Search

Introduction/Objective. The elderly (age ≥ 65 years) comprise an increasing proportion of patients undergoing emergency general surgery (EGS) procedures nowadays. The objective of the paper was to determine the intra-hospital mortality rate in elderly patients undergoing emergency gastrointestinal surgical procedures. Methods. 914 elderly patients (> 65 years old) were examined, divided into two groups: emergency and elective surgery patients, treated for diseases (benign and malignant) of the stomach, duodenum, small intestine and colon. The patients were divided into four age groups and five American Society of Anesthesiologists (ASA) groups, taking into account the presence of chronic diseases, the values of some laboratory parameters, administering transfusion, and the occurrence of surgical complications during hospitalization. Results. The mortality rate among elderly patients was 17.8%. The univariate analysis in EGS patients revealed that gastro-duodenal surgical interventions (p < 0.001), ASA ≥ 3 score (p < 0.001), heart, lung, kidney diseases, and postoperative complications (p < 0.001), as well as the white cell count > 10,000/mm3 (p = 0.043) were independent risk factors for mortality. In the multivariate analysis, in EGS patients, the significant risk factors for mortality were gastric surgical interventions (p = 0.001), ASA score of 4 (p < 0.001), heart and kidney disease (p ≤ 0.001), and white cell count > 10,000/mm3 (p = 0.039). Conclusion. The characterization of independent validated risk indicators for mortality in those patients is essential and may lead to an efficient specific workup, which constitutes a necessary step towards developing a dedicated score for elderly patients.

Introduction. Leiomyoma is a kind of benign tumors of smooth muscle origin, occurring mostly throughout the genitourinary system. They are rarely found in the anorectal region, where they represent less than 0.1% of the tumors of the rectum. Due to this exceptional occurrence, we report a case of leiomyoma arising in the anorectal region. Case outline. A 43-year-old otherwise healthy woman presents with the big mass in analorectal region. Major complain is pain and discomfort while sitting. Magnetic resonance imaging is done and pathohistology report confirmed large leiomyoma. Abdominoperianeal resection of the rectum was performed due to the size of the tumor. Postoperative course was uneventful. Conclusion. There is no gold standard technique, and decision about the best surgical approach for all pathohistological types of tumors in the anorectal region. The decision sometimes has to be made according to size and major complains.

Background/Aim. Postoperative ileus is a frequent and frustrating occurence for both, patients and surgeons after abdominal surgery. Besides clinical importance of postoperative ileus, its economic aspect is also important. The aim of this prospective study was to analyze development of prolonged postoperative ileus after elective colorectal surgery for cancer and its impact on early postoperative outcome. Methods. This prospective study included all eligible patients, 18 years or older, scheduled for open colorectal resection for cancer from June, 2015 to February, 2016. Patients with metastatic disease, prior hemoirradiation or any resection other then curative were excluded. The study duration was up to 30 days postoperatively. Primary outcome measure was development of prolonged postoperative ileus according to strict definition. The impact of prolonged postoperative ileus on other outcome measures such as postoperative complications, surgical site infections, anastomotic leakage, reoperations, mortality and length of hospital stay were of great interest, too. Results. This prospective study included 103 patients, 64 (37.9%) men and 39 (62.1%) women, mean age 66 years. Prolonged postoperative ileus developed in 12 (11.3%) patients. One third of the patients had some type of surgical site infection, while 47.6% had complications. Ten (9.7%) patients required reoperation. Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of surgical site infection and anastomotic leakage. There was statistically significant difference in terms of complications (_2 = 34.966; p < 0.001), complications grade III (_2 = 23.43; p < 0.001) and reoperations (_2 = 15.724; p

