Successful Endoscopic Removal of a Swallowed Toothbrush: Case Report

Most ingested foreign bodies will pass uneventfully through the gastrointestinal tract. Nevertheless, long and rigid foreign bodies are associated with an increased risk of gastrointestinal impaction, perforation and bleeding. Moreover, there has been no case of spontaneous passage of a toothbrush reported. Therefore, the prompt removal of such ingested foreign objects is recommended before complications develop. This case report describes a case of an 18-year-old woman who accidentally swallowed her toothbrush. The toothbrush was successfully removed via flexible endoscopy using a polypectomy snare. A swallowed toothbrush is a special clinical challenge. Early endoscopic retrieval of the toothbrush is critical for reducing morbidity and mortality. In cases when endoscopic removal fails, a laparoscopic surgical approach may be an alternative

Uloga ocjenskih ljestvica Injury Severity Score i Abbreviated Injury Scale u liječenju traumatskih ozljeda parenhimskih organa trbuha

Th e aim of this study was to investigate the infl uence of etiology, types of injury, levels of consciousness and the Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) values on the selection of treatment modality and survival in patients with injuries of parenchymal abdominal organs. Case records of 224 patients treated for traumatic injury of parenchymal abdominal organs from January 2003 until December 2015 were reviewed. Th e values of ISS and AIS of injury severity were calculated and compared to the values obtained according to the etiology, state of consciousness and survival. Of the 224 patients, 172 (76.8%) were treated by surgical approach and 52 (23.2%) were treated conservatively. Th e mean patient age was 40.1}18.3 years. Th ere were 97 (43.3%) polytrauma cases. Of the 224 injured patients, 143 (63.8%) were treated with transfusions of blood products. Two hundred and six (92%) patients survived. Th e mean AIS and ISS values were signifi cantly lower in patients that survived (AIS=3; ISS=28) than in those that died (AIS=5; ISS=34) (p<0.001). Th ere was a statistically signifi cant diff erence in AIS and ISS values between conscious (AIS=2.7; ISS=25.9) and unconscious (AIS=3.2; ISS=33) patients (p<0.001). Of the 224 patients that did not survive, 18 (8%) were hemodynamically unstable. Survival depended on hemodynamic stability at admission; the ISS and AIS values were associated with the injuries and state of consciousness at admission. Hemodynamic stability, state of consciousness, and ISS and AIS values were the quality predictors of survival after abdominal traumatic injury.Cilj ovoga rada bio je istražiti utjecaj etiologije, vrste ozljede, stanja svijesti te vrijednosti ocjenskih ljestvica Injury Severity Score (ISS) i Abbreviated Injury Scale (AIS) na izbor načina liječenja i preživljenje u bolesnika s traumatskim ozljedama trbuha. Povijesti bolesti 224 bolesnika liječenih zbog traumatskih ozljeda parenhimskih organa u razdoblju od siječnja 2003. Do prosinca 2015. godine retrospektivno su pregledane. Izračunate su vrijednosti ISS i AIS i uspoređene s vrstom ozljede, stanjem svijesti i etiologijom nastanka ozljede. Od ukupno 224 bolesnika, 172 (76,8%) ih je liječeno kirurškim pristupom, a 52 (23,2%) konzervativno. Srednja dob bila je 40,1}18,3 godina. Devedeset sedam (43,3%) bolesnika bilo je politraumatizirano. Od ukupnog broja bolesnika 143 (63,8%) ih je liječeno transfuzijama krvnih pripravaka. Ukupno je preživjelo 206 (92%) bolesnika. Srednje vrijednosti AIS i ISS bile su značajno niže u bolesnika koji su preživjeli (AIS=3; ISS=28) u odnosu na one koji su umrli (AIS=5; ISS=34) (p<0,001). Također je utvrđena statistički značajna razlika u vrijednostima AIS i ISS između bolesnika koji su bili pri svijesti (AIS=2,7; ISS=25,9) i onih koji su kod prijma bili bez svijesti (AIS=3,2; ISS=33) (p<0,001). Od ukupnog broja bolesnika 18 (8%) bolesnika koji nisu preživjeli bili su hemodinamski nestabilni. Preživljenje ovisi o hemodinamskoj stabilnosti pri prijmu, a vrijednosti ISS i AIS ovise o vrsti ozljeda i stanju svijesti pri prijmu. Hemodinamska stabilnost, stanje svijesti, ISS i AIS vrijednosti pokazali su se kao prediktori preživljenja u bolesnika s traumatskim ozljedama trbuha

