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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.

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]

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