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With the advancing maternal age the rate of fibroids in pregnancy is also growing. A small part of fibroids in pregnancy are complicated and in about 2.6% necessitate urgent surgical treatment. We present a clinical case of subserose fibroid at 20 gestational weeks complicated with acute abdomen treated urgently with normal continuation of pregnancy.

Aim: Lymphomas of the gastrointestinal tract are the most common type of primary extranodal lymphomas, accounting for 5 to 10% of all non-Hodgkin's lymphomas (NHL)., Patients and Methods: From January 1996 to November 2005, 10 patients with primary intestinal lymphomas were submitted with clinical signs of acute abdomen to the Pediatric surgical department in Sofia. The children presented with radiologically proven intussusception, ileal obstruction or peritonitis due to bowel perforation., Results: At exploration the tumor was located in the ileum in 4 cases, in the terminal ileum and coecum in 3 cases, appendix in one and multiple sites were found in 2 cases. Children with localized disease underwent radical resection of the tumor mass with ileo - transverso anastomosis (3), partial bowel resection (4), and appendectomy (1) whereas in 2 children with advanced disease diagnostic biopsy alone with temporary ileostomy in one were accomplished. According to histology, 5 patients had Burkitt lymphoma and 5 lymphoblast NHL. The children were treated according CHOP. Over five - years relapse - free survival for localized disease accounts 6 children., Conclusion: Primary NHL in children often presents with acute abdominal condition requiring surgical exploration. Prognosis depends of adequacy of surgical resection and the adjuvant chemotherapy.

The authors present a case of a 32 year old pregnant woman who is admitted to the Obstetric clinic in the 16th gestational week with a pain in the ileoceacal region of the abdomen and vomitting. The woman has clinical signs of acute abdomen. A clinical diagnosis of acute appendicitis was suggested. During the operation under general anesthesia was found a phlegmonous inflammation of a Mekel diverticulus with perforation as well as local peritonitis and a catharal inflammation of the appendix. The appendix and the Mekel diverticle were removed during the operation. No comlications were observed during the post operative period. No fetal distress was observed during and after the operation Three months later the same patient was admitted to the obstetric clinic in the 32nd gestational week with a diagnosis Threatened premature delivery in ml VIII status post resection of a Mekel diverticle and appendectomy. The patient had pain to the right of the umbilicus and vomiting. The labor was induced and a viable premature infant was born. Two days after delivery there was again a clinical symptoms and signs of an acute abdomen due to ileus. A strangulation of the terminal ileum was found due to adhesions A Debridman and a lavage were performed No complications were observed during the postoperative period. The authors discuss the difficulties which might ensue when the diagnosis acute abdomen is made in a pregnant woman

Proceeding from a comprehensive literature survey the urgency of acute abdomen conditions in elderly and senile patients is thoroughly discussed. Not infrequently, geriatric surgeons face serious difficulties of diagnostic and therapeutic character relating to the severity of clinical picture and elevated postoperative lethality, explaining in turn the great surge of interest in the problem. Recent achievements along this line, surgery in particular, provide for adequate conditions for performing early surgical interventions with reduced intraoperative risk in elderly and old age patients presenting acute abdomen.

In the period 1990 through 1995, one-hundred patients operated for acute abdomen or admitted on a routine basis, presenting evidence of anaerobic infection, undergo treatment in the clinic of emergency surgery. Septic shock develops in 10/100 patients (10 per cent). In six of the latter the outcome is fatal--three with infection caused by spore-forming anaerobes (gas gangrene of the inguinal region--of Fournier, and anterior abdominal wall--anus praeternaturalis--two), and three with infection caused by non-spore-forming anaerobes (mixed anaerobic-aerobic infection). Anaerobic surgical infection and septic shock specificity is discussed, with an algorithm of therapeutic approach, based on clinical experience had with 100 patients, being proposed in either of them. Special emphasis is laid on antibiotic prophylaxis against anaerobic surgical infection. Its implementation in the concrete clinical conditions in this country demands a clearcut hospital drug policy (adoption of the "Drug Formularies" system), and elaboration of a new economical approach to the choice of antibacterial agents (using some of the forms of pharmaco-economical analysis, practicable with a view to the Bulgarian health-care model).

The symptomatology of the ruptured follicular and corpus luteum cysts varies from clinical occult status to haemorrhagic shock according to clinical studies for a ten years period. The syndrome frequency is higher in women over 30 years of age at rate 1:2 of the follicular to luteum cysts affecting mainly the right ovary. Twenty percent of the patients have been treated conservatively. Preoperative and intraoperative diagnosis coincides in 92% of the cases.

