Multiple esophageal leiomyomas: a case report

Background: Primary intramural benign tumors of the esophagus are rare. Leiomyomas are the most common benign esophageal neoplasms. Multiple esophageal leiomyomas are very rare, with only a few reports on more than ten coexisting lesions. Case study: A male patient presented with progressing dysphagia and a tumor of the esophageal wall, over 10 cm in length, confirmed by magnetic resonance imaging and endoscopic ultrasound examination. There were no changes of the esophageal mucosa. Multiple fine needle aspirations were performed with inconclusive finding. Surgical exploration through right thoracotomy revealed multiple extramucosal tumors from 5 to 25 millimeters in size. A total of 16 tumors were removed by enucleation without opening the esophageal mucosa. Postoperative period was uneventful. Conclusion: Exact preoperative diagnosis of esophageal submucosal tumors may be difficult to establish without open biopsy. Removal by enucleation is the treatment of choice

Menstrual cycle related pneumothorax: case report and review of the literature

Background: Catamenial pneumothorax is the most common form of thoracic endometriosis syndrome. It occurs around the beginning of a menstrual cycle. Although the mechanism of catamenial pneumothorax is not definitely clear, endometriosis plays an important role in it. Video-assisted thoracic surgery is standard procedure for the treatment of recurrent pneumothorax in general. Case study: We report on a case of catamenial pneumothorax in women with a history of recurring spontaneous pneumotoraces associated with diaphragmatic endometrial implants who is involved in the IVF procedure. Conclusion: Combination of video-assisted thoracoscopic surgery (VATS) and gonadotropinreleasing-hormone analogue gives the best results, to reduce the risk of pneumothorax to recur. Treatment of catamenial pneumothorax is complex and should include thoracic surgeon and gynecologist as soon as the diagnosis is definitive

Ruptura maternice u trećem trimestru nakon prethodne miomektomije

Rupture of gravid uterus is surgical emergency causing maternal and fetal morbidity and mortality. The risk of uterine rupture is associated with uterine scars caused by previous cesarean section, myomectomy, hysteroscopic procedures, and curettage. We report a case of a 40-year-old woman in 31st week of gestation with spontaneous uterine rupture. It was her third pregnancy. She had two healthy children from previous pregnancies. Her symptoms were abdominal pain, vomiting and pain in the right shoulder lasting for 12 hours prior to admission. Ultrasound examination at admission revealed a dead fetus in the abdomen and free fluid in the abdominal cavity. She had previously undergone laparoscopic myomectomy. After myomectomy, she had one successful vaginal delivery. Every abdominal pain in pregnant woman with uterine scar should be carefully and promptly examined to exclude uterine rupture before further diagnostic procedures. This early time frame is essential for survival of the fetus and sometimes even of the mother. Uterine rupture represents indication for immediate cesarean section and it should be performed within 25 minutes of the first signs of uterine rupture. As shown in the case presented, one successful vaginal delivery after myomectomy is no guarantee for future pregnancies.Ruptura maternice je akutno stanje u porodništvu koje može voditi do majčine i/ili fetalne smrti. Rizik za rupturu maternice povezan je s ožiljkom na maternici uzrokovanim prethodnim carskim rezom, miomektomijom, histeroskopskim zahvatom ili kiretažom. Prikazuje se 40-godišnja trudnica u 31. tjednu trudnoće koja je imala spontanu rupturu maternice. Ovo je bila treća trudnoća ove bolesnice koja je iz ranijih trudnoća rodila dvoje zdrave djece. Simptomi su bili praćeni bolovima u trbuhu, povraćanjem i bolovima u desnom ramenu koji su trajali 12 sati. Ultrazvučnim pregledom kod prijma je nađen mrtav plod u trbušnoj šupljini uz slobodnu tekućinu u abdomenu. Prethodno je bolesnica jedanput imala laparoskopsku miomektomiju. Nakon miomektomije je vaginalno rodila. Svakoj boli u trbuhu kod trudnice s ožiljkom na maternici treba pristupiti pažljivo i hitno pregledati te obraditi kako bi se isključila ruptura maternice prije daljnjih dijagnostičkih postupaka. Ovo rano vrijeme prepoznavanja je ključno za preživljavanje fetusa, a ponekad i majke. Ruptura maternice je indikacija za hitni carski rez koji treba učiniti unutar 25 minuta od prvih znakova rupture maternice. Čak niti jedan uspješan porod nakon stanja poslije miomektomije ne jamči da će ožiljak izdržati drugu trudnoću

