The article presents a clinical observation of a patient with a pancreatic head tumor, when ultrasound and the standard MSCT protocol with the use of intravenous bolus contrast and multiphase scanning techniques revealed a tumor and its resequence could not be assessed. Inclusion in the protocol of CT scan of perfusion of the pancreas allowed to clearly visualize and localize the tumor, to estimate its size, the relationship with the main vessels. Based on the results of the examination, the patient underwent pancreatoduodenal resection.
A literature review is devoted to the current classifications of liver failure that occurs in obstructive jaundice. Modern methods of diagnosis and criteria for determining the time of development and assessing the severity of this disease, model assessment and prognosis of acute liver failure are also considered. Attention is paid to assessing the severity and determining the timing of the development of liver failure in extrahepatic cholestasis. In addition, there is no common understanding of the role of liver compensatory mechanisms involved in the development of this condition. There are no generally accepted views on the surgical tactics of treatment of patients with obstructive jaundice complicated by liver failure. The limits of application of step-by-step treatment of patients with neoplastic obstructive jaundice have not been reliably determined. All these issues require further research, search for universal tools for assessing liver failure, predicting postoperative complications for choosing the optimal surgical treatment tactics.
The article presents the clinical case of an abscess of the iliopsoas muscle (iliopsoitis), a rare abdominal infectious and inflammatory disease that required a multidisciplinary approach in the diagnosis of this pathology in a multidisciplinary hospital.
Aim. A clinical description of disseminated skin melanoma with endoscopic observation of its pathognomonic pigmented metastases into the stomach.Key points. A 66-yo patient was hospitalised with dyspnoea, general weakness, cough and suspected community-acquired pneumonia. The patient had a complex examination, including computed tomography, which revealed a presumed malignancy of the right lung with secondary changes in the chest and abdominal organs. Esophagogastroduodenoscopy (EGDS) visualised multiple pigmented spots and raised black plaques in cardia and the gastric body diagnosed as a metastasising melanoma in stomach. Endoscopic verification of the metastases confirmed the correct diagnosis of primary skin melanoma.Conclusion. Metastatic melanoma of the gastrointestinal tract has non-specific symptoms and most often occurs during the dissemination process. Endoscopy should be used to correctly verify pigmented mucosal lesions, necessarily allowing for non-pigmented gastric neoplasms in patients with skin melanoma in history.
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