STRATEGY OF DIAGNOSIS, PROGNOSIS AND MANAGEMENT OF ACUTE DESTRUCTIVE PANCREATITIS

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LIVER INJURY

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Diagnostic and treatment strategy in complicated colon diverticulitis

Acute diverticulitis is a disease with a wide clinical spectrum, ranging from a phlegmon (stage I a) to localized abscesses (stages I b and II), to free perforation with purulent (stage III) or feculent (stage IV) peritonitis. The planned therapy of colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. While there is a little debate about the best treatment for mild episodes, uncertainty persists about the optimal management for severe episodes and complicated diverticulitis

Iatrogenic Lesions of the Bile Ducts - a Surgical Strategy

Background: Bile duct injury is a complex and serious complication. Recently reported incidence of major BDI ranges from 0.3 to 0.55%. The objective of our study was to evaluate diagnostic and management strategies for the treatment of patients with iatrogenic lesions of the bile ducts (open and laparoscopic). Patients: Retrospective study of 81 patients with BDI was done - 57 female, 24 male. 72 of them had their primary surgery in another clinic. According to the site of lesion, the distribution was the following: d. hepaticus com. - 34; d. hep. dex - 15; confluens - 9; d. choledochus - 20. The most important factors predisposing to BDI are: anatomic variations and abnormalities of the biliary tract; severe fibroplastic adhesions in Callot`s triangle; extreme obesity in the region of the porta hepatis; local intraoperative hemorrhage; emergency surgeries; insufficient preoperative diagnosis; low qualification of the operating staff.Results: The appropriate management of biliary tract injuries depends on: time of diagnosis after the initial injury; type of lesion; extent and level of the injury. The performed operative procedures were: hepatico/choledocho/-jejunostomy - 61, T-tube drainage - 6; choledocho-duodenostomy - 3; T-T anastomosis with T-dr. - 4; hepato-jejunostomy - 2; endoprosthesis - 2. There was no postoperative mortality but there was high postoperative morbidity leading to prolonged hospitalization and high hospital cost.Conclusions: Factors related to the prognosis that must be emphasized are: surgeons` experience and skills; location of the stricture; diameter of the anastomosis. Long-term follow-up is necessary to fully evaluate the results of biliary reconstruction for BDI. They are best achieved in highly qualified hepatobiliary centers performing biliary reconstruction with a Roux-en-Y hepatico-jejunostomy

Neuroendocrine Tumors - Diagnosis and Treatment

Introduction: Neuroendocrine tumors originate from chromaffin-like cells and are tumors with neuroendocrine function and malignant potential. They originate from the nerve and endocrine cells spread in the entire body. NETs are a heterogeneous group with a different and complex clinical presentation, and a different location which influences mostly GIT and the pancreas. The tumor progression and the stage of the tumor process are the usual prognostic factors for NET. In recent years, with the improvements of the methods of imaging procedures, the process of diagnosis and the following surgical treatment of NET have improved significantly.Aim: The aim of this study is a retrospective analysis of the patients with neuroendocrine tumors operated on in Second Department of Surgery of UMHAT `Saint Marina` in the period 2010 - 2015.Materials and Methods: For the period between 2010 and 2015 in the Second Department of Surgery, UMHAT ` Saint Marina`, 19 patients with NET have been operated on. The gender distribution was as follows: 11 women and 8 men, with a ratio of 1.3:1. The average age of the patients was 57. The location of the tumor was as follows: large bowel - 6, the pancreas - 4, metastasis from NET-3, small intestine - 3, stomach - 2 and suprarenal gland - 1. US, CT, PET - CT were applied to all patients. The histological results were: neuroendocrine tumor - 17, insulinoma - 1, pheochromocytoma - 1.Conclusion: The NET diagnosis and treatment are part of a multidiscipline process. The surgical treatment of NET has to be considered for carefully selected patients with functional tumors, especially in the cases when they cannot be safely removed. The survival rate of patients diagnosed with NET is increasing significantly after a conducted surgical intervention even with the presence of metastases

Surgical complications in patients with stoma

Construction of a stoma is a surgical procedure which is performed in some bowel resections. Although there is a high frequency of these procedures, there is an appreciable complication rate (20-70% of all cases). The most common complications are skin excoriation and irritation, prolapse, retraction, ischemia, parastomal hernia and stenosis. For a 13-year period (May 2001 - May 2013), 478 surgical interventions performed in the Second Department of Surgery were completed with temporarily or permanently colostomy or ileostomy. A total of 86 corrections of a stoma with different complications were performed, but only in 21 of the patients (4,3%) the previous operation was in our Department. The cases were analyzed by age, gender, BMI, form and cause for the first operation, stoma complications and morbidity rate. In the present communication, we share our experience with the treatment of stoma complications

Neuroendocrine Tumor in Peripancreatic Lymph Nodes

Introduction: Neuroendocrine tumors originate from chromaffin-like cells and are tumors with neuroendocrine function and malignant potential. In the majority of the cases, they affect the gastrointestinal tract and pancreas. In the diagnosis of primary pancreatic carcinoma, 95% of cases are adenocarcinomas, and the remaining 5% are asymptomatic neuroendocrine tumors.Aim: We report a case of NET of the pancreas localized in processus uncinatus.Results: The patient underwent an enucleation of the tumor. On histological examination: markedly cellular with mostly dispersed tumor cells, also some loose clusters, acinus-like formations, small sheets, rosette-like formations and ribbons. Immunohistological stains were performed with the following results: the epithelial component was positive fоr Synaptophysin(+), Chromogranin(+), CDX2(+), TTF1(-), Ki6

Mirizzi Syndrome

First described in 1948 by Pablo Luis Mirizzi as `functional liver syndrome in jaundiced patients` and bearing his name, Mirizzi syndrome is a rare but serious complication of the gallstones, requiring careful approach in patients.For the period 2010-2015 in the Second Department of Surgery, 22 patients with Mirizzi syndrome are hospitalized. The ratio of women:men = 2.1:1. The age of the patients ranged from 19 to 78, all of them with long-established history and clinical presentation of gallstones.The patients had both planned and emergency surgeries, various types and sizes of surgical interventions were performed, including laparoscopical ones - cholecystectomy, cholecystectomy with drainage Kehr, cholecystectomy with biliary enteric anastomosis, reconstruction of the common bile duct

Acute Necrotizing Pancreatitis (ANP)

Necrosis of the pancreas and the peripancreatic tissue is present in 10-20% of patients with acute pancreatitis (AP) and is the reason for the high levels of morbidity and mortality rate in these cases. In the initial phase of acute necrotizing pancreatitis (ANP), the most important moments in the treatment are permanent correction of fluid and electrolyte imbalance, early enteral nutrition, ERCP in patients with cholangitis and increased pressure in the biliary tract, and patient admission in intensive care unit. When pancreatic and peripancreatic necroses become infected, surgical treatment is an optimal option, which, if possible, should be delayed till the fourth week after the onset of the disease. The type of surgery also experienced changes - from a classic open approach, with the introduction of wide drainage for postoperative lavage, through half-open techniques with subsequent repeated laparotomy, to a percutaneous drainage with a subsequent access to the retroperitoneum to perform minimally invasive necrectomy