Uloga ocjenskih ljestvica Injury Severity Score i Abbreviated Injury Scale u liječenju traumatskih ozljeda parenhimskih organa trbuha

Th e aim of this study was to investigate the infl uence of etiology, types of injury, levels of consciousness and the Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) values on the selection of treatment modality and survival in patients with injuries of parenchymal abdominal organs. Case records of 224 patients treated for traumatic injury of parenchymal abdominal organs from January 2003 until December 2015 were reviewed. Th e values of ISS and AIS of injury severity were calculated and compared to the values obtained according to the etiology, state of consciousness and survival. Of the 224 patients, 172 (76.8%) were treated by surgical approach and 52 (23.2%) were treated conservatively. Th e mean patient age was 40.1}18.3 years. Th ere were 97 (43.3%) polytrauma cases. Of the 224 injured patients, 143 (63.8%) were treated with transfusions of blood products. Two hundred and six (92%) patients survived. Th e mean AIS and ISS values were signifi cantly lower in patients that survived (AIS=3; ISS=28) than in those that died (AIS=5; ISS=34) (p<0.001). Th ere was a statistically signifi cant diff erence in AIS and ISS values between conscious (AIS=2.7; ISS=25.9) and unconscious (AIS=3.2; ISS=33) patients (p<0.001). Of the 224 patients that did not survive, 18 (8%) were hemodynamically unstable. Survival depended on hemodynamic stability at admission; the ISS and AIS values were associated with the injuries and state of consciousness at admission. Hemodynamic stability, state of consciousness, and ISS and AIS values were the quality predictors of survival after abdominal traumatic injury.Cilj ovoga rada bio je istražiti utjecaj etiologije, vrste ozljede, stanja svijesti te vrijednosti ocjenskih ljestvica Injury Severity Score (ISS) i Abbreviated Injury Scale (AIS) na izbor načina liječenja i preživljenje u bolesnika s traumatskim ozljedama trbuha. Povijesti bolesti 224 bolesnika liječenih zbog traumatskih ozljeda parenhimskih organa u razdoblju od siječnja 2003. Do prosinca 2015. godine retrospektivno su pregledane. Izračunate su vrijednosti ISS i AIS i uspoređene s vrstom ozljede, stanjem svijesti i etiologijom nastanka ozljede. Od ukupno 224 bolesnika, 172 (76,8%) ih je liječeno kirurškim pristupom, a 52 (23,2%) konzervativno. Srednja dob bila je 40,1}18,3 godina. Devedeset sedam (43,3%) bolesnika bilo je politraumatizirano. Od ukupnog broja bolesnika 143 (63,8%) ih je liječeno transfuzijama krvnih pripravaka. Ukupno je preživjelo 206 (92%) bolesnika. Srednje vrijednosti AIS i ISS bile su značajno niže u bolesnika koji su preživjeli (AIS=3; ISS=28) u odnosu na one koji su umrli (AIS=5; ISS=34) (p<0,001). Također je utvrđena statistički značajna razlika u vrijednostima AIS i ISS između bolesnika koji su bili pri svijesti (AIS=2,7; ISS=25,9) i onih koji su kod prijma bili bez svijesti (AIS=3,2; ISS=33) (p<0,001). Od ukupnog broja bolesnika 18 (8%) bolesnika koji nisu preživjeli bili su hemodinamski nestabilni. Preživljenje ovisi o hemodinamskoj stabilnosti pri prijmu, a vrijednosti ISS i AIS ovise o vrsti ozljeda i stanju svijesti pri prijmu. Hemodinamska stabilnost, stanje svijesti, ISS i AIS vrijednosti pokazali su se kao prediktori preživljenja u bolesnika s traumatskim ozljedama trbuha

Torsion of Epiploic Appendage Mimic Acute Appendicitis

Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We report a case of 36-year-old woman who presented with a classic signs of acute appendicitis. On examination, the obese, afebrile, and had very strong right iliac fossa tenderness and guarding. The white cell count was 12.82´109/L, and C reactive protein count was 15.13MG/DL. She underwent emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration of the abdominal cavity showed vermiform, no inflamed, appendix and necrotic appendix epiploica of the caecum. The treatment consisted of typical laparoscopic appendectomy and laparoscopic resection of the necrotic appendix epiploica. The patient made rapid recovery and was discharged from the hospital on second day after the operation. Histological investigation of the appendix epiploica revealed gangrenous epiploic appendage

