Rozhledy v Chirurgii最新文献

Introduction: The genitourinary tract and retroperitoneal hemorrhage belong to severe and sometimes life-threatening urological emergencies. Interventional radiology methods can significantly reduce morbidity and mortality in patients who fail conservative treatment and are unfit for surgery.

Materials: We performed a retrospective analysis of patients indicated for angiography and vasographic intervention due to urological pathology in 2015-2020. The study focused on the etiology, technical, clinical success, and possible complications related to angioembolization.

Results: In 5 years, we recorded 51 patients who underwent angiography to localize arterial bleeding or diagnose arteriovenous malformation. In 46 patients (90%), the interventional radiologist subsequently embolized active bleeding or selectively obliterated the main branches of the artery. Angiography did not show extravasation in five patients. Therefore, embolization was not performed. The radiologist assessed the technical success of embolization as 100% in all cases. Two patients experienced a recurrence of bleeding between 24 and 72 hours after the procedure, and the vasography had to be repeated. The predominant finding was hematuria in more than 75% of cases, followed by retroperitoneal hematoma, including perirenal hematoma. Twenty-four embolizations were performed in the renal artery basin; internal pelvic arteries were embolized or obliterated in 21 cases. In one case, a urologist indicated vasography of the left bulbar artery of the penis due to high-pressure priapism.

Conclusion: Vasographic embolization remains an important treatment option in case of hemodynamically significant hemorrhage. Our data support the importance of angioembolization in cases of severe bleeding in the urinary tract with good patient tolerability.

Over the time, preoperative surgical site antisepsis has demonstrated significant strides in both the understanding and practical application of antiseptic procedures. Surgical site infections (SSI) are still one of the most significant complications in health care providing. The source of the infection can be either endogenous by patient's own bacterial flora or exogenous. Interventions to reduce the risk of SSI are necessary. Preoperative antisepsis of the surgical site is a critical step in the prevention of SSI. Nowadays the most widely used antiseptics are chlorhexidine and povidone-iodine (PVI). This article describes current procedures, the effectiveness of various antiseptic agents and recommendations for clinical practice. The results indicate that the use of chlorhexidine with alcohol reduces the occurrence of SSI more than PVI, which supports recommendations for its wider use in surgical practice. Frequent use of the products of daily use can cause allergic sensitisation, which leads to subsequent exposure during surgery and thus can cause an anaphylactic reaction in some patients. NAP6 study (National Audit Project 6: Perioperative Anaphylaxis) indicates the incidence of chlorhexidine anaphylaxis to be of 0.78 per 100,000 exposures. When selecting the antiseptic solution for preparation of surgical field, it is also important to take into consideration possible risk of anaphylactic reaction, which can endanger the patient greatly.

Introduction: Laparoscopic cholecystectomy is currently the gold standard of treatment for cholecystolithiasis. The authors present a rare postoperative complication that -caused the development of septic shock with multiorgan failure and necessitated a number of other operations.

Case report: A 57-year-old woman underwent elective uncomplicated laparoscopic cholecystectomy for symptomatic cholecystolithiasis. The postoperative period was complicated by the development of septic shock with extensive abdominal wall gangrene. The finding necessitated surgical management and complex resuscitative care.

Discussion: Knowledge and skills in intensive and resuscitation care are nowadays among the basic minimum that an erudite surgeon working in hospital surgery must possess. One cannot rely solely on the intensive care provided by anaesthetists. Intensivists recruited from a specific specialty (surgery, internal medicine, pediatrics) may have a better insight into the problem due to their knowledge of the complexity of the disease and are complemented by anesthesiologists.

Conclusion: Initial treatment of septic shock must be early and aggressive, after stabilization of the condition it is necessary to sanitize the source of infection, if possible. Intensive care is an mandatory and necessary part of adequate treatment of septic patients.

Ruptures of the distal tendon of the biceps brachii muscle usually require surgical treat-ment to restore strong elbow flexion and forearm supination. However, the surgical procedure carries a risk of injury to neurovascular structures adjacent to the insertional tendon, and its success relies on respecting the original anatomical relations during reconstruction of the tendon. The aim of this article is to present a compendious review of relevant anatomy and practical notes which may enhance the optimal functional outcomes. Structured discussion on morphological aspects of the insertional tendon and its topography in relation to osseous and soft-tissue structures is presented. Moreover, attention is paid to technical aspects of implantation of fixation devices, so that physiological and anatomical reconstruction can be assured. This paper contains numerous schematic drawings to demonstrate the surgically relevant anatomy.

The technique of total mesorectal excision (TME) has become a widely accepted component of rectal cancer resection since its introduction in the 1980s. The quality of TME remains the only way for a surgeon to influence the oncological outcomes of surgical treatment for rectal cancer. A thorough understanding of the surgical anatomy of the pelvis, particularly the pelvic fasciae, vascular supply, and lymphatic drainage of the rectum, is essential for the proper technique of TME. Functional outcomes of rectal resections also depend on meticulous dissection and respect for the anatomy of the pelvic autonomic nerve plexuses. In this article, the authors define the key anatomical structures and terms, including lesser-known eponyms commonly used in rectal surgery. Finally, they describe the TME procedure based on the surgical anatomy of the pelvis, emphasizing the importance of respecting the developmental tissue planes and anatomical structures involved.

