Cilj: Prikazati slučaj pacijentice s akutnim abdominalnim bolom i Bouveretovim sindromom kao rijetkom komplikacijom kolecistolitijaze. Prikaz slučaja: Osamdesetogodišnja pacijentica primljena je u ...hitnu medicinsku službu zbog bolova u epigastriju i gornjem abdomenu uz povraćanje tamnog sadržaja koji traju unazad tri dana. Posljednja stolica pacijentice bila je uredna, uredne diureze i pacijentica je bila afebrilna. U laboratorijskim nalazima vrijednosti upalnih parametara bile su neznatno povišene. Učinjen je ultrazvuk abdomena koji je pokazao skvrčeni žučnjak s kamencima. Nativna snimka abdomena nije pokazala znakove pneumoperitoneuma i ileusa. Pacijentici je ordinirana ulkusna terapija s naglaskom da se javi na kontrolni pregled ako se stanje pogorša. Dva dana nakon prijama pacijentici se stanje pogoršalo te dolazi u gastroenterološku ambulantu, gdje joj je učinjena ezofagogastroduodenoskopija (EGDS) koja je pokazala tamnozeleni sadržaj u lumenu jednjaka i želuca te zaglavljen velik kamenac u pilorusu, zbog čega je pacijentica hospitalizirana. Drugog dana hospitalizacije pacijentici se ponovio EGDS s neuspješnim ishodom. Trećeg dana hospitalizacije pacijentici je neuspješno učinjena hitna eksplorativna laparoskopija i operativni zahvat se konvertirao u desnu subkostalnu laparotomiju, te je gastrotomijom ekstrahiran žučni kamenac. Pacijentici je dalje učinjena gastroenteroanastomoza i enteroenteralna anastomoza po metodi Braun, uveden je dren subhepatalno i rana je zašivena po slojevima. Postoperativni tijek kompliciran je infekcijom operacijske rane. Pacijentica je otpuštena dvadesetdrugog postoperativnog dana te nije imala bilijarnih smetnji u sljedećih šest mjeseci praćenja. Zaključak: Uzrok akutnog abdominalnog bola nerijetko može biti i komplikacija kolecistolitijaze. U rijetkim slučajevima kolecistolitijaza se može komplicirati žučnim kamencem prisutnim izvan žučnjaka koji migirira kroz biliogastričnu ili bilioduodenalnu fistulu s opstrukcijom pilorusa (Bouveretov sindrom), što predstavlja životno ugrožavajuće stanje uz smrtnost od 12 % do 30 %.
Aim: To present a case of a patient with acute abdominal pain and Bouveret's syndrome as a rare complication of cholecystolithiasis. Case report: An eighty-year-old patient was admitted to the emergency department for upper abdominal pain and vomiting of dark content lasting three consecutive days. The patient had regular bowel movements, with normal stool and diuresis and normal body temperature. Laboratory findings showed slightly elevated values of inflammatory parameters. Abdominal ultrasound showed a crumpled gallbladder with gallstones. Radiographic tomography showed no signs of pneumoperitoneum and ileus.The patient was prescribed gastric antisecretory therapy with warning to come back if symptoms got worse. After two days the patient returned with more severe symptoms. An upper gastrointestinal (GI) endoscopy showed dark green content in the esophagus and stomach with a large gallstone obstructing the pylorus, which was the reason for admission. Another upper GI endoscopy was repeated on the next day, with the intent of gallstone extraction, but was not successful. On the third day of hospitalization, the patient underwent emergency exploratory laparoscopy, which was due to technical reasons converted to right subcostal laparotomy with gastrotomy in order to extract the gallstone. Furthermore, a gastroenteral and enteroenteral anastomosis according to the Brown method were constructed, a subhepatic drainage was put and the wound was sutured in layers. The postoperative course was complicated by a wound infection, which was successfully treated accordingly. The patient was discharged on the twenty-second postoperative day and had no biliary symptoms in the six-month follow-up period. Conclusion: Complications of cholecystolithiasis may also be the cause of acute abdominal pain. In rare cases, cholecystolithiasis can be complicated by gallstones presenting outside the gallbladder that migrate through the biliogastric or bilioduodenal fistula (Bouveret’s syndrome), which is a life-threatening condition with the mortality rate from 12% to 30%.
