Acta Chirurgica Belgica最新文献

Background: Flexible intramedullary nailing is a minimally invasive method used for pediatric tibial shaft fractures stabilization.Case presentation: A 7-year-old boy sustained a midshaft oblique tibial fracture due to a fall from one meter height and was treated by closed reduction and intramedullary nailing. On the first postoperative day, a swelling of the proximal half of the lower leg occurred and progressed to compartment syndrome. The lower leg was edematous, firm and painful on palpation, and the pain at rest was out of proportion to injury. CT angiography showed a posterior tibial artery pseudoaneurysm and no signs of deep venous thrombosis. He was successfully treated by pseudoaneurysm evacuation and saphenous vein patch repair of the posterior tibial artery. Postoperative course was uneventful.

Conclusion: Vascular complications after flexible intramedullary nailing in children are rare and require early recognition. In this case, treatment by open surgical technique was successful.

Background. The work of the anatomist surgeon Joseph Maclise has been forgotten by history. His contributions are unknown to younger generations. This study aims to analyze his legacy, focusing on the surgical anatomy of hernias. Results. This is the first study to analyze Maclise's work from a surgical, rather than an artistic, perspective, focusing on the pathology of hernias. His life was marked by a lack of academic and/or institutional recognition. He was forgotten by the Royal College of Surgeons a decade before his death. He collaborated with Morton on his treatise on surgical anatomy. His work was fundamental to the training of surgeons for at least three decades and served as a bridge between two continents. In the field of hernias, he simplifies knowledge for surgeons, shows each type of hernia in anterior and posterior approaches, and describes the region as a single space where all hernias appear. Conclusion. Maclise was an exemplary Victorian surgeon who cultivated many fields of practice (surgical anatomy, comparative anatomy and naturalism, experimental anatomy and physiology, embryology, art and painting), committed to the advancement of science in his time. His surgical anatomy of hernias facilitated the visual understanding of this pathology for surgeons of several generations.

Objectives: Lungs are the second most frequent site of colorectal cancer metastases. Complete resection of isolated lung metastases is recommended in the current guidelines because of the high long-term survival rate and low morbidity-mortality. The aim of this study is to determine prognostic factors for lung metastasectomy in order to better select patients who will benefit from surgical resection.

Methods: This single-center retrospective study is based on the medical data of patients operated for resection of colorectal lung metastases between 2004 and 2023.

Results: A total of 109 patients were selected, and four had to be excluded. The univariate analysis revealed factors influencing the survival: primary cancers that were metastatic at diagnosis, high preoperative CEA rate, the number and size of metastases, hilar lymph node involvement, invasion of the resection margins and poorly differentiated histological grade. A multivariate analysis including only the pre-operative factors was performed: CEA (p < 0.001), the size (p = 0.003) and number (p = 0.038) of metastases and the metastatic stage of the primary cancer at diagnosis (p = 0.052).

Conclusions: The 5-year survival rate in this study is 55%. Survival can be evaluated by four preoperative factors: CEA rate, size and number of metastases and metastatic status of the primary cancer. These factors can be combined to form a survival score, each factor being worth one point. Patients with a score of 0 have a 5-year survival of around 90%, while patients with a score of 3 have a 5-year survival of around 10%. This score could be used to select patients eligible for surgery.

Background: Ovarian torsion is a rare but important cause of acute abdominal pain in paediatric and adolescent populations. Delayed diagnosis can lead to loss of ovarian function, with non-specific symptoms often complicating timely identification. Ultrasound is the primary diagnostic tool, but its sensitivity varies.

Aims: This study reviews the clinical presentation, diagnosis, and outcomes of paediatric and adolescent ovarian torsion cases over an 8-year period.

Methods: A retrospective analysis of 23 ovarian torsion cases in patients under 16 years treated within NHS Lothian between January 2016 and January 2024 was conducted. Data on patient demographics, clinical symptoms, imaging findings, and surgical interventions were collected.

Results: All patients presented with abdominal pain, with 91% also reporting nausea and/or vomiting. Ultrasound confirmed torsion in 80% of cases. Surgical intervention showed 56.5% of ovaries were necrotic or ischaemic, though no significant correlation was found between raised inflammatory markers and necrosis. Ovarian-sparing surgery was performed in 82.6% of cases, with good follow-up outcomes.

Conclusion: Ovarian torsion remains a diagnostic challenge due to its non-specific symptoms. Ovarian preservation is achievable in most cases. Prompt diagnosis and intervention are critical.

Background: Adrenal myelolipomas are benign tumors composed of mature adipose tissue and hematopoietic elements, such as myeloid and erythroid cells. They are often asymptomatic and do not require treatment unless complications arise.

Methods: A case description and brief review of the literature is performed.

Results: This case report outlines the hospital course and management of a 77-year-old woman who was admitted to the emergency department with hemorrhagic shock after a traumatic fall. A full body computed tomography (CT) scan revealed a voluminous mass in the right adrenal gland with an active hemorrhage in the right hypochondrium. After reviewing her medical records, it became clear that the hemorrhage arose from a pre-existing adrenal myelolipoma, discovered nine years earlier. Additionally, she sustained multiple fractures including right-sided rib fractures, a compression fracture of L1, and a complex fracture of the right scapula, accompanied by a significant hematoma. The clinical approach included initial stabilization, embolization procedures to control the hemorrhage, and comprehensive follow-up care.