Massive Gastrointestinal Bleeding and Obstruction of the Ureter Caused by the Migration of a Swallowed Toothpick from the Sigmoid Colon – A Case Report

In this study, a case of an ingested toothpick partially migrating from the sigmoid colon, causing massive lower gastrointestinal bleeding due to arterial-colic fistula, and stricture of the left ureter is presented. A 70-year-old male was admitted to the emergency department after having feces mixed with fresh and coagulated blood for the past two days. Computed tomography and retrograde ureteropyelography showed the stricture of the left ureter, 1.5 cm below the branching of iliac artery, without any signs of malignancy. Colonoscopy showed fresh blood in the rectum and sigmoid colon up to the neoplasm like granulation tissue mixed with fresh and coagulated blood, which almost obstructed the lumen. Explorative laparotomy showed a foreign body (toothpick) perforating the sigmoid colon through the mesenterial wall, and being stocked with one-third into the left internal iliac artery, causing arterial-colic fistula. The remaining part of the toothpick was surrounded by granulation tissue and chronic inflammatory process, pressing on the distal third of the left ureter. We conclude that a swallowed toothpick may cause a significant gastrointestinal injury with a wide variety of clinical manifestations, and it must be treated with caution. The imaging studies are often inadequate in detecting toothpicks, and thus, we insist on a physical examination, as the best indicator of injury

Uloga gena nm23 u kolorektalnom karcinomu

The aim of this study was to investigate the correlation of immunohistochemical expression of nm23 gene in colorectal cancer cells with tumor stage according to Dukes, tumor differentiation, occurrence of distant metastases and patient survival. This retrospective study included 100 colorectal cancer patients who underwent surgical treatment. Both pathological and clinical data were analyzed according to sex, age, immunohistochemical expression of nm23, tumor stage, tumor differentiation, occurrence of distant metastases and patient survival. Overexpression of nm23 gene was related to both good tumor differentiation and Dukes’ stage A, whereas no significant correlation was found between the occurrence of metastases and nm23 gene expression. There was no significant correlation between nm23 gene expression and 5-year survival of colorectal cancer patients either. Although the results of this study suggested that higher expression of nm23 gene correlated with an early stage of tumor and its good differentiation, this parameter cannot yet be taken as an independent and reliable prognostic indicator in colorectal cancer.Cilj ovoga rada bio je istražiti povezanost između promjene ekspresije gena nm23 u stanicama kolorektalnog karcinoma sa stadijem tumora po Dukesu, diferenciranosti tumora, pojavom udaljenih metastaza i petogodišnjim preživljenjem. U ovom istraživanju obrađeno je 100 bolesnika oboljelih od karcinoma debelog crijeva koji su operirani u Klinici za kirurgiju KBC Split. Patohistološki i klinički podaci analizirani su prema spolu, dobi, imunohistokemijskoj ekspresiji gena nm23, stadiju tumora po Dukesu, stupnju histološke diferenciranosti tumora, pojavi udaljenih metastaza i petogodišnjem preživljenju. Utvrđeno je da dobro diferencirani karcinomi pokazuju statistički značajnu prekomjernu ekspresiju gena nm23. Isto tako, nađena je prekomjerna ekspresija gena nm23 u stadiju tumora Dukes A. Nije nađena povezanost između promjene ekspresije gena nm23 i pojave udaljenih metastaza ni petogodišnjeg preživljenja. Promjena ekspresije gena nm23, prema rezultatima ovoga istraživanja, ne može se rabiti za predviđanje pojave metastaza i procjenu petogodišnjeg preživljenja, ali povezanost prekomjerne ekspresije gena nm23 s ranim kliničkim stadijem (Dukes A) i dobrom diferencijacijom tumora upućuje na mogućnost zaštitnog djelovanja gena nm23 u ranom procesu tumorigeneze

