Severe intrapericardial adhesions, regardless of their etiology, represent a major challenge in cardiac surgery. Such adhesions increase the risk of cardiac injury, excessive bleeding, and technical difficulty in establishing cardiopulmonary bypass, thereby necessitating meticulous preoperative planning and careful intraoperative management. Herein, we report a 74-year-old female patient who required cardiac surgery in the presence of severe pericardial adhesions. Echocardiography demonstrated severe mitral regurgitation due to P3 prolapse, accompanied by progressive left atrial enlargement. Preoperative imaging findings suggested the presence of dense pericardial adhesions; therefore, a median sternotomy was selected with careful surgical planning. The patient underwent mitral valve repair with artificial chordae implantation and annuloplasty, along with concomitant tricuspid valve repair. Intraoperatively, extensive intrapericardial adhesions were confirmed, requiring cautious and meticulous dissection to avoid cardiac injury. The postoperative course was uneventful, and mitral regurgitation improved to a minimal degree. The patient was discharged on postoperative day 12 and remained free from heart failure symptoms during follow-up. Severe pericardial adhesions can substantially increase the complexity and risk of cardiac surgical procedures, irrespective of the underlying cause. Accurate preoperative assessment, anticipation of technical difficulties, and selection of an appropriate surgical strategy are crucial for ensuring procedural safety and achieving favorable surgical outcomes.

NOTCH3 variants cause CADASIL (cerebral autosomal dominant arteriopathy and subcortical infarcts and leukoencephalopathy), the most common monogenetic form of small vessel disease (SVD) and vascular dementia (VaD). The molecular mechanisms driving CADASIL pathogenesis remain poorly understood, and no specific treatments are currently available. NOTCH3 is mainly expressed in vascular smooth muscle cells (VSMCs) that arise from different embryonic origins. Using human induced pluripotent stem cell (iPSC) models, we generated origin-specific VSMCs and found that cerebral, but not peripheral, VSMC mimics are selectively vulnerable to NOTCH3 variants. CADASIL iPSC–derived brain-specific VSMCs acquired a synthetic phenotype, accompanied with extensive extracellular matrix accumulation and impaired cell adhesion leading to anoikis. Furthermore, an endothelial-independent nitric oxide signaling was substantially impaired in CADASIL iPSC–derived VSMCs. Phosphodiesterase-5 inhibition successfully reversed the functional abnormality and survival of mutant VSMCs. Our findings uncovered mechanistic insights and suggest a viable therapeutic strategy for NOTCH3-associated SVD/VaD, reinforcing the value of patient-specific iPSCs for disease modeling and potential drug discovery.

We report a rare case of advanced abdominal ectopic pregnancy with prolonged fetal demise that progressed to acute obstructive abdomen in a 39-year-old multiparous woman living in a socially vulnerable setting and with a history of polysubstance use. The case highlights the diagnostic and therapeutic challenges of abdominal ectopic pregnancies, a condition associated with high maternal morbidity and mortality, in which early detection is often hindered by nonspecific symptoms and the absence of prenatal care. The diagnosis was initially suggested by ultrasonography and subsequently confirmed by exploratory laparotomy, which revealed a deceased fetus freely located within the abdominal cavity, a thrombosed placenta, and extensive intestinal adhesions, consistent with acute intestinal obstruction. A multidisciplinary surgical approach, involving both obstetrics and general surgery teams, enabled safe removal of the retained fetus, adhesiolysis, and resolution of the obstructive process, resulting in a favorable maternal outcome. This case underscores the importance of continuous obstetric surveillance, comprehensive women’s healthcare, and strengthened care networks for socially vulnerable populations, in whom severe conditions may remain undetected for prolonged periods.

