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A rare case of delayed jejunal perforation is reported, with a time window of approximately five hours. The diagnosis is challenging: there are no proper protocols, planned early physical examination checkups are advised. The forensic medical aspects of the occasional therapeutical delays are remarkable.

Pyoderma gangrenosum (PG) of the breast is a rare, ulcerative disease of rapid onset normally associated with systemic disorders and triggered by surgery or trauma. Early diagnosis and appropriate treatment of this disease pose a real challenge. We present a case of a PG of the breast in a patient with associated diabetes mellitus, with minor triggering injury. Our patient's condition was diagnosed and treated as an infected breast ulcer; after getting the correct diagnosis we treated her with systemic steroids and finally (at the patient's request) with breast ablation.

Introduction. An estimated 20–30% of patients with ulcerative colitis need surgery. The generally accepted procedure for the surgical treatment is total proctocolectomy with ileal pouch-anal anastomosis. Nowadays laparoscopic technique is used more frequently. Minimally invasive surgical technique is used during the surgical treatment of colorectal diseases in the Department of Surgery in Szeged since 2005. Aim. We aimed to compare the last 16 years’ results of patients treated with conventional and laparoscopic methods. Methods. Between 01. 01. 2005. and 31. 03. 2021. 99 patients (53 female, 46 male) received surgery. The laparoscopic technique was used in 74 (74.7%) and the conventional method in 25 (25.3%) cases. General status of patients, early and late results of surgical treatment, and mainly complications were analyzed. Results. There was no difference between the groups in-hospital stay, the number of days spent in the intensive care unit and the need for transfusion. During the follow-up period the time to the recovery of the bowel function, and the occurrence of late complications were significantly lower in the laparoscopically operated group of patients. Conclusions. Laparoscopic surgical treatment can be used safely for both emergency and elective cases in UC patients. The short-term perioperative results and the morbidity showed no differences between the laparoscopic and open techniques. The long-term effect of laparoscopic surgery insured a lower rate of complications.

Introduction. Recently the therapeutic treatment for advanced, stage T2-T4 gastro-oesophageal junction cancer and those adjacent to the regional lymph nodes involves neoadjuvant chemotherapy with subsequent surgical intervention. Method. Neoadjuvant oncological treatment for gastro-oesophageal junction cancer previously consisted of the intravenous administration of epirubicin, cisplatin and fluorouracil (ECF) or epirubicin, cisplatin and capecitabine (ECX) combination (Group I). In the course of the new protocol (FLOT-, F: 5-FU, L: leucovorin, O: oxaliplatin, T: docetaxel), patients were included with resectable gastro-oesophageal junction cancer who had a clinical-stage cT2 or higher nodal positive cN+ disease (Group II). Between 31st of December 2013 and 1st of June 2021 we retrospectively analyzed the effect of these FLOT oncological protocols in terms of surgical outcomes in cases of T2-T4 tumors (n = 9). We compared the results of the randomly assigned nine patients from earlier ECF/ECX protocol (Group I). We analyzed the effect of the different neoadjuvant therapy on tumor regression, and evaluated the types of possible side effects, type of surgery, and the oncological radicality of surgical procedures (number of removed regional lymph nodes, resection margins). Results. Comparing the two groups we found that in cases of FLOT neoadjuvant chemotherapy complete regression was achieved significantly a higher number like in earlier ECX/ECF therapy. Furthermore, the average number of removed lymph nodes, and the safety resection margins (distal, circumferential) no significant difference was found between the two groups. Neutropenia was the most frequently encountered side effect. Leukopenia, neutropenia and nausea occurred more frequently in cases of the old protocol (Group I). Conclusions. As a result of the FLOT neoadjuvant oncological protocol for advanced gastro-oesophageal junction cancer, the number of cases with complete tumor regression has significantly increased. The present results strongly suggest a significant advantage in favor of FLOT neoadjuvant treatment following surgery. The prevalence of side effects was also appreciably lower in cases of the FLOT protocol.

For the centenary of the Department of Surgery, University of Szeged we have investigated and summarized the results and outcomes of 779 anti-reflux surgery cases between 1. January 2000 – 31. May 2021. The indication for surgery was made in close collaboration with the internal medicine workgroup depending on the results of endoscopy and functional tests. The primer indication for surgery was medical therapy-resistant reflux disease. Based on our clinical practice we performed laparoscopic Nissen fundoplication in 98,2% of the cases. Besides the long- and short-term postoperative complications, we investigated the long-term effect of anti-reflux surgery on acid and bile reflux, and the improvement of the patients' quality of life using the Visick score, and modified GERD-HRLQ score. Our investigations have proven the effect of acid and bile reflux in the pathogenesis of Barrett's esophagus and furthermore we have confirmed that laparoscopic anti-reflux surgery restores the function of the lower esophageal sphincter and eliminates acid and bile reflux, so in certain cases Barrett's esophagus regression can be achieved. But due to the heterogeneity of GERD and Barrett's esophagus long-term and regular endoscopic control is necessary.

Introduction The authors introduce the history of liver surgery in Szeged on the occasion of the 100th anniversary of the Surgery Department's establishment. Material and methods After the initiation of liver surgery in Szeged by Professor Karácsonyi 1982 we are treating not only patients with benign and malignant focal liver diseases but also others with surgery required because of complications of portal hypertension. Patients are presented in two periods. Discussion We operated on 46.5% of the patients with malignant and 53.5% of the patients with benign diseases between 1981 and 1991. The surgical spectrum extended to trisegmentectomy. There were 14% of minor and 9.9% of major complications, the mortality was 3.23% which meets international standards. In the second period, 50.5% of the patients were operated on because of malignant and 46.5% of the patients suffered from benign focal diseases from 1992. Among the patients who had been operated on because of liver malignancy, there were 51% metastasis mostly of colorectal cancer, 22% were hepatocellular, 16% were cholangiocellular carcinoma and in 11% were other malignant tumors. In those patients who had been operated on because of benign focal liver diseases, there were 32% cysts, 25% echionococcus cysts, 26% haemangiomas, 8% adenomas, 7% FNH, and 2% because of others. The summarized mortality rate was 1.3%. There were peritoneo-venous shunt implantations in 126 cases because of therapy-refracter ascites. We performed oesophageal transection with a circular stapler after failed endoscopic haemostasis in 50 cases. Conclusion Chances of liver surgery have been basically widened because of the financial investment that is connected to the Department of Surgery's move to a new building. The liver unit in Szeged today can take care of patients in a full spectrum of liver surgery.