Role of a Stoma Nurse in the Management of the Specific Stoma-Related Complications.

Nursing care for patients with intestinal stomas is essential for ensuring their comfort, to prevent complications and promote their overall well-being. The quality of life of the patients with stomas can vary widely depending on their ability to adapt to the new physical and emotional state, but also to social changes that came with it. Health care professionals specializing in ostomy care can provide valuable guidance and support throughout the process. This study aims to identify and to summarize methods of nursing care for patients with an intestinal stoma and how these impact the perceived quality of life for those patients. Preoperative evaluation by an entero-stomal therapist and stoma site marking has been proved to reduce postoperative complications. Many of the peristomal skin complications can be prevented entirely by meticulous skin care. Follow-up is essential for the patient with a newly acquired intestinal ostomy to detect and provide treatment for ostomy-related complications that may occur. Regular monitoring and early intervention can help manage parastomal hernias effectively and improve the patient's quality of life.

Hepatocellular Carcinoma with Gastrointestinal Involvement: A Systematic Review.

In this paper, we aimed to evaluate clinical and imagistic features, and also to provide a diagnostic algorithm for patients presenting with gastrointestinal involvement from hepatocellular carcinoma (HCC). We conducted a systematic search on the PubMed, Scopus and Web of Science databases to identify and collect papers oncases of HCC with gastrointestinal involvement. This search was last updated on 29 April 2022. One hundred and twenty-three articles were included, corresponding to 197 patients. The majority of the patients were male (87.30%), with a mean age of 61.21 years old. The analysis showed large HCCs located mainly in the right hepatic lobe, and highly elevated alfa-fetoprotein (mean = 15,366.18 ng/mL). The most frequent etiological factor was hepatitis B virus (38.57%). Portal vein thrombosis was present in 27.91% of cases. HCC was previously treated in most cases by transarterial chemoembolization (32.99%) and surgical resection (28.93%). Gastrointestinal lesions, developed mainly through direct invasion and hematogenous routes, were predominantly detected in the stomach and duodenum in equal measure-27.91%. Gastrointestinal bleeding was the most common presentation (49.74%). The main diagnostic tools were esophagogastroduodenoscopy (EGD) and computed tomography. The mean survival time was 7.30 months. Gastrointestinal involvement in HCC should be included in the differential diagnosis of patients with underlying HCC and gastrointestinal manifestations or pathological findings in EGD.

Nonoperative Treatment of Abdominal Trauma Involving Liver and Spleen.

Introduction: The management of this type of trauma has evolved considerably, especially with the introduction of interventional radiology (angiography, splenic artery embolization - SAE) but also the concept of non-operative treatment (NOT), defined as a follow-up of injuries, without surgery. Material and Method: We have established a strategy for dealing with cases of abdominal trauma with injuries by non-operative treatment (NOT). We applied NOT to 13 patients in 50 (26%), of which 8 were patients with spleen injuries and 5 were patients with liver damage. Most of the lesions were grade II (8 cases), 2 cases were grade I and 3 cases were grade III. Results: There was only one case dealt by NOT, in which surgery was performed 48 hours after admission. In two patients with extravasation of the contrast agent on CT and angiography, angioembolization of the splenic artery was performed, with good results. Control CT was performed at a period that varied between 24 hours and 5 days after admission. The average period of hospitalization of patients approached by NOT was 6,6 days. Conclusions: Contrast-enhanced CT examination remains the basis for NOT initiation, providing the necessary data on the degree of liver or splenic lesion, the size of blood collections and extravasation of the contrast substance but is also the essential imaging exploration in assessing NOT efficacy. Angioembolization can be successfully performed in cases where CT examination and angiography show contrast extravasation. There was only one case included in the NOT, which was operated laparoscopically, but most authors emphasize that this should not be considered a failure of the method.

Role of Contrast-Enhanced Ultrasonography in Hepatocellular Carcinoma by Using LI-RADS and Ancillary Features: A Single Tertiary Centre Experience.

Clinical utility of ancillary features (AFs) in contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS®) is yet to be established. In this study, we assessed the diagnostic yield of CEUS LI-RADS and AFs in hepatocellular carcinoma (HCC). We retrospectively included patients with risk factors for HCC and newly diagnosed focal liver lesions (FLL). All lesions have been categorized according to the CEUS LI-RADS v2017 by an experienced sonographer blinded to clinical data and to the final diagnosis. From a total of 143 patients with 191 FLL, AFs favoring HCC were observed in 19.8% cases as hypoechoic rim and in 16.7% cases as nodule-in nodule architecture. From the total of 141 HCC cases, 83.6% were correctly classified: 57.4%- LR-5 and 26.2%- LR-4. In 9.21% cases, CEUS indicated LR-M; 2.12% cases- LR-3. The LR-5 category was 96.2% predictive (PPV) of HCC. LR-5 had 60.4% sensitivity and 93.6% specificity. PPV for primitive malignancy (LR-4 + LR-5) was 95.7%, with 88% sensitivity, 89.3% specificity and 88.4% accuracy for HCC. LR-4 category had 94.8% PPV and 26.2% sensitivity. CEUS LR4 + LR5 had 81,8% sensitivity for HCCs over 2 cm and 78.57% sensitivity for smaller HCCs. CEUS LR-5 remains an excellent diagnostic tool for HCC, despite the size of the lesion. The use of AFs might improve the overarching goal of LR-5 + LR-4 diagnosis of high specificity for HCC and exclusion of non-HCC malignancy.

One stop shop approach for the diagnosis of liver hemangioma.

Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.

A Rare Case of Walled-off Pancreatic Necrosis Complicated by Splenic Artery Rupture Manifested After Surgical Internal Drainage - Diagnostic and Therapeutic Aspects.

Large walled-off pancreatic necrosis (WON) is a well-known complication of severe acute pancreatitis, and it is associated with significant morbidity and mortality. This is the case report of a rare and potentially fatal complication of WON - a delayed splenic artery rupture close to its origin after surgical drainage. A 44-year old male patient admitted in our Surgical Department and diagnosed with WON evolving without infection for 6 months, after an episode of acute pancreatitis, underwent a Rouxen- Y WON-jejunostomy. In the 4th postoperative day patient presented melenic stools and a selective celiac trunk angiography was performed with the suspicion of a bleeding from the WON. At the initial injection of contrast a small leakage of contrast was observed but did not reappear despite repeated injection. The procedure was aborted, and the patient put under close observation. The 6th postoperative day bleeding re-occurred, and the angiography indicated a breach in the splenic artery. As the patient developed hemodynamic instability in the Radiology Department he was immediately transferred into the operating room and an exploratory laparotomy with suture of the splenic artery was performed. The patient had an uneventful recovery and at one-year follow-up was without any particular problems.

Detection of arterioportal shunt on long term follow-up of a patient diagnosed with liver abscess.

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A rare case of ovarian splenosis.

Splenosis is a very rare entity that often appears following a traumatic rupture of the spleen or after splenectomy and represents heterotopic transplantation of splenic tissue. The ovary is reported as an atypical and rare localization. We report a case of a middle-aged woman, which presented with a left adnexal mass. Transvaginal ultrasonography, computed tomography (CT) and high-field 3T magnetic resonance imaging (MRI) revealed the left adnexal mass. Laparoscopy was performed, and histological and immunohistochemical examination revealed that resected mass was splenic tissue.