A 69-year-old woman was referred to our department for an abnormal shadow on chest radiography. Contrast-enhanced computed tomography (CT) revealed a solid nodule in the right lower lobe and defects in the branches of the middle and lower lobes of the pulmonary artery (PA). Furthermore, collateral circulation had developed via the right internal thoracic, bronchial, intercostal, inferior phrenic, and subdiaphragmatic arteries. The solid nodule was diagnosed as adenocarcinoma by CT-guided biopsy. The day before surgery, embolization was performed using interventional radiology (IVR) to mitigate the risk of bleeding during thoracotomy, resulting in minimal intraoperative bleeding during the subsequent right middle and lower lobectomies with lymph node dissection (ND2a-1). UAPA is a rare congenital abnormality characterized by unilateral pulmonary artery agenesis. The presence of recurrent infections, extensive intrathoracic adhesions, and developed collateral circulation may pose challenges during surgical procedures.

Differentiating pulmonary nodule pathology is challenging. Pleural adhesions complicate surgery, potentially relating to nodule characteristics. This study explores the correlation between nodule pathology and pleural adhesions. A single-center retrospective study included 539 patients with surgically resected pulmonary nodules. Pleural adhesions were graded, and univariate/multivariate analyses identified influencing factors. Prediction models and a nomogram were constructed. Benign nodules had a higher adhesion rate (54.8% vs. 17.6%) but mostly localized adhesions; malignant nodules had more extensive adhesions (7.2% vs. 1.6%). Age, benign nodules, and preoperative fibrinogen were independent factors. Fibrinogen alone (AUC = 0.907) and the combined model (AUC = 0.894) showed excellent predictive performance. Benign nodules are more associated with pleural adhesions, while malignant ones cause more extensive adhesions. Age and fibrinogen are key risk factors. Fibrinogen is a reliable biomarker, and the nomogram aids individualized preoperative risk assessment.

Pleurodesis is a widely used technique in thoracic surgery aimed at preventing the recurrence of pleural effusion and pneumothorax. Although chemical sclerosing agents such as talc are effective, their use is often limited by significant adverse effects, prompting interest in safer and more biocompatible alternatives. This experimental study evaluates the pleurodesis-inducing potential of three autologous biological agents-autologous blood (AB), platelet-rich plasma (PRP), and injectable platelet-rich fibrin (i-PRF)-in a rat model. Twenty-eight adult Wistar albino rats were randomly divided into four groups: control (saline), AB, PRP, and i-PRF. Each agent was administered intrathoracically, and the animals were observed over a 21-day period. Subsequently, pleural and pulmonary tissues were examined histopathologically. PRP induced the most pronounced pleurodesis response, with significant pleural thickening, extensive fibrous adhesions, and dense collagen deposition. i-PRF, though less potent than PRP, showed a biocompatible and structurally organized fibrotic effect, with moderate collagen formation and minimal inflammation. AB elicited a modest, inconsistent pleurodesis response, with limited fibrotic remodeling. These findings suggest that platelet-based products, particularly PRP, may serve as effective and physiologically compatible alternatives to conventional chemical agents in pleurodesis. Furthermore, i-PRF represents a promising candidate in scenarios where minimizing inflammation is critical. This study is the first to evaluate i-PRF in pleurodesis and supports its potential translational application. Further clinical studies are warranted to validate these findings in human subjects.

Tricuspid valve surgery inherently carries an increased peri-operative risk. In the redo setting, impaired right ventricular function and the frequent presence of hepatic dysfunction are further amplified by extensive adhesions. Conventional re-sternotomy, although well-established, requires substantial tissue trauma. Therefore, strategies that minimize surgical trauma-such as a minimally invasive approach on the beating heart with limited access-may be advantageous in this high-risk population. In this video tutorial, we present a minimally invasive (totally endoscopic) second re-operation in a 65-year-old male with severe tricuspid valve regurgitation and advanced right heart failure (New York Heart Association III) after prior double valve replacements for infective endocarditis. Given the elevated surgical risk (EuroSCORE II 5.4 %, Society of Thoracic Surgeons predicted risk of mortality 3.0 %, Model for End-Stage Liver Disease 19) and the presence of dense adhesions, a right microthoracotomy (periareolar incision) approach was chosen. The operation was performed with a beating heart without cardiac arrest, and the right atrium was opened directly through the pericardium to avoid extensive adhesiolysis. Full cardiopulmonary bypass was achieved using the smartcanula system, which obviated the need for neck venous cannulation and caval snaring. In a well-established minimally invasive cardiac surgery programme, this strategy is able to minimize surgical trauma and complexity in redo cases, providing safe and effective tricuspid valve surgery while reducing myocardial injury and procedural risk.

