Acta Chirurgica Belgica最新文献

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: Surgical procedures often entail significant blood loss, potentially leading to various complications. Thus, reducing perioperative bleeding is crucial to enhancing patient outcomes. This study systematically evaluates and conducts a meta-analysis on the efficacy of tranexamic acid (TXA) in patients undergoing burn surgery.

Methods: A comprehensive literature search was performed across PubMed, the Cochrane Central Register of Controlled Trials, Embase, and Web of Science databases to identify pertinent clinical studies on the application of TXA in burn-related surgical procedures. The evaluated outcomes included total blood loss, postoperative hemoglobin levels, postoperative hematocrit, intraoperative packed red blood cell (PRBC) transfusion units, incidence of intraoperative transfusion, and duration of hospitalization.

Results: The analysis incorporated seven studies with a total of 427 patients. Compared to the control group, TXA was associated with a significant reduction in total blood loss [MD = -152.17 mL (95% CI: -159.48 to -144.87)], total PRBC units transfused [MD = -0.61 units (95% CI: -0.92 to -0.30)], and intraoperative transfusion incidence [logRR = -0.70 (95% CI: -1.04 to -0.35)]. However, there were no significant differences observed in postoperative hemoglobin levels [MD = 0.47 g/dL (95% CI: -0.12 to 1.06)], postoperative hematocrit [MD = 2.13% (95% CI: -0.66 to 4.92)], or length of hospital stay [MD = -2.80 days (95% CI: -6.44 to 0.83)].

Conclusions: TXA appears to effectively reduce blood loss and the requirement for PRBC transfusions in burn surgery. Further high-quality research is necessary to substantiate these findings.Abbreviations: TXA: tranexamic acid; PRBC: packed red blood cell; MD: mean difference; REML: restricted maximum likelihood; logOR: log odds ratio.

Anaplastic thyroid carcinoma (ATC) is a rare type of thyroid cancer that is characterized by its rapid onset and progression. It tends to metastasize to various organs, including the lungs, brain, bones and, less commonly, the small bowel. This case report describes a 74-year-old woman who had small bowel metastasis leading to obstruction three years after diagnosis and local resection of ATC, followed by adjuvant chemotherapy. The patient presented at the emergency department with abdominal pain and vomiting. A CT-scan of the abdomen showed signs of intestinal perforation, combined with diffuse dilatation of the ileal small bowel, for which a segmental enterectomy was performed. Histological findings of the resected small bowel diagnosed the tumor as a jejunal metastasis of an ATC. The morphology of this lesion was compared to that of this patient's ATC. We present a rare case of small bowel metastasis from ATC which has previously been described in just a few case reports in the medical literature. Therefore, this case report contributes to the limited knowledge available on this condition.

Background: The treatment of acute pancreatitis (AP) with pancreatic and peripancreatic necrosis (PN and PPN) can be challenging. It is unclear why some patients respond to conservative management while others require an invasive treatment. This study aimed to assess the clinical and radiological characteristics of patients with gallstone or alcohol-induced AP with PN and PPN who underwent interventional or non-interventional treatment.

Methods: Subjects with gallstone or alcohol-induced AP and radiological evidence of PN and PPN, from 2010 to 2018, were divided in two treatment-based groups: interventional-percutaneous drainage (PD) and/or surgical necrosectomy-and non-interventional. A comparison of clinical and radiological characteristics between groups was conducted.

Results: Of 99 patients, 18 underwent interventional treatment, 81 conservative management. The interventional group had larger PN (p = 0.010) and a greater proportion of infected necrosis (p = 0.002). Acute necrotic collection (ANC) >10 cm (95% CI 1.26-3.6, OR 1.839, p = 0.012), infected necrosis (95% CI 4.28-61305.6, OR 153.9, p = 0.026), admission to the intensive care unit (ICU) (95% CI 16.79-326,532.21, OR 489.915, p = 0.007), were predictors of interventions. Patients who underwent PD only had up to four drains inserted and 16.7% hospital mortality; subjects who underwent surgery had up to two drains and 33.3% death rate.

Conclusions: Most subjects with severe gallstone and alcohol-related AP were treated medically. Large ANC, infected necrosis, and ICU admission predicted the need for intervention. When an invasive treatment was required, PD alone was effective with a tendency towards repeated drain insertions.

Purpose: To understand the possibilities and the limitations of the modern Greek surgeons during nineteenth century on hernia surgery.

Methods: Research on the authentic medical writings of the Greek physicians during nineteenth century. The majority of them is brought to light for the first time.

Results: The Greek surgeons of the nineteenth century tried a lot to be updated according to the achievements of the European surgeons regarding the surgery of hernias. Many prominent Greek surgeons contributed to the formation of a scientific method in order this to be taught to the medical students and to the other Greek physicians of the time.

Conclusion: In Greece, it was Spyridon Kontoleon who adopted Lister's method to prevent infections, while his team of physicians contributed further in hernia surgery. The earliest documented with a figure hernia case was that of Pavlos Ioannou in 1882. Theodoros Aretaios recorded his cases, demonstrating an interest in hydroceles. Many of his cases may be found in his archive in the National Library of Greece. Procedures' description and vivid depictions paved the way of hernia surgery's evolution in the newly formed Greek state.

Introduction: Percutaneous endoscopic (PEG) and laparoscopic gastrostomy (LG) are two widely used techniques for gastrostomy placement in infants. We aimed to compare the risk of complications using a validated grading system and parent satisfaction.

Methods: Infants undergoing gastrostomy placement in a tertiary referral center were retrospectively included. Local and general complications were graded using the Clavien-Dindo (CD)system and categorized as early (≤ 30 days) vs late (>30 days) postoperatively. Parent satisfaction was evaluated prospectively using a questionnaire (Numeric Rating Scale 0- 10).

Results: Out of 102 patients, 52 underwent LG and 50 PEG. General complications (CD IIIa, IIIb and IV) were rare and occurred all late (n = 3), local complications were common: twice as much minor local early complications occurred in the LG cohort, however this was not statistically significant (28.8% vs 14.0%; p = 0.092). There was a trend toward more major local late CD IIIb complications in the PEG group, but this was not statistically significant (20.4% vs 8.0%; p = 0.088). After button removal, there was a higher risk of gastrocutaneous fistula requiring surgical closure after LG (53.1% vs 26.7% after PEG; p = 0.003). Parental satisfaction was high in both groups (mean score 8.3 for PEG vs 7.9 for LG; p = 0.341).

Conclusion: While the risk of general complications after gastrostomy placement is low, local complications are common. However not significant, PEG was associated with a higher risk of major long-term local complications, while LG required more surgical closures after button removal. Parental satisfaction was high in both groups. Further prospective comparisons are needed.