Akutni apendicitis jedan je od najčešćih uzroka razloga indiciranja neopstetričkog operativnog zahvata u trudnica. Iako se može prezentirati klasičnom kliničkom slikom, u trudnoći je zbog fizioloških ...i anatomskih promjena atipična slika češća. To čini dijagnozu ovog stanja kompliciranom te ona zahtijeva osim kliničkog pregleda i daljnje pretrage. One uključuju diferencijalnu krvnu sliku i CRP te slikovne pretrage. Činjenica da leukocitoza u trudnoći ne predstavlja patologiju te da CRP može pokazivati tendenciju rasta potvrđuje da ove metode nisu pretjerano uspješne. Od slikovnih pretraga najbolja se pokazala magnetska rezonancija, ali je njezina dostupnost ograničena. Liječenje se provodi kirurški, pri čemu postoje različiti pristupi. Iako postoje brojni radovi koji preferiraju otvorenu nad laparoskopskom apendektomijom, novija istraživanja pokazuju kako nema značajnih rizika za majku i fetus kod korištenja laparoskopskog pristupa. U novije se doba spominje i konzervativni način liječenja antibioticima, ali zbog mogućih komplikacija on se izbjegava, osim u slučajevima nedostupne kirurške skrbi. Akutni apendicitis je stanje koje treba brzo riješiti kako bi se izbjegle komplikacije koje u nekim slučajevima mogu izazvati značajne posljedice za majku i dijete. U članku je prikazan cjelovit pristup trudnici s apendicitisom uz korištenje najnovije literature.
Acute appendicitis (AA) is one of the most common non-obstetric indications for surgery in pregnant women. Even though it can present with a typical set of symptoms, in pregnancy due to the physiological and anatomical changes, an atypical presentation is more common. This makes the diagnosis of AA very complicated and it requires additional exams which include a blood work, CRP and imaging studies. Since leucocytosis and increased levels of CRP are physiological finding in pregnancy, those tests are not very helpful. MRI is the best imaging test in this situation, but its availability is limited. The treatment is surgical, and it includes two approaches: open appendectomy (OA) or laparoscopic appendectomy (LA). Even though many studies that predilect OA can be found, recent discoveries indicate that there is no statistically significant difference in the risk for the mother and foetus between the two approaches. Some studies introduce a non-operative approach as a valuable substitution for a surgical approach in case of AA especially in the areas where surgical care is limited or unavailable. AA in pregnancy is a condition that must be recognized and treated as soon as possible in order to avoid severe complications for the mother and the child. This review gives an integral approach to a pregnant woman with appendicitis, and it’s based on the latest published literature.
Perforin-(P-) related characteristics of cytotoxic T lymphocytes and natural killer cells were investigated in peripheral blood of patients subjected to open (OC; n=23) or laparoscopic ...cholecystectomy (LC; n=21) and healthy controls (n=20). Blood samples were obtained preoperatively and 24 hours after the surgeries, and the data were correlated with the intensity of cholestasis and concomitant inflammation, determined by functional hepatic tests. Postoperative differences were found to be minimal: OC decreased only the percentage of CD56+ cells, while LC decreased the fraction of CD8+P+ cells and augmented the mean fluorescence intensity of P in CD56 cells. Patients elected for OC had, however, higher preoperative numbers of total P+, CD3+P+, and CD4+P+ cells than patients elected for LC and healthy controls, while both groups of patients, preoperatively, had lower fraction of CD16+P+ and CD56+P+ cells. These changes were in high correlation with blood concentrations of CRP, AP, and ALT, emphasizing the link between the preoperative cholestasis and inflammation and P-dependent cytotoxic mechanisms.
