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Introduction: Patients with abdominal trauma appear frequently. The most vulnerable organs in these patients are the liver and the spleen. Injuries of the small and large intestines are relatively less frequent. The diagnostic process of these injuries is complex and requires an analysis of all results. Therefore it is highly probable that the final diagnosis can be delayed and so can be delayed an indication of surgical exploration of the abdominal cavity, which can have serious consequences on the morbidity and mortality of these patients with intestinal trauma., Methods: We collected our data using the WinMedicalc 2000 software. We searched for patients hospitalised in years 20082017 in the Department of Surgery, Faculty of Medicine in Pilsen subjected to surgical revision of the abdominal cavity for intestinal trauma., Results: Our set comprised 41 patients, including 30 men and 11 women. The mean age of the patients was 41 years, 4 of the patients were children. Twenty-three of the patients suffered from polytrauma, while 9 of the patients had a relatively isolated injury of either the small intestine or the colon. Six of the patients died. The small intestine was injured in 17 patients, the colon was injured in 14 patients and both were injured in 10 patients. The intestinal injury was diagnosed in 17 cases based on CT imaging (performed 31 times in total); 23 cases were diagnosed in the peroperative period., Conclusions: We assessed a set of patients with an intestinal injury in terms of specific diagnosis, severity of trauma, diagnostic process and treatment. The results are similar to the results of studies in large sets of patients. Even though imaging methods can help to reach the right diagnosis, they are insufficient as a sole diagnostic method, and physical examination plays a major role.

Unlabelled: Hartmann's procedure is an operation indicated especially in emergency cases for left-sided colonic pathology where primary anastomosis is considered unsafe., Methods: Retrospective study 95 patients who underwent Hartmann's procedure over a 5 year period in the Surgical Clinic of the University Hospital in Pilsen., Results: 81 (85%) operations were emergency procedures. 45 (47%) operations were done for the malignant disease, the remaining 50 (53%) for benign disease (33 for complications of diverticular disease). Median age of patients was 69.4 years. The 30-day mortality rate was 16.8%. 37 patients had colostomy reversed, after a mean of 5.6 months with no mortality., Conclusions: Hartmann's procedure is a safe method. Our results are similar to results collected by foreign clinics.

Laparoscopically assisted resection of the large intestine in the Hirschprung's disease patients was introduced into practice worldwide in mid 90-ies of the last century. In the Czech Republic this procedure had not been conducted. The aim of this work was to introduce the method in the Czech Republic. In this study the authors present their initial experience with this new method. They have successfully operated three patients with this disorder.

Aims: An investigation of some relationships of routinely and rarely used biochemical markers to surgical (operating) trauma., Patients and Methods: A group of 37 patients was divided to two subgroups according type of disease with need a resection of large bowel for malignant or benign malady. Large bowel adenocarcinoma was dominated in a subgroup of malignancies (23 patients, mean BMI 25.59, mean age 63.65 years) and Crohn's disease and complicated diverticullary disease were the reasons to operate in the second subgroup of benignities (14 patients, mean BMI 21.21, mean age 39.5 year). Blood samples were taken before an operation, postoperatively (immediately) and at 6:00 a.m. the 1st, 3rd and 5th postoperative day. The routine methods (albumin, CRP, cholinesterase, haptoglobin, cholesterol), special methods (SOD, glutathion) and ELISA methods (leptin, IL-2r, IL-8, TNF)were used for evaluation markers. The results were estimated by statistic methods Sigma-Stat, One Way ANOVA and linear regression test., Results: The mean serum concentrations of albumin, leptin, cholesterol shifted down very clearly compared to preoperative values. The mean serum concentrations shifted up the 3rd day postoperatively to 722% in benignities and to 1814% in malignancies respectively. The values of cholinesterase, glutation, SOD, and haptoglobin didn't show any more serious dynamics perioperatively. The serum leptin concentrations correlated with BMI but other markers serum concentrations didn't correlate with BMI or with age., Conclusions: The serum leptin, albumin, haptoglobin, CRP concentrations demonstrated serious dynamics perioperatively. These concentrations are stabilized and they reach preoperative levels the 5th postoperative day. Each-other markers correlation is minimal.