Torsion of Epiploic Appendage Mimic Acute Appendicitis

Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We report a case of 36-year-old woman who presented with a classic signs of acute appendicitis. On examination, the obese, afebrile, and had very strong right iliac fossa tenderness and guarding. The white cell count was 12.82´109/L, and C reactive protein count was 15.13MG/DL. She underwent emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration of the abdominal cavity showed vermiform, no inflamed, appendix and necrotic appendix epiploica of the caecum. The treatment consisted of typical laparoscopic appendectomy and laparoscopic resection of the necrotic appendix epiploica. The patient made rapid recovery and was discharged from the hospital on second day after the operation. Histological investigation of the appendix epiploica revealed gangrenous epiploic appendage

Primary Malignant Fibrous Histiocytoma of the Spleen: Recurrence Eight Years after Splenectomy – Report of a Case and Literature Review

Primary intraabdominal malignant mesenchymal tumors are very rare. There are just few cases of intraabdominal visceral malignant fibrous histiocytoma in the literature. We report a case of primary malignant fibrous histiocytoma of the spleen in a 57-year-old man, with a recurrence eight years after the splenectomy. After the initial surgery the patient was without complaints, and refused to receive chemotherapy or radiotherapy. Eight years after the surgery the patient reported due to general weakness and malaise when the diagnosis of disease relapse was established. Radical surgery was performed although the tumor involved large curvature of the stomach, left crus of the diaphragm, splenic flexure of the colon and tail of pancreas. Four months after the surgery patient died. To the best of our knowledge, to date, only 18 cases have been reported in the literature, describing malignant fibrous histiocytoma of the spleen

The Value of Injury Severity Score and Abbreviated Injury Scale in the Management of Traumatic Injuries of Parenchymal Abdominal Organs

Th e aim of this study was to investigate the infl uence of etiology, types of injury, levels of consciousness and the Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) values on the selection of treatment modality and survival in patients with injuries of parenchymal abdominal organs. Case records of 224 patients treated for traumatic injury of parenchymal abdominal organs from January 2003 until December 2015 were reviewed. Th e values of ISS and AIS of injury severity were calculated and compared to the values obtained according to the etiology, state of consciousness and survival. Of the 224 patients, 172 (76.8%) were treated by surgical approach and 52 (23.2%) were treated conservatively. Th e mean patient age was 40.1}18.3 years. Th ere were 97 (43.3%) polytrauma cases. Of the 224 injured patients, 143 (63.8%) were treated with transfusions of blood products. Two hundred and six (92%) patients survived. Th e mean AIS and ISS values were signifi cantly lower in patients that survived (AIS=3; ISS=28) than in those that died (AIS=5; ISS=34) (p<0.001). Th ere was a statistically signifi cant diff erence in AIS and ISS values between conscious (AIS=2.7; ISS=25.9) and unconscious (AIS=3.2; ISS=33) patients (p<0.001). Of the 224 patients that did not survive, 18 (8%) were hemodynamically unstable. Survival depended on hemodynamic stability at admission; the ISS and AIS values were associated with the injuries and state of consciousness at admission. Hemodynamic stability, state of consciousness, and ISS and AIS values were the quality predictors of survival after abdominal traumatic injury

Primary malignant fibrous histiocytoma of the spleen: recurrence eight years after splenectomy - report of a case and literature review [Primarni maligni fibrozni histiocitom slezene recidiv osam godina nakon splenektomije]

Primary intraabdominal malignant mesenchymal tumors are very rare. There are just few cases of intraabdominal visceral malignant fibrous histiocytoma in the literature. We report a case of primary malignant fibrous histiocytoma of the spleen in a 57-year-old man, with a recurrence eight years after the splenectomy. After the initial surgery the patient was without complaints, and refused to receive chemotherapy or radiotherapy. Eight years after the surgery the patient reported due to general weakness and malaise when the diagnosis of disease relapse was established. Radical surgery was performed although the tumor involved large curvature of the stomach, left crus of the diaphragm, splenic flexure of the colon and tail of pancreas. Four months after the surgery patient died. To the best of our knowledge, to date, only 18 cases have been reported in the literature, describing malignant fibrous histiocytoma of the spleen

Acute Appendicitis as a Complication of Varicella

Introduction: Obstruction of the appendiceal lumen is the primary cause of appendicitis. The most common causes of luminal obstruction are fecaliths and lymphoid follicle hyperplasia. Additionally, bacterial infections or enteric and systemic viral diseases can cause a reaction of the lymphoid follicle. Case presentation: An 11-year-old boy with active phase of chickenpox presented on our Pediatric surgery emergency department under the impression of acute appendicitis. An appendectomy was performed on the same day. An inflamed and edematous retrocecal appendix was removed during surgery. Histological investigation of the appendix revealed transmural acute inflammation, with diffuse proliferation of inflammatory cells, with characteristic intranuclear inclusion surrounded by a clear halo. The PCR analysis of peripheral blood and appendix tissue specimen revealed positive VZV DNA. Conclusion: We have shown that varicella-zoster virus infection of the appendix is associated with acute appendicitis and possibly also with severity of the disease

