Rozhledy v Chirurgii最新文献

Child abuse, whether physical, sexual, or psychological, is a health and social problem both globally and regionally. During the examination and diagnostic treatment of a child due to trauma, it is necessary to take into account physical abuse as a possible cause of trauma. We present the case of a female newborn referred from the General Hospital due to inconsolable crying and poor mobility of the left leg. According to the anamnesis, clinical examination, and diagnostic processing, physical violence was highly suspected. Specific fractures were verified by X-ray and computed tomography, and after excluding possible other causes, the case was reported to the competent institutions that excluded the child from the family. Given the increase in domestic violence, healthcare professionals must be aware of the fact that they must pay extra attention to certain indicators and act accordingly. When abuse is suspected, such children require a multidisciplinary approach by several specialists to minimize the possibility of error in the final diagnosis.

A 68-year-old man with severe craniofacial trauma underwent endoscopic surgery for nasal cerebrospinal fluid leak. During the operation, a plastic object in the shape of a spectacle lens was found wedged in the left nasal passage, which we extracted. As subsequently established from the patient's documentation, it was a dislodged acrylic implant originally placed at the base of the orbit which was surgically treated after an injury to the facial skeleton thirty-five years ago. What is also rare about this is the fact that the patient had been examined for many years at the otorhinology department for purulent discharge from the left nasal cavity and impaired ventilation. The patient had also undergone an endoscopic examination of the nasal cavity during which an intranasal tumor was even suspected, but it was not histologically confirmed.

Hemobilia is an unusual type of gastrointestinal bleeding most frequently due to iatrogenic injury, trauma, or neoplasia. Acute cholecystitis as a cause of hemobilia is rare. We present the case study of a patient with bleeding from eroded gallbladder mucosa in the setting of severe calculous cholecystitis. The hemorrhagic episode was preceded by acute ERCP due to obstructive icterus with extraction of the calculi, followed by the development of severe acute pancreatitis. These factors initially misled the diagnosis. The bleeding was not hemodynamically important and routine diagnostic methods did not reveal its exact source. Direct choledochoscopy (SpyGlassTM) proved to be helpful in determining the right diagnosis, as it ruled out any injury or tumor in the main bile ducts and considerably supported the assumption of intrabladder bleeding. Surgical revision confirmed the cause, and subsequent cholecystectomy solved the whole problem.

Pneumoperitoneum as a finding on imaging examinations is not always a sign of acute abdomen due to gastrointestinal perforation. These findings must be viewed in connection with the clinical condition and personal history of each patient because they may also indicate a non-surgical or spontaneous pneumoperitoneum. This condition is repeatedly described but very often neglected. This paper presents the case report of a patient with non-surgical pneumoperitoneum where, despite proceeding according to the guidelines, no expected intra-abdominal pathology explaining the patient's problems was found.

Introduction: The study identifies risk factors predicting cervical spine fracture on CT based on information in the referral form.

Methods: All patients aged over 18 years with a CT scan of the head and cervical spine completed at the University Hospital Brno in the year 2019 to exclude any fresh trauma were included in the retrospective study. The analyzed potential risk factors included gender, age over 65 years, unconsciousness or impaired consciousness, mechanism of injury, paresthesia or plegia suspected to be associated with trauma, cervical spine pain, other neurological symptomatology, presence of cervical collar, presence of intracranial hemorrhage on head CT, and presence of skull fracture on head CT.

Results: In total, a cervical or upper thoracic spine fracture was described in 51 of 1177 patients (4.3%). Statistically significant risk factors for cervical spine fracture on CT scan were identified as mechanism of injury similar to car accident or jumping into water (OR 2.52; p=0.004), pain of the cervical spine (OR 1.81; p.

The article reports on three patients with a solitary fibrous tumor of the chest. The first patient had a tumor in the area of the dome of the right pleural cavity which was radically resected together with the chest wall around its origin. In the second case, the tumor was attached by a vascular pedicle to the lower lobe of the right lung. This tumor was resected atypically, via thoracotomy, along with a margin of healthy lung tissue at the base of its pedicle. The last patient had a tumor of the lower lobe of the right lung, surrounding the lower pulmonary vein, which did not have a clear margin of healthy lung tissue. This finding required right lower lobectomy via posterolateral thoracotomy. The presented cases describe rare types of tumors in the chest area which at the time of detection often reach large dimensions, necessitating extensive surgical procedures. Due to the biological nature of these tumors, long-term patient follow-up is advisable.

The management of severe traumatic bleeding includes damage control resuscitation procedures including, in addition to surgical bleeding control, the application of the massive transfusion protocol. The aim of this paper is to present the massive transfusion protocol and selected scoring systems for an early detection of patients with severe post-traumatic bleeding. The use of a standardized protocol to activate the massive transfusion protocol reduces lethality due to severe traumatic bleeding and the consumption of blood products in trauma centers.

