Internal Hernias in Acute Abdomen: Review of Literature and Report of four Cases

Internal hernias are very rare in clinical practice and surgeons often disregard internal hernias in spectrum of differential diagnosis in acute abomen. Reaching the diagnosis before internal hernia causes an acute abdomen, is difficult despite modern diagnostic tools, mostly because of wide range of symptoms and variable time of their occurrence. Furthermore, the lag in diagnosis may prove dangerous as they can cause acute bowel or intestinal obstruction. In such cases high mortality has been recorded. In fact, emergency exploratory surgery seems to be of high importance because timing directly influences the outcome. Herein we present four cases with developed acute abdomen due to internal hernia, treatments provided and their outcome along with review of literature

Internal Hernias in Acute Abdomen: Review of Literature and Report of four Cases

Internal hernias are very rare in clinical practice and surgeons often disregard internal hernias in spectrum of differential diagnosis in acute abomen. Reaching the diagnosis before internal hernia causes an acute abdomen, is difficult despite modern diagnostic tools, mostly because of wide range of symptoms and variable time of their occurrence. Furthermore, the lag in diagnosis may prove dangerous as they can cause acute bowel or intestinal obstruction. In such cases high mortality has been recorded. In fact, emergency exploratory surgery seems to be of high importance because timing directly influences the outcome. Herein we present four cases with developed acute abdomen due to internal hernia, treatments provided and their outcome along with review of literature

Biliopankreatično skretanje s gastrektomijom u obliku rukava i antroilealnom anastomozom - prikaz slučaja

Obesity is becoming a major epidemiological problem throughout the world. Current estimate of obesity in Croatia is 25% of males and 24% of females (BMI ≥30 kg/m2). Biliopancreatic diversion combines both restrictive and malabsorptive component of bariatric surgery. It was first described by Scopinaro in 1979 and later modified with sleeve gastrectomy by Marceau in 1993. It is reserved for super obese patients with BMI ≥50 kg/m2 and is sometimes done in two acts, i.e. sleeve gastrectomy first and then biliopancreatic diversion. A 61-year-old female patient with BMI 52.6 kg/m2 and multiple comorbidities is presented. She had previously had many unsuccessful attempts at losing weight with conservative methods. Due to the high BMI and comorbidities, we decided to perform biliopancreatic diversion with sleeve gastrectomy and antroileal anastomosis. On postoperative day 12, the patient was discharged with BMI 49.2 kg/m2, yielding a 12% excess weight loss (EWL). After five weeks, she was rehospitalized for suspected pulmonary embolism and was discharged three weeks later. On regular follow up at three months after surgery, the patient had 112 kg, yielding a 35% EWL.Pretilost postaje jedan od vodećih epidemiološ.kih problema današnjice. Trenutna procjena broja pretilih ljudi u Hrvatskoj je 25% muškaraca i 24% žena (indeks tjelesne mase, BMI ≥30 kg/m2). Biliopankreatično skretanje kombinira i restriktivnu i malapsorpcijsku sastavnicu barijatrijske kirurgije. Prvi ga je izveo i opisao Scopinaro 1979. godine, a kasnije ga je Marceau 1993. godine modificirao izvođenjem gastrektomije u obliku rukava. Danas se ova operacija prvenstveno izvodi kod super pretilih bolesnika s BMI ≥50 kg/m2. Ponekad se izvodi u dva akta: prvo resekcija želuca, a potom biliopankreatično skretanje. Prikazuje se slučaj 61-godišnje bolesnice s BMI od 52.6 kg/m2 i više istodobnih bolesti. Bolesnica je prethodno u više navrata neuspješno pokušala smršaviti konzervativnim metodama. Zbog visokog BMI i drugih bolesti odlučili smo se za biliopankreatično skretanje s gastrektomijom u obliku rukava i antroilealnom anastomozom. Dvanaestog poslijeoperacijskog dana bolesnica je otpuštena kući s BMI 49.2%, što je već bio gubitak prekomjerne tjelesne težine (EWL) od 12%. Nakon pet tjedana bolesnica je ponovno hospitalizirana s kliničkim znakovima plućne tromboze te je tri tjedna kasnije otpuštena kući. Na kontrolnom pregledu tri mjeseca nakon operacije bolesnica je imala 112 kg ili EWL 35%

Kirurško liječenje kolorektalnog karcinoma

Surgery remains the only radical treatment for colorectal cancer. However, with introduction of multidisciplinary teams and availability and advancement in all modes of treatments (surgical technique, technology and perioperative care, sistemic therapy and radiotherapy protocols), in more advanced stages the better disease control is achieved. In this article we outline primarily indications and considerations in surgical treatment modeKirurško liječenje je jedini kurativni pristup liječenju kolorektalnog karcinoma. Ipak, uvođenjem multidisciplinarnih timova i napretkom i dostupnošću svih načina liječenja (kirurška tehnika i tehnologija kao i perioperativna skrb za pacijenta, te napredak u sistemskoj i radioterapiji) u poodmaklim stadijima, su omogućili uspješniju kontrolu bolesti. U ovom članku izosimo primarno indikacije i dileme kirurškog načina liječenj

