Background/Objectives: Acute pancreatitis (AP) is a highly variable inflammatory condition that can lead to severe complications and high mortality, particularly in its severe forms. Early risk stratification is essential; however, the delayed availability of traditional scoring systems often limits its effectiveness. This study aimed to evaluate the clinical utility of systemic inflammation indices as early predictors of severity in patients with acute pancreatitis. Methods: A retrospective, observational study was conducted among patients diagnosed with acute pancreatitis, classified according to the revised Atlanta criteria. Upon admission, systemic inflammation indices were calculated from complete blood count parameters, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). Severity was assessed using the APACHE II score. Statistical analysis involved Kruskal–Wallis tests, Dunn’s post hoc comparisons, ROC curve analysis, logistic regression for odds ratios (ORs), and Spearman correlations. Results: SII, NLR, MLR, SIRI, and AISI showed statistically significant associations with AP severity (p < 0.05). MLR and SIRI exhibited the highest predictive performance (AUC = 0.74). ORs for severe pancreatitis were: MLR = 19.10, SIRI = 7.50, NLR = 7.33, AISI = 5.12, and SII = 4.10. All four indices also demonstrated moderate positive correlations with APACHE II scores. Conclusions: Systemic inflammation indices are simple, cost-effective, and accessible tools that can aid in the early identification of patients at high risk for severe acute pancreatitis. Their integration into clinical practice may enhance early decision-making and improve patient outcomes.

Anatomical variations of the biliary tree pose diagnostic and treatment challenges. While most are harmless and often discovered incidentally during procedures, some can lead to clinical issues and biliary complications, making knowledge of these variants crucial to prevent surgical mishaps. Here, we present an unusual and clinically significant case. A 61-year-old man is admitted to the hospital with epigastric pain and diagnosis of pancreatitis of biliary origin and intermediate risk of choledocholithiasis. Magnetic resonance cholangiopancreatography (MRCP) reported hepatolithiasis and choledocholithiasis, whereas endoscopic retrograde cholangiopancreatography showed cystic drain of the right hepatic duct. One month later the patient presented again to the emergency room with increasing abdominal pain and a computed tomography that demonstrated the presence of hepatic abscess and acute cholecystitis. The patient underwent percutaneous drain abscess and a subtotal laparoscopic cholecystectomy. Biliary anatomical variants present challenges on the diagnostic investigations, interventional and surgical procedures, understanding the possible complications is essential.

The incidence of acute pancreatitis is 34 per 100 000 people in the general population and is on the rise. Approximately 15% to 20% of all patients experience severe pancreatitis, with a mortality rate nearing 20%. This condition is often linked to vascular complications, although mesenteric thrombosis is a rare presentation. We present two cases of severe acute pancreatitis resulting in multiple organ failure. Histopathological examination revealed acute hemorrhagic pancreatitis with necrosis and mesenteric thrombosis in both cases. Mesenteric thrombosis, though uncommon, is a serious complication with atypical symptoms and high mortality rates. Vascular complications in severe acute pancreatitis should not be overlooked. This case report underscores the significance of recognizing such rare complications and the need for comprehensive consideration in clinical assessments.

Intestinal malrotation is the failure of the fetal intestine to complete a 270-degree counter clockwise rotation around the superior mesenteric artery, resulting in positional and fixation abnormalities of the small and large intestine. Adult presentation is uncommon with an estimated incidence of 0.2 to 0.5%. There is no consensus on treatment in patients with asymptomatic intestinal malrotation in adults. The aim of this document was to report and review a case of intestinal malrotation conditioning intestinal obstruction in an adult patient with successful laparoscopic management. We conclude that laparoscopic resolution is feasible, reproducible and may ensure a faster recovery in a selected group of patients.

Introduction Stoma placement is a common surgical procedure that can be performed in the context of urgent and elective surgery for benign and malignant conditions, with an estimated morbidity ranging from 21% to 70%. Methods A retrospective cohort analysis to determine the incidence of stoma placement postoperative-related complications and potential associated factors. This study was conducted at a single tertiary care center in Mexico City including all patients who underwent a stoma construction between January 2016 and October 2023. Results A total of 276 patients underwent stoma construction. Eighty-one (29.3%) patients presented morbidity exclusively related to the ostomy.The multivariate analysis showed the following risk factors: advanced age for developing stoma-related complications; obesity for developing parastomal hernia; strangulated hernia and complicated diverticular disease for developing mucocutaneous dehiscence; bowel obstruction and parastomal hernia for developing stomal prolapse; anastomotic leak and preoperative corticosteroid therapy for developing parastomal abscess; and end-colostomy and advanced age for reoperation. Discussion Ostomy creation carries a high morbidity rate. Preoperative features such as advanced age, obesity, corticosteroid therapy, the indication of the surgery, as well as the type of the stoma created must be considered as they could significantly impact the development of adverse outcomes.

Background Xanthogranulomatous cholecystitis (XG) is a rare inflammatory disease of the gallbladder (GB), macroscopic appearance may be confused with gallbladder cancer (GC) making the diagnosis challenging. Laparoscopic cholecystectomy (LC) is considerate the gold standard for the management of benign gallbladder disease however LC in XGC is associated with a high conversion rate to open cholecystectomy with a rate of 10.6 to 80%. The aim of this study was to determinate the rate of laparoscopic cholecystectomy on patients with histopathological diagnosis of CXG and the associated morbidity to the procedure. Material and methods This study is an observational, retrospective, and cross-sectional study carried out over a period of 18 years in a single institution. Patients underwent to laparoscopic cholecystectomy with histopathological diagnosis of xanthogranulomatous cholecystitis were included. The primary outcome was the rate of conversion to open surgery; secondary outcomes were the morbidity and mortality. The data were reported on percentages and averages. Statistical Package for the Social Sciences (SPSS, version 26) was used to analyze the data. The study was approved by the board of ethical committee in our institution in 2018. Results We registered 142 patients operated from cholecystectomy with histopathologic results of XGC and 106 surgeries were performed laparoscopically (74.6%); 52 were emergency surgeries (49%) and 54 elective (51%). The conversion rate to open cholecystectomy was 3.7% (4 patients). There were 5 post-surgical complications (4.7%) two bilomas, one surgical site infection, and two biliary leak. Conclusions XGX represents a surgical challenge from diagnosis to surgical management and is associated to a higher number of perioperative complications; nevertheless, a laparoscopic approach is safe in high volume centers with experience in laparoscopy.