Ishod trudnoće uz gestacijski dijabetes u usporedbi s indeksom tjelesne mase

Gestational diabetes involves disorder of glucose metabolism first diagnosed in pregnancy. Obese women undoubtedly have more often complications in reproductive age, such as fertility difficulties, spontaneous and recurrent miscarriages, premature births, and various obstetric and surgical complications related to the course of pregnancy, delivery and puerperium. Children of obese pregnant women are more likely to develop obesity in childhood and adulthood. We analyzed the outcome of 51 pregnancies in obese pregnant women and 50 pregnant women with normal body mass index. All women in both groups were diagnosed with gestational diabetes by the IADPSG criteria. We analyzed gestational age at delivery and mode of delivery, gestational weight gain, presence of concomitant diagnosis of gestational or chronic hypertension, difference in birth weight, and prevalence of hypertrophic newborns. There was no significant difference in gestational age at pregnancy termination and in the mode of delivery. There was a significant difference in gestational weight gain, number of pregnant women with hypertension, neonatal birth weight and number of hypertrophic children. Based on the data presented, we conclude that obesity is an unfavorable factor for pregnancy outcome. It also influences birth weight and fetal hypertrophy, as well as gestational weight gain.Gestacijski dijabetes podrazumijeva poremećaj metabolizma glukoze koji se prvi puta dijagnosticira u trudnoći, a njegova incidencija je u porastu. Pretile žene nedvojbeno imaju češće probleme i komplikacije u reproduktivnim godinama, što podrazumijeva teškoće pri zanošenju, spontane i habitualne pobačaje, prijevremene porođaje i različite opstetričke i kirurške komplikacije vezane za tijek trudnoće, porođaja i babinja. Djeca iz takvih trudnoća češće razvijaju pretilost u djetinjstvu kao i u odrasloj dobi. S obzirom na navedeno analizirali smo ishod trudnoća u 51 pretile trudnice i 50 trudnica s urednim indeksom tjelesne mase, pri čemu su sve trudnice (u objema skupinama) imale dijagnozu gestacijskog dijabetesa prema kriterijima IADPSG. Analizirali smo gestacijsku dob, način dovršenja trudnoće, prirast na težini trudnica, prisutnost istodobnih dijagnoza gestacijske ili kronične hipertenzije, razliku u težini novorođenčadi te učestalost hipertrofične novorođenčadi. Rezultati su pokazali da ne postoji statistički značajna razlika u gestacijskoj dobi kad je završena trudnoća niti u načinu dovršenja porođaja. Utvrđena je statistički značajna razlika u dobivenim kilogramima tijekom trudnoće, broju trudnica s hipertenzijom, porođajnoj masi novorođenčadi i broju hipertrofične djece. U zaključku, pretilost u trudnoći s gestacijskim dijabetesom je nepovoljan čimbenik za ishod trudnoće, porođajnu masu i prekomjeran rast novorođenčadi, kao i za prirast tjelesne mase trudnice tijekom trudnoće

Balon za sazrijevanje cerviksa maternice u predindukciji porođaja - jednocentrična studija

