Morphological and biomechanical modifications in blood vessels decellularization: 341.01 Tissue engineering and cell cultures: Summary of PhD thesis in medical sciences

Structure of the thesis. The thesis includes annotations in Romanian, Russian and English, list of abbreviations, 48 figures, 6 tables, introduction, 4 chapters with general conclusions, practical recommendations, and study limitations. The paper is followed by the list of bibliographic references with 287 sources, author’s disclaimer, and author's CV. The principal results of the study were published in 20 scientific papers. Keywords: Cardiovascular diseases, peripheral arterial disease, bypass surgery, vascular graft, tissue engineering, tissue engineered vascular graft, decellularization, detergent, enzymatic treatment, sonication. The aim of study. To develop new methods for decellularization of large- and small-diameter blood vessels. Objectives of the study. (1) To evaluate the efficiency of sonication-assisted methods for decellularization of arterial vessels; (2) To test the effect of acoustic amplitude on the vascular matrix; (3) To evaluate the effectiveness of chemical (SDS, SDC, Triton X-100, hypotonic solution) and enzymatic (DNase-I) treatment in vascular tissue decellularization; (4) To evaluate whether the decellularization protocol efficiency is depending on the vessel diameter; (5) To check the informativeness of qualitative methods (H&E and DAPI) for confirmation of the decellularization process; (6) To do morphological, biochemical, and biomechanical characterization of treated blood vessels; (7) To assess the biocompatibility of acellular scaffold by performing in vitro contact test; (8) To determine the efficiency of perfusion decellularization for uniform cells’ elimination from long segments of blood vessels. Scientific originality and novelty. Conducting the experimental study with comparison and multilateral characterization of decellularization efficiency of different decellularization approaches in term of cells’ elimination and matrix strength preservation contributed to the completion of some gaps in the current scientific literature. The scientific problem solved in the thesis consists in identifying the factors associated with efficient cells’ removal and establishing a novel procedure for blood vessels decellularization and optimal characterization of acellular scaffold’s structure, a fact that will allow the modification of the experimental paradigm through the scientifically reasoned selection of the optimal experimental conditions. Theoretical significance and applicative value. Decellularization efficiency of different chemicals was specified; in addition, the indispensability of the enzymatic treatment in combination with strong detergents for accelular vascular scaffolds production was demonstrated. The data obtained during the research scientifically argue for the modification of the current research strategy through the preferential use of carotid artery vs aorta as testing model for development of small-diameter tissue-engineered vascular grafts. The failed attempt to use the ultrasound for vascular tissue DC defines the necessity to perform additional studies regarding the mechanism of ultrasound-induced cellular destruction. The practical impact of the present study consists in implementation of a novel technique of blood vessels decellularization in the Laboratory of Tissue Engineering and Cell Culture, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Diverticulul duodenal asimptomatic depistat ocazional: caz clinic

