Bolus ileus-an occasional cause of small bowel obstruction-case report

A food bolus can be an occasional cause of small bowel obstruction. Especially older and senile patients are at higher risk for developing a bolus ileus. Certain pathological conditions are associated with a higher risk for developing a bolus ileus, such as duodenal and small bowel diverticula. In this paper is presented a case of a 68-year-old female patient with food bolus, that caused a mehanical small bowel obstruction. The abdominal computed tomography scan before surgery did not show the precise cause of intestinal obstruction. During surgery we found a big grape in the distal ileum, which was removed through enterotomy. Further postoperative course was uneventful

Left-sided gall bladder found incidentally during emergency laparoscopic appendectomy due to acute appendicitis

The gallbladder is affected by a large number of congenital anomalies, which may affect its location, number, size, or form. Some of these malformations are very rare and may lead to misdiagnosis. Knowledge of the location of the gallbladder is of great importance for the surgeon, particularly when cholecystectomy or other biliary surgery is to be performed. There are many variants not only of the position of the gallbladder but also in the way the cystic duct joins the biliary tree. The left-sided gallbladder remains a scarce anomaly with prevalence of 0.3%. This report presents a case of a young male patient, who was operated due to acute appendicitis. Laparoscopic appendectomy was performed and at laparoscopy a left-sided gallbladder was found, located on the III liver segment, on the left side of the round ligament

Bone metaplasia of the appendix presented with clinical and computed tomography signs of acute appendicitis managed with laparoscopic appendectomy

Bone metaplasia or heterotopic ossification of the appendix is an extremely rare condition, which is usually associated with mucinous appendiceal neoplasms. This case describes a young male patient, who presented to the surgical emergency department with clinical and computed tomography signs of acute appendicitis. Laparoscopic appendectomy was performed. The final histopathological examination revealed a bone metaplasia of the distal appendix, without any other associated appendiceal pathology. According to our knowledge and literature review, this is the first such case described in the English literature yet

Acute cholecystitis – early surgery or an attempt at conservative treatment?

Acute cholecystitis is a common disease, which ofen requires admission to hospital and surgical treatment. Acute cholecystitis is defined as inflammation of the gallbladder and usually occurs due to cystic duct obstruction from stones or sludge. It is a relatively common complication of gallstones, but it can also occur without gallstones. A combination of relevant clinical symptoms and ultrasound evidence is required to make a diagnosis of acute cholecystitis. Early surgery is recommended for all patients that are in good physical condition. There is still a debate how to treat high-risk and critically ill patients. Laparoscopic cholecystectomy is the method of choice for treatment of patients with acute cholecystitis. Early laparoscopic cholecystectomy should be done within 72 hours from the onset of symptoms. This article presents current guidelines according to the Tokyo guidelines and the World Society of Emergency Surgery guidelines, and at the end, experiences of some clinical trials

Acute cholecystitis – early surgery or an attempt at conservative treatment?

Acute cholecystitis is a common disease, which ofen requires admission to hospital and surgical treatment. Acute cholecystitis is defined as inflammation of the gallbladder and usually occurs due to cystic duct obstruction from stones or sludge. It is a relatively common complication of gallstones, but it can also occur without gallstones. A combination of relevant clinical symptoms and ultrasound evidence is required to make a diagnosis of acute cholecystitis. Early surgery is recommended for all patients that are in good physical condition. There is still a debate how to treat high-risk and critically ill patients. Laparoscopic cholecystectomy is the method of choice for treatment of patients with acute cholecystitis. Early laparoscopic cholecystectomy should be done within 72 hours from the onset of symptoms. This article presents current guidelines according to the Tokyo guidelines and the World Society of Emergency Surgery guidelines, and at the end, experiences of some clinical trials

Multidisciplinary diagnostic and therapeutic approach to acute mesenteric ischaemia

