Bleeding Meckel\u27s diverticulum: case report

Meckelov divertikul ispoljava svoje simptome u oko 4 - 30% bolesnika u dobi ispod 2 godine, a u starijih od 8 godina u oko 10% slučajeva. Dijagnostička scintigrafija tehnecij 99m pertehnetatom je zlatni standard dijagnostike. Osjetljivost pretrage je svega 62% u odrasloj populaciji. Iako je prva scintigrafija i u ovdje prikazanom slučaju negativna, ima načina kako se lažno negativni rezultati mogu smanjiti na najmanju moguću mjeru, odnosno kako se može povećati osjetljivost pretrage, a samim time i izbjeći ponavljana testiranja.Symptomatic presentation of Meckel\u27s diverticulum occurs in 4-30% of patients under 2 years of age and in 10% of cases where the patients are older than 8. Diagnostic Technetium-99m-Pertechnetate scintigraphy is the standard test for making this diagnosis. However, the sensitivity of the scan is only 62% in adult population. Although the Technetium Pertechnetate scan is falsely negative in this case report (and in a number of other cases) there are ways to increase its sensitivity and possibly avoid repeated testing

Liver injuries caused by blunt trauma

Tijekom zadnjih 10 godina na Kirurškom odjelu Opće bolnice Nova Gradiška liječena su 24 bolesnika sa ozljedom jetre. U 95,84% slučajeva te ozljede nastale su djelovanjem tupe traume u prometnim nezgodama. U 91,67% slučajeva radilo se o politraumi, a svi bolesnici su već pri prijemu bili u stanju hemoragijskog šoka. Najčešće ozlijeđeni organski sustav uz jetru bio je skeletni. U 87,50% slučajeva ozlijeđeni su bili muškarci između 20—30 godina starosti. Ozljede jetre bile su najčešće I. i II. stupnja. Visoki stupanj jetrenih ozljeda bio je rijedak, ali za nas još uvijek nesavladiv problem. Smrtnost u na­ šem materijalu iznosila je 29%. Uzrok smrti bio je iskrvarenje u 42,85% slučajeva, sepsa u 14,28% slu­čajeva, a u preostalim slučajevima multipla trauma. Da bi se spasio život bolesniku sa ozljedom jetre, važna je brza naknada svježe krvi, brza dijagnostika, te brza i adekvatna kirurška terapija.Twenty-four liver injuries have been treated af our ward during the last 10 years. 95.84% of them were caused by traffic accidents. All the patients were in the conditions of haemorrhagic shock at the moment of coming to the hospital and with 91.67% it were the cases of polytrauma. The sceletal system was most frequently injured aside to liver. 87,50% of cases were men aged 20—30 years. The liver injuries were most frequently of the first and second grade. The high grades of liver injuries were very rare, but they were insurmountable in our experience. Mortality in our material was 29%. The cause of death was the exsanguination in 42.85% of cases, sepsis in 14.28% of cases and multiple trauma in all other cases. The fast compensation of fresh blood, immediate diagnosis and fast and adequate surgical therapy are very essential

Complications of the urgent abdominal laparoscopic procedures and potential conversion to the conventional surgical procedure