Atipična manifestacija nemikrocelularnog karcinoma pluća: metastaze u ingvinalne limfne čvorove kao prvi znak recidiva bolesti

A case is presented of a 67-year-old male patient with atypical non-small cell lung cancer, where inguinal lymph node metastases were the first sign of disease relapse. The patient had a long-term smoking history of 30 cigarettes per day, with no other important personal or family medical history data. Because of prolonged cough, the patient underwent diagnostic procedure, which revealed squamous cell carcinoma of the lung (stage IIIB, T3N2M0). Concomitant radiochemotherapy and consolidation chemotherapy according to PE protocol was administered. Multislice computed tomography performed upon chemotherapy completion showed almost complete tumor regression and withdrawal of mediastinal lymph node enlargement, and the patient felt well. However, in the next few months, enlarged lymph nodes appeared in both inguinal regions. Histopathologic analysis revealed metastatic lung cancer. Four months after the presentation of enlarged inguinal lymph nodes, lung cancer metastases were also diagnosed in the liver and lumbosacral spine. Despite additional treatments, the patient died four months later. Although it is well known that inguinal lymph nodes can harbor lung cancer metastases, in our patient inguinal lymph node metastases were the first sign of lung cancer relapse.Prikazuje se slučaj 67-godišnjeg bolesnika s neuobičajenim razvojem kliničke slike planocelularnog karcinoma pluća, kod kojeg su metastaze u preponskim limfnim čvorovima bile prvi znak recidiva bolesti. Dugogodišnji je pušač koji puši oko 30 cigareta na dan, a osobna i obiteljska anamneza su bez osobitosti. Zbog dugotrajnog kašlja učinjena mu je dijagnostička obrada koja je pokazala da se radi o planocelularnom karcinom pluća (stadij IIIB, T3N2MO). S obzirom na stadij proširenosti tumora ordinirano je provođenje konkomitantne radio-kemoterapije i konsolidacijske kemoterapije, prema protokolu PE. Iako je kontrolna kompjutorizirana tomografija pokazala gotovo potpunu regresiju tumora i iako se bolesnik osjećao značajno bolje, nekoliko mjeseci nakon provedene konsolidacijske kemoterapije pojavili su se povećani limfni čvorovi u obje preponske regije, patohistološka analiza kojih je pokazala metastatski planocelularni karcinom pluća. Četiri mjeseca nakon pojave metastaza u preponskim limfnim čvorovima dijagnosticirane su metastaze u jetri i lumbosakralnoj kralježnici. Unatoč provedenoj terapiji bolesnik je preminuo. Iako je poznato da preponski limfni čvorovi mogu biti sijelo metastatskog karcinoma pluća, ovdje se opisuje slučaj gdje su povećani preponski limfni čvorovi bili prvi znak recidiva bolesti