Nicolae Anestiadi Department of Surgery no. 1, Hepato-Pancreato-Biliary Surgery Laboratory, Nicolae Testemitanu SUMPhBackground. Diverticula of the duodenum(DD) are fairly common anatomical entities, estimated incidence 22%, however most DD are asymptomatic and rarely become serious clinical problems. In majority of cases DD are discovered incidentally during medical examination for other pathology. Objective of the study. To present the peculiarities of therapeutic management of a duodenal diverticulum combined with hiatal hernia, the case being surgically resolved with diverticulectomy, cruroraphy and Nissen fundoplication. Material and Methods. P. S., w/60 years, was hospitalized with medical history of precordial chest pain and epigastric discomfort. She received symptomatic treatment at cardiologist without any positive outcomes. Anamnesis vitae: chronic pancreatitis, chronic acalculous cholecystitis, inguinal herniotomy operation. Results. At hospitalization laboratory tests, ECG, echocardiography–normal values; X-ray of the large intestine–dolicocholon, divericulosis. Barium swallow X ray revealed a hiatal hernia gr. II-III with supradiaphragmatic prolapse of the gastric cardia and partially of the fornix and a duodenal diverticulum in D4 (2.1x3.2cm). When acute cardiac pathology was excluded, the patient was prepared for surgery: posterior cruroraphy and Nissen fundoplication, identification and mobilization of the diverticulum, mechanical suture at its base with peritonization of the suture line. Favourable course of the postoperative period with no complications was registered. Conclusion. Even DD become symptomatic only in case of complications development (hemorrhage, perforation) and frequently are discovered incidentally during imaging exploration for another medical condition, simultaneous prophylactic diverticulectomy is recommended.Introducere. Diverticulele duodenale (DD) sunt structuri anatomice frecvent descrise în literatură, cu incidența la 22%, însă deseori sunt asimptomatice și rareori devin adevărate provocări clinice. În majoritatea cazurilor sunt descoperite accidental în cadrul examinărilor pentru altă patologie. Scopul lucrării. Prezentarea particularităților de rezolvare a unui diverticul duodenal combinat cu hernie hiatală, cazul fiind gestionat chirurgical cu o diverticulectomie, crurorafie și operație Nissen. Material și Metode. P. S., f/60 ani, se internează cu anamneză de dureri precordiale și epigastrale surde. A fost tratată simptomatic la cardiolog, fără ameliorare. Antecedente: pancreatită cronică, colecistita cronică alitiazică, herniotomie inghinală. Rezultate. La spitalizare datele de laborator, ECG, ecocardiografie– normale; la irigoscopia–dolicocolon, diverticuloză. Pasajul baritat a relevat hernia hiatală axială gr. IIIII cu prolabarea supradiafragmatic a cardiei și parțial fornixului gastric și diverticul duodenal la nivelul D4 (2.1x3.2cm). După excluderea patologiei cardiace acute a fost preluată pentru intervenție chirurgicală: crurorafie posterioară și fundoplicație Nissen, identificarea și mobilizarea divericulului, sutura mecanică la baza acestuia, cu peritonizarea liniei de sutură. Perioada postoperatorie favorabilă. Concluzii. Chiar dacă DD devin simptomatice doar la apariția complicațiilor (hemoragie, perforație) și mai frecvent sunt descoperite cu ocazia explorării imagistice efectuate pentru o altă afecțiune, diverticulectomia profilactică simultană este recomandată

Qualitative evaluation of detergent-enzymatic decellularized small-caliber blood vessels

Introduction. Despite the obvious advantages of decellularized (DC) arteries as optimal vascular graft material, there are still some technical problems regarding the proper evaluation of the quality of obtained scaffolds. Scanning electron microscopy (SEM) and a series of histochemical stains as hematoxylin and eosin (H&E), Elastica van Gieson, Masson’s trichrome, and Movat pentachrome can be used for scaffold characterization. H&E staining is indicated for qualitative assessment of remaining cellular components through the matrix, while SEM allows evaluation of the topology of the DC surface on the nano-scale and estimation of the preservation of the basal lamina integrity, thought to be important for cell adhesion and biocompatibility of scaffolds. Obviously, the balance between keeping the vessel architecture and removal of cellular components is crucial. Aim of study. To evaluate the efficiency of a combined decellularization approach in cell removal from vascular tissue by H&E stain, and to appreciate its impact on the surface structure by SEM analysis. Methods and materials. Cryopreserved porcine carotid arteries were treated with detergents for 48h under rotation (24h exposure to 0.5% SDS and 0.5% SDC, followed by 24h exposure to 1% TritonX-100) followed by an enzymatic digestion of DNA (48h exposure to 300 U/ml DNase I). The efficacy of DC and structural integrity preservation were evaluated by H&E stain and SEM. The sample preparation for SEM included the specimens’ fixation, dehydration, critical point drying and metal coating. Results. H&E stain revealed no persisting cells in the study group. SEM analysis demonstrated the luminal surface of carotid arteries was free of structural cellular artefacts after the treatment. In addition, the basal lamina of arteries appeared intact, fragmentation with fibers exposition being detected only within a few areas. Conclusion. Complex characterization of decellularized scaffolds is mandatory, including qualitative and quantitative analysis of remaining cellular elements, structural evaluation of the matrix, and its biomechanical assessment. Histochemical stains, as H&E, allows to determine the presence of intact nuclei, indicative for whole cells, while SEM permits an overview of the morphology of the luminal surface. Additional assessments, such as immunohistochemical staining for basal lamina proteins (laminin, collagen IV, or fibronectin) can be considered beneficial to ensure that a basal lamina is truly present and can be tested for biocompatibility

