Usporedba vrijednosti serumskog i intraperitonealnog C-reaktivnog proteina u ranoj dijagnostici dehiscencije anastomoze nakon kirurgije debeloga crijeva

In colorectal surgery, anastomotic leakage is a serious complication, leading to higher postoperative morbidity and mortality. The aim of this study was to evaluate the accuracy of serum and intraperitoneal C-reactive protein (CRP) in early diagnostics of anastomotic leakage on the first four postoperative days after colorectal surgery. From January to October 2019, fifty-nine patients with colorectal carcinoma were operated on, with formation of primary anastomosis. Anastomotic leakage was diagnosed in eight patients. Comparing the levels of serum and intraperitoneal CRP, our study showed that serum CRP was a better predictor of anastomotic leakage. Serum CRP levels lower than 121 mg/L on postoperative day 4 were predictive of good healing of anastomosis.U kirurgiji debelog crijeva dehiscencija crijevne anastomoze je ozbiljna komplikacija koja dovodi do povećanja pobola i smrtnosti nakon operativnog zahvata. Cilj ove studije bio je utvrditi točnost serumskog i intraperitonealnog C-reaktivnog proteina u ranoj dijagnostici dehiscencije crijevne anastomoze u prva četiri poslijeoperacijska dana nakon operacije debelog crijeva. Od siječnja do kolovoza 2019. godine operirano je 59 bolesnika s rakom debelog crijeva uz uspostavu primarne crijevne anastomoze. Kod osam bolesnika dijagnosticirana je dehiscencija crijevne anastomoze. Uspoređujući vrijednosti serumskog i intraperitonealnog C-reaktivnog proteina naša studija je pokazala da je serumski C-reaktivni protein bolji biljeg u predviđanju dehiscencije crijevne anastomoze. Vrijednosti serumskog C-reaktivnog proteina manje od 121 mg/L četvrtog poslijeoperacijskog dana pokazatelj su dobrog cijeljenja anastomoze

Masivna endometrioza koja klinički oponaša tumor – neuobičajen slučaj intususcepcije crvuljka

Appendiceal intussusception is a rare clinical entity that, in women of reproductive age, may be caused by endometriosis. We report a case of a 36-year-old woman presenting with abdominal pain. The patient underwent laparoscopic surgery, during which a suspicion of a cecal tumor was raised. A laparoscopic right hemicolectomy was performed. The patohistological exam showed an intussuscepted appendix, and the cause of the intussusception was massive endometriosis involving the colon, ileum, and appendix. It is important not to mistake appendiceal intussusception and appendiceal endometriosis with other intraabdominal pathologies whose symptoms they can mimic.Intususcepcija crvuljka je rijedak klinički entitet koji u žena reproduktivne dobi može biti uzrokovan endometriozom. U članku je prikazan slučaj 36-ogodišnje žene koja se javila u hitnu službu s bolovima u abdomenu. Učinjena je laparoskopska operacija tijekom koje je postavljena sumnja na tumor cekuma te je napravljena desnostrana hemikolektomija. Patohistološki nalaz je pokazao intususcepciju crvuljka čiji je uzrok bio opsežna endometrioza koja je zahvatila debelo crijevo, ileum i crvuljak. Važno je prepoznati intususcepciju i endometriozu crvuljka, jer ih je lako zamijeniti za drugu intraabdominalnu patologiju, čije simptome mogu oponašati

Osjetljivost i specifičnost Fenyö-Lindbergova i Teicherova sustava bodovanja u dijagnostici akutne upale crvuljka u žena

