosis of ovarian lesions from appendiceal tumors is worth being mentioned.