Laparoscopic cholecystectomy due to acute calculouscholecystitis in 16 weeks' in vitro fertilization and embryo transfer pregnancy: report of the first case

The most common casues of acute abdomen during pregnancy are acute appendicitis followed by acute cholecystitis. The case presented is a 33-year-old patient in 16 weeks' in vitro fertilization and embryo transfer pregnacy who developed acute cholecystitis. Previously there were two unsuccessful cycles, one complicated with ovarian hyperstimulation syndrome. Due to clinical deterioration during intravenous antibiotic therapy laparoscopic cheolecystecomy was performed and acute cholecystitis found. The postoperative course was uneventful. During the first 24 h tocolysis with intravenous fenoterol in addition to peroral atenolol 2 Χ 50 mg was administered. Postoperative course was uneventuful with further normal pregnancy. Elective cesarean section was made in term pregnancy (39 weeks) with singleton with Apgar 10/10. Current guidelines do not recommend prophylactic tocolysis in pregnant population with acute abdomen but there is no mention of the IVF-ET subpopulation of patients. Also, there are no guidelines for thromboprophylaxis in such patients with increased risk of thromboembolic accidents. To our knowledge this is the first case report of a laparoscopic cholecystectomy during IVF-ET gestation

Hernia in Ambulatory Surgery Centre

Surgical treatment of hernia is one of the most common procedures in general population. Since it was traditionally treated as “non‐complex” operation, it is an ideal procedure for ambulatory surgery settings. Ambulatory surgery is superior to in‐hospital treatment due to faster patient flow, reduced patient stress, early mobilization, and lower overall costs. Unforeseen hospitalization can be avoided with meticulous patient selection, education and preparation, use of local anesthesia whenever possible, and avoidance of opioids in early postoperative period

Correlation between the liver transection line localization and future liver remnant hypertrophy in associating liver partition and portal vein ligation for staged hepatectomy

Background and aimsColorectal liver metastases (CRLMs) represent the most prevalent form of secondary liver tumors, and insufficient future liver remnant (FLR) often leads to unresectability. To tackle this challenge, various methods for stimulating liver hypertrophy have been developed including portal vein embolization (PVE), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and the newest one, liver venous deprivation (LVD). ALPPS was thoroughly studied over the last decade and it has been shown to induce rapid and intensive FLR hypertrophy. The objective of this study was to assess whether the localization of the liver transection line during the initial stage of ALPPS correlates with the degree of FLR hypertrophy.MethodsA retrospective, multicentric study was conducted, and we analyzed all consecutive patients with CRLMs who underwent ALPPS over the eight-year period. Patients were categorized into two groups based on the type of resection—right trisectionectomy (ERH) or right hemihepatectomy (RH) respectively. The degree of hypertrophy (DH), its correlation with FLR and postoperative outcomes were assessed.ResultsThe cohort consisted of 136 patients (72 in the ERH group and 64 in the RH group). Baseline characteristics, hypertrophy interval, and total liver volume showed no significant differences between the groups. DH was greater in the ERH group (83.2% vs. 62.5%, p = 0.025). A strong negative correlation was observed between FLR volume and DH in both groups. Postoperative outcomes and one-year survival were comparable between the groups.ConclusionsFLR hypertrophy is influenced by the localization of the liver transection line in ALPPS. Furthermore, correlation analysis indicated that a smaller estimated FLR is associated with greater DH. No statistical difference in outcomes was noted between the groups

Rectal cancer and Fournier's gangrene - current knowledge and therapeutic options

Fournier's gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects

NEOPSTETRIČKI SPONTANI RAZDOR KORONARNE ARTERIJE MATERNIČNOG SUBSEROZNOG MIOMA: PRIKAZ BOLESNICE I PREGLED LITERATURE

This is a report of a case of arterial bleeding from spontaneous nonobstetric uterine myoma, with review of the literature. A 38-year-old multipara with myomatous uterus presented with spontaneous abdominal pain, nausea and malaise, free from comorbidities and abdominal trauma. After emergency diagnostic workup, urgent laparotomy with supracervical hysterectomy was performed with uneventful course. Hemoperitoneum resulting from spontaneous nonobstetric rupture of the uterine myoma artery is exceptionally rare. Despite its rarity, it should be included in the differential diagnosis of the known myomatous uterus, acute abdominal pain and nonobstetric hemoperitoneum.Prikazan je slučaj i literaturni pregled spontanih neopstetričkih arterijskih krvarenja materničnih mioma. Bolesnica, 38-godišnja višerotkinja s miomatoznom maternicom u anamnezi, zaprimljena je sa spontanim bolovima, mučninom i slabošću, bez podataka o trbušnoj traumi, bez komorbiditeta. Nakon hitne obrade učinjena je hitna laparotomija sa supracervikalnom histerektomijom. Kako je hemoperitonej zbog spontanoga neopstetričkog razdora arterije materničnih mioma iznimno rijedak, akutna trbušna bol s neopstetričkim hemoperitonejem može upraviti dijagnozu u tom smjeru

Non-Hodgkin\u27s lymphoma discovered by impacted endocapsule in a stenotic small intestine - a case report