Conclusion: This case illustrates that timely recognition and management of traumatic hemorrhage from pre-existing masses, such as an adrenal myelolipoma, are crucial for improving patient outcomes and minimizing complications such as hypovolemic shock.

Background: Laparoscopic cholecystectomy (LCCE) has been the standard treatment for acute cholecystitis since the 1980s, but it may pose a significant hazard for high-risk patients. Endoscopic gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) offers a minimally invasive alternative for these patients. While LAMS is effective, the need for subsequent LCCE and long-term outcomes remains under investigation. This study aims to retrospectively assess the safety and feasibility of cholecystectomy after LAMS placement in a series of patients initially deemed unfit for surgery.

Methods: A retrospective review included patients who underwent LCCE following EUS-GBD with LAMS between January and September 2024 was conducted. Data on demographics, procedural details, technical success, and postoperative outcomes were retrieved.

Results: Eight patients with acute cholecystitis underwent gallbladder drainage with transduodenal LAMS placement. Two required ICU care for sepsis but recovered. All eight subsequently underwent elective LCCE with 100% technical success. LAMS placement facilitated faster resolution of cholecystitis, resulting in a clear visualization of Calot's triangle, allowing precise dissection and closure of the cholecystoduodenostomy without complications. The median interval between LAMS placement and LCCE was 117.5 days (111 days excluding one outlier). LCCE was performed in a median operative time of 49 min. No conversions to open surgery or postoperative complications occurred, and the median postoperative hospitalization was 2 days.

Conclusion: Interval LCCE following EUS-GBD is a safe and effective option for managing acute cholecystitis in high-risk patients, with outcomes comparable to standard LCCE. Randomized controlled trials are necessary to establish definitive guidelines for this approach.

Background: The present original study was first conducted by Prof. Apostolakis. The aim of this study was to investigate the frequency of Meckel's diverticulum morphological variations and surgical anatomy in a Greek population. A review of the relevant literature was also conducted by the authors. In addition, we would like to highlight, with this opportunity, the life and scientific work of the respectful Greek Professor of anatomy George Apostolakis.

Methods: 151 formalin-fixed cadavers were dissected in the Anatomy Department of the Medical School of the National and Kapodistrian University of Athens, Greece, in 1932. A review of the relevant literature was also conducted by the authors.

Results: Meckel's diverticulum was found in the case series of Apostolakis in 3.3% from the free (40%) or lateral border (20%) of the ileum. The diverticulum was observed only in male cadavers. Its origin varied, arising either from the free margin of the ileum or from its lateral border. In one case, a triangular serosa's leaflet was noted, extending partly over the diverticular process and partly over the free edge of the ileum. This finding may represent a remnant of the anterior intestinal wall from an embryological perspective.

Conclusion: In this study Meckel's diverticulum is found in a higher frequency than reported in the international literature (2%). With our work we would like to highlight, the life and scientific work of the respectful Greek Professor of anatomy George Apostolakis.

Background: Professor Theodoros Aretaios (1829-1893) was the most prominent figure in Greek Surgery during nineteenth century. Apart from other operations he performed, he focused also on breast surgery.

Methods: Theodoros Aretaios was a prolific writer. He wrote two main textbooks in Greek. The one is a surgical atlas and the other a surgical pathology textbook. Apart from them he left a great archive of the patient he operated on. Most of them refer to breast surgery and will be highlighted by our study.

Results: Except two male patients all the others were women in Theodoros Aretaios' archive, and the vast majority suffered from breast cancer. Benign disease of the breast although more common were mentioned concisely. Theodoros Aretaios performed total or partial mastectomy, lymphadenectomy and he underlined that the excision of the thoracic muscles or even the ribs had nothing to offer apart from aggravating patient's condition allowing us today to understand his pioneering role in the medical thought of his time.

Conclusion: Theodoros Aretaios patient archive about breast diseases is the first systematic review of such patients in Greece, after the creation of the modern Greek State. The great variety of information shows the very high level of theoretical knowledge in breast surgery, which can be also seen by the surgical approach to benign and malignant disease.

Background: Recurrent pyloric stenosis (RPS) is a very rare condition that occurs after an initially successful pyloromyotomy for hypertrophic pyloric stenosis. Over the last decade, the number of reported cases of recurrent pyloric stenosis has increased considerably. Given the rarity of this condition and the paucity of literature on the subject, there is a certain diagnostic difficulty, particularly at ultrasound level, where it is difficult to differentiate a true recurrence of pyloric stenosis from an initial incomplete pyloromyotomy.

Methods: A systematic literature review was performed to characterize the diagnosis of RPS and to report on all cases previously described in literature.

Results: We identified a total of 15 patients (median age of 19 days at first pyloromyotomy; average of 31 days of symptom-free interval before RPS; 66,7% male). Eleven cases fulfilled the 3 Kuckelman criteria for RPS (weight gain, 3 weeks resolution of symptoms, restenosis on imaging). The length of the pylorus on ultrasound appears to increase or remain above 18 mm for RPS, where normally it should decrease immediately after pyloromyotomy. RPS seems to occur more frequently when the first pyloromyotomy is performed at an early age.

Conclusion: Hypertrophy of the pyloric muscle is a progressive entity, and if operated upon too early can favor recurrence. The diagnosis of a RPS can be made through the combination of clinical criteria and ultrasound, specifically length measurements of the pylorus. Additional studies need to be performed to confirm our findings and to define strategies to reduce risks for RPS.