A Step-By-Step Description of the Hysteroscopic Injection of Platelet-Rich Plasma (PRP) Into the Endo-Myometrial Junction For Patients With Asherman's Syndrome.

Objective: This study processes and analyzes rectal MRI images of patients with mid-to-low rectal cancer using deep learning technology, and integrates these data with clinical baseline information to construct a fully automated end-to-end prediction model. The model is designed to assist colorectal surgeons in preoperatively assessing surgical difficulty and selecting the optimal surgical approach. Methods: We prospectively collected data from patients with mid-to-low rectal cancer who underwent laparoscopic total mesorectal excision (TME) and had been graded according to the surgical difficulty system recorded in Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, between March, 2019 and May, 2025. Inclusion criteria: (1) age 18-75 years; (2) tumor lower edge within 10 cm of the anal verge as measured by rectal MRI; (3) pathologically confirmed rectal adenocarcinoma; (4) complete, accessible preoperative rectal MRI DICOM images; and (5) tumor invasion depth of T1-4aNanyM0. Exclusion criteria: (1) synchronous or metachronous multiple primary colorectal cancer with concurrent surgery; (2) Any surgery other than TME; (3) tumor involvement of surrounding organs requiring combined organ resection; (4) unfitness for laparoscopic surgery (e.g. extensive adhesions from previous abdominal surgery, contraindications to pneumoperitoneum for various reasons, etc.); and (5) Robot-assisted radical resection of rectal cancer. Included patients were divided into training and test datasets, and deep learning techniques (rectal MRI image annotation, image preprocessing, data augmentation, and feature extraction) were used for model construction. Results: A total of 366 patients were included, with 253 males. The median BMI was 24.1 (22.0, 26.6) kg/m², and the median distance from the tumor lower edge to the anal verge was 6.5 (4.7, 7.8) cm. A total of 288 patients received neoadjuvant chemoradiotherapy. Based on intraoperative difficulty grade, patients were divided into the difficult group (199 cases) and the nondifficult group (167 cases). Compared to the nondifficult group, the difficult group showed several statistically significant differences (all P<0.05): higher proportion of males [86.9%(173/199) vs. 47.9%(80/167), χ²=64.813, P<0.001]; higher BMI [25.4 (23.2, 27.6) kg/m² vs. 23.1 (21.2, 25.2) kg/m², Z=-6.082, P<0.001]; and higher proportion of neoadjuvant chemoradiotherapy [88.9% (177/199) vs. 66.5%(111/167), χ²=27.357, P<0.001]. However, there was no statistically significant differences in the distance from the tumor lower edge to the anal verge between the two groups [6.4 (4.7, 7.9) cm vs. 6.6 (4.7, 7.7) cm, Z=-0.001, P=0.999]. Importantly, our surgical difficulty prediction model achieved an accuracy of 0.729, a precision of 0.684, a specificity of 0.521, a recall of 0.915, an F1-score of 0.782, and an AUC of 0.83. Conclusions: We proposed a prediction model with reasonable accuracy using artificial intelligence that can assist surgeons in determining surgical difficulty and choosing the optimal surgery approach for mid-low rectal cancer.

