Laparoscopic cholecystectomy due to acute calculouscholecystitis in 16 weeks' in vitro fertilization and embryo transfer pregnancy: report of the first case

The most common casues of acute abdomen during pregnancy are acute appendicitis followed by acute cholecystitis. The case presented is a 33-year-old patient in 16 weeks' in vitro fertilization and embryo transfer pregnacy who developed acute cholecystitis. Previously there were two unsuccessful cycles, one complicated with ovarian hyperstimulation syndrome. Due to clinical deterioration during intravenous antibiotic therapy laparoscopic cheolecystecomy was performed and acute cholecystitis found. The postoperative course was uneventful. During the first 24 h tocolysis with intravenous fenoterol in addition to peroral atenolol 2 Χ 50 mg was administered. Postoperative course was uneventuful with further normal pregnancy. Elective cesarean section was made in term pregnancy (39 weeks) with singleton with Apgar 10/10. Current guidelines do not recommend prophylactic tocolysis in pregnant population with acute abdomen but there is no mention of the IVF-ET subpopulation of patients. Also, there are no guidelines for thromboprophylaxis in such patients with increased risk of thromboembolic accidents. To our knowledge this is the first case report of a laparoscopic cholecystectomy during IVF-ET gestation

Bilateral ovarian torsion during follow-up for antenatally detected ovarian cysts

Ovarian torsion is a surgical emergency demanding timely diagnosis and treatment to prevent loss of the ovaries which if happens may result in functional and emotional consequences. Simple (less than 5cm in size) ovarian cysts require follow-up for potential self-resolution. We describe a case of antenatally detected bilateral ovarian cysts that developed bilateral ovarian torsions on follow-up, postnatally

APENDICITIS U RANOM PUERPERIJU: PRIKAZ BOLESNICE

Appendicitis is the most common nonobstetric surgical diagnosis in pregnancy, but the diagnosis during immediate postpartum period is exceptionally rare. The case of a 27 year-old puerpera who survived a rather unspecific clinical course of the disease is presented. Initial abdominal symptoms had occurred two days before term delivery but the signs of abdominal disease had been obscured by the preparation for the process of the delivery and usual complaints during the early puerperium. A day after delivery, puerpera again complained of nausea and vomiting. The abdomen was somewhat tender, but without defense, laboratory parameters were within normal limits and abdominal X rays revealed nothing suspicious, so conservative therapy was initially administered. During the next two days meteorism occurred, abdominal tenderness increased and the laboratory findings deteriorated. Now abdominal X rays prompted urgent explorative¬ laparatomy and the patient was saved.Apendicitis je najučestalija neobstetrička dijagnoza u trudnoći koja zahtijeva kirurški zahvat, dok je u ranom postpartalnom periodu iznimno rijetka. Prikazat ćemo 27-godišnju babinjaču s vrlo neobičnim kliničkim tijekom bolesti. Inicijalni abdominalni simptomi pojavili su se dva dana prije termina poroda, ali su znaci karakteristični za akutni abdomen bili prikriveni samim početkom poroda, te uobičajenim smetnjama tijekom puerperija. Dan nakon poroda babinjača se ponovo žalila na mučninu i povraćanje. Abdomen je bio osjetljiv, ali bez defansa, laboratorijski parametri u granicama normale, a rendgenski nalaz uredan, pa je primijenjeno konzervativno liječenje. Tijekom iduća dva dana pojavio se meteori¬zam, abdominalna osjetljivost je porasla, a laboratorijski nalazi su se pogoršali. Prema rendgenogramu indicirana je hitna eksplorativna laparotomija te je pacijentica uspješno zbrinuta

Varicocele – a silent killer of male fertility?

Pod pojmom varikokele podrazumijevamo varikoznu dilataciju vena pampiniformnog spleta. Kod djece mlađe od 10 godina ovakav nalaz je rijedak, dok se u adolescenata javlja s učestalošću od oko 15 %. Nalaz varikokele može biti ljevostran, desnostran i obostran. U kliničkoj praksi najčešće nalazimo varikokele lijeve strane, što objašnjavamo retroperitonealnim anatomskim odnosima. Varikokela u adolescenata obično je asimptomatska, no može biti praćena bolovima u skrotumu. Za postavljanje dijagnoze najčešće su dovoljni klinički pregled i ultrazvuk. Budući da ovo stanje može uzrokovati dugoročnu supfertilnost pacijenta, ključno je pravovremeno donijeti odluku o operativnom zahvatu. Postoji više kirurških tehnika za rješavanje ove patologije. Donedavno su se operacije vršile isključivo tehnikom otvorenog transingvinalnog ili supraingvinalnog pristupa. Upotreba ostalih, manje invazivnih metoda, sve je češća.Under the term varicocele, we assume the varicose dilatation of the pampiniform plexus. In children under the age of 10, this is a rare finding, while it can be found in approximately 15 % of adolescents. Varicocele findings can be left-sided, right-sided and both-sided. In clinical practice, we mostly find left-sided varicoceles which can be explained by retroperitoneal anatomy. In adolescents, varicocele is usually asymptomatic, however it can also be accompanied by scrotal pain. For setting a diagnosis, a clinical examination paired with an ultrasound is mostly sufficient. Seeing as how this condition can cause long-term patient subfertility, it is of the utmost importance to make timely decisions on operating procedures. There are a number of surgical techniques that can be used to resolve the pathology. Until recently, operations have been conducted exclusively using the open transingvinal or supraingvinal technique. The use of other, less invasive methods is, however, becoming more often