Modificările morfologice și biomecanice în decelularizarea vaselor sanguine: 341.01 Ingineria tisulară și culturi celulare: Rezumatul tezei de doctor în științe medicale

Structura tezei. Teza include adnotările în limbile engleză, română și rusă, lista abrevierilor, 48 de figuri, 6 tabele, introducere, 4 capitole cu concluzii generale, recomandări practice și limitări ale studiului. Lucrarea este urmată de lista de referințe bibliografice cu 287 de surse, declarația autorului și CV-ul autorului. Principalele rezultate ale studiului au fost publicate în 20 de lucrări științifice. Cuvinte-cheie: boli cardiovasculare, boala arterială periferică, chirurgie bypass, grefă vasculară, inginerie tisulară, grefă vasculară obținută prin inginerie tisulară, decelularizare, detergent, tratament enzimatic, ultrasunet. Scopul studiului. Dezvoltarea unor tehnici noi de decelularizare a vaselor sanguine de calibru mare și mic. Obiectivele studiului. (1) Evaluarea eficienței metodelor asistate de sonicare în decelularizarea vaselor arterelor; (2) Testarea efectului amplitudinii acustice asupra matricei vasculare; (3) Determinarea eficacității tratamentului chimic (SDS, SDC, Triton X-100, soluție hipotonică) și enzimatic (DNază-I) în decelularizarea țesutului vascular; (4) Evaluarea eficienței protocolului de decelularizare în funcție de diametrul vasului; (5) Aprecierea informativității metodelor calitative (H&E și DAPI) pentru confirmarea procesului de decelularizare; (6) Caracterizarea morfologică, biochimică și biomecanică a vaselor sanguine prelucrate; (7) Testarea biocompatibilității matricei acelulare prin efectuarea testului de contact in vitro; (8) Determinarea eficienței decelularizării prin perfuzie pentru eliminarea uniformă a celulelor din segmentele lungi ale vaselor sanguine. Originalitatea și noutatea științifică. Realizarea studiului experimental cu compararea și caracterizarea multilaterală a eficienței diferitor tehnici de decelularizare în ceea ce privește eliminarea celulelor și păstrarea rezistenței matricei pentru completarea unor lacune din literatura științifică actuală. Problema științifică rezolvată în teză constă în: identificarea factorilor asociați cu îndepărtarea eficientă a celulelor din matrice și stabilirea unei proceduri noi de decelularizare a vaselor sanguine de calibru mic, și caracterizarea optimă a structurii acelulare, fapt care va permite modificarea paradigmei experimentale prin selectarea rațională din punct de vedere științific a condițiilor experimentale optime. Semnificația teoretică și valoarea aplicativă. A fost specificată eficiența de decelularizare a diferitor substanțe chimice; în plus, a fost demonstrat caracterul indispensabil al tratamentului enzimatic în combinație cu detergenți puternici pentru producerea matricei vasculare acelulare. Datele obținute argumentează științific modificarea strategiei actuale de cercetare prin utilizarea preferențială a arterei carotide față de aortă ca model de testare pentru dezvoltarea grefelor vasculare de diametru mic prin inginerie tisulară. Încercarea eșuată de a utiliza ultrasunetul pentru decelularizarea țesutului vascular definește necesitatea de a efectua studii suplimentare privind mecanismul de distrugere celulară indusă de undele sonore. Impactul practic al prezentului studiu constă în implementarea unei tehnici noi de decelularizare a vaselor sanguine în cadrul Laboratorului de inginerie tisulară și culturi celulare, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica Moldova

Blood vessel decellularization – challenges and perspectives.