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms that predominantly originate in the gastrointestinal tract. Extra‐gastrointestinal GISTs can occur in atypical locations such as the pelvis, which may mimic gynecologic malignancies, creating diagnostic challenges. This case report presents a 39‐year‐old female with a history of Type 1 diabetes mellitus and prior kidney and liver transplantation who presented with progressive abdominal bloating and discomfort. Initial pelvic ultrasound revealed a large right adnexal mass (18.8 × 12.8 × 9.8 cm), suggestive of an ovarian mass. CT imaging confirmed a complex pelvic tumor exerting mass effect on surrounding organs, initially concerning for gynecologic malignancy. Following an unrevealing endoscopic evaluation, the patient underwent exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo‐oophorectomy, and tumor debulking. Intraoperative findings included a large right pelvic mass with extensive adhesions, friable tumor implants, and mesenteric lymphadenopathy. Postoperative pathology confirmed a high‐grade GIST with epithelioid features, positive for DOG1 and CD117, with a Ki‐67 index exceeding 30%. Molecular testing identified a KIT Exon 9 mutation, leading to initiation of imatinib therapy. Overall, this case represents an extra‐GI/pelvic GIST that mimicked a primary ovarian neoplasm. We achieved a complete macroscopic cytoreduction (no gross residual disease) but explicitly note pT4 (due to intraoperative rupture), informing adjuvant KIT inhibition. This case emphasizes the diagnostic challenge of extra‐GI/pelvic GISTs mimicking ovarian tumors. Studies show that GISTs mimicking primary ovarian tumors (GIST‐OTs) typically occur in younger women, have lower recurrence rates (6.8% vs. 54.5% in metastatic ovarian GISTs), and achieve complete resection more frequently (> 90% vs. 57% in metastatic cases). Immunohistochemical profiling (DOG1 and CD117) and molecular testing are crucial for accurate diagnosis and treatment planning. Although imatinib remains the cornerstone of GIST management, dose adjustments based on specific mutations may be necessary, as patients with KIT Exon 9 mutations might benefit from higher dosing. Multidisciplinary approaches combining imaging, histology, and molecular profiling are essential for optimizing outcomes in these complex cases. This extra‐GI/pelvic GIST occurred under chronic posttransplant immunosuppression after renal and liver transplantation; as such, we highlight the transplant–oncology interface, notably, an elevated posttransplant cancer risk, rare but documented GIST after kidney transplant, and TKI–calcineurin‐inhibitor interactions that require coordinated management.

Endometriosis involves ectopic endometrial tissue outside the uterus, commonly in the pelvis but sometimes affecting organs like the urinary tract, gastrointestinal system, and respiratory tract. Abdominal wall endometriosis (AWE) is a rare subtype where endometrial tissue infiltrates the abdominal wall, often occurring secondarily in surgical scars, particularly after cesarean sections. Diagnosing AWE is difficult due to varied symptoms and locations, making imaging techniques such as ultrasound and MRI crucial for evaluation. Preoperative assessment is vital to determine the extent of tissue invasion, especially if large muscles, the peritoneum, or bowel are involved, which may require general surgical intervention. A 43-year-old woman with a history of three cesarean sections presented with menorrhagia, chronic pelvic pain, and a palpable lump above her cesarean scar. Ultrasonography revealed a hypoechoic irregular mass measuring 39 × 34 mm in the linea alba above the cesarean scar, extending into the peritoneal cavity and adherent to the uterine body. Surgical wide excision of the mass was attempted, but due to its extension and severe adhesion to the uterus, complete excision with clear margins was not possible. So, a total hysterectomy with bilateral salpingo-oophorectomy was performed. AWE mainly results from iatrogenic implantation of endometrial cells, particularly following cesarean sections, though lymphatic spread and metaplasia are also possible causes. It typically presents as a painful abdominal mass with symptoms like localized pain, swelling, bruising, bleeding, intermittent pelvic pain, and reduced fertility. Diagnosis is primarily made via abdominal and transvaginal ultrasound, with MRI used in uncertain cases. Medical treatments such as oral contraceptives, progesterone, danazol, and GnRH agonists offer only partial symptom relief without curing AWE. The definitive treatment is wide local surgical excision with at least 1 cm margins to prevent recurrence or rare malignant transformation. When the fascia and muscle are involved, or defects exceed 50 mm, fascia mobilization and polypropylene mesh placement may be necessary. In malignant or extensive cases, complete hysterectomy with bilateral salpingo-oophorectomy may be indicated. Preventive surgical measures during cesarean sections include gentle uterine handling, bleeding control, high-pressure saline irrigation before closure, avoiding dead spaces, use of wound protectors, thorough abdominal wall cleaning, specimen retrieval bags, and employing new needles and sutures to reduce AWE risk. AWE is a rare condition with unclear causes, increasingly relevant due to rising cesarean and obstetric procedures. Diagnosis relies on clinical assessment, patient history, ultrasound, and MRI. The primary treatment is wide surgical excision, which may be more extensive for large or complex lesions, with careful follow-up to monitor for recurrence.