Laparoskopski operacijski zahvati sve se češće izvode u hitnoj kirurškoj službi što ovisi o opremljenosti ustanove i educiranosti kirurškog tima. Materijal i metode: U Odjelu abdominalne kirurgije II KB "Dubrava", Zagreb u 2003. godini operirana su 902 bolesnika, od toga je bilo 276 (30 %) laparoskopskih kirurških zahvata. Među laparoskopskim zahvatima bila su 63 hitna laparoskopska zahvata ili 22% ukupnog broja laparoskopskih zahvata. Od hitnih laparoskopskih zahvata učinjeno je sljedeće: 36 laparoskopskih kolecistektomija zbog akutnog kolecistitisa, 12 laparoskopskih apendektomija zbog akutne upale crvuljka, dvije cistektomije s hemostazom i elektrokoagulacijom rupturiranih cista jajnika, pet sutura s omentoplastikom kod perforiranog duodenalnog ulkusa, tri eksploracije trbuha kod politrauma, jedna prezervacija slezene, jedna drenaža akutnog hidrocefalusa i tri lavaže i drenaže kod adneksitisa i pelveoperitonitisa. Rezultati: Kod četiri bolesnika učinjena je konverzija (6 %). Tri bolesnika su imali komplikacije (4,7%). Bila je jedna upala supraumbilikalne incizije prilikom laparoskopske kolecistektomije zbog gangrenoznog kolecistitisa. Kod jedne apendektomirane bolesnice zbog flegmonozne upale crvuljka bilo je krvarenje iz trbušne stijenke nakon odstranjenja troakara desno iznad razine pupka, a kod jednog bolesnika operiranog zbog gangrenoznog perforiranog crvuljka paralitički ileus s peritonealnim podražajem. Zaključak: Laparoskopski kirurški zahvati sve češće zamjenjuju otvorene kirurške zahvate u hitnoj kirurškoj službi. Za prevenciju infekcije rane preporuča se uvijek koristiti najlonsku vrećicu kod vađenja upaljenog žučnjaka ili crvuljka. Za prevenciju krvarenja iz stijenke preporuča se osvijetliti trbušnu stijenku laparoskopom u mračnoj operacijskoj dvorani prilikom postavljanja abdominalnih troakara.The popularity of laparoscopic procedures is increasing in the emergency surgical care, depending on equipment and surgical training. Materials and methods: In our Department, in the year 2003, the authors performed 902 surgical procedures. The procedures were completed by laparoscopy in 276 (30%) patients. 63 (22%) of the laparoscopic procedures were urgent procedures. 36 patients underwent laparoscopic cholecystectomy as treatment of the acute cholecystitis, 12 underwent laparoscopic appendectomy because of acute appendicitis, 2 patients underwent laparoscopic cystectomy of the ovarian cysts with haemostasis and electrocoagulation, 5 patients had perforated duodenal ulcer and we made sutures with omentoplasty, 3 patients underwent laparoscopic exploration because of abdominal trauma, 1 patient underwent laparoscopic haemostasis of bleeding spleen, 1 patient underwent laparoscopic setting of Pudenz drain because of hydrocephalus and 3 patients underwent aparoscopic drainage and lavage because of adnexitis and pelveoperitonitis. Results: 4 (6%) laparoscopic procedures had to be converted to conventional surgical procedures. 3 (4,7%) patients had surgical complications. One patient who underwent laparoscopic cholecystectomy had inflammation of supraumbilical incision because of gangrenous cholecystitis. One patient had abdominal wall bleeding after removing supraumbilical port, and one patient had paralytic ileus after laparoscopic appendectomy. Conclusion: The popularity of laparoscopic procedures is increasing due to the apparent advantages of the procedure even in the emergency care. As a prevention of wound infection it is always recommended to use a plastic bag when removing an inflamed billiar cyst or an appendix. As a prevention of abdominal wall bleeding it is always recommended to make a laparoscopic diascopy of abdominal wall when setting laparoscopic ports

Malignant epithelial skin tumors

Kirurški je liječeno 55 bolesnika s malignim epitelnim tumorom kože. Na bazocelularne karcinome je otpadalo 69%, a na spinocelularne karcinome 31% malignih epitelnih tumora kože. Na donjoj usni bilo je 41% spinocelularnih karcinoma. Najveći broj oboljelih bio je u sedmom desetljeću života (36%). Oboljeli su najčešće bili poljoprivrednici i domaćice. Najčešća lokalizacija bila je lična regija (62%). Lezije su u svim slučajevima bile manje od 2 cm u promjeru. U 73% slučajeva operativni postupak se sastojao od ekscizije i pokrivanja defekta lokalnim rotacijskim režnjem. U 5 bolesnika sa spinocelularnim karcinomom donje usne učinjena je operacija po Karapandžiću, a u dva bolesnika klinasta ekscizija i suture. U 4% slučajeva malignih epitelnih tumora kože učinjena je ekscizija i defekt je pokriven slobodnim kožnim transplan tatom pune debljine kože. U 15% bolesnika učinjena je ekscizija lezije uz direktne suture. Kod bazocelularnih karcinoma ekscizija je rađena 5 mm od ruba vidljive lezije, a kod spinocelularnih karcinoma ekscizija je rađena 10 mm od ruba vidljive lezije. Nakon patohistološkog pregleda, rubovi preparata bili su u svim slučajevima uredni. Bolesnici su pra­ćeni od 6 mjeseci do 3 godine i zasad nema recidiva.Fifthy-five patients with malignant epithelial tumors were surgically treated. There were 69% of patients with basal cell carcinoma and 31% with squamous cell carcinoma. Forty-one percent of squamous cell carcinomas were on the lower lip. The majority of the patients were farmers and housewives. The most common localization was the facial area (62%). In all cases, the lesions were smaller than 2 cm. In 73% of the cases, surgical procedure consisted of excision and covering of the defect by a local rotation flap. Surgical treatment according to Karapandžić was performed in five cases, and wedge shaped excision and sutures in two patients with squamous cell carcinoma of the lower lip. In 4 cases of malignant epithelial tumor, excision was performed and the defect covered by a free skin graft matching full depth of the skin. In 15% of the cases, excision of the lesion, accompanied by direct sutures, was performed. In the cases of basal cell carcinoma, excision was performed 5 mm from the edge of the visible lesion. In the cases of squamous cell carcinoma, excision was performed 10 mm from the edge of the visible lesion. Pathohistologic examination showed that the edges of the preparates were clean in all cases. The patients were controlled during a period ranging from 6 months to 3 years. No relapses have been reported to date