Tissue Engineering and Cell Cultures laboratory, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Cardiovascular disease is a general term for conditions affecting the heart and circulation. It is the number one cause of death globally. It is predicted that the annual incidence of cardiovascular disease - related mortalities will rise to 23,3 million globally by 2030. Developed disorders are often associated with the narrowing or blockage of the luminal diameter leading to inhibited blood flow through the affected vessels and tissue damage due to inadequate nutrient supply. The treatment options depend on the type of condition the person has and may range from dietary and lifestyle modification to pharmaceutical therapies and endovascular or surgical interventions. Despite advantages and increased popularity of endovascular surgery, the preferred treatment for the long term revascularization is surgery utilizing vascular grafts. Currently available conduits for vascular grafting do not satisfy completely surgeons’ requirements due to poor clinical efficacy, especially in small diameter vessels applications (< 6 mm). Therefore, tissueengineered materials are the only alternative solution through the generation of biologically based functional vessels. Aim of the study. To provide an overview of decellularization techniques employed current to produce a clinically viable tissue-engineered vascular grafts; to highlight both benefits and drawbacks of each strategy. Materials and methods. Articles containing the keywords: Cardiovascular disease; Tissueengineered vascular grafts (TEVG); Vessel decellularization; Decellularization reagents; Mechanical properties of vessel substitutes were selected from the PubMed and Springer Link databases. Results. The use of biological scaffolds composed by extracellular matrix (ECM) as a strategy for tissue or organ replacement has increased. One technique that has shown good results in several tissue engineering applications, including blood vessels, is the use of decellularized scaffolds. Decellularization is the complete removal of all cellular and nuclear matters from a tissue while preserving ECM, and can be done by using detergents, enzymatic digestion, or mechanical stimulation. Decelullarization process induces the loos of the major histocompatibility complex while avoiding any adverse immunological reactions by the host. It allows the use of decellularized biological tissue not only as autografts but also as allografts and xenografts. Conclusions. It is confirmed that the decellularization process is suitable for the generation of acellular scaffolds for vascular tissue engineering applications. However, the best technique that allows the preservation physicochemical properties similar to fresh vessels is yet to be determined. Researches and clinical trials should be continued in this field

Hartmann procedure in emergency colorectal surgery – a single center experience

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Procedeul Hartmann (PH) este o intervenție frecvent efectuată pentru formațiunile tumorale complicate ale hemicolonului stâng. Rezecția colonului de tip Hartmann este considerată rapidă și sigură, fiind folosită în special, în cazurile de urgență. Scop: Concretizarea indicațiilor PH în intervențiile de urgență pe colonul stâng. Material și metode. Studiu retrospectiv pe 79 pacienți cu cancer colorectal complicat (CCRc) operați în urgență, în cadrul IMU (Chișinău) în perioada 2019-2022. Raportul B:F = 1.1:1, vârsta medie – 70.1±1.34 ani. Indicațiile preoperatorii au fost: ocluzia intestinală acută(OIA) – 62(78.5%) și perforație cu peritonită – 17(21.5%) operate în primele 8 ore de la spitalizare. Localizarea tumorii a fost: sigmoidul – 39(49.4%), descendentul – 16(20.2%), joncțiunea rectosigmoidiană – 24(30.4%) (p<0.01). Rezultate. Majoritatea bolnavilor au fost operați în baza examenului radiologic panoramic al abdomenului și doar 9(11.4%) – prin irigografie de urgență. În toate cazurile s-a aplicat procedeul Hartmann. Au necesitat relaparotomie 5(6.3%) bolnavi pentru necroza stomei. Mortalitatea postoperatorie generală a constituit 29.1% (n = 23), indusă de complicații cardio-pulmonare și infecția COVID-19. Concluzii. PH este o intervenție salvatoare și o bună opțiune pentru pacienții cu formațiuni maligne complicate ale colonului stâng. Indicațiile acestei proceduri se limitează la cazurile de urgență, când aplicarea anastomozei primare este riscantă. PH este încă unul fezabil din punct de vedere tehnic și cu rezultate rezonabile.Background. Hartmann’s procedure (HP) is a commonly performed operation for complicated left colon malignancy. Colonic resection according to the procedure by Hartmann is considered a fast and safe surgical intervention, which has been used for years, in particular, in emergencies. Objective of the study. To define indication of HP under emergency interventions on the left colon. Materials and Methods. Retrospective study of 79 patients with complicated colorectal cancer (CCRC) operated in emergency at Institute of Emergency Medicine (Chișinău), during 20192022. Ratio M:F = 1.1:1, mean age – 70.1±1.34 years. The indications were intestinal obstruction (IO) – 62 (78.5%) and perforation with peritonitis – 17 (21.5%) operated in the first 8 hours. Localization – sigmoid colon – 39 (49.4%), descending colon – 16 (20.2%), rectosigmoid junction – 24 (30.4%) (p<0.01). Results. Most of the patients were operated on the basis of the panoramic radiological examination of the abdomen and only 9 (11.4%) – by emergency irrigography. Were performed in all cases Hartmann procedure. In 5 (6.3%) cases the colostomy was complicated with necrosis. The post-operative mortality rate was 29.1% (n = 23), induced by cardio-respiratory diseases and COVID-19 infection. Conclusion. HP can be a life-saving procedure and suitable option in patients with left sided colonic emergencies. The indications to this procedure are limited to emergency when immediate anastomosis is not possible. Today HP are technically feasible with reasonable outcomes