Cistični limfangiom mezenterija jejunuma koji oponaša akutni apendicitis: prikaz slučaja

Cystic lymphangiomas of the small bowel mesentery are rare manifestations of intra-abdominal tumors. Usually, they are discovered incidentally during examination for an unrelated abdominal illness. We present a case of a 4-year-old boy who was admitted to our hospital because of the right lower quadrant acute abdominal pain suspect of acute appendicitis. At laparotomy, a giant, cystic, encapsulated and lipomatous mesenterial mass was found, 15x15x10 cm in size, infiltrating the jejunum. The tumor was located 70 cm from Treitz’s ligament. Extirpation of tumor mass with intestinal resection of the involved loops was necessary. Pathologic examination confirmed the diagnosis of mesenteric cystic lymphangioma. Although they are rare, cystic mesenteric lymphangiomas should be considered as a possible cause of acute abdomen and treated with surgical resection. Prognosis after surgical removal is excellent.Cistični limfangiomi mezenterija tankog crijeva pripadaju rijetkim intraabdominalnim tumorima. Obično se nađu slučajno tijekom obrade zbog neodređene trbušne boli. Prikazuje se slučaj četverogodišnjeg dječaka hospitaliziranog zbog bolova u donjem desnom abdominalnom kvadrantu sumnjivih na akutnu upalu crvuljka. Nakon učinjene laparotomije našla se velika, cistična, inkapsulirana, lipomatozna mezenterijska masa veličine 15x15x10 cm koja je infiltrirala jejunum. Tumor je bio smješten oko 70 cm aboralno od Treitzova ligamenta. Učinjena je ekstirpacija tumora s infiltriranom jejunalnom vijugom. Patohistološki nalaz je potvrdio dijagnozu mezenterijskog cističnog limfangioma. Iako rijetki, cistični mezenterijski limfangiomi se mogu smatrati mogućim uzrokom akutne abdominalne boli i liječiti kirurškom resekcijom. Prognoza je nakon kirurškog odstranjenja odlična

Inicijalna iskustva u provođenju terapije površnim negativnim tlakom pri liječenju dječjih opeklina [Initial experience with topical negative pressure therapy in the treatment of pediatric burns]

We are presenting the experience of the Referral Centre for Pediatric Traumatism of the Croatian Ministry of Health in the usage of topical negative pressure therapy (TNP) method for the treatment of pediatric burns. In the period of 20 months we have used negative pressure wound therapy method in eight children aged between 1.5 and 10 years. Burn injuries total body surface area ranged between 3% and 30%. TNP was used either for the wound bed conditioning or for the fixation of skin grafts. Average skin graft „take” was 86% eight days after surgery according to the evaluation by the senior author. Based on our initial experience, we can confirm that TNP is a very useful tool which enables good wound bed conditioning as well as a good fixation tool for skin grafts if the burned area does not exceed 30% of total body surface area

INITIAL EXPERIENCE WITH TOPICAL NEGATIVE PRESSURE THERAPY IN THE TREATMENT OF PEDIATRIC BURNS

Prikazujemo iskustvo Referentnog centra za traumatizam dječje dobi Ministarstva zdravstva Republike Hrvatske u provođenju terapije površnim negativnim tlakom pri liječenju dječjih opeklina. U periodu od 20 mjeseci koristili smo se kod osmero djece u dobi od 1,5 godina do 10 godina s opeklinskim ozljedama koje su zahvaćale od 3 do 30% tjelesne površine sistemom površnoga negativnog tlaka ili radi kondicioniranja podloge opeklinske rane prije transplantacije kože djelomične debljine ili za fiksaciju kožnih transplantata. Prosječni je prihvat transplantata 8. dan nakon operacije prema procjeni prvog autora iznosio oko 86%. Temeljem svojih inicijalnih iskustava možemo reći da je terapija površnim negativnim tlakom korisna metoda jer pomaže i u kondicioniranju podloge opeklinske rane prije transplantacije kože i za fiksaciju kožnih transplantata ako opeklina ne zahvaća više od 30% tjelesne površine.We are presenting the experience of the Referral Centre for Pediatric Traumatism of the Croatian Ministry of Health in the usage of topical negative pressure therapy (TNP) method for the treatment of pediatric burns. In the period of 20 months we have used negative pressure wound therapy method in eight children aged between 1.5 and 10 years. Burn injuries total body surface area ranged between 3% and 30%. TNP was used either for the wound bed conditioning or for the fixation of skin grafts. Average skin graft „take” was 86% eight days after surgery according to the evaluation by the senior author. Based on our initial experience, we can confirm that TNP is a very useful tool which enables good wound bed conditioning as well as a good fixation tool for skin grafts if the burned area does not exceed 30% of total body surface are