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Diverticulitis of the ileum is an inflammatory complication of diverticulosis. It is an uncommon cause of acute abdomen that can have a very serious course, leading, for example, to intestinal perforation or bleeding. Imaging findings are very often negative and the true cause of the condition is only revealed peroperatively. In this case report, we present a case of perforated ileal diverticulitis in a patient with bilateral pulmonary embolism. This was the main reason for conservative management in the first period of time. After resolution of the pulmonary embolism, resection of the affected bowel segment was performed at the time of the next attack.

Appendiceal mucocele is an obstructive dilatation of the appendix, which results from the filling of its lumen with mucus. This is a rare condition that is asymptomatic in half of the patients. Its severity depends on the cause of appendiceal dilatation. In a small percentage of cases, the dilated appendix ruptures, leading to the development of serious complication; this is termed as pseudomyxoma peritonei. Due to the possibility of malignant etiology of the mucocele, surgical resection remains an essential part of the treatment.

Treatment of metastatic rectal cancer and liver metastases continues to pose a major challenge. Synchronous liver metastases are present in up to one fifth of patients diagnosed with rectal carcinoma. Multidisciplinary cooperation is essential for determination of the consequent diagnostic and therapeutic plan. Only tight collaboration of experts from different medical fields allows for optimal timing of various medical procedures leading to a maximal benefit for the patient. Given the complexity of the problem, different specific methods and combinations thereof are applied in the course of the therapy, making the design of straightforward guidelines impossible. Since open surgery is complicated by the vastly distant locations of the rectum and liver, minimally invasive approach brings more perspectives in simultaneous surgery. A novel possibility of robotic and/or laparoscopic surgery performed by two teams is currently being developed. Despite the progress in surgical technology, optimal strategy has not yet been established.

Unlabelled: The authors refer about their first experience with radiofrequency ablation of locally advanced pancreatic tumors. They put forward the prospective study of five patients (four with ductal adenocarcinoma of the head and one with malignant neuroendocrine tumor of pancreatic body), who either because of local advanced disease or performance status, were not able to undergo radical curative surgery. All patients underwent peroperative radiofrequency ablation of pancreatic tumors. In the case of pancreatic head localization, posterior retrocolic gastro-enterostomy and hepatico-jejunostomy to Y Roux jejunal loop were performed. There was no perioperative mortality. In one case duodenal leak apeared in the fourth postoperative day. This was healed conservatively by drainage. At one patient the subfascial absces developed. This was solved by drainage reoperation at the fourteenth postoperative day. After consolidation, all patients were released to home care., Conclusion: According to our early experience, radiofrequency ablation of inoperable pancreatic tumors is relatively save cytoreductive procedure.

Anticoagulation therapy may be complicated by spontaneous onset of an intramural hematoma of the duodenum and small intestine. Other causes were published only as case reviews. Radiological literature describes typical findings, which are fundamental for the diagnostics. However, only a fraction of patients present with them. This article describes a case of a female patient, treated for stomach pains. Based on her history, laboratory findings, ultrasound and CT findings, the condition was mistaken for acute pancreatitis and the pancreatic body necrosis with pseudocysts, drained under the CT control. The correct diagnosis was established a year later. Surgical revision indicated for a cystoid relaps and difficulties with intestinal passage revealed an old intramural hematoma within the duodenojejunal junction wall, the hematoma was evacuated and gastroenteroanastomosis performed.

The authors present a rare case of the fish bone migration from the upper GIT into the liver parenchyma. Furthermore, a possibility of the diagnostics and management of its rare complication- an inflammatory pseudotumor of the liver is presented. Based on the literature data, other possible complications of foreign objects in the liver parenchyma are listed, including their diagnostic and treatment options.

Objective: To demonstrate in a group of 26 patients with benign stenosis of the trachea the possibility to use a Palmaz stent as the method of choice., Material and Methods: The authors introduced since 1995 to patients with benign stenosis of the trachea 36 stents (1 Wallstent, 2 Z stents and 33 Palmaz stents). The operation was performed under general anaesthesia in an operating theatre under skiascopic and optic control. The stent was inserted along a guide. Before insertion of the stent they dilated the stenosis by means of a balloon dilatation catheter., Results: Respiration improved in all patients within 6 days after introduction of the stent. Within 30 days after insertion of the stent none of the patients died. Two patients (7.7%) died four weeks (Palmaz stent) and 11 months (Wallstent) after insertion of the stent. Restenosis was observed in 9 patients (34.6%) 2-16 weeks after introduction of the stent. In 5 patients restenosis developed repeatedly. At present 19 patients (73%) are free from complaints for 1 month to 4 years after insertion of the stent (average 28 months). 5 patients (19%) had a tracheostomy and insertion of the stent in these patients did not produce so far the anticipated result., Conclusion: The authors assume that the use of Palmaz stent is in patients with benign stenosis of the trachea in indicated cases the method of choice.