This study is an analysis of the large series of laparoscopic cholecystectomies and compare our results with those reported in the literature concerning complications.
From December 1993 to September ...2010, 10,317 patients with gallstone disease underwent laparoscopic cholecystectomy. Previously operated patients were also included in the study. We analyzed the successfulness of the results, intraoperative and postoperative complications, conversions in open cholecystectomy, mortality and reoperation rate.
We registered 23.28% complications. Intraoperative complications were bleeding in 9.84%, gallbladder perforation in 8.63%, stone loss in 1.37%, common bile duct injury in 0.24% and injury of intraabdominal organs in 0.07% of cases. Postoperative complications were bleeding in 1.12%, wound infection in 0.59%, bile leakage in 0.5%, incisional umbilical hernias in 0.37%, subhepatal collection in 0.33%, residual gallstones in choledocus in 0.09%, urine retention in 0.08% and biliary peritonitis in 0.01% of patients. Conversion to open cholecystectomy was necessary in 2.13%. Reoperation was performed in 0.27%. The mortality rate was 0.019%.
Our results on large number of patients are similar to other series in the newer literature but the rate of complications should be decreased. The incidence of complications decreases with growing laparoscopic experience.
The aim was to analyze our results and complications in laparoscopic-assisted placement of the Tenckhoff catheter for peritoneal dialysis in comparison with results reported in the literature. Fifty ...patients were included in this retrospective analysis. From January 2000 to November 2010, they underwent laparoscopic-assisted placement of catheter for peritonea dialysis at the University Department of Surgery, Rijeka University Hospital Center. The results of this approach, early and late postoperative complications, conversions to open technique, and reoperation rate were analyzed. The complications that occurred within the first 4 weeks were considered as early complications. In 23 patients, 29 complications were recorded. There were 18 early complications, of which 2 acute peritonitis, 2 ileus, 4 bleeding, 4 catheter infection, 3 fluid leakage, 2 catheter malpositioning and 1 genital edema. There were 11 late complications, of which 5 acute peritonitis, 1 recurrent peritonitis, 1 bleeding, 1 catheter infection, 1 catheter malpositioning, 1 fluid leakage and 1 port site hernia. There were no deaths after surgery or any complications disabling the implementation of peritonea dialysis. In patients with end-stage renal disease, laparoscopic-assisted placement of catheter for peritoneal dialysis is a safe and appropriate method of treatment
Zbog iznimne važnosti koronarnih arterija, osobito u patogenezi srčanih bolesti, istraživanja srčanih vena desetljećima su bila zapostavljena. Napretkom moderne medicine uvođenje inovativnih ...dijagnostičkih i terapeutskih postupaka dovelo je do potrebe za alternativnim putovima pristupa oštećenom srcu, gdje vene srca imaju značajnu ulogu. Dok se ranije za prikaz krvnih žila srca koristila samo sekcija srca, danas su zbog primjene novih metoda prikaza krvnih žila srca prisutne različite podjele srčanih vena. Većina srčanih vena završava u desnom atriju. Istaknutu ulogu u odvođenju krvi iz srca ima koronarni sinus, sinus coronarius i njegove pritoke te prednje srčane vene, vv. cardiacae anteriores. Ove vene pripadaju velikom srčanom sustavu, dok mali srčani sustav čine Thebesijeve žile. One su predmet stalnih istraživanja jer se prilagođavaju različitim potrebama prokrvljenosti miokarda ovisno o životnoj dobi i promjenama u različitim srčanim bolestima. Varijacije srčanih vena su uobičajene. Poznavanje varijacija i anastomoza srčanih vena osobito je važno za razumijevanje i tumačenje slikovnih prikaza srčanih vena prilikom izvođenja dijagnostičkih i terapeutskih postupaka.