Naša iskustva u liječenju opstrukcijskog ikterusa

The aim of the study was to estimate the prevalence and causes of obstructive icterus in patients operated on during the 2003-2004 period at University Department of Surgery, Split University Hospital in Split. In addition, data on the patient age and sex, type of surgical treatment, and existence and impact of risk factors on operative outcome were analyzed. Data on 114 patients with obstructive icterus treated at the Department during the 2-year period were retrospectively analyzed. Obstructive jaundice is a disease predominantly affecting female population (61.4% of patients), mostly those aged 60-74 (40% of patients). Cholelithiasis with choledocholithiasis is the most common cause of obstructive jaundice. Therefore, the most frequently used procedure for obstructive jaundice is cholecystectomy with or without choledochotomy and concrement extraction. The number of patients diagnosed with obstructive icterus shows a considerable increase. Although the same surgical methods have been applied for years, endoscopic surgery has gradually displaced classic methods of surgical treatment.Cilj rada bio je ispitati učestalost i uzroke opstrukcijskog ikterusa kod bolesnika koji su u razdoblju od 2003. do 2004. godine operirani u Klinici za kirurgiju Kliničke bolnice Split. Uz navedeno analizirali smo dob i spol bolesnika, vrstu primijenjenog kirurškog liječenja, te postojanje i utjecaj čimbenika rizika na ishod kirurškog liječenja. U dvogodišnjem razdoblju retrospektivno su analizirani podaci 114 bolesnika koji su zbog opstrukcijskog ikterusa liječeni u Klinici za kirurgiju KB Split. Opstrukcijska žutica je bolest koja pretežito zahvaća žensku populaciju (61,4% bolesnika) i to najčešće u dobi od 60 do 74 godine (40% bolesnika). Kolelitijaza s koledokolitijazom i dalje je najčešći uzrok opstrukcijske žutice. Sukladno navedenom, najčešće izvođeni zahvat u liječenju opstrukcijske žutice je kolecistektomija s koledokotomijom i ekstrakcijom konkrementa ili bez toga. Broj bolesnika kojima se dijagnosticira opstrukcijski ikterus pokazuje značajan porast. Iako se već dugi niz godina u liječenju primjenjuju iste kirurške metode, endoskopska (laparoskopska) kirurgija postupno istiskuje klasične oblike kirurškog liječenja

Laparoscopic Abdominal Cysts Fenestration Using Harmonic Scalpel

The use of ultrasonically activated scalpel for tissue cutting and coagulation is a potential replacement for electrosurgery, which can be related to different complications. Its working principle is to transform the electric power into the mechanical longitudinal movement of the working part of the instrument, by a piezoelectric transducer situated in the hand piece. Between October 2000 and June 2004, six patients with abdominal cysts were treated by laparoscopy, using the harmonic scalpel. The average age was 40.8 (ranging from 15–60) years. Laparoscopic abdominal cyst fenestration was performed in five patients, and laparoscopic cholecystectomy and abdominal cyst fenestration were done in one patient during the same operation. The average duration of the operation was 40 (ranging from 25–70) minutes and hospital stay was 2.8 (ranging from 1–5) days. Laparoscopic abdominal cyst fenestration using the harmonic scalpel is a safe and successful operation, with good results including all the advantages of the minimally invasive surgery

Torsion of Epiploic Appendage Mimic Acute Appendicitis

Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We report a case of 36-year-old woman who presented with a classic signs of acute appendicitis. On examination, the obese, afebrile, and had very strong right iliac fossa tenderness and guarding. The white cell count was 12.82´109/L, and C reactive protein count was 15.13MG/DL. She underwent emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration of the abdominal cavity showed vermiform, no inflamed, appendix and necrotic appendix epiploica of the caecum. The treatment consisted of typical laparoscopic appendectomy and laparoscopic resection of the necrotic appendix epiploica. The patient made rapid recovery and was discharged from the hospital on second day after the operation. Histological investigation of the appendix epiploica revealed gangrenous epiploic appendage

Torsion of Epiploic Appendage Mimic Acute Appendicitis

Epiploic appendagitis is a rare cause of focal abdominal pain which, depending on its localisation, can mimic a variety of abdominal diseases. We report a case of 36-year-old woman who presented with a classic signs of acute appendicitis. On examination, the obese, afebrile, and had very strong right iliac fossa tenderness and guarding. The white cell count was 12.82´109/L, and C reactive protein count was 15.13MG/DL. She underwent emergency laparoscopic procedure after the acute appendicitis diagnosis has been established. Laparoscopic exploration of the abdominal cavity showed vermiform, no inflamed, appendix and necrotic appendix epiploica of the caecum. The treatment consisted of typical laparoscopic appendectomy and laparoscopic resection of the necrotic appendix epiploica. The patient made rapid recovery and was discharged from the hospital on second day after the operation. Histological investigation of the appendix epiploica revealed gangrenous epiploic appendage