Serious abdominal complications occurring after chest and lung operations are discussed. The most common abdominal complications include acute dilatation of the stomach, paralytic ileus, gastrointestinal tract hemorrhage, as well as perforations of hollow abdominal organs. An interesting case presenting perforation of the small intestine after lung resection for pulmonary carcinoma is reported. The attention of surgeons is called to severe surgical complications, such as profuse hemorrhages from the gastrointestinal tract, and perforations of hollow abdominal organs, first and foremost.

The life of the patients having aneurysms of aorta abdominal is in danger seriously because of the strong tendency of the aneurysms to make ruptures with the expansion of the diameter. The inhibition, even the retardation of the expansion of the aneurysms is impossible and the treatment can be only a surgical one. Stating the diagnosis aneurysm of aorta abdominal in the not specialized hospitals appears possible only in 30-50% from the cases. The frequency of the faults with the symptomatic aneurysms is comparatively high and 50% of the patients are being set for operations with a diagnosis "acuta abdomen". In the cases of ruptures the number of the faults reaches up to 72%. The lethality of the planned operative treatment is 3-5%. The lethality in the cases of urgent operation with ruptures is 50-75%. In order to avoid the faults and the complications in diagnosis of the illness we have made practical recommendations for consideration and discussion of the diagnosis and the tactics with patients having abdominal aneurysms. They are recommended for use in dispensary, surgical, urological and cardiological consulting rooms and the respective departments of the hospitals without special profile.

Reviewing the literature, the authors discuss the diagnostic and surgical problems of abdominal adhesion disease in emergency surgery. The etiology and pathogenesis of adhesion disease is complex and still poorly understood. A number of etiologic factors are considered responsible. The authors formulate the current concepts on the pathogenesis of this disease and some classifications in the world literature. Adhesion disease is a major problem in emergency surgery, especially the form known as acute breed ileus. The prophylaxis, conservative and adequate operative treatment are of great importance.

A review of the literature is made on the complicated course of infectious and parasitic diseases, in which acute surgical abdomen syndrome develops. Surgical treatment of complicated infectious and parasitic diseases is a complex endeavour both from surgical and epidemiologic aspect. The high mortality rate after operations in complicated forms is associated with tactical errors in the surgical treatment and erroneously estimated extent of the surgical intervention.

In a series of 4350 children with abdominal surgical diseases operated at the Department of Pediatric Surgery in Sofia for a period of 3 years (1987-1989) the authors have observed 4 cases of pleuropulmonary complications (0.09 per cent). In two of these children the primary abdominal operation was for liver echinococcus, in 1--rupture of the liver and subphrenic abscess and in 1--perforative appendicitis and purulent peritonitis. Symptoms of respiratory failure developed in addition to the abdominal symptoms. Leading in the complex treatment was sanation of the abdominal cavity from the purulent process and double pleural drainage. The severe pathologic changes in the organs of the two adjacent cavities were responsible for the high case fatality rate (25 per cent).

Eighty-three patients with surgical abdominal pathology were included in the study. On the isotopic nephrogram they all had bilateral symmetric and analogous pathologic changes with varying degree of severity. The most common cause of renal function changes in patients with abdominal pathology was the reduced intravascular volume or vascular capacity changes, registered on the isotopic nephrogram with characteristic symmetrical pathologic curves. The sharp renal perfusion decrease, leading to decrease of glomerular filtration and diminution of diuresis explains the bilateral changes in the isotopic nephrogram which most frequently resemble obturation. The curves returned to normal 1 to 2 weeks after the physiologic state of the patients was stabilized, indicating extrarenal origin of the registered changes in the isotopic nephrogram. The latter should carefully be interpreted, in view of the possible influence of it of extrarenal factors.

Sixteen cases of Meckel's diverticulum are reported, 14 of them detected during emergency operative intervention for acute surgical abdomen and 2 during planned operation. The complicated forms of Meckel's diverticulum were 10: acute diverticulitis 4 (25 per cent), intestinal obstruction 4 (25 per cent), neoplastic process 1 (6.25 per cent), intestinal hemorrhage 1 (6.25 per cent). Symptom-free were 43.75 per cent of the diverticuli. The clinical symptoms of acute diverticulitis resembled much those of acute appendicitis. The method of choice for its surgical management is cuneiform resection of the intestinal wall at the site of the diverticulum and transverse reconstruction of the intestinal lumen. Cancer of the diverticulum requires extended intestinal resection.