The clinical relevance of coeliac trunk variations

The coeliac trunk is a surgically significant artery originating from the abdominal aorta and supplying the supracolic organs. Branches of this arterial trunk supply the primary organs of the abdomen and divert a significant volume of blood from the abdominal aorta. Past research has shown that the anatomy of the coeliac trunk is not identical for all human beings and that about 15% of the population displays significant variations from the typical branching pattern. Data derived from earlier research has been consolidated to give an account of the major variations found in the anatomy of the coeliac trunk and to put forward some theories for the cause of such variation. It is crucial to achieve full comprehension of these topics as knowledge of these variations is indispensable in operative and diagnostic procedures within the abdomen. Without understanding of the arterial architecture and knowledge of the variation characterising the patient in this critical region surgery may entail a considerable risk of an error being committed that may occasionally lead to lethal complications

Ruptured ectopic pregnancy diagnosed with computed tomography

Background: The rupture of ectopic pregnancy (EP) still remains the primary and direct cause of death in the first trimester of pregnancy. Ultrasonography is known to be a modality of choice in EP diagnostics. We found a severe discrepancy between the frequency of ectopic pregnancies (EP) and the number of available computed tomography (CT) examinations. Case Report: A 29-year-old woman was admitted to the emergency department with a history of abdominal pain, nausea, vomiting and collapse. Sonographic findings of a suspected EP were unclear. Moreover, not all features of intrauterine pregnancy were present. Due to the patient's lifethreatening condition, an emergency multi-slice CT with MPR and VRT reconstructions was performed, revealing symptoms of a ruptured EP. In the right adnexal area, a well-vascularized, solid-cystic abnormal mass lesion was found. Intraperitoneal hemorrhage was confirmed intraoperatively, and the right fallopian tube with a tubal EP was resected. In the surgery in situ, as well as in the pathological examination of the tumor mass, a human embryo of approximately 1.5 cm in length (beginning of the 8th week of gestation) was found. Conclusions: Although ultrasonography still remains the first-line imaging examination in EP diagnostics, sometimes the findings of suspected EPs are unclear and not sufficient. The rupture of EP, with serious bleeding and symptoms of shock, may require an emergent pelvic and abdominal CT inspection. A clear correlation was found between the macroscopic CT images and the intraoperatively sampled material

The place of subfascial endoscopic perforator vein surgery (SEPS) in advanced chronic venous insufficiency treatment

In spite of medical science development and initiation of new technologies in minimally invasive surgery, treatmentof advanced chronic venous insufficiency at the 5th and 6th degree of CEAP classification is still a great clinical challenge.In case of no satisfactory results of non-surgical treatment of recurrent venous ulcers, scientists search for alternativetherapeutic methods which could be more effective and lasting. Subfascial endoscopic perforator vein surgery(SEPS) as a method of reducing venous pressure in the superficial venous system could provide healing of the recurrentvenous ulcer. In this study we present a review of contemporary opinions about the place and significance of subfascialendoscopic perforator vein surgery as a treatment of advanced chronic venous insufficiency