Appendicolith as a cause of late complications after appendectomy - a case report and literature review.

INTRODUCTION: Acute appendicitis is one of the most common acute abdominal conditions. One of its complications is postoperative formation of abscesses in the peritoneal cavity or in the retroperitoneal space. Among other things, appendicoliths left in the peritoneal cavity are responsible for this process. Their release from the lumen occurs preoperatively and during the operation. An appendicolith, with the bacteria present on its surface, provides an environment that supports the onset of an infection. CASE REPORT: The authors present a less common case of a retroperitoneal abscess caused by an incarcerated appendicolith. Unusual is the long period between appendectomy and clinical manifestations of the abscess. The patient underwent surgical treatment with abscess evacuation and extraction of the appendicolith. The postoperative course was adequate; wound healing was supported by negative wound pressure therapy. CONCLUSION: During appendectomy, it is necessary to keep in mind the risk of releasing appendicoliths and their role in infectious complications. A conscientious revision of the peritoneal cavity is required, as well as a good surgical technique. If necessary, imaging methods can help to locate the appendicolith in the postoperative period.

Liver abscess as a rare complication of PEG.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is one of the most effective methods of providing long-term enteral nutrition in patients with the impossibility of oral intake. Complications are relatively common. The most common is peristomal wound infection at the site of the insertion and leakage along the cannula. Lesscommon complications are colo-cutaneous fistulas and peritonitis. A very rare complication is liver abscess. CASE REPORT: The authors describe a case of a 51-year-old man with a hepatic abscess with inoperable pharyngeal carcinoma with PEG. The patient was admitted to hospital with a developing septic condition due to a liver abscess. The liverabscess resulted from the buried bumper syndrome of the PEG and subsequent complete dislocation of the bumper into the left liver lobe area.. This condition was treated by a surgical review with abscess drainage and the construction of classical gastrostomy. CONCLUSION: Buried bumper syndrome with its complications, such as a liver abscess is a relatively rare complication, but challenges both the diagnosis and therapy of the syndrome itself. Its management requires a close cooperation between a gastroenterologist and a surgeon. Early recognition and treatment can prevent the progression of the condition to sepsis or a septic shock, which can lead to death.

[Dehiscence of laparotomy after hysterectomy - wound management]. / Dehiscencia laparotómie po hysterektómii - manazment hojenia rany.

Authors of the paper present prospective case report about nursing process and healing of extensive dehiscence of middle lower laparotomy wound in patient after surgical procedure for endometrial carcinoma. The aim of the paper is to describe, analyse and evaluate the process of complicated postoperative wound healing using negative pressure and moist therapy. They emphasize importance of cooperation between particular departments in complicated postoperative wound therapy management. They point out using new and easily available techniques and methods, risk factors elimination and maintenance of the factors that have a positive influence on wound healing.Key words: postoperative wound dehiscence, negative pressure wound therapy, moist therapy, case report.

Treatment results of non-varicose bleeding from upper gastrointestinal tract.

UNLABELLED: Treatment results of non-varicose bleeding from upper gastrointestinal tract are changing by improved endoscopic methods and introduction of new drugs in treatment. OBJECTIVE: Objective of this work was to compare the results in treatment of patients with non-varicose bleeding from upper gastrointestinal tract in two different 5-years periods. MATERIAL: We hospitalised 229 patients with non-varicose bleeding from upper gastrointestinal tract at the Department of Surgery in Faculty Hospital of Martin in the period 1992-1996. (161 men and 68 women, average age 56.7, patients up to 60 were 42.4%). 203 patients were hospitalised in the years 2003-2008 (146 men and 57 women, average age 61.5, patients up to 60 were 54%). METHODS: We compared both groups by retrospective analysis and we evaluated differences by using statistical methods (nonparametric test of independence of the qualitative data). RESULTS: There was only minimal difference in primary conservative and endoscopic haemostasis in both groups. Relaps of bleeding was the same in both groups. Definitive conservative and endoscopic haemostasis was higher by 3.2% in the period 2003-2008 and number of urgent operations decreased by 5.1%. Differences in total mortality were minimal between both groups but postoperative mortality was higher by 5.9% in the years 2003-2008. CONCLUSION: Number of urgent operations decreased due to improved results in definitive conservative and endoscopic haemostasis in the treatment of non-varicose bleeding from upper gastroinestinal tract. There was no significant change in the relaps of bleeding. There were only minimal changes in total mortality between both groups, but postoperative mortality increased in the second period (Tab. 8, Ref. 35).

[Laparoscopic distal pancreatectomy for neuroendocrine pancreatic tumors--initial experience]. / Laparoskopická distálna pankreatektómia pre neuroendokrinné nádory pankreasu--prvé skúsenosti.

INTRODUCTION: Although the first successful laparoscopic distal pancreatectomy in Martin was recorded in 2005, after five years we have successfully established this unique surgical procedure. The aim of this paper is to present two successful laparoscopic distal pancreatectomies in patients with neuroendocrine tumors of the distal pancreas. MATERIALS AND METHODS: Laparoscopic distal pancreatic resection is currently challenging many pancreatobiliary surgeons. Its open alternative is the standard surgery for tumors in the body and tail of pancreas. Laparoscopic distal pancreatectomy meets all aspects of radical oncological resection including lymphadenectomy. Similarly to open resection is often associated with splenectomy, but brings significant benefit to the patient in the form miniinvasivity. The paper gives crucial points of surgical procedure that is still an unique surgery. RESULTS: Although the last 4 months we operated on laparoscopically only 2 patients we present at least the preliminary experience with this method as well as a rich documentation of these procedures. CONCLUSION: Laparoscopic distal pancreatectomy in the hands of an experienced laparoscopic surgeon has the chance to become an alternative to an open surgery.