Klatskin Tumor – Results of Surgical Therapy

Between January 1st 1990 and December 31st 1999, 24 patients affected by Klatskin tumor underwent operation in our department of surgery. According to Bismuth’s classification, there were 0 (0%) type I, 5 (21%) type II, 6 (25%) type IIIa, 4 (17%) type IIIb and 9 (37%) type IV tumors. Five patients (21%) were treated by curative resection (group I) while in 14 patients (58%) palliative surgical procedure was performed (group II). In 5 cases (21%) the extension of malignancy did not allowed any procedure (group III). Curative resection for malignant tumors of the hepatic duct bifurcation included wide tumor excision and bile duct resection at the liver hilum (with »wedge« hepatic resection in one patient) and creation of biliary-enteric anastomosis. Palliative surgical procedure included stent insertion. Jaundice was completely relieved in all patients undergoing resection, since 3 patients (21%) after stenting hadn’t satisfactory biliary drainage. There was 1 (20%) perioperative death in the group 1, while in group 2, 5 patients (36%) died postoperatively. In this series, the mean postoperative survival of all patients was 16 months. The mean postoperative survival of patients undergoing localized tumor resection with curative intent was 38 months, in contrast to 10 months for those undergoing operative stent insertion. In addition, only 1 patient from group III, in whom only exploratory surgery were performed survived 7 months, while other 4 patients died in the hospital. This retrospective review suggests that aggressive surgical treatment could improve survival and quality of life in patients suffering from Klatskin tumor

Uloga fotodinamske terapije u liječenju karcinoma probavnog sustava

The discovery that particular substances can cause photosensitivity is attributed to Oscar Raab, however, the modern era of photodynamic therapy was established by Dr. T.J. Dougherty from Buffalo Memorial Institute. He was the first to report that a systemically injected porphyrin (hematoporphyrin), when activated by red light, caused complete eradication of transplanted experimental tumors. He also was the first to demonstrate the preferential accumulation of the photosensitizer in malignant cells. The first clinical application of photodynamic therapy was in 1980 at the Tokyo Medical College in a patient with a small upper bronchial squamous cell tumor, treated at bronchoscopy with photodynamic therapy using a laser as the light source. The tumor was completely eradicated. Simultaneously, a case of large obstructing esophageal cancer similarly treated with photodynamic therapy with good relief of dysphagia and prolonged survival was reported. The current state-of-the-art and results recorded in the clinical use of photodynamic therapy in the management of gastrointestinal malignancies are presented.Otkriće da određene tvari mogu uzrokovati fotosenzitivnost pripisuje se Oscaru Raabu, međutim, ocem moderne ere fotodinamske terapije smatra se T. J. Dougherty s Instituta Buffalo Memorial. On je naime prvi objavio da sistemski dan porfirin (hematoporfirin), kada se aktivira crvenom svjetlošću, uzrokuje potpuno uništenje transplantiranog eksperimentalnog tumora. Također je prvi otkrio i objavio da fotosenzibilizirajuće tvari imaju sklonost nakupljanju u malignim stanicama. Prvi slučaj kliničke primjene fotodinamske terapije učinjen je na Tokyo Medical Collegeu 1980. godine. Bolesnik s malim skvamoznim tumorom gornjeg bronha bio je bronhoskopski podvrgnut fotodinamskoj terapiji, pri čemu se kao izvor svjetlosti rabio laser, a rezultat je bio potpuna eradikacija tumora. Istodobno je objavljen slučaj kliničke primjene fotodinamske terapije kao palijacijske metode u bolesnika s velikim karcinomom jednjaka, što je dovelo do uklanjanja disfagije te produžilo bolesnikov život. Ovaj rad prikazuje dosadašnje spoznaje i rezultate kliničke primjene fotodinamske terapije u liječenju malignih bolesti probavnog sustava

Local Recurrence of Primary Non-Ampullary Adenocarcinoma of Duodenum after Surgical Treatment – A Case Report and a Literature Review

Worldwide there is no general attitude on optimal surgical procedure in treatment of primary non-ampullary adenocarcinoma of duodenum, especially for early stage of duodenal cancer. Some authors prefer local excision and segmental resection while others rather perform duodenopancreatic resection, even in the case of early stage of duodenal cancer with aim to avoid tumor recurrence. In this paper we present a rare clinical course of a 60-year-old male patient with an endoscopically and pathohistologically proven early stage duodenal cancer that was treated by wide local excision. Three years after operation, control endoscopy showed »flat« polyp in the duodenum and radical duodenopancreatic resection was performed. Pathohistological examination of resected specimen showed cancer that had spread throughout the duodenal wall with metastases in the regional lymph nodes. According to our findings and literature review we gave some direction concerning the optimal diagnostic and surgical procedure for this rare tumor

Local Recurrence of Primary Non-Ampullary Adenocarcinoma of Duodenum after Surgical Treatment – A Case Report and a Literature Review

Worldwide there is no general attitude on optimal surgical procedure in treatment of primary non-ampullary adenocarcinoma of duodenum, especially for early stage of duodenal cancer. Some authors prefer local excision and segmental resection while others rather perform duodenopancreatic resection, even in the case of early stage of duodenal cancer with aim to avoid tumor recurrence. In this paper we present a rare clinical course of a 60-year-old male patient with an endoscopically and pathohistologically proven early stage duodenal cancer that was treated by wide local excision. Three years after operation, control endoscopy showed »flat« polyp in the duodenum and radical duodenopancreatic resection was performed. Pathohistological examination of resected specimen showed cancer that had spread throughout the duodenal wall with metastases in the regional lymph nodes. According to our findings and literature review we gave some direction concerning the optimal diagnostic and surgical procedure for this rare tumor