In patients with end-stage renal disease who are candidates for peritoneal dialysis (PD) and have gallstones or gallbladder polyps, it is advised to perform synchronous insertion of PD catheter and ...cholecystectomy. With gallbladder removal at the time of peritoneal catheter insertion we can avoid infective complications, such as acute cholecystitis and possible PD failure. This article presents our experience with synchronous laparoscopic cholecystectomy and insertion of a PD catheter.
Bone metaplasia or heterotopic ossification of the appendix is an extremely rare condition, which is usually associated with mucinous appendiceal neoplasms. This case describes a young male patient, ...who presented to the surgical emergency department with clinical and computed tomography signs of acute appendicitis. Laparoscopic appendectomy was performed. The final histopathological examination revealed a bone metaplasia of the distal appendix, without any other associated appendiceal pathology. According to our knowledge and literature review, this is the first such case described in the English literature yet.
Spontaneous splenic rupture is a rare entity that requires high index of suspicion for diagnosis. Usually, it occurs due to underlying pathology that could be inflammatory, neoplastic or infectious. ...However, there are also cases of spontaneous splenic rupture in a normal-sized spleen without obvious pathologic process. In our case, the patient suffered a spontaneous splenic rupture 1 week after laparoscopic appendectomy due to acute appendicitis. Histopathologic examination revealed a normal-sized spleen without any obvious pathology. In our patient, we did not found any explanation for a spontaneous splenic rupture, besides her primary inflammatory condition.
Laparoscopic peritoneal dialysis catheter insertion is an established method for peritoneal dialysis catheter placement. One critical aspect of this procedure is rectus sheath tunneling. Proper ...peritoneal dialysis catheter incorporation within the abdominal wall is important for reducing pericatheter leaks and for proper peritoneal dialysis functioning. Particularly, accurate positioning of the internal cuff within the rectus muscle sheath is crucial to prevent potential dialysate fluid leakage. In the present report, we describe the utilization of intraoperative ultrasound as a valuable tool for determining the ideal location of the internal cuff and assessing the course of the inferior epigastric artery during rectus sheath tunneling. This technique aims to optimize the position of the internal cuff and minimize complications such as vessel injury and pericatheter leaks. Furthermore, we demonstrate that post-catheter insertion, ultrasound imaging offers valuable insights into evaluating the appropriate placement of the internal cuff, external subcutaneous cuff, and potential bleeding within the abdominal wall.
Peritoneal dialysis (PD) is a generally accepted method for treatment of patients with the end-stage renal disease. A larger proportion of PD patients transfer to haemodialysis every year than the ...converse. Many of the underlying causes of transfer to haemodialysis are preventable. Infectious complications still remain the most common reason for transfer of PD patients to haemodialysis, catheter-related problems are the second most common cause. For PD to be effective it is very important to provide a quality peritoneal access with the insertion of PD catheter with minimum complications. With the development of minimally invasive and laparoscopic surgery, laparoscopic insertion of PD catheter is becoming widely accepted method, which showed to be effective with minor complications. In our institution, laparoscopic insertion of PD catheter in adult patients is a standard method for providing peritoneal access for chronic peritoneal dialysis.
•Inguinal bladder hernia was accidentally found during surgical procedure for incarcerated inguinal hernia.•During procedure urinary bladder wall was lesioned.•Physicians should think of this ...condition in elderly, obese male, with sudden onset of lower urinary tract symptoms.•Treatment of this condition is surgical, exception are unfit, asymptomatic patients.•Urologist should be consulted to exclude urological malignancy – bladder cancer.
Inguinal bladder hernia is rare condition found in about 1–5% of inguinal hernias. The condition is usually diagnosed intraoperatively. Patients rarely have symptoms regarding urinary tract. The best management is surgical, open surgical technique is preferred over laparoscopic. Possible urinary tract damage during surgery should be recognized and resolved.
The following paper presents case of inguinal bladder hernia in 82-year old Caucasian male. Patient presented at our emergency department with incarcerated left inguinal hernia. Preoperative ultrasound has shown small bowel loop inside hernia sac. The condition was diagnosed intraoperatively – the whole bladder was found inside hernia sac. During surgery minor damage of the bladder was caused and repaired. Hernia defect was repaired using Bassini hernioplasty.
Elderly male more often present with inguinal bladder hernia. Sometimes urinary malignancy may be cause for inguinal bladder hernia. In cases where inguinal bladder is found inside hernia sac, urologist should be consulted to exclude urological pathology. Surgical treatment is indicated in all symptomatic patients. Patients with small, asymptomatic inguinal bladder hernias could be treated conservatively.
Physicians seeing patients with inguinal hernia should be aware that patient may have inguinal bladder hernia, especially in patients presenting with newly developed symptoms of lower urinary tract.
Superior mesenteric artery embolisation is the most common cause of acute mesenteric ischaemia. Superior mesenteric artery embolisation can be caused by various cardiac diseases (myocardial ischaemia ...or infarction, atrial tachyarrhythmias, endocarditis, cardiomyopathies, ventricular aneurysms and valvular disorders), arterial aneurysms, ulcerated atherosclerotic plaques of the major arteries and others. A case of 65-year-old, previously healthy man with superior mesenteric artery embolism, who was found to also have mural aortic thrombi, is presented. The patient underwent an emergency procedure; small intestine and cecum were resected and jejuno-ascendo anastomosis was performed. The patient was put on lifelong anticoagulation therapy. Neither cardiac diseases nor arterial aneurysms were detected. There were no signs of underlying atherosclerosis. Work-up for antiphospholipid antibodies and rheumatic diseases was negative. Tumour markers were within normal levels and blood cultures were negative. This case represents the challenges in recognising an underlying cause of acute mesenteric embolism and highlights the importance of multidisciplinary diagnostic and treatment approach.
Background and Objectives: The aim of our study was to evaluate the value of leukocyte, C reactive protein (CRP), procalcitonin, lactate, and carcinoembryonic antigen (CEA) in blood and peritoneal ...fluid in early recognition of anastomotic leak (AL) after colorectal resections. Materials and Methods: Our pilot prospective cohort study was conducted at the abdominal surgery department at University Medical Center Ljubljana. A total of 43 patients who underwent open or laparoscopic colorectal resection because of benign or malignant etiology were enrolled. All of the patients had primary anastomosis without stoma formation. Results: Three patients in our patient group developed AL (7%). We found a statistically significant elevation of serum lactate levels in patients that developed AL compared to those who did not but noted no statistically relevant difference in the blood or peritoneal fluid levels of other biochemical markers. Conclusions: Elevated lactate levels may be considered a promising biomarker for the early diagnosis of AL, but more research on bigger patient groups is warranted.
We present a case of male patient, who was referred to our department because of acute intestinal obstruction, which was the initial clinical symptom of primary lung cancer. The abdominal computed ...tomography (CT) prior to the emergency operation showed small intestinal obstruction and metastases to both adrenal glands. The patient underwent an emergency abdominal exploratory laparotomy, that confirmed small bowel obstruction and diffuse metastatic lesions along the entire small bowel length. During the operation we took a sample of one metastasis for pathological examination and we created an intestinal bypass to relieve small bowel obstruction. The pathologist suspected to primary lung cancer according to the immunohistochemical staining. The chest CT after the emergency operation showed a large primary tumor in the left upper pulmonary lobe.
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