Age is a powerful risk factor for development of colorectal cancer but is not a contraindication for surgery, although this surgery is characterised by poor outcomes, increasing morbidity and mortality. Contributing factors include their poor nutritional status, pre-existing comorbidity, polypharmacy, psychosocial issues, delayed diagnoses and frailty. To improve morbidity and mortality, several aspects of care need to be addressed. These include accurate and timely preoperative assessment to identify treatable pathology and, where possible, to consider and correct age specific disease processes. Identification of patients in whom treatment would be futile or associated with high risk is needed to avoid unnecessary interventions and to give patients realistic expectations. Therefore, by the creation of a multidisciplinary approach, where surgeons work side by side with anesthesiologists, geriatricians, physiotherapists, nutritionists and other professionals, can provide favourable surgical outcomes, through improved selection of candidates for intervention and a more considered exclusion of patients characterized by high risk profiles or a poor prognosis.
Background: Cecal diverticulitis is an unusual condition that presents clinically similar to appendicitis. The diagnosis is not always easy and in the majority of cases it is usually made during laparotomy. The aim of the present study is to retrospectively report our experience with solitary cecal diverticulitis, to determine its incidence in patients presenting as an acute abdomen, as well as identify the symptoms and clinical features that may aid in making a pre-operative diagnosis. And to compare this with a review of the literature, focusing on the surgical treatment and also on the indication of appendectomy in the presence of cecal diverticulitis not requiring surgery. Material and methods: Data was collected in patients hospitalized for acute appendicitis or acute abdomen, in the surgical emergency unit of University Hospital Centre "Mother Teresa" Tirana, in a period of 3 years (2015-2017). Sex, age, duration of symptoms, preoperative diagnosis, management, intraoperative findings, histologic examination, length of hospital stay and complications of all patients affected by solitary cecal diverticulitis were reviewed. Results: In the study period, 15 patients presented with a solitary cecal diverticulitis. All patients presented with abdominal pain, additional symptoms were nausea, vomiting and fever. The mean white blood cell count was from 8500-19.200/mm3, while the remaining laboratory results were normal. There were no specific findings on abdominal X-ray or ultrasonography. Intraoperative findings ranged from localized /circumscript peritonitis to generalised peritonitis due to acute diverticulitis and a normal appendix. Surgery ranged from diverticulum resection accompanied to appendectomy, to ileocecal resection, and right hemicolectomy. Conclusions: Cecal diverticulitis should be included in the differential diagnosis of the cases with pain in the right lower quadrant. Preoperative diagnosis of cecal diverticulitis cannot always be made, since the signs and symptoms are similar to acute appendicitis, but is important in order to decide how to manage this condition. Diverticulectomy and incidental appendectomy are the preferred method of treatment in uncomplicated cases. Right hemicolectomy is a recommended treatment option in complicated patients or those suspicious for tumor during surgery.
Introduction: Ascites is of Greek derivation (“askos”) and refers to a bag or sack. The word is a noun and describes pathologic fluid accumulation within the peritoneal cavity. Orientation in finding or excluding portal hypertension through examination of ascitic fluid is the first step towards an accurate diagnosis. Material and Methods: The aim of this study was to evaluate the role of SAAG (Serum Ascites Albumin Gradient) in the differential diagnosis between cirrhotic and malignant ascites. The SAAG is obtained by subtracting the value of serum albumin, the value of ascites albumin (from samples to be taken on the same day) and is a reflection of hepatic sinusoidal pressure. Result: All ascitic fluids were analyzed on the laboratory parameters of ascitic albumin values and at the same time serological albumin through the blood was taken for analysis on the same day as the diagnostic paracentesis. The value of SAAG was calculated for each patient between their two groups: 64 patients with cirrhotic ascites and 8 patients with malignant ascites. Higher SAAG values were found in the group of patients with hepatic cirrhosis (2.02 ± 0.42) compared to the group of patients with malignant pathology (0.68 ± 0.19). Conclusion: This prospective study showed statistically significant differences (p <0.0001) between cirrhotic ascites and malignant ascites in terms of SAAG, emphasizing the important role of diagnostic paracentesis and in particular the SAAG in the differential diagnosis of ascitic fluid, in accordance with cut-off values ≥1.1 g / dl referring to ascites from portal hypertension, which suggests a nonperitoneal cause of ascites.
Background: Intestinal stomas are used to divert the fecal stream away from distal bowel in order to allow a distal anastomosis to heal as well as to relieve obstruction in emergency situation. The aim of the present study was to identify indications for emergency laparotomy, commonly performed intestinal stomas and to study complications related to it.Methods: This is a retrospective study and was carried out in the surgical unit of Mother Teresa University Hospital Center, from January 2017 to August 2018. All patients were admitted through emergency and underwent surgery for various reasons and were followed up to note any complication which resulted in the creation of intestinal stomas, and who fit in to inclusion criteria. Results:The most common indication for stoma formation was colorectal carcinoma (n=77) followed by sigmoid volvulus (n=16), perforated sigmoid diverticula (n=12), recto-sigmoid perforation by corpus alienum (n=6). A total of 106 patients underwent colostomy formation, of which 85 were end colostomy and 21 were Baguette colostomy. Thirty-one (31) patients underwent ileostomy formation, of which 9 were loop ileostomy and 10 were temporary end ileostomy, one was double barrel ileostomy. Nine (9) cases were treated with jejunostomy and 5 cases with duodenostomy. Conclusion:Fecal/intestinal diversion remains an effective option to treat a variety of gastrointestinal and abdominal conditions. Stoma formation is the best minimum surgical procedure to save the life in emergency intestinal surgery for obstructive cancer, inflammatory colic disease, anastomotic leaks with low mortality.
The aim of this study is to assess the complications of T-tube (Kehr) and C- tube (Cystic) drainage used for biliary drainage, following biliary surgery. We evaluate all possible complications, related to the tube in situ, during cholangiography and following t- tube removal retrospectively, during a 4- year period 2016-2019. T-tubes were inserted in 48 patients, with 11 (22.8%) patients experiencing complications related to T-tube. A broad spectrum of complications was found, ranging from biliary-specific complications such as a biliary leak, biliary peritonitis, and retained stones, to systemic general complications as wound infection, pulmonary thromboembolism, and internal hemorrhage. Although this retrospective study has underestimated the incidence of T-tube complications, it has demonstrated significant morbidity related to T-tube use, which poses the need for replacement by minimally invasive surgical techniques.
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