Acute mesenteric thrombosis is a relatively rare condition associated with extremely high mortality rates. The unfavorable prognosis is largely explained by the nonspecific clinical presentation, which often delays diagnosis and results in late surgical intervention. The occurrence of mesenteric thrombosis in patients following abdominal operations further complicates both recognition and management. The aim of this report was to present the experience of successful treatment of postoperative mesenteric thrombosis, the peculiarity of which was the unusual localization of intestinal necrosis. A 76-year-old man was admitted with signs of acute adhesive intestinal obstruction. His past surgical history was significant: 20 years earlier he underwent gastroenterostomy, cholecystojejunostomy, and pancreatocystojejunostomy for a pancreatic cyst; five years earlier he underwent suturing of a perforated gastroenteroanastomotic ulcer. Concomitant diseases included long-standing stage III hypertension complicated by an ischemic stroke 21 years earlier, coronary artery disease, and chronic heart failure class II. Despite conservative treatment, intestinal obstruction persisted, and laparotomy was performed. During laparotomy a pronounced adhesive process in the upper floor of the abdominal cavity was revealed that made it practically impossible to differentiate the anatomical structures. The initial loops of the small intestine were markedly dilated, up to 5 cm in diameter. At a distance of approximately 70 cm from the ligament of Treitz a adhesion was identified, which compressed and twisted the jejunum. After crossing of this adhesion intestinal patency was restored. However, in the course of viscerolysis the loop of the jejunum efferent from the cholecystojejunostomy was inadvertently damaged, and the defect was sutured. Due to the risk of further complications, the operation was completed at this stage. Seven days later acute peritonitis developed. Leakage of the intestinal sutures was suspected, and relaparotomy was performed. Local mesenteric thrombosis with necrosis of the jejunal loop from the cholecystojejunostomy was revealed. The free necrotic part was resected, while the remaining segment embedded in an adhesive conglomerate could not be separated. The loop was tamponed and isolated with the omentum, and a terminal enterostomy was created. The loop of the small intestine afferent to the interintestinal anastomosis was brought out in the form of a terminal enterostomy. In the early postoperative period up to 300 ml of bile was discharged daily through the cholecystojejunostomy; this gradually decreased and stopped spontaneously after four weeks, and the wound healed by secondary intention. Suppuration of the postoperative wound was managed conservatively. The patient was discharged on day 33 (total stay 41 days). Eighty days later the terminal enterostomy was closed without complications. This case demonstrates the difficulties of managing local mesenteric thrombosis in the setting of extensive adhesions and multiple previous operations. The unusual localization of necrosis in the jejunal loop from the cholecystojejunostomy made surgical tactics especially challenging. As no standardized guidelines exist for such situations, individualized intraoperative decision-making is crucial.