The article reports the case of a patient with bronchopulmonary sequestration complicated by destructive actinomycotic inflammation leading to life-threatening hemoptysis. It was an adult patient with the history of repeated right-sided pneumonia the cause of which had not been investigated in detail in the past. Only hemoptysis, which appeared as a complication, led to a closer investigation of the background of repeated right-sided pneumonia. CT scan of the chest revealed a lesion of the middle lobe of the right lung with anomalous vascularization - compatible with intralobar sequestration. Initially, conservative antibiotic treatment of pneumonia was provided at a local clinic. Embolization of the afferent vessels of the sequestrum was indicated due to persistent hemoptysis; this led to a reduction of its blood supply, proven by a follow-up CT examination of the chest. Clinically, the hemoptysis subsided. Three weeks later, the hemoptysis reocurred. The patient was acutely hospitalized at a specialized thoracic surgery department where shortly after admission, hemoptysis progressed to life-threatening hemoptea. Urgent middle lobectomy of the right lung was approached via thoracotomy to treat the source of bleeding. The case describes unrecognized bronchopulmonary sequestration as a possible cause of recurrent ipsilateral pneumonia in adulthood; additionally, it emphasizes the possible risks associated with a pathologically altered tissue microenvironment of pulmonary sequestration, and the need for surgical removal in all indicated cases.

Introduction: During the last decades, simultaneously with the development of surgical technique, modern equipment and perioperative management, there has been a significant improvement in postoperative outcome. Despite this, infectious complications and perioperative bleeding remain the leading causes of postoperative morbidity and mortality in HPB surgery.

Methods: We conducted a retrospective study over a three-year period in 256 patients who underwent surgery of the pancreas, liver, gallbladder, or bile ducts. We monitored perioperative blood loss, the number of administered transfusions, the type and severity of postoperative complications, the number of reoperations and the number of readmissions.

Results: The average blood loss was 457 ml. We administered transfusions to 39 patients (17%). We confirmed the hypothesis that the presence of blood loss statistically significantly increases the development of deep intra-abdominal infections (p=0.0188). Morbidity increases with increasing blood loss (p=0.0168). We confirmed a statistically significant difference in the blood loss between the groups with and without complications (p=0.001). Postoperative 30-day mortality was less than 1% (n=2). There were 15 (6%) reoperated patients, seven for acute bleeding and eight for infectious complications. The length of hospital stay was statistically significantly longer in patients who received transfusions - erythrocytes (p=0.023), and plasma (p=0.011). We readmitted 12 patients, three patients died during rehospitalization (the 90-day mortality rate was 2%, n=5). A total of 59% patients in our group were classified as ASA III.

Conclusion: With increasing blood loss, morbidity (development of intra-abdominal infections) increases significantly, but despite this, overall post- operative mortality remains low. Early postoperative bleeding is the cause of more than half of reoperations. The length of hospitalization increases significantly with the number of transfusions administered.

Introduction: Variations in hepatic artery anatomy are very common in the population. The aim of this study is to evaluate the rates of individual types of hepatic artery variants in the population of patients undergoing pancreaticoduodenectomy (PD), assess the accuracy of preoperative staging CT imaging to identify hepatic artery variants, and evaluate the impact of the hepatic artery variants on perioperative and postoperative morbidity of PD patients.

Methods: A prospective observation study of 147 patients undergoing PD for a pancreatic head pathology at the 1st Department of Surgery, University Hospital Olomouc between 1/2015-12/2018. Preoperative diagnosis of the course of the hepatic artery was made based on staging CT imaging analysis of the abdomen. The result was classified according to the Michels' scale and correlated with the final perioperative finding. Demographic, histopathological and clinicopathological data were included in a prospectively maintained database.

Results: A total of 147 patients were included in the study, 83 (56.5%) males and 64 (43.5%) females, median age 65.0 (37-83) years. A variant course of the hepatic artery was found in 37 (25.2%) patients. The accuracy of preoperative CT imaging in determining the variant was 100%. The presence of a hepatic artery variant was not statistically significant as a factor in terms of postoperative complications - CD I-II (50.0% vs 47.2%), CD III-IV (8.3% vs 13.8%). Similarly, the 30-day (4.2% vs 2.4%) and 90-day mortality rates (4.2% vs 3.3%) were comparable in both groups.

Conclusion: Preoperative diagnosis of vascular variants based on multidetector CT imaging of the abdomen is routinely available and shows high detection accuracy. There was no difference in postoperative morbidity and mortality in patients with and without a variant hepatic artery undergoing PD.