[Ovarial hyperstimulation syndrome in the differential diagnostics of acute abdomen]. / Ovariálny hyperstimulacný syndróm v diferenciálnej diagnostike náhlej brusnej príhody.

INTRODUCTION: The massive world-wide development of assisted reproduction (AR) technology and marked increase of females with infertility treatment lead to different medical complications. One of them is ovarian hyperstimulatory syndrome (OHSS), potential fatal complication in AR. It demonstrates with abdominal discomfort, nauzea, vomitus, ascites, and general alteration. It can imitate an acute abdomen syndrome, and it can lead to the primary surgical assessment. AIM: The description of OHSS as a cause of an acute abdomen syndrome. METHODS: Authors present a case of OHSS with the symptomatology of acute abdomen, which was handled by surgeon, primarily. CONCLUSION: Consistent patient history, including gynecological history, and careful physical and laboratory examinations with relevant imaging methods lead to the elimination of invasive procedures. OHSS is the most actual in differential diagnosis of acute abdomen in fertile females for that reasons.

[Gastric lymphoma as a cause of massive bleeding in a patient with Castleman's disease]. / Lymfóm zalúdka ako prícina masívneho krvácania u pacienta s Castlemanovou chorobou.

Primary lymphomas of the stomach belong to rare gastrointestinal malignancies. In their etiology very often play role infections caused by Helicobacter pylori. Rare cause of these tumors can be systemic immunopatological disease connected with the immunodeficiency. Authors in their contribution refer about the patient with the gastric lymphoma, in which was Castleman's disease diagnosed by the lymph-nodes biopsy. The patient was hospitalized with massive bleeding from gastric ulcers, which was treated by urgent surgical therapy. The final histological diagnosis was aggressive B-NHL of the stomach.

The significance of clinical markers in the prediction of hemodynamic and cardiac complications of capnoperitoneum in patients at risk.

OBJECTIVES: The aim of this prospective study was to find out the predictive value of concomitant diseases of cardiovascular system (CVS), lungs and kidneys as well as metabolic diseases to be able to anticipate the potential origin of hemodynamic and cardiopulmonary complications as a result of insufflated CO2 peritoneum. METHODS: The study investigated eleven patients at the anaesthetic risk of ASA III-IV and cardiac risk of NYHA II-III in whom elective laparoscopic surgical intervention had been indicated. RESULTS: We have found out that the significance of the increase in biologic ANP markers, catecholamines and PRA was not sufficient to signal the deepening of cardiac dysfunction, latent cardiac failure or hemodynamic disorder (p > 0.01). The courses of regression lines have shown the dependence on the increased IAP (intra-abdominal pressure) of capnoperitoneum in PRA and adrenaline. The reactions of biologic markers correlated with reactions of clinical hemodynamic markers of BP and HR. We have proved that the increased level of IAP causes a significant increase in CVP (p < 0.01) being one of the factors determining the preload of right ventricle (RV) and in coincidence with intact transpulmonary circulation also the optimal function of left ventricle (LV). CONCLUSION: Our investigation of peroperative clinical and biologic markers of hemodynamics and neuroendocrine response to operative stress and development of CO2 peritoneum has proved that the course of laparoscopic operations in patients in the risk group of ASA III-IV and NYHA III does not necessarily have to be deteriorated by complications. It can be assumed that increased values of biologic markers regulate the neurohumoral response in the physiologic range and do not predict a severe CVS dysfunction within its course. (Tab. 2, Fig. 3, Ref. 22.)

[Acute cholecystitis in diabetics]. / Akútne cholecystitídy u diabetikov.

UNLABELLED: Diabetes modifies by its consequences the course of different diseases. OBJECTIVE: In the submitted work the authors compare the course of acute cholecystitis in diabetic and non-diabetic subjects. METHOD: The authors evaluated in a retrospective study a group of 246 patients whom they operated on account of acute cholecystitis. The group comprised 44 (18%) diabetics and 202 (82%) non-diabetic subjects. They compared the two groups in some selected parameters. The significance of differences was evaluated by statistical methods. RESULTS: Significant differences between the groups were found in the pathomorphological finding on the gallbladder, in the incidence of acute cholangitis, comorbidity and early infection to the disadvantage of diabetics. CONCLUSION: The clinical course of acute cholecystitis in diabetics may be masked which is often the reason of inadequate therapeutic radical measures and of subsequent risks of the development of serious perioperative complications. Despite the higher comorbidity in the diabetic-group the perioperative course in the two groups was comparable if early surgery and adequate preoperative preparation were provided.

[Cholelithiasis and acute pancreatitis]. / Cholelitiáza a akútna pankreatitída.

The authors evaluate the results of treatment of acute pancreatitis at the surgical clinic in 1972-1988. In 64% biliary pancreatitis was involved. The group with a more severe, complicated course is formed by 22.1% patients. In that group the mortality rate was 21.6%. In 57% it was accounted for by patients with biliary pancreatitis. In the group with a mild course of pancreatitis (77.9% of patients) the mortality was 0.9%. The approach to treatment of cholelithiasis in the acute stage of pancreatitis must be considered on an individual basis. In the majority of patients disease of the biliary pathways can be treated after control of acute pancreatitis during the primary hospitalization. In some patients surgery of the biliary pathways during acute pancreatitis is indicated. The risk of operation is high. Therefore in some patients endoscopic papillosphincterotomy is indicated.