Background: Hybrid vaginal-assisted natural orifice transluminal endoscopic hysterectomy (VANH) combines vaginal surgery with laparoscopic assistance, offering a minimally invasive option in patients with prior pelvic surgery or altered anatomy where standard vaginal hysterectomy may be unfeasible. Methods: We present a video-based technical report of a VANH performed in a 43-year-old woman with symptomatic adenomyosis, previous cesarean section, and extensive pelvic adhesions. The procedure begins with a purely vaginal phase: anterior and posterior colpotomy and transection of uterine pedicles. Following this, an Alexis retractor is introduced transvaginally through the colpotomies, establishing communication with the peritoneal cavity. Pneumoperitoneum is created via transvaginal insufflation. The hysterectomy is completed using standard endoscopic instruments inserted through the Alexis port, under simultaneous laparoscopic guidance via a single umbilical trocar. The vaginal cuff is closed vaginally. Results: The procedure was completed without complications. Total operative time was 80 minutes, with minimal blood loss. The patient was discharged within 24 hours. The video demonstrates step-by-step execution of this hybrid approach, with emphasis on anatomical orientation, safe energy use, and team coordination between the vaginal and laparoscopic phases. Conclusions: Hybrid VANH with transvaginal pneumoperitoneum and laparoscopic assistance is a safe, effective alternative for complex hysterectomy. It allows reduced abdominal port use while preserving visual control and access. This Video 1 serves as a practical educational resource for advanced gynecological surgeons. Video 1: This video demonstrates a hybrid VANH performed on a patient with a suspected challenging pelvic anatomy. Laparoscopic assistance improved spatial orientation and facilitated safe dissection. The dual visualization is a valuable training aid for surgeons learning the VANH technique. VANH, vaginal-assisted natural orifice transluminal endoscopic hysterectomy.

Background and Objectives: Vaginal uterine manipulators facilitate laparoscopic hysterectomy but are limited by cost and anatomical constraints. The Boztosun method offers a cost-effective intra-abdominal alternative. This study evaluated the clinical performance and safety of this technique. Materials and Methods: This single-center, retrospective descriptive study analyzed 40 patients who underwent laparoscopic hysterectomy using the Boztosun method at Akdeniz University Hospital between October 2021 and June 2022. Clinical characteristics and perioperative outcomes were assessed. Results: The mean operative time was 78.5 ± 20.6 min, and the mean colpotomy time was 8.05 ± 3.57 min. Conversion to laparotomy occurred in 3 patients (7.5%), primarily due to extensive adhesions or large uterine size. No intraoperative complications, organ injuries, or blood transfusions were recorded. All patients were discharged within two days. Patients with prior abdominal surgery had significantly longer operative and colpotomy times (p < 0.05). Conclusions: The Boztosun method is a safe, efficient, and low-cost alternative to vaginal manipulators in laparoscopic hysterectomy. It may be particularly useful in resource-limited settings or when vaginal manipulation is not feasible.

Persistent descending mesocolon(PDM)is a fixation abnormality caused by the failure of the left colon to fuse with the parietal peritoneum during embryological development. In cases of PDM, extensive adhesions and characteristic vascular branching anomalies are often observed. Therefore, great care must be taken to avoid intestinal injury due to adhesion dissection and intestinal ischemia due to vascular damage. Particularly during lymph node dissection for sigmoid colon or rectal cancer, it is recommended to preserve the left colic artery(LCA)or assess blood flow using indocyanine green(ICG)fluorescence imaging to ensure adequate blood supply to the oral side of the anastomosis. In this study, we report 6 cases of colorectal cancer surgery involving PDM that we have experienced.

Meckel's diverticulum (MD) is a frequently silent congenital anomaly of the gastrointestinal tract. While complications such as bleeding and obstruction are more common, traumatic perforation remains extremely rare, particularly from penetrating injuries. To date, isolated perforation of MD following self-inflicted abdominal stab wounds has been reported only sporadically. We present the case of a 39-year-old male with a long-standing history of schizophrenia and epilepsy who arrived at the emergency department following his fifth self-inflicted abdominal stab injury over the past decade. On physical examination, a segment of small bowel was found protruding from a 4 cm periumbilical wound. Emergency exploratory laparotomy revealed extensive intra-abdominal adhesions and an isolated perforation of a Meckel's diverticulum located 60 cm proximal to the ileocecal valve. No other visceral injuries or hemorrhage were detected. The diverticulum was resected using a linear stapler, and serosal defects were repaired. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Isolated MD perforation caused by penetrating abdominal trauma is exceedingly rare and diagnostically challenging. When occurring in psychiatric patients with repetitive self-harm behavior, it presents an even more complex scenario. This case underscores the importance of meticulous intra-abdominal exploration in stab wound patients and contributes novel insight to the limited literature on traumatic MD injuries.