Superior mesenteric artery embolisation is the most common cause of acute mesenteric ischaemia. Superior mesenteric artery embolisation can be caused by various cardiac diseases (myocardial ischaemia or infarction, atrial tachyarrhythmias, endocarditis, cardiomyopathies, ventricular aneurysms and valvular disorders), arterial aneurysms, ulcerated atherosclerotic plaques of the major arteries and others. A case of 65-year-old, previously healthy man with superior mesenteric artery embolism, who was found to also have mural aortic thrombi, is presented. The patient underwent an emergency proceduresmall intestine and cecum were resected and jejuno-ascendo anastomosis was performed. The patient was put on lifelong anticoagulation therapy. Neither cardiac diseases nor arterial aneurysms were detected. There were no signs of underlying atherosclerosis. Work-up for antiphospholipid antibodies and rheumatic diseases was negative. Tumour markers were within normal levels and blood cultures were negative. This case represents the challenges in recognising an underlying cause of acute mesenteric embolism and highlights the importance of multidisciplinary diagnostic and treatment approach

Comparison of a five-year survival and cancer recurrence between laparoscopically assisted and open colonic resections due to adenocarcinoma

Background and objectives: When resecting colon adenocarcinoma, surgeons decide between the use of laparoscopically assisted and open surgery. Laparoscopic resection is known to have short-term benefits over an open operation. However, researchers are not as unified about the long-term findings. The aim of this research is to elaborate on five-year post-operative differences in survival and cancer recurrence between these two different approaches. Materials and methods: 74 enrolled patients were evaluated five years after a primary operation. We collected dates of deaths of deceased patients and time after operation of possible recurrences. Carcinoma staging was done by a pathologist after operation. Blood samples were taken before surgery in order to measure tumor markers (CA19-9 and CEA). Results: Survival after colonic adenocarcinoma surgery did not differ between the two different surgical approaches (p = 0.151). Recurrence of cancer was not associated with the type of operation (p = 0.532). Patients with recurrence had a 37.6 times greater hazard ratio of dying (95% CI: [12.0, 118]p < 0.001). Advanced age adversely affected survival: patients aged < 0.001). Patients with different TNM stages did not have any statistically significant differences in survival (HR$_{II}$ = 2.4995% CI: [0.67, 9.30]p$_{II}$ = 0.173) (HR$_{III}$ = 2.1895% CI: [0.58, 8.12]p$_{III}$ = 0.246) or recurrence (p = 0.097). Conclusion: The obtained results suggest that laparoscopic resection of colon cancer is not inferior from an oncologic point of view and results in a similar long-term survival and disease-free interval. Recurrence of carcinoma, older age at initial operation and elevated tumor markers, above a pre-set threshold at operation, were found to be independent factors of lower survival. We believe that the obtained results will be of benefit when choosing treatment for colon adenocarcinoma

Minimally invasive peritoneal dialysis catheter insertions with concomitant cholecystectomy or hernioplasty

Introduction: Peritoneal dialysis is a well-accepted replacement therapy in patients with end-stage renal disease. There are many different options adopted on how to insert a peritoneal dialysis catheter. In our institution, a laparoscopic insertion has become the method of choice for providing peritoneal dialysis access in adult patients. The aim of this study was to analyze surgical outcomes of patients after laparoscopically assisted placement of a PD catheter some of them after concomitant cholecystectomy or hernioplasty. Methods: We have evaluated 70 consecutive patients from 1st of October 2015 to 30th of April 2020 who underwent laparoscopic insertion of a peritoneal dialysis catheter. Demographic data, details about surgery and about peri- and postoperative complications were gathered. Results: Out of 70 enrolled patients, 15 had gallstones (21%) and underwent concomitant laparoscopic cholecystectomy. Three patients (4%) had abdominal wall hernia and underwent concomitant hernioplasty. We observed no perioperative complications connected with any of the performed procedures. There was one early postoperative complication: an early leak of dialysate fluid. Late complications were observed in nine patients (13%): mechanical catheter problems (two patients), peritonitis (three patients), skin exit-site infections (two patients), peri-catheter leak (one patient), and port-site hernia (one patient). Conclusions: For all patients with concomitant gallbladder disease or abdominal wall hernias we suggest to perform synchronous surgeries, due to finding no more complications after concomitant procedures in comparison to patients in whom only a PD catheter was inserted. Concomitant procedures are done to spare patients two separate procedures and to avoid possible complications. We also suggest using the cholecystectomy first, PD catheter insertion second approach for having excellent peri- and postoperative results