Introduction. Necrotizing soft tissue infection (NSTI) is a life-threatening condition, characterized by widely spread necrosis of skin, subcutaneous fat, fascia and muscles. Treatment involves surgical debridement and broad-spectrum antimicrobial therapy. Mortality is still high due to diagnostic delays. NSTI is rare in general population, there are even less literature data of this condition in pregnancy. Timely diagnosis and therapy is crucial for outcome of these patients. Clinicians should have in mind NSTI in patients with perianal infections, especially in cases where immunosuppressive role of pregnancy is present. Case outline. We present a case of a 21-year-old pregnant woman with NSTI spreading from perianal region. The patient was admitted to hospital in the 31st week of otherwise healthy twin pregnancy one day after incision of perianal abscess. At admission she was examined by a gynecologist; vital signs were stable, laboratory results showed the presence of infection. She was referred for another surgical procedure and broad-spectrum antibiotics were prescribed. The next morning the patient complained of intense abdominal pain. Clinical exam revealed only discrete redness of the skin tender on palpation, crepitating. She was immediately referred to surgery. Intraoperative findings revealed massive soft tissue infection spreading up to the chest wall. Wide skin incisions and debridement were performed. The patient developed septic shock and after initial resuscitation gynecologist confirmed intrauterine death of twins and indicated labor induction. Over the next few days the patient’s general condition improved. On several occasions the wounds were aggressively debrided under general anesthesia, which left the patient with large abdominal wall defect. Twenty-three days after the initial operation, the defect was reconstructed with partial-thickness skin grafts, providing satisfactory results. Conclusion. Diagnosis and outcome of NSTI are challenging for many reasons. Course of the disease is rapid and hidden. Chances of survival depend on early recognition and prompt treatment.

Introduction. Leiomyomas are benign smooth muscle tumors that usually arise from the uterus. Case report. We present a patient with a 6-month history of vague abdominal discomfort, occasional nausea, vomiting and urinary incontinence. On examination, there was an extremely large firm unpainfull palpable abdominal mass. Laboratory investigation revealed mild leukocytosis and blood creatinine elevation. Abdominopelvic ultrasonography and computed tomography revealed a massive well bordered, encapsulated intraabdominal tumor, extending from the pelvis to epigastrium and almost completely fulfilling the pelvic and abdominal cavity. At laparotomy, tumor arising from the retroperitoneum was excised in toto. Histopathological examination disclosed that the tumor was composed mainly of smooth muscle cells and very rare fibrous connective tissue elements with myxomatous alteration and with no mitotic activity. The negative results of numerous additional parameters analyzed (pancytokeratin, epithelial membrane antigen, S100 protein, CD68, CD34, desmin, aktin) ruled out different origin of a tumor. One year after resection the patient had no complaints and no radiological evidence of tumor recurrence. Conclusion. Considering current limitations in radiological diagnosis, in toto resection of these tumors is necessary to rule out malignancy.

Introduction. Intussusception is a rare phenomenon in adults. It is caused mainly by malignant neoplasm. Primary lymphoma of the colon is a rare malignancy of the large intestine. The association of intussusception in adult and primary colorectal lymphoma is a diagnostic challenge, since they occur with a variety of atypical symptoms. Case Outline. We report a case of ileocolic intussusception in a 26-year-old man induced by primary lymphoma of the cecum. He was admitted to our hospital for incomplete intestinal obstruction. After thorough diagnostic work-up (plain abdominal radiography, abdominal ultrasonography, multi-slice computerized tomography, colonoscopy with biopsy), the patient underwent surgery. Intraoperative findings confirmed lymphoma as the cause of intussusception. The right hemicolectomy was carried out with end-to-side ileo-transverse anastomosis. Conclusion. Primary colorectal lymphomas should be considered in differential diagnosis of intussusceptions in adults. The treatment of choice is a radical resection where all oncological standards must be fulfilled.

