Situs viscerum inversus totalis is a rare condition in which organs are transposed from the normal side to the opposite side in the abdominal and chest cavity. It occurs in a ratio from 1:5000 to 1:20000. In this case report, a case of a 50-yearold man who was diagnosed with the symptomatic presence of gallstones with the usage of ultrasound. The patient underwent the laparoscopic cholecystectomy, the surgical procedure lasted for 90 minutes, it was successfully completed and the patient was discharged on the first postoperative day.
Spontaneous spleen rupture rarely occurs, and is primarily present in patients with splenomegaly. This is a life-threatening condition that, without adequate surgical treatment, always ends lethally. The very etiology of spontaneous atriumatic spleen rupture is not known, but it can often be associated with neoplastic diseases, liver cirrhosis, and some infectious diseases. Diagnosis is made by non-invasive methods (findings of red blood cell elements, ultrasonography, computerized tomography of abdominal CT, magnetic resonance NMR). The therapy consists of laparotomy, evacuation of the haemorrhagic content and removal of the spleen. Surgical treatment is successful, and as a postoperative complication, bleeding may occur as a result of inadequate care of the laryngeal artery and vein, and short gastric blood vessels. Here we presented a 58-year-old male patient who, due to a marked abdominal pain, low blood pressure, and low blood cell counts, was taken to hospital and successfully surgically treated at the Clinic for General and Abdominal Surgery.
Sažetak. Cilj rada bio je da se analiziraju rani rezultati operativnog liječenja bolesnika sa metastazama kolorektalnog karcinoma u jetri. Studijom su obuhvaćena 453 bolesnika operisana na Klinici za opštu i abdominalnu hirurgiju Kliničkog centra u Banjoj Luci u periodu od 01. aprila 2004. do 31. marta 2009. Metastaze u jetri imalo je 108 (23,84%) bolesnika. Kod 49 (45,37%) bolesnika one su bile sinhrone, a kod 59 (54,63%) metahrone. Kod 39 (36,11%) bolesnika postavljena je indikacija za hirurško liječenje, a kod 27 (25%) urađena je uspješna resekcija jetre. U grupi uspješno operisanih bilo je 14 (51,85%) žena, prosječne starosti 60,4 (46-75) godine i 13 (48,15%) muškaraca, prosječne starosti 66,8 (57-75) godina. Kod 16 (59,26%) bolesnika korišćena je desna subkostalna laparotomijska incizija, a kod 11 (40,74%) pristup po Makuchiju. Kod 6 (22,22%) bolesnika je urađena segmentektomija, kod 3 (11,11%) bisegmentektomija, kod 4 (14,81%) lijeva hepatektomija, kod 2 (7,41%) desna hepatektomija i kod 12 (44,44%) atipična resekcija jetre. Prosječno je operacija trajala 138 (75-265) minuta. Kod 15 (55,56%) opsežnih resekcija korišćena je tehnika hepatične vaskularne izolacije (kod 6 selektivno klemovanje portne trijade za resektovani lobus i kod 9 bolesnika intermitentno klemovanje hepatoduodenalnog ligamenta po Pringleu). Prosječno vrijeme hepatične vaskularne izolacije iznosilo je 30 minuta. Od ukupnog broja operisanih 16 (59,26%) bolesnika dobili su transfuziju krvi (u prosjeku 450 mL). Prosječna hospitalizacija je trajala 9,3 dana. Komplikacije su se javile kod 5 (18,52%) bolesnika, a nijedan bolesnik nije podlegao intraoperativno i postoperativno. Anatomske resekcije jetre sa selektivnom vaskularnom hepatičnom ekskluzijom i uz upotrebu harmoničnog skalpela ili uređaja za tkivno spajanje jesu uspješne i pouzdane metode sa minimalnim intra-i postoperativnim komplikacijama.
So far, ALPPS (Associating liver and portal vein partition ligation for staged hepatectomy) operation has been performed only as an individual procedure in big specialized centers in developed countries. ALPPS is two-stage curative hepatectomy for which indication is inadequate, the so-called, future liver remnant (FLR). In the case report, we described the case of 63-year-old patient with verifi ed colorectal cancer and large metastases in the liver, to whom we conducted simultaneous resection of the rectal cancer and liver metastases using the ALPPS technique with good clinical results.
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