Colorectal cancer is the second most common malignant disease in developed countries, with about one million new cases worldwide every year, accompanied with high mortality rate. We examined the ...survival rate and recurrence (occurrence of distant metastases and/or local recurrence) of patients with colorectal cancer in Primorsko-Goranska and Istarska County who received adjuvant chemotherapy, compared to those who did not in the period since 1980. until 1999. This study involves 483 patients with colorectal cancer stages II and III of Primorsko-Goranska and Istarska County, which were underwent curative resections of colorectal cancer at the Clinical Hospital Centre Rijeka, and then treated with chemotherapy (288) or without Chemotherapy (195). We analyzed the five year survival rate and the recurrence of malignant disease in the adjuvant treatment group in comparison with not treated group with chemotherapy, depending on the stage of disease, degree of histological differentiation, patient age and location of cancer (colon or rectum). After follow-up of 60 months died 44.79% (129/288) of patients who received chemotherapy and 53.33% (104/195) of patients who did not receive chemotherapy. The relative risk of death (from any cause) in chemotherapy-treated group versus the group without chemotherapy was 0.82 (p < 0.008). Recurrence of malignant disease in the chemotherapy group was 38.54% (111/288), and in the group without chemotherapy was 46.15% (90/195). The relative risk of recurrence of malignant disease in the chemotherapy group versus the group without chemotherapy was 0.78 (p < 0.001). There was no difference in treatment efficacy regard to the localization of the tumor, but there were differences in efficiency with respect to disease stage, grade and age. Chemotherapy with 5-fluorouracil and leukovorin ameliorate the survival and reduces recurrence and distant metastases in patients with colorectal cancer stages II and III.
Harmonic scalpel for the tissue cutting and coagulating is a replacement for the high frequency current, which can be connected with diverse complications. The principle is transforming of the ...electric power into mechanical longitudinal movement of the working part of the instrument, by piezoelectrical transducer situated in the hand piece. Between October 2000 and June 2001, one hundred and three patients were operated using harmonic scalpel. The average age was 50.2 years. Laparoscopic cholecystectomy, appendectomy and abdominal cyste fenestration was performed in 86, 12 and 4 patients respectively. In one patient laparoscopic cholecystectomy and abdominal cyste fenestration were done during the same operation. The average hospital stay was 2.8 days. Laparoscopic cholecystectomy, appendectomy and cyst fenestration using the harmonic scalpel are safe and successful operations, with good results and advantages of the minimally invasive surgery.
Prikazujemo analizu naših rezultata i komplikacija pri postavljanju Tenckhoffova katetera za peritonejsku dijalizu laparoskopskom
metodom i usporedbu s objavljenima u literaturi. Retrospektivna ...analiza uključila je 50 bolesnika koji su podvrgnuti postavljanju
katetera za peritonejsku dijalizu laparoskopskom tehnikom u Klinici za kirurgiju Kliničkog bolničkog centra Rijeka od siječnja 2000. do studenog 2010. godine. Analizirani su uspješnost rezultata, rane i kasne postoperacijske komplikacije, konverzija u otvoren pristup te stopa reoperacije. Ranim komplikacijama su smatrane one nastale u prvih 4 tjedna od operacije. Komplikacije su se javile u 23 bolesnika (29 komplikacija). Ranih komplikacija bilo je 18, od toga 2 akutna peritonitisa, 2 ileusa, 4 krvarenja, 4 infekcije izlaznog mjesta katetera, 3 propuštanja dijalizata oko peritonejskog katetera, 2 malpozicije katetera te 1 genitalni edem. Kasnih komplikacija je bilo 11, od toga 5 akutnih peritonitisa, 1 recidivni peritonitis, 1 krvarenje, 1 infekcija izlaznog mjesta katetera, 1 malpozicija katetera, 1 propuštanje dijalizata oko peritonejskog katetera i 1 hernija u području implantacije peritonejskog katetera. Nije bilo smrtnih ishoda nakon operacije niti je bilo komplikacija koje su onemogućile provođenje peritonejske dijalize. Zaključujemo da se u liječenju bolesnika s terminalnim renalnim zatajivanjem laparoskopska tehnika pokazala prikladnom i sigurnom metodom postavljanja peritonejskog katetera.
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