Pneumoperitoneum in in-vitro Conceived Quadruplet Neonate: Rare Manifestation of Hirschsprungʼs Disease – Report of a Case

Introduction: Hirschsprung’s disease is a congenital colonic aganglionosis, usually presented as inability or difficulty in passing of meconium, chronic and persistent obstipation, maleficent feeding, vomiting, distension and lethargy. Case presentation: We presented a case of an in-vitro conceived quadruplet premature neonate who presented with pneumoperitoneum caused by transverse colon spontaneous perforation and microcolon appearance of distal bowel, treated by resection and temporary colostomy turns to be a rare manifestation of Hirschsprung’s disease. Conclusion: Assisted reproductive technologies increases chances for multiple pregnancies and may increase chance for major congenital anomalies. Rare manifestation of Hirschsprung’s disease is spontaneous pneumoperitoneum which remains a surgical emergency. Delay in recognizing and treatment can significantly worsen prognosis. In neonate with intestinal perforation one should consider Hirschsprung’s disease

Bilateral Simultaneous Testicular Torsion in a Newborn: Report of a Case

Introduction: Testicular torsion is a urological emergency. If not recognized in time, this condition may result in ischaemic injury and loss of testis. Simultaneous bilateral neonatal testicular torsion is extremely rare and is usually misdiagnosed. Case report: We report a case of a male newborn, who presented with bilateral scrotal swelling and redness of the scrotum. Doppler ultrasound supported the diagnosis of bilateral testicular torsion, with an absent blood flow signal on the right side and a weak signal on the left side. Testicular exploration through scrotal incision was performed and bilateral testicular torsion was found. Right testis was grossly gangrenous, and right orchiectomy was performed. Left testicle was dark but showed recovery after detorsion with some bleeding from incised tunica albugenia. Fixation of the left testicle was performed. At six month follow-up, the left testis showed signs of atrophy and hormonal assay showed very low testosterone and elevated LH and FSH, suggesting hypogonadism. Conclusions: Management of neonatal testicular torsion is a matter of controversy. Testicular torsion results into acute ischemia and urgent surgical exploration is the key point of management. Although the possibility of salvaging the involved testicles is usually very low it is hard to justify a passive approach to a bilateral torsion resulting in such a devastating condition as anorchia

Primarni maligni fibrozni histiocitom slezene recidiv osam godina nakon splenektomije

Primary intraabdominal malignant mesenchymal tumors are very rare. There are just few cases of intraabdominal visceral malignant fibrous histiocytoma in the literature. We report a case of primary malignant fibrous histiocytoma of the spleen in a 57-year-old man, with a recurrence eight years after the splenectomy. After the initial surgery the patient was without complaints, and refused to receive chemotherapy or radiotherapy. Eight years after the surgery the patient reported due to general weakness and malaise when the diagnosis of disease relapse was established. Radical surgery was performed although the tumor involved large curvature of the stomach, left crus of the diaphragm, splenic flexure of the colon and tail of pancreas. Four months after the surgery patient died. To the best of our knowledge, to date, only 18 cases have been reported in the literature, describing malignant fibrous histiocytoma of the spleen.Primarni intraabdominalni mezenhimski tumori su vrlo rijetki. U literaturi postoji svega nekoliko opisanih slučajeva malignog fibroznog histiocitoma koji zahvaća visceralne intraabdominalne organe. Prikazujemo slučaj 57-godišnjeg bolesnika sa primarnim malignim fibroznim histiocitomom slezene, te recidivom 8 godina nakon splenektomije. Nakon primarne operacije bolesnik se dobro osjećao, bio je bez tegoba, te je odbio primati kemoterapiju i radioterapiju. Osam godina nakon operacije bolesnik se javio liječniku zbog opće slabosti i malaksalosti te mu je dijagnostičkom obradom utvrđen recidiv bolesti. Učinjen je radikalni operacijski zahvat iako je proces zahvatio veliku krivinu želuca, lijevi dio ošita, lijenalnu fleksuru debelog crijeva i rep gušterače. Četiri mjeseca nakon operacije bolesnik je umro. Prema našim saznanjima, do danas je u literaturi objavljeno samo 18 slučajeva koji opisuju maligni fibrozni histiocitom slezene