Angioembolization in solving blunt splenic injuries. Literature review.

Catedra de Chirurgie nr. 1 “Nicolae Anestiadi”, Universitatea de Stat de Medicină și Farmacie “Nicolae Testemițanu”Splina este cel de-al doilea organ cel mai frecvent lezat în urma traumatismelor abdominale închise. În ultimele două decenii, prin abordarea nonoperatorie în managementul curativ al acestor leziuni, s-a înregistrat o creștere a numărului de prezervări ale acestui organ. Embolizarea arterei splenice ca nouă achiziție în prezervarea splinei după traumatism abdominal închis a determinat creșterea ratei de succes a tratamentului nonoperator (TNO) până la 9799%. În acest articol sunt prezentate rolul și importanța noilor abordări tactice și tehnice în rezolvarea leziunilor lienale (LL) închise, indicațiile, considerațiile tehnice, eficacitatea și rata de complicații dezvoltate după embolizarea arterei splenice.The spleen is the second most commonly injured organ, caused by blunt abdominal trauma. Thanks to the nonoperative curative management approach of these injuries, an increase in number of preservations of this organ has been registered. As a new acquisition in spleen preservation, after blunt abdominal trauma, splenic artery embolization has increased the success rate of nonoperative management (NOM) up to 97-99%. This article presents the role and importance of new tactical and technical approaches in solving blunt splenic injuries, indications, technical considerations, effectiveness and the rate of complications developed after splenic artery embolization