Introduction: Pancreaticopleural fistula (PPF) represents a rare complication of chronic pancreatitis. The treatment is complex including pleural drainage, decompression of main pancreatic duct by endoscopic retrograde cholangiopancreatography, pancreas rest with parenteral or enteral nutrition via naso-jejunal feeding tube and somato-statin analogues application. Surgery is indicated when the conservative or endoscopic treat-ment is not successful. In selected cases, total pancreatectomy may be consid-ered. -After these procedures, unstable diabetes mellitus may be a problem. In this case report, the authors present an alternative way to resolve pancreatico-pleural fistula in patients with a history of pancreatic resection.

Case report: A 49-year-old man underwent pancreatoduodenectomy with pancreato-gastrostomy for chronic pancreatitis in 2018. Two years after the procedure, he had severe dyspnea, with X-ray showing left-sided fluidothorax. Pleuracentesis confirmed high amylase activity in pleural effusion. A CT scan was performed and a diag-nosis of pancreaticopleural fistula was made. Due to the failure of conservative treatment, the residual pancreas was resected. The islets of Langerhans from the resected pancreatic tissue were isolated and transplanted back into the patient's liver via the portal vein. The postoperative course was uneventful. Two year after the procedure, the patient was asymptomatic without pleural effusion recurrence and no need of insulin replacement therapy.

Conclusion: Total pancreatectomy with islet autotransplantation may be an appropri-ate method of treatment for recurrent pancreaticopleural fistula in situations where less radical procedures are not possible.

Background: The inflammatory myofibroblastic tumour (IMT) of the stomach is an extremely rare tumor. The authors present the case report of a patient with primary gastric IMT.

Case presentation: A 24-year-old man presented with a 50-mm tumorous mass on the anterior wall of the middle third of the stomach, detected by -upper gastrointestinal endoscopy and suspected to be a gastrointestinal stromal tumour. Endoscopic ultrasonography-guided fine needle aspiration was performed and an inflammatory myofibroblastic tumour of the stomach was confirmed. A laparoscopic wedge resection was performed.

Discussion: A primary gastric inflammatory myofibroblastic tumour is a very rare mesenchymal neoplasm of uncertain malignant potential. Upper gastrointestinal endoscopy, endoscopic ultrasonography followed by fine needle aspiration, seems to be a method of choice in the preoperative diagnostic method for submucosal tumors of the stomach. The types of surgical procedures used in the treatment of primary gastric IMTs depend on the localization of the tumor and its size as well as on the general condition of patients. The recurrence rate after resection is about 15-35%, with distant metastases occurring in less than 5% of patients. In the event of a recurrence, re-excision is generally recommended, when possible. Modern biological treatment with significant effects includes the use of ALK inhibitors and other targeted therapy guided by molecular predictors.

Conclusions: When submucosal tumour of the stomach is identified, the possibility of gastric IMT should be considered.

Acute conditions in proctology refer to anorectal disorders presenting with symptoms such as acute anal pain and bleeding that may require immediate treatment. This pub-lication discusses the diagnosis and management of common anorectal emergencies such as hemorrhoidal crisis, bleeding anorectal varices, anal fissure, anorectal abscess, strangulated rectal prolapse, Fournier gangrene and retained anorectal foreign bodies. Although many acute complications occurring in emergency cases are not life-threat-ening and can be successfully treated in an outpatient setting, accurate diagnosis and proper treatment can prevent serious complications such as sepsis or permanent func-tional impairment. A detailed medical history and careful physical examination, including digital rectal examination and anoscopy, are essential for a correct diagnosis and treatment plan. In some cases, some imaging tests such as computed tomography and ultrasonography are required. When in doubt, treating physicians should not hesitate to consult a specialist for diagnosis, proper treatment and appropriate follow-up, e.g. colorectal surgeon.

Acute abdomen represents a large complex of acute situations in general surgery. There could be inflammatory (such as acute appendicitis, acute cholecystitis etc.), non-inflammatory (ileus), hemorrhage or traumatic situations (perforation of the gastrointestinal tract etc.). Our work presents two case reports of two not significantly ill female patients with an uncommon inflammatory process of the caecum. Acute typhlitis is an archaism for most of surgeons. It used to be a synonym for acute appendicitis; however, the modern literature defines this diagnose as a different disease - neutropenic enterocolitis. It is a rare but serious disease causing a right lower quadrant pain, often mimics acute appendicitis. Usually, it occurs in immunocompromised patients (patients after an immunosuppressive therapy, neutropenic patients, people with hematologic malignancies, AIDS positive patients, etc.); however, a few case reports of entirely healthy patients have been published. Nevertheless, there is however a limited number of these cases.

Introduction: Cholecystectomy is one of the most common operations in surgical departments. Complications after gallbladder removal are mainly bleeding, infection including abscess in the gallbladder bed or in the abdominal wall, wound dehiscence, acute pancreatitis or injury of the bile ducts. In the further course, hernias in the scar may appear after both laparoscopic and open cholecystectomy, strictures of the bile ducts and symptoms of the so-called postcholecystectomy syndrome. The presence of residual gallstones is rare, statistically reported in 0.08-0.3%.

Case report: The goal of our message is to present the case of a patient taken into our care 7 years after laparoscopic cholecystectomy indicated for cholecystitis with wedged lithiasis in the gallbladder neck, proven by ultrasound. In our department, the -patient was treated for a re-current fistula in the scar of the right subcostal area. Definitive -healing from the initial manifestation of the fistula occurred despite repeated revisions after the precise localization and removal of the retained gallstone.

Conclusion: Thanks to the use of an extensive spectrum of diagnostic methods and at the same time thinking about the rare causes of a recurrent purulent collection with a fistula, we purposefully searched for an infectious source. Only perioperative radiography with injection of contrast material identified the presence of a retained gallstone. It was possible to extirpate it from the space between the intercostal muscles and the peritoneum, thereby relieving the patient of her problems.