Acute appendicitis is one of the most common urgent abdominal interventions. Open appendectomy has been a standard procedure for acute appendicitis for more than 100 years. However, in the last 20 years, after many studies, laparoscopic appendectomy has become a gold standard in solving acute appendicitis. The main goal of our study was to compare results of open and laparoscopic appendectomies with regard to in-hospital stay, time of operation, postoperative complications and postoperative pain. All patients underwent open or laparoscopic appendectomy in the Center of Minimally Invasive Surgery and Emergency Center of the University Clinical Center Niš, Serbia in the period of one year. A total of 126 patients were enrolled and submitted to retrospective analysis. One hundred and twenty-six patients who underwent laparoscopic or open appendectomy surgery were retrospectively analysed. A laparoscopic appendectomy was performed in 58 patients, while 68 patients underwent an open appendectomy. Groups were demographically similar and there was no significant difference between the age structure and gender distribution (t = 0.927; p = 0.057). Average height (p = 0.123), weight (p = 0.200) and BMI (p = 0.425) were mostly similar. Previous surgical operations were more common in patients with open appendectomy, but with no statistical significance (p = 0.141). Percentage of patients with WBC > 10 were the same in both groups (p = 0.927). Diabetes mellitus was more common in patients with open appendectomy, but with no statistical significance (p = 0.563). Acute and perforated appendicitis were similar in both groups (p = 0.490). Average time of operation was the same in both groups (p = 0.751). Number of days of in-hospital stay was shorter in patients who underwent laparoscopic appendectomy (p < 0.001). The analysis of administration of parenteral and oral analgesics showed that postoperative pain was less in the group of patients who underwent laparoscopic appendectomy than in the group of patients with open appendectomy. There was no statistically significant difference with respect to postoperative complications between two groups (p < 0.001). The treatment of appendicitis by using laparoscopic surgery in comparison to open approach provides a better result in terms of duration of hospital stay, recovering time, postoperative complications and postoperative pain. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Medianae is the property of Acta Medica Medianae and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pilonidal disease is a common and well-recognized medical condition. It affects people in reproductive age, especially men and in combination with in-patient and outpatient treatment and absence from work it causes a considerable socioeconomic loss. This fact led to a renewed interest in understanding of the disease and search for the ideal method of treatment. The purpose of this review was to provide update on therapeutic options for patients with pilonidal disease. In case of chronic or recurrent pilonidal disease various treatment options exist, addressing different measures of surgical outcome. Like for many conditions, there is increase in the use of minimally invasive techniques in the treatment, which could be alternative to surgical excisions for pilonidal disease. Procedures for treatment of pilonidal disease can be divided in two large groups: minimally invasive treatment and excisional procedures. Although various treatment options exist nowadays, surgery is still preferred as definitive treatment. The optimal closure of the wound following an excision is still under debate since outcome measures depend mostly on type of closure selected. Most of the procedures fail to achieve the goals altogether. The final decision on treatment should be made based on surgeon and the patient’ preference. [ABSTRACT FROM AUTHOR]

The use of screening programms in elderly population (age ≥65 years) comprises an increasing proportion of patients undergoing emergency general surgery (EGS) procedures nowadays. The aim was to determine the intra-hospital mortality rate in elderly patients undergoing gastric surgical procedures. 108 elderly patients (≥65 years old) were examined, divided into two groups: deceased and surviving surgical patients, treated for diseases (benign and malignant) of the stomach. The patients were divided into four age groups and five ASA groups, taking into account the presence of chronic diseases, the values of some laboratory parameters, administered transfusion and the occurrence of surgical complications during hospitalization. The mortality rate among elderly patients was 28.7%. The significant risk factors for mortality were: emergency surgery (p < 0.001), bleeding gastric ulcer operations (p = 0.042), lung (p = 0.003), kidney (p < 0.001), heart (p = 0.025) diseases, ASA score of 4 or higher (p < 0.001), serum levels (higher after two times measurement) of creatinine, haemoglobin, CRP, PCT and glycemia (p < 0.001). In order to improve medical treatment, the determination of independent validated risk indicators for mortality in elderly patients might lead to developing a dedicated scoring system. [ABSTRACT FROM AUTHOR]