One of the basic therapeutic procedures in surgical intraabdominal infections is early administration of antimicrobial drugs. The basic requirement for the selection of antimicrobial drugs is a broad-spectum bactericide action with low toxicity. Within the framework of a retrospective non-comparative investigation the action of the betalactam antibiotic piperacillin combined with the betalactamase inhibitor tazobactam was tested which was used in the initial empirical antimicrobial treatment of 33 patients with intraabdominal infectious complications caused by perforation of the large bowel or dehiscence of the anastomosis on the large intestine or rectum. Twenty-eight patients developed diffuse inflammation of the peritoneum (caused by perforation of a diverticulum in 17, by dehiscence of the anastomosis on the large intestine and rectum after resection on account of carcinoma in 7, by a penetrating injury of the large bowel and rectum in 3 and by postirradiation necrosis of the rectum in one female patient). Five patients developed an intraabdominal abscess as a complication of diverticulitis of the large intestine or as a postoperative infectious complication after resection of the large bowel and rectum. All patients were operated (resection of the large bowel according to Hartmann, or stoma above the site of injury or dehiscence of the intestinal anastomosis or drainage of the abscess). After surgery administration of piperacillin/tazobactam (4.5 g, subsequently after 8 hours). The period of administration was on average 8 days (5 to 11 days). After surgery the contents of the peritoneal cavity were collected for bacteriological examination incl. evaluation of the sensitivity of the isolated bacteria to piperacillin/tazebactam. From the isolated pathogens 58% were Gram-negative aerobic bacteria, in 24% anaerobic bacteria and in 18% enterococci. In 3 patients antimicrobial treatment was because of resistance of isolated bacteria to piperacillin/tazobactam (Klebsiella species, Pseudomonas aeruginosa) combined with aminoglycosides (amikacin, netilmicin). Postoperative complications developed in 9 patients (27%), incl. 3 who died (9%). In patients with intraabdominal infection caused by perforation of the large bowel and rectum or dehiscence of the anastomosis after resection of the large bowel and rectum piperacillin/tazobactam is the antibiotic of choice for the initial empirical antimicrobial treatment on account of its great efficacy against the majority of isolated bacteria, its safety and low toxicity.

The authors evaluated the results of operations of the large intestine and rectum on account of cancer, covering a 4-year period. In all instances a stapler or Valtrac were used. Dehiscence of the anastomosis was recorded in one instance.

Perforations of the large intestine during colonoscopy are relatively rare but serious complications of this routine examination. In recent years the approach to their treatment has changed in favour of more conservative procedures, in particular in perforations which occurred during polypectomy. In the authors' department during the last five years 12 patients were treated with perforations which occurred during colonoscopy. Ten patients were operated on (4x suture of the perforation, 2x primary anastomosis, 5x derivation of the gut), two patients were successfully treated by conservative methods without surgery. Fifty per cent of the operated patients had complications. Nobody died. The mean period of hospitalization was 27.9 days in the operated patients and 4.5 days in those who did not undergo surgery. From the results ensues that a differentiated approach must be used in perforations and in indicated cases (perforations after polypectomy, satisfactory condition of the patient, minimal assumed contamination of the abdominal cavity) a conservative method can be used. Correct surgical tactics reduce the morbidity and mortality.

The authors evaluate their own group of 49 patients subjected in 1982-1990 to primary resection of the large intestine with an immediately established anastomosis. 32 patients (65.31) recovered per primam and were discharged on average after 14.9 days. A disorder of the anastomosis was recorded in 5 patients, i.e. on 10.2%. In the conclusion the authors express conditions essential for the safety of these operations.