Management of traumatic diaphragmatic injuries

Introduction. Diagnostic and curative management of diaphragmatic lesions (DLs) is still difficult, representing a significant medical problem in both penetrating and blunt trauma. Aim of study. To review the anatomy and physiology of the diaphragm, to describe the clinical presentation of traumatic DLs, and to discuss the diagnosis and therapeutic options available for traumatic DLs while highlighting the role of the trauma team in evaluating patients with this condition Methods and materials. Retrospective study was conducted between 2014−2021 in Surgery Department Nr.1 ”Nicolae Anestiadi”, the Institute of Emergency Medicine, which included 48 patients with diaphragmatic lesions. The following parameters were evaluated: epidemiological data, trauma causes, defect size, presence of associated lesions, mean time from injury to surgery, applied surgical procedure, and postoperative morbidity and mortality. Results. M:W ratio 2:1, mean age–35±13.4 years. Penetrating injuries were registered in 38 (79.2%) cases, while blunt abdominal trauma in 10 (20.8%) situations. Traumatic events: stabbing–35 (72.9%), aggression–2 (4.2%), car crashes–9 (18.75%), and catatrauma–2 (4.2%). On admission 13 (27.1%) patients were hemodynamic unstable. The following diagnostic tests were performed: chest radiography−39 (81.25%), FAST−36 (75%), Computed Tomography−15 (31.25%), laparoscopy−15 (31.25%), and thoracoscopy−3 (6.25%). In most cases, the diagnosis was established during first 72h after traumatic event−43 (89,6%). DL was discovered preoperative in 23 (48%) cases, while intraoperative in 25 (52,1%) victims. Isolated DL was established in 8 (16.7%) cases, accompanied injuries were present in another 40 (83.3%) situations, including parenchymatous organ injury−23 (57.5%), hollow organ lesion–12 (30%), and lung damage−7 (14.6%). DL was localized on the left side in 33 (68.75%) cases, on the right side−15 (31.25%), the wound diameter ranging from 0.5cm to 20cm. Surgical treatment was applied in all the cases. The following surgical access techniques were used: laparotomy−40 (83.3%), thoracotomy−2 (4.2%), combined thoracoabdominal access−3 (6.3%), and thoracoscopy−3 (6.3%). The surgical procedure involved a reduction of herniated viscera, treatment of associated lesions, and defect repair by simple suture in 46 (95.8%) cases, and duplication−2 (4.2%). Postoperative mortality−2 (4.2%). Conclusion. Diaphragmatic injury should be routinely suspected in patients with chest or abdominal trauma. The most common diaphragmatic lesion is found intraoperatively, the laparotomy being dictated by the hemoperitoneum. In patients with inferior thoracic wounds and hemodynamic stability, laparoscopy and thoracoscopy can definitely establish the diagnosis. In addition, in the absence of intraabdominal lesions, thoracoscopy allows definitively to resolve the defect

Appendiceal intussusception – a diagnostic and therapeutic surgical provocation

Introduction. Appendicular intussusception (AI) is a rare and unexplained phenomenon characterized by appendix segment telescoping into itself or into the cecum causing acute abdomen syndrome. It was first described by McKidd in a 7-year-old boy in 1858. Since then the literature on it has been confined to a few case reports and very small cases series, in totally 280 cases being reported till now. Aim of study. Searching for specialized literature and analysis of demographic characteristics (age and gender), clinical features and optimal treatment options in case of AI. Materials and methods. Examination of publications from PubMed and Google Scholar Search according to the following keywords: „appendiceal AND intussusception”, „appendix AND intussusception”, and „appendix AND intussuscepted” with identification of 89 cases of AI reported during the period 2008- 2020. Additionally, Chaar CI et al (2009) paper on the topic was included in the evaluation list, representing a comprehensive review of the English literature on AI and presenting 191 cases described for the period 1858-2007. Results. The incidente of AI in adults accounts for about 80% of all cases, most frequently the pathology being diagnosed in middle-aged females (72.2%). Although it does occur in children (20%) too; however, in this case it seems to be slightly more common in males (63%) younger than 10 years of age. The pathophysiology of AI remains unclear; several etiologies have been described, namely, anatomical variations (fetal-type cecum, mobile appendix and mesoappendix, wide appendicular lumen relative to the distal portion) and pathological conditions of the appendicular wall (tumors-27.5%; endometriosis-22.1%; inflammation-20.7%). The signs and symptoms of AI are variable and range from asymptomatic to those suggestive for acute appendicitis, including severe pain in the right lower quadrant of the abdomen, nausea, vomiting, diarrhea or constipation, anorexia. Several radiological and endoscopic preoperative examinations seem to be useful in AI detection: barium enema, ultrasound of the right iliac fossa, computed tomography, magnetic resonance imaging, colonoscopy or diagnostic laparoscopy. Treatment options (conservative management, minimally invasive approach, surgery) differ significantly depending on underlying pathological condition, benign or malignant. In addition, spontaneously reduced appendiceal intussusception cases have also been reported in the literature. Conclusion. AI is a rare pathological entity which in most cases presents clinically appendicitis-like symptoms; however, it should be taken into consideration when assessing the patient with right lower quadrant abdominal pain. In addition, due to these differences in operative management it is imperative that the practicing surgeon be aware of this rare but benign and resectable diagnosis