Bleeding from colon cancer

Od siječnja 1985. do lipnja 1987. godine, u Kirurškom odjelu Opće bolnice Nova Gradiška, lije­čeno je i operirano 28 bolesnika zbog karcinoma debelog crijeva. Ispitivani su učestalost i jačina krvarenja iz karcinoma debelog crijeva. Okultno i minimalno krvarenje preoperativno je dijagnosticirano u 20 bolesnika ili 71,5%.. Klinički manifestno obilnije krvarenje dijagnosticirano je samo u jednog bolesnika ili 3,5% bolesnika. Ni u jednom slučaju nije bila potrebna hitna kirurška intervencija zbog krvarenja iz karcinoma debelog crijeva. Okultno i minimalno krvarenje su karatkeristični za karcinom debelog crijeva. Svako krvarenje iz debelog crijeva zahtijeva radiološke i endoskopske pretrage debelog crijeva.28 patients suffering from colon cancer were treated and operated on at the Department of Surgery, General Hospital in Nova Gradiška in the period January 1985 to June 1987. The frequency and intensity of bleeding from the colon cancer were examined. Preoperative minimal bleding was found with 20 patients (71.5%). More abundant bleeding was diagnosed with only one patient, or in 3.5% cases. Urgent surgical operation because of colon cancer bleeding was not necessary in any of the cases. Minimal bleedings are characteristics for colon cancer. Every colon bleeding requires radiological and endoscopic examination of the colon

Influence of polyglactin 910 on postoperative scar

Cilj rada bio je procijeniti razliku u stvaranju ožiljka pri korištenju običnog katguta ili poliglaktina 910 kao potkožnih šavova u eksperimentalnom i kliničkom modelu. Eksperimentalni i klinički dio studije učinjeni su 1998. godine. Pretpostavka je bila da će duža potkožna potpora poliglaktinom 910 (2-3 tjedna) u odnosu na obični katgut tjedan dana dati bolji i estetski prihvatljiviji ožiljak. U šest ovaca učinjena je incizija u glutealnoj regiji, te je ožiljak s pripadajućom okolnom kožom nakon tri mjeseca ekscidiran i procijenjen klinički i histološki. Studijom je obuhvaćeno 35 bolesnika s učinjenom hemioplastikom po Lichensteinu. U lateralnoj polovici svake rane potkožje je sašiveno običnim katgutom, a u medijalnoj polovici rane poliglaktin 910 šavovima. Ožiljci su procjenjivani s obzirom na boju, bolnost, širinu i uzdignuće ili uleknuće nakon 3 mjeseca, 6 mjeseci, 12 mjeseci i 5 godina nakon operacije. U eksperimentalnom modelu nije nađena razlika u izgledu ožiljka s obzirom na korišteni materijal za šivanje. Histološkim pregledom nađeno je stvaranje granuloma u ožiljcima u području u kojem je korišten obični katgut kao potkožni šav. U kliničkom modelu nisu nađene razlike u procjenjivanim parametrima 12 mjeseci i 5 godina nakon operacije.Aim of the paper was to evaluate the difference in scar formation when using catgut or Polyglactin 910 subcuticular sutures in experimental and clinical model. Experimental and clinical part of the study were performed in 1998. Hypothesis was that longer subcuticular support by Polyglactin 910 (2-3 weeks) would lead to better and cosmetically more acceptable scar in relation to plain catgut (1 week). Incision was made in gluteal region of six sheep, after three months scar was excised along with the surrounding tissue and evaluated both clinically and histologically. The Study included 35 patients with Lichtenstein hemioplasty. In the lateral part of each wound the subcutis was sutured with plain catgut, and the medial half with Polyglactin 910 sutures. The scars were evaluated for coloration, painfulness, scar width, scar depression or elevation 3 months, 6 months, 12 months and 5 years after operation. In experimental model no difference was found in scar appearance in relation to different suture materials. By histological examination, granuloma formation was found in scars where the plain catgut was used for subcuticular suture. In clinical model there weren\u27t any differences found between the study parameters either 12 months or 5 years after operation

Common Bile Duct Obstruction Caused by the Hydatid Daughter Cysts

Echinococcosis is a human parasitary disease. In 2002, 29 new cases of liver echinococcosis were recorded in Croatia. Liver is the most common site of hydatid cysts. Nine patients with echinoccocal liver disease were operated in our department in 2002. Here we present a case where a patient with verified hydatid cyst in the left liver lobe developed high fever, jaundice, nausea, vomiting and pain in the upper abdomen. The symptoms were initially ascribed to the acute cholangitis. After unsuccessful antibiotic treatment, computerized tomography and endoscopic retrograde cholangiopancreatography (ERCP) were performed, demonstrating daughter cysts in the common bile duct. During ERCP, papilotomy was made and daughter cysts were extracted. Hydatid cyst was surgically removed, and a communication between the cyst and left hepatic duct was noted during surgery. Pericystectomy, choledochotomy, removal of remaining daughter cysts from the common bile duct, and sutures of left hepatic duct were performed. The patient recovered fully after the surgery. One of the possible complications of the liver hydatid cysts is the communication between cyst and the biliary tree. Such communications are usually asymptomatic, but symptoms can also mimic acute cholangitis and jaundice, which may lead to the misdiagnosis of the patient’s condition