Objective: The aim was to demonstrate a diagnostic challenge of sclerosing mesenteritis initially considered as liposarcoma. Clinical Presentation and Intervention: A 45-year-old man was admitted with a painful abdominal mass. Abdominal computed tomography demonstrated a well- demarcated tumor in his left hemiabdomen, with a large fat component and areas of soft tissue attenuation suggestive of liposarcoma. Intraoperative findings showed a tumor arising from the greater omentum. The tumor was completely removed, and histopathology confirmed a pseudotumorous type of sclerosing mesenteritis with dominant mesenteric lipodystrophy. Conclusion: This case showed that a pseudotumorous type of sclerosing mesenteritis should be considered in the differential diagnosis of the mesenteric tumors.
We present a case report that demonstrates diagnostic and intraoperative challenges in the laparoscopic management of initially unrecognized splenic hydatid disease. A male patient, aged 44, was admitted to our department with a big unilocular splenic cyst, radiologically (ultrasonography, computed tomography) characterized as a simple cyst. Serological tests for anti-Echonococcus antibody were negative, and chests X-ray findings were unremarkable, so laparoscopic cyst fenestration with omentoplasty was planned. The intraoperative finding did not correspond to a simple splenic cyst. Hydatid daughter cysts were recognized after the careful opening of the cyst wall. The operation was completed without shifting to open procedures. Laparoscopic partial pericystectomy with omentoplasty is a safe and effective surgical procedure for the management of splenic hydatid disease.
The phenomenon now known as haemobilia was first recorded in XVII century by well known anatomist from Cambridge, Francis Glisson and his description was published in Anatomia Hepatis in 1654. Until today etiology, clinical presentation and management are clearly defined. Haemobilia is a rare clinical condition that has to be considered in differential diagnosis of upper gastrointestinal bleeding. In Western countries, the leading cause of haemobilia is hepatic trauma with bleeding from an intrahepatic branch of the hepatic artery into a biliary duct (mostly iatrogenic in origin, e.g. needle biopsy of the liver or percutaneous cholangiography). Less common causes include hepatic neoplasm; rupture of a hepatic artery aneurysm, hepatic abscess, choledocholithiasis and in the Orient, additional causes include ductal parasitism by Ascaris lumbricoides and Oriental cholangiohepatitis. Clinical presentation of heamobilia includes one symptom and two signs (Quinke triad): a. upper abdominal pain, b. upper gastrointestinal bleeding and c. jaundice. The complications of haemobilia are uncommon and include pancreatitis, cholecystitis and cholangitis. Investigation of haemobilia depends on clinical presentation. For patients with upper gastrointestinal bleeding oesophagogastroduodenoscopy is the first investigation choice. The presence of blood clot at the papilla of Vater clearly indicates the bleeding from biliary tree. Other investigations include CT and angiography. The management of haemobilia is directed at stopping bleeding and relieving biliary obstruction. Today, transarterial embolization is the golden standard in the management of heamobilia and if it fails further management is surgical.
This study has been performed in the Emergency center, Clinical centre of Serbia, during the period 01.03.2007-01.09.2007. We performed this study on 57 patients with diagnosis suspected for acute appendicitis (ages 16-70). Parameters that make the Alvarado score are the following: migration of pain, anorexia, nausea or vomiting, right lower abdominal quadrant tenderness, rebound tenderness in right iliac fossa, elevated temperature, leukocytosis, shift to the left of neutrophils. The aim of the work is to evaluate the Alvarado scoring system in diagnosis of the acute appendicitis. With all the patients Alvarado score has been determinate preoperatively, and diagnosis was confirmed by intraoperative finding and histopatological examination of the removed appendix. All the patients with score 7 or more were surgically managed. Specificity (positive predictive value) was 92.59 % in males and 76.67 % in females. The negative appendectomy rate was 7.41 % with the males and 23.33 % with the females. The values of the Alvarado score are significantly higher in the patients with acute appendicitis, compared with the patients of the other diseases. With the application of the Alvarado scoring system we can decrease postoperative morbidity and mortality.
Colonized or infected patients with Acinetobacter spp. play a major role in contamination of hands of the medical staff in the course of care and treatment, while inadequate hand hygiene of the staff leads to cross transmission of the causative organism to infection-free patients. Selective antibiotic pressure, particularly administration of quinolones and broad-spectrum cephalosporins, favor onset of multiresistant species of Acinetobacter spp., and therefore appropriate prophylaxis and treatment represent basic preventive measures against the onset and spreading of the causative organisms.
Laparoscopic cholecystectomy is a surgical procedure of choice for benign gallbladder diseases. In about 1-2% of cases histopathological examination demonstrate incidental gallbladder cancer (GBCA). We report a case of a 61 year old woman who developed port site metastases after laparoscopic cholecystectomy for adenocarcinoma of the gallbladder. Metastases appeared on all four port sites. Review of literature regarding incidental GBCA an port site metastases was also performed. We conclude that the retrieval bag should be routinely used in laparoscopic cholecystectomy; the procedure should be performed with minimal trauma; in cases of incidental GB carcinoma, full thickness excision of the abdominal wall of the port sites demands additional studies; additional liver bed excision and local lymphadenectomy for T1b carcinoma are yet to be considered.
Peripankreatièna tuberkulozna limfadenopatija je retko oboljenje sa teškom dijagnostikom. Prikazan je sluèaj bolesnice stare 61 godinu koja je primljena zbog tupih povremenih bolova u gornjim partijama trbuha u trajanju 3-4 meseca praaeenih muèninom, gubitkom apetita i na telesnoj težini. Primenjene dijagnostièke pro ce dure ukazuju na promenu u predelu glave pankreasa. Metoda izbora za postavljanje definitivne patohistološke dijagnoze je biopsija promene. Biopsiju promene je moguaee uraditi primenom ultrasonografije (US), kompjuterizovane tomografije (CT), endoskopske ultrasonografije (ENDO US) i laparoskopije. Hirurgija je samo krajnje sredstvo za uspostavljanje definitivne patohistološke dijagnoze. Kljuène reèi: tuberkulozna intraabdominalna limfadenopatija, limfni nodusi pankreasa, diferencijalna dijagnostika. UVOD E kstrapulmonalna tuberkuloza je redak oblik TBCa. 34 Tuberkulozna limfadenopatija može biti cervikalna, intratorakalna, intraabdominalna, ingvi nalna i aksilarna. 34 Intraabdominalna tuberkuloza se lokalizuje na crevnim vijugama i peritoneumu, retko na limfnim nodusima. 10,26,27,30 Ona je karakteristièna za nerazvijene zemlje sa prenaseljenim i neishranjenim stanovništvom. 5,26 U razvijenim zemljama oboleti mogu osobe koje se leèe od imunokompromitujuaeih bolesti ili imigranti iz nerazvijenih zemalja. 3,10, 33 Anamnestièki podaci obièno nisu od znaèaja. 3,19 Klinièka slika vrlo je nespecifièna, nekad asimptomatska tokom više meseci. 5,13,26 Fizikalni pregled može ponekad verifikovati palpabilnu intraabdominalnu masu ili ascit. 8,18, 19,21,22 Laboratorijske analize su u granicama normalnih vrednosti ili neznatno poremeaeene. 26 Tuberkulozna limfadenopatija zahvata periportne, peripankreatiène, mezenteriène, paraaortne limfne no duse. 6, 7, 8, 17, 20 Osnovne dijagnostièke pro ce dure su: ultrasonografija trbuha (UZ) i kompjuterizovana tomografija (CT).
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