Risk factors for post-ERCP complications.

BACKGROUND: In the 21st century, endoscopic retrograde cholangiopancreatography (ERCP) has emerged as a diagnostic and therapeutic method for diseases of the pancreaticobiliary duct system. However, like any other diagnostic and therapeutic method, ERCP carries the risk of unwanted complications. MATERIAL AND METHODS: We retrospectively followed patients who underwent ERCP examinations from January 2013 to April 2023. We focused on early post-ERCP complications and their risk factors, prevention, treatment, and mortality. RESULTS: A total of 4,814 patients were recorded, of which 175 patients had early post-ERCP complications, including acute pancreatitis, acute cholangitis, perforation, and bleeding. We focused on the statistical significance of risk factors such as BMI, repeated ERCP, bleeding disorders, and repeated pancreatitis or cholangitis. CONCLUSION: Ensuring proper preparation and appropriate indication for ERCP examination can significantly mitigate the risk of post-ERCP complications. Additionally, early diagnosis and prompt treatment of any post-ERCP complications are essential strategies for reducing mortality associated with these conditions (Tab. 3, Fig. 3, Ref. 32). Text in PDF www.elis.sk Keywords: post-ERCP complication, risk factor, BMI, prevention.

The Frontal Phocomelia in a 3-Year-Old Girl.

Background: Phocomelia is a congenital limb deformity in which the proximal part of the upper or lower limb does not develop. Occasionally the malformed limb may be located ectopically. Case report: We present a frontal phocomelia in a three-year-old girl with right-hand phocomelia and thoracoschisis. The patient's arm was connected directly from the front of the chest, with a rudimentary thumb and two fingers. The truncated arm was not functional. The acromioclavicular joint was abnormal and ectopic, the limb articulated with the medial side of sternum. The thoracoschisis manifested as eventration of the right liver lobe and right side of chest wall. Conclusion: Ectopic phocomelia can be associated with thoracoschisis, it can be nonfunctional, and can articulate with the sternum.

Bouveret's Syndrome: A Rare Form of Gallstone Ileus Caused by Large Renal Cysts.

Bouveret's syndrome is a rare variant of gallstone ileus caused by gastric outlet obstruction that arises from gallstones impacted in the distal stomach or proximal duodenum after passing through a cholecystoduodenal or cholecystogastric fistula. Simple kidney cysts are one of the most common lesions found in the elderly. They are usually asymptomatic, but the cysts can put pressure on the surrounding organs if they grow to large dimensions.This case report highlights a rare case of Bouveret's syndrome due to the presence of a large gallstone in the pyloric region that was caused by the creation of a cholecystogastric fistula from pressure exerted by two giant cysts of the right kidney.

The Role of Surgery in Chronic Pancreatitis.

Chronic pancreatitis is an inflammatory disease characterized by the progressive replacement of the functional pancreatic parenchyma with fibrotic tissue. This leads to exocrine and endocrine insufficiency. A typical clinical feature is recurrent, severe upper abdominal pain, which negatively affects the patient's quality of life. Conservative treatment as the method of first choice does not prevent irreversible changes in the pancreatic tissue. While endoscopic drainage can have some benefits in the early stages of the disease, it is generally unsuccessful in the long term. Based on recent studies, surgical intervention appears to be the most suitable treatment option for improving the patient's quality of life. It currently includes a wide range of effective, proven drainage and resection procedures. Advances in surgical techniques and postsurgical intensive care have increased the frequency of pancreatic surgeries, while improvements in diagnostic methods have increased the number of patients who meet the indications for such surgery, including elderly and chronically ill patients. However, despite mortality rates decreasing, high morbidity rates remain a problem. Currently, in patients with an inflammatory mass in the head of the pancreas, pyloric and duodenal-preserving resection offers the best results. Different variants of these techniques appear to produce similar results. Various techniques have shown similar outcomes in terms of mortality, morbidity, pain relief, life expectancy and improved quality of life. The optimal timing of surgery has been addressed by several studies and most surgeons now favor early surgical intervention in order to prevent extensive destruction of pancreatic tissue.

Reversed Z-effect and Z-effect phenomena in femoral neck fracture treated with a dynamic locking plate fixation: Case report.

The aim of this case report is to present an unusual mechanism of failure of a dynamic locking plate (DLP), previously reported in dual lag screw proximal femoral nails. A 78-year-old female patient experienced a displaced right femoral neck fracture (FNF) which was managed with DLP. At the postoperative sixth-week appointment, her hip radiographs showed that two of three telescoping screws had slid within the telescrew barrel, and one screw was fully extended and cutting through the femoral head. At the third-month checkup, radiographs revealed an unhealed FNF and 12 mm sliding on all three telescoping screws. At the final 11th-month follow-up, two screws were completely collapsed and the previously nonpenetrating screw was partially extended and cutting through the femoral head. Femoral neck shortening and femoral neck nonunion were noticed as well. In conclusion, the postoperative course of the case supports the hypothesis of a specific pattern of DLP failure resembling reversed Z- and Z-effects found in dual lag screw proximal femoral nails.