Acute appendicitis within an umbilical hernia: as a rare cause of pseudo-strangulation

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Apendicele vermiform inflamat poate fi întâlnit în toate tipurile de hernii abdominale externe (0,13%), cel mai frecvent la nivelul inghinal și femural. Conținutul herniilor ombilicale (HO) este, de obicei, omentul sau ansele intestinale; în literatura au fost identificate doar câteva cazuri de apendicită acută (AA) în cadrul unei HO care imită strangulare. Scopul lucrării. De a raporta un caz rar de AA în sacul HO. Material și metode. O femeie obeză, diabetică, 55 ani, cu antecedente de HO netratată, s-a prezentat în urgență cu istoric de durere abdominală severă de 3 zile, febră (38-39 ° C) și prezența unei tumefieri în regiunea ombilicală. Dereglări ale tranzitului intestinal sau simptome urinare nu au fost constatate. Status localis: HO strangulată 15×15 cm cu semne de flegmon al sacului. Investigațiile de laborator au evidențiat leucocitoză ușoară (14,3×10 9 /L) și nivel crescut de fibrinogen (5,39 g/L); ureea, creatinina, bilanțul electrolitic și probele hepatice – în limitele normei. Pacienta a fost internată cu diagnostic prezumtiv de HO strangulată. Rezultate. A fost folosit abordul laparotomic median sub protecția anesteziei generale. La deschiderea sacului herniar a fost depistat lichid inflamator, o porțiune a omentului mare, două anse ale intestinului subțire și apendicele flegmonos schimbat. S-a efectuat apendicectomia cu repararea defectului herniar cu țesuturi locale. Prezența procesului purulent a servit contraindicație pentru plasarea plasei. Examenul microbiologic a depistat Klebsiella pneumoniae. Examenul histopatologic a evidențiat AA, periapendicita și paniculită în epiploon. Evoluția postoperatorie favorabilă, pacienta a fost externat în a șasea zi postoperatorie. Concluzii. Diagnosticul preoperator al AA în sacul herniar este practic imposibil, expresia clinică fiind determinată de strangularea herniei.Background. The inflamed vermiform appendix can be found in all types of external hernias (0.13%), most frequently in inguinal and femoral sites. The content of umbilical hernias (UHs) is usually omentum or bowel loops; however, a few cases of acute appendicitis within an UH mimicking strangulation could be identified in English language specialized literature. Objective of the study. To report a rare case of appendicitis within a UH. Material and methods. A 55-year-old obese, diabetic woman with medical history of untreated UH presented to the emergency unit with a 3-day history of severe pain, mild fever (38-39 ° C), and umbilical swelling. No changes in bowel habit or urinary symptoms were reported. Status localis: strangulated UH of 15×15 cm with the local signs of the phlegmon of the hernia sac. Laboratory investigation showed mild leukocytosis (14.3×10 9 /L) and elevated fibrinogen level (5.39 g/L); urea, creatinine, electrolytes, and liver function test were within normal ranges. The patient was admitted with the presumed diagnosis of strangulated UH. Results. The abdomen was explored through a midline incision under general anesthesia. Opening the sac revealed inflammatory fluid, omentum, two loops of the small intestine, and phlegmonous appendix. Appendectomy was performed with repair of the fascial defect. Presence of pus served as a contraindication for mesh placement. Culture was positive for Klebsiella pneumoniae. Histopathological examination revealed acute appendicitis, periappendicitis and panniculitis in the omentum. Hospital stay was uneventful and the patient was discharged on the sixth postoperative day. At follow-up the patient was well. Conclusion. Pre-operative diagnosis of appendicitis within a hernia seems to be impossible, the clinical signs being determined by hernia strangulation