Objective: The authors submit for discussion a group of patients where they resolved a relapsing benign stenosis of the biliary pathways by insertion of a metal stent., Material and Methods: Since 1995 the authors introduced a metal stent in 29 patients with benign stenosis of the biliary pathways. In the majority they used a Palmaz stent., Results: The 30-day mortality in the group of patients was 3.4% (1 patient, myocardial infarction). Two patients (6.9%) died 3 and 18 months resp. after insertion of the stent (pneumonia complicated by a pulmonary abscess, hepatorenal failure). Signs of obstruction of the stent (raised levels of bilirubin and liver enzymes) were observed in 5 patients (17%). In 8 cases (27%) migration of the stent occurred. The follow-up period in 26 patients with benign stenosis with a stent is two months--4 years (mean 19 months). Sixteen patients are followed up for more than 12 months., Conclusion: In the treatment, in particular of relapsing benign stenosis of the biliary pathways, specially when located in the area of the anastomosis, insertion of a metal stent is effective alternate treatment.

The contemporary incidence of the tumours of the pancreas is approximately 3.5% in the Czech Republic. Benign tumours represent only about 2% of them. We have found 7 such patients (2.3%) in our population of 303 patients operated for pancreatic tumours. This paper summarizes our experience with the diagnostics and surgical treatment of these patients.

The authors used between October 1993 and January 1997 in 131 patients with inoperable malignant or benign stenosis of the oesophagus an expansible metal stent. In 25 patients the stenosis was in the upper third of the oesophagus, in 44 in the medium part, in 53 in the lower third of the oesophagus and in 9 patients in the area of the anastomosis. All patients suffered at the time when the stent was introduced from marked dysphagia (stage 3-4 according to the international classification). In 45 patients the authors introduced more than one stent. 112 patients suffered from malignant stenosis (67 squamous cell carcinoma, 27 adenocarcinoma, 9 pulmonary or bronchogenic carcinoma, in two instances lymphoma, in two instances leiomyosarcoma and in five patients another type of tumour). Seventeen patients suffered from benign stenosis (8 complications of reflux oesophagitis, 3 stenosis in the anastomosis, in two instances corrosion by acid, 2 cases of epidermolysis bullosa oesophagi and one post-radiation stenosis). In these patients repeatedly before introduction of the stent dilatation of the stenosis by means of a balloon dilatation catheter was attempted. In two instances the etiology of the stenosis was obscure. Complications related to the procedure proper or after insertion of the stent were recorded in 49 patients-dislocation of the stent 23x, occlusion of the stent 17x, development of a fistula 6x, ulceration 16x, haemorrhage 4x, hyperplasia of the mucosa 21x, ileus 2x, inadequate expansion of the stent 8x.

The authors compare the importance of modern imaging methods and simple X-rays of the abdomen for the accurate diagnosis of ileus conditions. They discuss the possibilities of different methods and emphasize the importance of series of simple X-rays of the abdomen in different positions. The objective of the recommended procedures is to examine as well as possible a group of patients with an obstruction in the small or large intestine, to localize the obstruction, assess its etiology and not merely state that on the simple X-ray the horizontal beam reveals levels.

The authors summarise their experience with the treatment of almost 100 patients with malignant or benign stenosis of the biliary pathways by a percutaneously inserted expansible metal stent. They compare the advantages of different percutaneous procedures and evaluate critically indication for the introduction of an expansible metal stent or self-expansible stent in patients with malignant or benign stenosis of the bile ducts.

External pancreatic fistulas are feared complications of pancreatic surgery or to trauma of the pancreas. In our paper we report on 2 patients suffering of external pancreatic fistulas successfully treated by operation. We demonstrate the examinations suitable for preoperative mapping of the fistula, the possibilities of conservative treatment and the strategy of surgical management of the fistulas. During the follow-up time the results of the operation are excellent.

The authors present their experience with preoperative external-internal percutaneous transhepatic drainage of the biliary pathways (PTD) in 143 patients. From this group in the final stage 53 patients were operated. The authors discuss the contemporary position and importance of preoperative PTD and compare the advantages of external-internal PTD and external drainage of the biliary pathways. A rapidly performed and correctly indicated external-internal PTD reduces effectively within several days the patient's bilirubin level, the bile passes into the duodenum, dehydration of the organism does not occur and vitamin K absorption is not impaired. All this has an impact on the success of surgery. Moreover, the external-internal drain modified in a suitable way surgical tactics and ensured effective drainage of the biliary pathways during the early postoperative period. If radical surgery is impossible, it is feasible as a suitable alternative procedure of palliative surgery to insert by the percutaneous route an expansible metal stent or leave the external-internal PTD drain in situ for a prolonged period. The authors discuss the criteria for indication, analyze the main problems of this procedure and submit their results.