Complicated form of ulcerative colitis - strategy and treatment - case report

Introduction: Ulcerative colitis is one of the inflammatory bowel diseases (IBD) and affects the colon and rectum. Typically it manifests as continuous areas of inflammation and ulceration. One of the features of the disease is the development of local and systemic complications. A very serious complication is the development of toxic megacolon with uncontrollable bleeding from the colon.Materials and methods: A 43-year-old man was hospitalized in the clinic of Gastroenterology at St. Marina Hospital with bloody diarrhoea, abdominal pain and fever with a history of ulcerative colitis. Optical colonoscopy was performed and it showed a typical active ulcerative colitis. The early treatment algorithm started with antibiotics and methylprednisolone 40mg. For the accompanying symptoms, Salofalk 1g, Antispasmodics and Proton pump inhibitors were added. The conservative therapy had no effect over the condition and the continuing bleeding from the colon. Therefore a transfer to an intensive care unit was required.Results: Due to the depletion of the conservative treatment measures for complicated ulcerative colitis and after stabilizing his vital signs the patient was operated on by a surgical team from First Clinic of Surgery. Laparoscopic proctocolectomy with ileostomy was performed. In the postoperative period there were clinical and radiological signs of a limited pelvic abscess, which was treated by percutaneous drainage and antibiotics. The patient was to be indicated for surgery for J pouch ileo-anal anastomosis during the second stage.Conclusion: Complications of ulcerative colitis are serious and in some cases life-threatening. The latest studies have shown that laparoscopic proctocolectomy with a second-step J pouch ileo-anal anastomosis is standard in cases of complicated ulcerative colitis. It is important to know the disease and the right combination of conservative and surgical treatment to ensure disease control and a complete lifestyle

Advantages of laparoscopic surgery in inguinal hernia repair

Introduction: Inguinal hernia has been one of the most common surgical conditions for the last few decades. Risk factors for hernia are excessive physical activity in adults or athletes and birth defects in collagen production. Over the years hernia repair has evolved as a simple, rapid and safe operation with the lowest complication rate. In the last decades laparoscopic hernia repair has replaced the clas­sic open method. The two most popular laparoscopic approaches are totally extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP).Materials and methods: The goal is to do an analysis based on scientific studies. A literature review using PubMed, Google Scholar was conducted. Keywords like inguinal hernia, laparoscopic and open surgery were used. The aim was to compare the laparoscopic versus open hernia surgery for length of hospital stay, postoperative pain, complication rate and return to normal activity.Results: Based on the conducted literature review, laparoscopic surgery was observed to be less pain­ful and the complication rate is lower. Furthermore the length of hospital stay and time until the re­turn to normal activity are shorter. Laparoscopic operations provide the ability to view the abdomi­nal cavity for other pathologies. The efficacy of the repair depends on the experience of the surgeon.Conclusion: In the last decades laparoscopic hernia repair has evolved. It has imposed itself as a gold­en standard in most countries, except for the patients with severe comorbidities. In conclusion, TAPP and TEP are preferred from the patients and replace the different types of open hernia repair, due to their numerable advantages

Retroperitoneal Hematoma - a Case Report

Introduction: The acute hemorrhage of the adrenal glands is a rare condition. Trauma is the most common cause, but non-traumatic etiology has been reported.Materials and Methods: We present a case of a 67-year-old patient, who came to our clinic with complaints of strong, unbearable pain in the upper part of abdomen, pale skin and cyanosis on the face. The CT results showed a retroperitoneal hematoma or a highly vascularized tumor formation, as well as intraperitoneal free fluid. The unstable hemodynamics, the shock and the temporary cardiac arrest could not be controlled with a conservative treatment. The patient`s condition, the increased quantity of the retroperitoneal hematoma and the intraperitoneal free fluid required emergency surgery. During the operation we found a rupture of the left adrenal gland and a crossing of the hematoma in the right part of the retroperitoneal space. We performed left adrenalectomy.Results: In the early postoperative period, the condition of the patient remained critical despite the postoperative intensive care and the compensation of the blood loss and that led to a lethal outcome.Conclusion: The formations of the adrenal glands may present a diagnostic challenge and difficulty in choosing a treatment approach. This is due to the a wide range of differential diagnoses (adenoma, cysts, pheochromocytoma, myelolipoma, metastases or primary carcinoma), the evaluation of hormonal activity and differentiation between benign and malignant formations. Surgical treatment is indicated in those cases with potentially malignant formations and with a risk of spontaneous rupture