Cervical ripening can be promoted in many ways, but mechanical methods are among the oldest. Like all other methods, this one also has its pros and cons. Disadvantages compared to pharmacological methods include some maternal discomfort upon manipulation of the cervix, a theoretical increase in the risk of maternal and neonatal infection from the introduction of a foreign body, potential disruption of a low-lying placenta, and increase in the need of oxytocin induction of labor. The aim of the study was to evaluate the effect of using cervical ripening balloon in preinduction on the mode of delivery. This was a longitudinal, cohort, intervention, non-randomized one center study. Inclusion criteria were term pregnancies with gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Preinduction of labor was performed in term pregnancies at Sestre milosrdnice University Hospital Center. Results in the first 150 women having undergone labor preinduction with cervical ripening balloon were included. Two-sided p values <0.05 were considered significant. Statistical analysis was done using SPSS Version 20.0. The study included 150 women; one woman was excluded from further analyses due to conversion of fetal presentation (head to breech). Indications for labor preinduction were as follows: gestational diabetes, oligohydramnios, intrauterine growth restriction, gestational hypertension/preeclampsia and pregnancies after 41 weeks of pregnancy. Women with normal vaginal delivery (96/149) had lower rates of gestational diabetes and oligohydramnios and used epidural analgesia more frequently. Women with dystocia (32/53) had a significantly longer labor duration and higher neonatal birth weight. In multivariate analysis, multiparity, greater cervical dilatation after balloon removal and use of epidural analgesia were associated with a decreased risk of cesarean section, while the presence of gestational diabetes and oligohydramnios was associated with an increased risk of cesarean section. We found this preinduction method safe and efficient, with a potential to increase the rate of vaginal deliveries.Sazrijevanje cerviksa maternice može se poticati na nekoliko načina. Najstarije metode su mehaničke metode koje imaju svojih prednosti i nedostataka. Nedostaci u usporedbi s farmakološkim metodama uključuju određenu majčinsku nelagodu pri manipulaciji cerviksom maternice, povećanje rizika od majčine i neonatalne infekcije zbog unošenja stranog tijela, mogućnost ozljede posteljice niskog sijela i povećanu potrebu za uporabom oksitocina u porođaju. Cilj istraživanja bio je procijeniti učinak korištenja balona na sazrijevanje cerviksa maternice u predindukciji porođaja. Provedena je longitudinalna, kohortna, intervencijska, ne-randomizirana studija. Kriteriji za uključivanje bili su terminske trudnoće s gestacijskim dijabetesom, oligohidramnijem, intrauterinim zastojem u fetalnom rastu, gestacijskom hipertenzijom/preeklampsijom i trudnoća nakon navršenih 41 tjedna trudnoće. Studiju smo provodili kod žena s terminskim trudnoćama u Kliničkom bolničkom centru Sestara milosrdnica. Prikazani su rezultati u prvih 150 trudnica kod kojih je provedena predindukcija porođaja cervikalnim balonom. Vrijednosti p<0,05 smatrale su se značajnima. Statistička analiza provedena je pomoću SPSS Version 20.0. Studija je obuhvatila 150 trudnica, a jedna žena je bila isključena iz daljnjih analiza zbog konverzije fetalnog stava (glave u zadak). Indikacije za predindukciju porođaja su bile: gestacijski dijabetes, oligohidramnij, intrauterini zastoj fetalnog rasta, gestacijska hipertenzija/preeklampsija i trudnoća nakon navršenih 41 tjedna trudnoće. Trudnice koje su rodile vaginalno (96/149) imale su manju učestalost gestacijskog dijabetesa i oligohidramnija i kod njih je češće korištena epiduralna analgezija. Trudnice bez napredovanja porođaja (32/53) imale su značajno duže trajanje porođaja i veću tjelesnu težinu novorođenčeta. U multivarijatnoj analizi su multiparitet, veća dilatacija cerviksa nakon uklanjanja balona i primjena epiduralne analgezije bili povezani sa smanjenim rizikom carskog reza, dok je prisutnost gestacijskog dijabetesa i oligohidramnija bila povezana s povećanim rizikom carskog reza. Smatramo da je ova predindukcijska metoda sigurna, učinkovita i može dovesti do povećanja broja vaginalnih porođaja

Slučajan nalaz trostrukog uretera nađenog tijekom operacije cervikalnog karcinoma

Ureteral triplication is a very rare anomaly found in the upper urinary tract. This condition can be connected with a higher incidence of congenital anomalies and predisposition for urinary infections. Operative procedure is considered in cases where symptoms reduce the patient’s quality of life. The type of surgical treatment depends on symptom manifestation. The risk of renal failure is usually a deciding factor, which can be found in conditions such as vesicoureteral reflux, obstruction, ureteral ectopy and recurrent infections. Simultaneous treatment of upper and lower urinary tract can be performed. We report a case of a 38-year-old female patient diagnosed with cervical carcinoma, where ureteral triplication was detected incidentally during a radical operative procedure.Anomalija trostrukog uretera je iznimno rijetka anomalija gornjeg urotrakta. Također može biti povezana s povećanom incidencijom kongenitalnih anomalija, kao i s predispozicijom za češće mokraćne infekcije, no nije nužno klinički značajna. Kod postojanja simptoma koji smanjuju kvalitetu života svakako treba razmišljati o operativnom zahvatu koji se planira ovisno o vrsti tegoba koje trpi bolesnik. Kirurško liječenje bolesnika s utrostručenjem uretera obično je indicirano ako postoji rizik bubrežnog zatajenja. Ta stanja su najčešće vezikoureteralni refluks, opstrukcija, ureteralna ektopija i ponavljajuće infekcije. Kirurški zahvat može uključiti istodobni tretman gornjih i donjih mokraćnih putova. Prikazuje se slučaj 38-godišnje bolesnice kojoj je tijekom radikalne operacije raka vrata maternice pronađen slučajan nalaz trostrukog lijevog uretera

Porođajna ozljeda rektuma s intaktnim analnim sfinkterom - dva prikaza slučaja

Background: Injury of the rectum with intact anal sphincter is an extremely rare but very serious complication of vaginal delivery. It is also called a “buttonhole” tear. Case: We present two cases of “buttonhole” tear/injury. Results: In one case, the injury was recognized at the time of delivery and adequately treated. In the other case the injury was not diagnosed on time and the patient was treated for complications on the 6th postpartal day. Conclusion: The consequences for the wellbeing of young mothers with perineal injury can be serious and affect social and sexual aspects of their lives. Adequate surgical treatment and postoperative care assure optimal results and prevent long term complications such as fistulas or fecal incontinence.Pozadina: Ozljeda rektuma s intaktnim analnim sfinkterom je izrazito rijetka no vrlo ozbiljna komplikacija vaginalnog poroda. To se također naziva „buttonhole“ razdor. Slučaj: Predstavljamo dva slučaja „buttonhole“ razdora. Rezultati: U jednom je slučaju ozljeda primijećena pri porodu te prikladno zbrinuta. U drugom slučaju ozljeda nije diagnosticirana na vrijeme, pa je pacijent liječen zbog komplikacija 6. dan nakon poroda. Zaključak: Posljedice za zdravlje u mladih majki s perianalnom ozljedom mogu biti ozbiljne i utjecati na društvene i seksualne aspekte njihovih života. Primjereno kirurško liječenje i postoperativna njega osiguravaju optimalne rezultate i sprječavaju dugoročne komplikacije kao što su fistule ili fekalna inkontinencija