A man in his 40s presented with fever and right lower abdominal pain. Laboratory data showed elevated inflammatory markers. Abdominal CT showed a 3 cm mass in the mid-lower abdomen with fluid retention and gas continuity with the small bowel, consistent with diverticulitis. Multiple hepatic nodules were also noted. After antibiotic therapy, laparoscopic surgery was performed on hospital day 3. Intraoperatively, a firm mass was found approximately 30 cm proximal to the ileocecal valve, with extensive adhesions to the mesentery and omentum. Multiple white nodules were observed in both hepatic lobes. We performed partial small bowel resection(approximately 60 cm)and partial liver resection for liver biopsy. The pathological diagnosis was adenocarcinoma arising from Meckel's diverticulum with multiple liver metastases(pT3pN1bpM 1a, pStage Ⅳa). We decided to introduce systemic chemotherapy similar to that used for colorectal cancer in small bowel cancer, and we started systemic chemotherapy with mFOLFOX6 at 8 weeks after surgery. Bevacizumab was added from the fourth course due to progressive liver metastasis on CT imaging. After 15 courses, a partial response(PR)of the liver metastases was achieved with no local recurrence or new lesions. Meckel's diverticular adenocarcinoma is extremely rare, and no standard chemotherapy has been established. We have observed relatively good results with mFOLFOX6 plus bevacizumab in this setting.

Stump pyometra associated with ovarian remnant syndrome is a late complication resulting from incomplete ovariohysterectomy and represents a relevant condition in small animal surgical and clinical practice. This report describes the case of an elderly spayed female dog presenting recurrent vulvar discharge, pain and signs compatible with hormonally driven cyclicity, culminating in the diagnosis of an infected uterine stump associated with functional ovarian remnant. Diagnosis was established through clinical evaluation, laboratory testing, ultrasonography and intraoperative confirmation. The patient underwent exploratory celiotomy for complete removal of the uterine stump and residual ovarian tissue, a procedure successfully performed despite extensive adhesions and large ovarian cystic changes. Postoperative recovery was satisfactory and all clinical signs resolved. This case reinforces the need for meticulous surgical technique during ovariohysterectomy and highlights the importance of integrating clinical signs, physical examination findings and imaging results to achieve accurate diagnosis and definitive treatment of this condition.

Chronic pelvic and lower gastrointestinal symptoms often pose diagnostic difficulty, especially in resource-limited settings where advanced imaging and specialized surgical services are scarce. We report the case of a 76-year-old woman with a decades-long history of progressively narrowing stool caliber and left iliac fossa pain, for whom repeated colonoscopic and radiologic investigations failed to identify a cause. Diagnostic laparoscopy revealed extensive pelvic adhesions tethering the proximal rectum to the posterior uterus. Adhesiolysis resulted in marked symptomatic improvement. This case highlights the diagnostic utility and therapeutic role of laparoscopy in detecting adhesive bowel disease, particularly in rural centres. Strengthening minimally invasive surgical capacity in such regions can greatly improve outcomes for patients with chronic, unexplained gastrointestinal symptoms.

Craniofacial microsomia (CFM) presents with variable underdevelopment of craniofacial structures. The clinical severity varies widely and may lead to airway compromise and feeding difficulties in neonates. Herein, we describe a rare case of unilateral CFM with a severe Tessier number 7 cleft, complete mandibular agenesis, ear deformities, and extensive intraoral adhesions. Particularly, adhesions between the tongue and oral mucosa induced a deficiency of reconstructable soft tissue, making the release of the adhesion challenging and complicating the timing of surgical intervention. The patient required tracheostomy for respiratory distress and was fed via a nasogastric tube due to severe Tessier number 7 cleft, which caused significant difficulty with oral feeding. Considering the need for oral feeding and the anatomical challenges, surgical intervention was performed on day 70. The procedure involved removal of intraoral adhesions, separation of the oral cavity from the external face to restore functional integrity, and reconstruction of the oral commissure. This allowed initiation of oral feeding and facilitated aesthetic improvement without complications. This case illustrates a severe form of CFM and highlights the importance of timely, growth-adapted interventions to restore essential functions.