The aim of the study was to assess diagnostic accuracy (sensitivity and specificity) of Fenyö-Lindberg and Teicher scores for distinguishing patients that need immediate surgical treatment from the others, in a female population from an urban setting. The study prospectively included 130 female patients admitted to the emergency department with abdominal pain indicating acute appendicitis. The scores and parameters of validity were calculated and compared to definitive diagnosis. For Fenyö-Lindberg score of -17 or less, 84.5% sensitivity, 55.6% specificity, 87.9% positive predictive value (PPV) and 48.4% negative predictive value (NPV) were recorded. For cut-off value greater or equal to -2, there was 59.2% sensitivity, 77.8% specificity, 91% PPV and 33.3% NPV. The Receiver Operating Characteristic (ROC) curve analysis of Fenyö-Lindberg score showed that the best single cut-off value for discriminating acute appendicitis in the study population was -15. For Teicher score, values greater than -3 yielded 89.3% sensitivity and 22.2% specificity, 81.4% PPV and 35.3% NPV. In conclusion, Fenyö-Lindberg score could be used as an additional tool to exclude appendicitis and avoid unnecessary appendectomies. Teicher score may help in recognizing patients with appendicitis. None of the two scores can indicate or decline appendectomy in all cases. Scoring systems may be useful for pointing to important clinical signs and symptoms in specific subpopulations.Cilj istraživanja bio je analizirati dijagnostičku točnost (osjetljivost i specifičnost) Fenyö-Lindbergove i Teicherove bodovne ljestvice u postavljanju dijagnoze akutne upale crvuljka u ženskoj populaciji u urbanom okruženju. U studiju je prospektivno uključeno 130 bolesnica primljenih u hitnoj službi s bolovima u trbuhu i sumnjom na akutni apendicitis. Rezultati i parametri valjanosti izračunati su i uspoređeni s obzirom na konačnu dijagnozu. Za vrijednosti Fenyö-Lindbergova zbira -17 ili manje nađena je osjetljivost od 84,5%, specifičnost od 55,6%, pozitivna prediktivna vrijednost (PPV) od 87,9% i negativna prediktivna vrijednost (NPV) od 48,4%. Za vrijednosti istoga zbira većeg ili jednakog -2 utvrđena je osjetljivost od 59,2%, specifičnost od 77,8%, PPV od 91% i NPV od 33,3%. Usporedba krivulja ROC za Fenyö-Lindbergov zbir pokazala je da je najbolja pojedinačna granična vrijednost u proučavanoj populaciji u svrhu diskriminacije akutne upale crvuljka -15. Za Teicherov zbir vrijednosti veće od -3 pokazale su osjetljivost od 89,3%, specifičnost od 22,2%, PPV od 81,4% i NPV od 35,3%. U zaključku, Fenyö-Lindbergov zbir se može koristiti kao dodatni alat u isključivanju upale crvuljka i izbjegavanju nepotrebnih operacija. Teicherov zbir može pomoći u prepoznavanju bolesnica s akutnom upalom crvuljka. Niti jedan zbir se ne može koristiti kao jedino sredstvo za indiciranje ili nepoduzimanje operacije akutne upale crvuljka u svim slučajevima. Bodovni sustav može biti koristan u isticanju važnih kliničkih znakova i simptoma u pojedinim skupinama bolesnika

Massive endometriosis mimicking tumor – unusual cause of appendiceal intussusception

Appendiceal intussusception is a rare clinical entity that, in women of reproductive age, may be caused by endometriosis. We report a case of a 36-year-old woman presenting with abdominal pain. The patient underwent laparoscopic surgery, during which a suspicion of a cecal tumor was raised. A laparoscopic right hemicolectomy was performed. The patohistological exam showed an intussuscepted appendix, and the cause of the intussusception was massive endometriosis involving the colon, ileum, and appendix. It is important not to mistake appendiceal intussusception and appendiceal endometriosis with other intraabdominal pathologies whose symptoms they can mimic

Comparison of C-Reactive Protein Levels in Serum and Peritoneal Fluid in Early Diagnosis of Anastomotic Leakage after Colorectal Surgery

In colorectal surgery, anastomotic leakage is a serious complication, leading to higher postoperative morbidity and mortality. The aim of this study was to evaluate the accuracy of serum and intraperitoneal C-reactive protein (CRP) in early diagnostics of anastomotic leakage on the first four postoperative days after colorectal surgery. From January to October 2019, fifty-nine patients with colorectal carcinoma were operated on, with formation of primary anastomosis. Anastomotic leakage was diagnosed in eight patients. Comparing the levels of serum and intraperitoneal CRP, our study showed that serum CRP was a better predictor of anastomotic leakage. Serum CRP levels lower than 121 mg/L on postoperative day 4 were predictive of good healing of anastomosis

Sensitivity and specificity of Fenyö-Lindberg and Teicher scores in the diagnosis of acute appendicitis in women

The aim of the study was to assess diagnostic accuracy (sensitivity and specificity) of Fenyö-Lindberg and Teicher scores for distinguishing patients that need immediate surgical treatment from the others, in a female population from an urban setting. The study prospectively included 130 female patients admitted to the emergency department with abdominal pain indicating acute appendicitis. The scores and parameters of validity were calculated and compared to definitive diagnosis. For Fenyö-Lindberg score of -17 or less, 84.5% sensitivity, 55.6% specificity, 87.9% positive predictive value (PPV) and 48.4% negative predictive value (NPV) were recorded. For cut-off value greater or equal to -2, there was 59.2% sensitivity, 77.8% specificity, 91% PPV and 33.3% NPV. The Receiver Operating Characteristic (ROC) curve analysis of Fenyö-Lindberg score showed that the best single cut-off value for discriminating acute appendicitis in the study population was -15. For Teicher score, values greater than -3 yielded 89.3% sensitivity and 22.2% specificity, 81.4% PPV and 35.3% NPV. In conclusion, Fenyö-Lindberg score could be used as an additional tool to exclude appendicitis and avoid unnecessary appendectomies. Teicher score may help in recognizing patients with appendicitis. None of the two scores can indicate or decline appendectomy in all cases. Scoring systems may be useful for pointing to important clinical signs and symptoms in specific subpopulations