Ruptura uterusa u posljednjem trimestru nakon resekcije roga maternice zbog ektopične trudnoće

Uterine rupture during pregnancy is a critical obstetric complication associated with maternal and fetal mortality and morbidity. The risk is increased in patients with a history of previous uterine surgery including cesarean section, myomectomy, salpingectomy, as well as uterine and placental anomalies and polyhydramnios. It can also occur spontaneously. We present a case of uterine rupture in the early third trimester in a woman who had undergone previous laparoscopic removal of the left fallopian tube due to sactosalpinx and laparotomic removal of left uterine horn due to ectopic pregnancy.Ruptura maternice u trudnoći teška je opstetrička komplikacija povezana sa značajnom maternalnom i fetalnom smrtnošću. Rizik raste kod žena s prethodnom uterotomijom koja uključuje carski rez, miomektomiju, salpingektomiju, ali i različite anomalije posteljice i maternice, polihidramnij, a u rijetkim slučajevima može nastati i spontano. Prikazujemo slučaj rupture maternice u ranom trećem trimestru trudnice koja je prethodno imala lijevostranu salpingektomiju zbog saktosalpinksa učinjenu laparoskopskim putem i resekciju lijevog roga kao terapiju ektopične trudnoće laparotomijom

Spontano prsnuće unutarnje ilijačne arterije u trudnoći: prikaz slučaja

Rupture of the internal iliac artery is a rare complication in pregnancy that is associated with maternal and fetal morbidity and mortality. We present a case of a 30-year-old primipara admitted to our department in 39th week of gestation after sudden onset of intense abdominal pain. On admission, the patient was pale, tachycardiac, but with normal blood pressure and afebrile. Symptoms of acute abdomen were clear and surgery was indicated. Diagnosis was confirmed during cesarean section. Enlarged gravid uterus compressed the ruptured artery and prevented heavier bleeding. Acute bleeding due to arterial rupture causes severe symptoms, predominantly abdominal pain. Changes in blood count become significant some time after the onset of rupture. As the gravid uterus compressed the arterial rupture, preoperative bleeding was by far less abundant than the bleeding after the baby had been delivered and the size of the uterus decreased. Any cause of acute abdomen during pregnancy (abruption of the placenta, spleen rupture, visceral artery thrombosis) requires urgent surgical treatment, as well as intraoperative and postoperative intensive treatment. Rupture of the internal iliac artery is a rare complication in pregnancy, but has to be considered as a differential diagnosis of abdominal pain.Prsnuće unutarnje ilijačne arterije je rijetka komplikacija u trudnoći, a može uzrokovati majčinu i/ili fetalnu smrt. Prikazuje se slučaj tridesetogodišnje prvorotkinje koja je primljena na našu kliniku u 39. tjednu trudnoće s iznenadnom i intenzivnom boli u trbuhu. Kod prijma trudnica je bila izrazito blijeda, afebrilna, tahikardna, ali s normalnim krvnim takom. S obzirom na to da su postojali jasni simptomi akutnog abdomena kirurški zahvat je bio neophodan. Dijagnoza prsnuća unutarnje ilijačne arterije potvrđena je tijekom carskog reza. Uvećana trudna maternica je pritiskala prsnutu krvnu žilu i sprječavala obilnije krvarenje. Akutno krvarenje zbog prsnuća arterije uzrokuje snažnu bol u trbuhu. Promjena u krvnoj slici bila je značajna tek nakon nekog vremena od prsnuća žile. Kako je gravidna maternica pritiskala mjesto krvarenja, prijeoperacijsko krvarenje je bilo znatno manje od krvarenja koje se dogodilo nakon što je porođeno dijete i nakon dekompresije. Akutni abdomen u trudnoći, bila to abrupcija posteljice, prsnuće slezene ili visceralna arterijska tromboza, zahtijeva hitno kirurško liječenje, ali i intraoperacijsku i poslijeoperacijsku intenzivnu skrb. Iako rijetka komplikacija u trudnoći, prsnuće unutarnje ilijačne arterije treba razmotriti kao diferencijalnu dijagnozu kod akutnog abdomena