Bleeding during liver resection is a significant threat to the clinical outcome. Portal triad occlusion with complete ischemia of the liver flow of hepatoduodenal ligament is a well-documented, safe and useful way to reduce this problem. Although the technique is efficient in limiting blood loss, there is still controversy concerning potential disadvantages and subsequent reperfusion liver injury. A prospective analysis will include at least 30 patients 18-75 years old, who are undergoing liver resection due to metastases of the colorectal carcinoma. After signing the informed consent, the parameters will be analyzed in three phases, pre-, intra- and postoperatively. During surgery (indicated by a surgical/oncological team of doctors not related to our study) liver tissue samples will be taken of the “healthy liver” (not involved in the tumor process) in which after tissue homogenization, analysis of parameters will be done responsible for the development of liver injury. This research will not affect the clinical practice, course and outcome of the treatment in patients who are included. The study may be useful for future patients who will undergo liver resections. The application of modern research methods with scientific validity of statistical processing of data and the use of appropriate literature, significant data will be obtained about the character, i.e. intensity of damage of the liver tissue in patients undergoing liver resections. [ABSTRACT FROM AUTHOR]

A perineal hernia can severely affect everyday activities. We represent a case of a sixty-five-year-old with perineal hernia after abdominoperineal resection for rectal cancer. Bulging in the perineum appeared 24 months following operation with uneventful postoperative course. She felt pain and difficulty while sitting. At physical examination the defect in perineum was approximately 3x3 cm. After cancer recurrence had been excluded, hernioplasty was planned. A 10x15 cm composite mesh was used for pelvic floor reconstruction. The mesh was sutured through urogenital diaphragm. Postoperative course was uneventful. Three years after surgery, there was no recurrence of cancer or hernia. Repair of perineal hernia is challenging, with limitation regarding guidelines in literature. [ABSTRACT FROM AUTHOR]

Necrotizing soft tissue infection is a life-threatening condition, characterized by extensive necrosis of skin, subcutaneous, fascia and muscle. 82% of patients exhibit some of the risk factors, such as diabetes mellitus, obesity and alcoholism, smoking, immunodeficiency, malnutrition or low socioeconomic status. The necrotizing soft tissue infection is initially diagnosed by a clinical examination. The use of imaging, particularly computed tomography, represents a golden standard; the CT exam usually shows the presence fluid collections, abscess, adipose tissue degeneration and subcutaneous emphysema. The treatment of necrotizing soft tissue infection involves surgical debridement, drainage, wide incisions of the affected area, tissue decompression and application of broad-spectrum antimicrobial therapy. Despite existing modern methods of treatment, or the so-called principle of "source control", the mortality is still up to 51%. Necrotizing soft tissue infection is a very dangerous infection we should always be aware of, and treat it as early as possible. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Medianae is the property of Acta Medica Medianae and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Primary malignant melanoma of the anorectum is rare. It accounts for 0.2-0.3% of all malignant melanomas. Prognosis is very poor since majority of patients dies within first two years. We report a case of a 76 year-old man with anoretal melanoma. Digital rectal examination revealed a mass on the anterior wall. Biopsy report favored two possibilities, first, malignant melanoma and second, poorly differentiated carcinoma. Abdominal ultrasonography and chest X-ray did not show signs of distant metastasis. Computed tomography of abdomen and pelvis revealed presence of a large, irregular hypodense mass with heterogeneous enhancement in anal canal accompanied by enlarged lymph nodes. Abdomino-perineal resection was performed. Histopathological examination of resected specimen confirmed diagnosis of malignant melanoma. Postoperative course was uneventful. However, patient died one year after due to metastasis. Surgery is the mainstay of curative treatment of anorectal melanoma, effective systemic adjuvant therapy has been lacking. Long-term survival is rare, as most patients die of disseminated systemic disease. [ABSTRACT FROM AUTHOR]