Capsule endoscopy is an endoscopic method that was approved in 2001 and is used for the evaluation of mucous membranes in the small intestine. It is of special significance in cases of small intestinal pathologies that cannot be sufficiently examined and therefore diagnosed by the current gold-standards, enteroscopy and ileocolonoscopy. One major complication of capsule endoscopy is the retention of the device, which occurs in conditions that obstruct the lumen of the intestines such as inflammatory bowel disease (IBD), polyps or neoplasms. A 59-year-old patient who presented with nonspecific abdominal symptoms and a suspicion of inflammatory bowel disease received a capsule endoscopy which later became stuck due to obstruction and had to be retrieved through invasive surgical methods. The role of Magnetic enterography is constantly increasing. So far it has been recognized as a diagnostic method of choice for patients who are diagnosed with IBD or small intestinal neoplasms, especially those having complications involving intraluminal changes. Inconvenient complications exhibited by capsule endoscopy can be avoided by Magnetic enterography, moreover, it can diagnose various small intestinal pathologies more effectively

Mogu li faktori rizika biti bolji prediktori rane akutne mezenterijalne ishemije od laboratorijskih i slikovnih pretraga? Retrospektivna studija i algoritam za ranu intervenciju

Objectives The aim is to delineate relevant risk factors and construct an algorithm for earlier performance of selective mesenteric angiography, thus lowering mortality rates of acute mesenteric ischemia. Methods During a 5-year period 31 patients were examined. Thirteen risk factors were analysed and compared to standard diagnostic procedures. Results Only one patient did not have arterial hypertension. The second most common risk factor is atrial fibrillation with the incidence rate of 64.5%. The largest group of patients (38.7%) had two risk factors and there were 6.5% patients with six risk factors and 87.2% of all patients had two or more risk factors. In 67.7% of the patients we only performed emergency laparotomy due to inoperable state. Hospital mortality was 74.2%. Conclusions Combination of age over 70, hypertension and two or more risk factors associated with elevated D-dimers, in a patient with severe abdominal pain and minimal clinical findings with nonspecific laboratory findings and plain abdominal radiographs, could be an indication for early selective mesenteric angiography.Ciljevi Cilj je naznačiti relevantne faktore rizika i izraditi algoritam za ranije slučajeve selektivne mezenterijalne angiografije te na taj način smanjiti stopu smrtnosti akutne mezenterijalne ishemije. Metode Tijekom petogodišnjeg razdoblja pregledan je 31 pacijent. Analizirano je 13 faktora rizika koji su uspoređeni sa standardnim dijagnostičkim postupcima. Rezultati Samo jedan pacijent nije imao arterijsku hipertenziju. Drugi najčešći faktor rizika je atrijalna fibrilacija s učestalošću od 64,5%. Najveća skupina pacijenata (38,7%) imala je dva faktora rizika, 6,5% pacijenata imalo je šest faktora rizika, a 87,2% svih pacijenata imalo je dva ili više faktora rizika. U 67,7% pacijenata izveli smo samo hitnu laparotomiju zbog neoperabilnog stanja. Bolnička smrtnost bila je 74,2%. Zaključci Kombinacija dobi iznad 70, hipertenzije i dva ili više faktora rizika povezanih s povišenim D-dimerima, kod pacijenta sa znatnom abdominalnom boli i minimalnim kliničkim zaključcima s nespecifičnim laboratorijskim zaključcima i uobičajenim abdominalnim radiografima mogu biti indikacija za ranu selektivnu mezenterijalnu angiografiju

Tumor retroperitoneuma: pričaj mi o živcima Retroperitonealni femoralni schwannom sa jatrogenom postoperacijskom femoralnom neuropatijom: prikaz slučaja

Retroperitoneal femoral schwannomas constitute a rather small percentage of primary retroperitoneal tumors. Proper preoperative diagnosis is often difficult since imaging studies are nonspecific and differential diagnosis quite extensive. We present the case of a 71-year-old patient with a radiologically described retroperitoneal mass - postoperatively confirmed by pathohistology as a benign schwannoma. The tumor was removed in toto; however, the postoperative course was complicated with symptoms of femoral nerve damage. Although benign in nature (and exceedingly rare to turn malignant) schwannomas are treated surgically as the rate of complete resection without nerve damage is high. Left untreated they gain in mass and can cause significant pain due to displacement of the involved nerve. The significance of this case report is in highlighting the importance of considering schwannomas as a differential diagnosis of retroperitoneal tumors which in turn will lead to a strong strategy for avoiding postoperative complications.Retroperitonealni schwannomi femoralnog živca predstavljaju mali udio primarnih tumora retroperitoneuma. Uzimajući u obzir kako je radiološka dijagnostika u ovom slučaju nespecifična, a diferencijalna dijagnoza primarnih retroperitonealnih tumora široka, ispravnu preoperacijsku dijagnozu ponekad je teško postići. U ovom radu prikazat ćemo slučaj 71-godišnjeg pacijenta sa radiološki opisanim tumorom retroperitoneuma koji je nakon kirurške ekstirpacije patohistološki definiran kao schwannom. Tumor je odstranjen u cijelosti, međutim postoperacijski tijek kompliciran je simptomima jatrogenog oštećenja femoralnog živca. Iako su schwannomi uglavnom dobroćudni tumori uz rijetke slučajeve maligne alteracije, njihovo liječenje prvenstveno je kirurško. Postotak cjelovite resekcije bez oštećenja živca je visok. Neliječeni schwanomi dobivaju na masi te uzrokuju bol pomicanjem i pritiskanjem okolnih struktura. Važnost ovog prikaza leži u naglašavanju femoralnog schwannoma kao diferencijalno-dijagnostičke mogućnosti u razmatranju retroperitonealnih tumora. Na taj način može se stvoriti uspješna strategija sprječavanja postoperacijskih komplikacija