Acute complicated jejunum diverticulitis: a case report with a short literature review.

Introduction: Jejunal diverticulosis is a rare condition. Most of the time, it is asymptomatic; but it can cause severe complications such as intestinal perforation, mechanical occlusion, and hemorrhage. Case presentation: A patient aged 78 years, with a history of biological aortic valve prosthesis, atrial fibrillation, type 2 diabetes mellitus, and chronic obstructive pulmonary disease, presented in the emergency department for acute abdominal pain in the lower abdominal floor, nausea, and inappetence. Abdominal computed tomography revealed an inflammatory block in the hypogastrium, agglutinated small intestinal loops, fecal stasis, and air inclusions. Pulled mesentery and associated internal hernia are suspected. Exploratory laparotomy was performed, revealing an inflammatory block in the hypogastrium, whose dissection revealed inner purulent collection and the appearance of jejunal diverticulitis, a diagnosis confirmed by histopathological examination. Segmental resection of the jejunum with double-layer terminal-terminal enteroenteric anastomosis, lavage, and drainage was performed. The evolution was favorable. Conclusion: Based on our brief review, the diagnosis of complicated jejunal diverticulosis is difficult and sometimes not accurately established, even by high-resolution imaging techniques, with diagnostic laparotomy being necessary for these situations. Surgical treatment should be considered before severe complications develop.

Histological Changes in the Popliteal Artery Wall in Patients with Critical Limb Ischemia.

INTRODUCTION: This prospective study aims to illustrate the histopathological arterial changes in the popliteal artery in peripheral arterial disease of the lower limbs. MATERIAL AND METHOD: A total of 60 popliteal artery segments taken from patients who had undergone lower limb amputation were examined between April and June 2023. The degree of arterial stenosis, medial calcinosis, and the vasa vasorum changes in the arterial adventitia were quantified. The presence of risk factors for atherosclerosis was also observed. RESULTS: Atherosclerotic plaque was found in all of the examined segments. Medial calcinosis was observed in 40 (66.6%) of the arterial segments. A positive association between the degree of arterial stenosis and the vasa vasorum changes in the arterial adventitia was also found (p = 0.025). The level of blood sugar and cholesterol were predictive factors for the severity of atherosclerosis. CONCLUSIONS: Atherosclerosis and medial calcinosis are significant in patients who underwent lower limb amputation. Medial calcinosis causes damage to the arterial wall and leads to a reduction in responsiveness to dilator stimuli.

The Efficiency of Serum Biomarkers in Predicting the Clinical Outcome of Patients with Mesenteric Ischemia during Follow-Up: A Systematic Review.

The initial clinical manifestation of acute mesenteric ischemia poses a diagnostic challenge, often leading to delays in identification and subsequent surgical intervention, contributing to adverse outcomes. Serum biomarkers, offering insights into the underlying pathophysiology, hold promise as prognostic indicators for acute mesenteric ischemia. This systematic review comprehensively explores the role of blood biomarkers in predicting clinical outcomes during follow-up for patients with mesenteric ischemia. A thorough literature search across the PubMed, Cochrane Library, and EMBASE databases yielded 33 relevant publications investigating the efficacy of serum biomarkers in predicting outcomes for mesenteric ischemia. Numerous studies underscore the utility of blood biomarkers in swiftly and accurately differentiating between causes of mesenteric ischemia, facilitating a prompt diagnosis. Elevated levels of specific biomarkers, particularly D-dimers, consistently correlate with heightened mortality risk and poorer clinical outcomes. While certain serum indicators exhibit substantial potential in associating with mesenteric ischemia, further research through rigorous human trials is imperative to enhance their consistent predictive ability during the follow-up period. This study underscores the diagnostic and prognostic significance of specific biomarkers for mesenteric ischemia, emphasizing the necessity for standardized procedures in future investigations.

Metabolic Signatures: Pioneering the Frontier of Rectal Cancer Diagnosis and Response to Neoadjuvant Treatment with Biomarkers-A Systematic Review.

Colorectal cancer (CRC) is one of the most aggressive, heterogenous, and fatal types of human cancer for which screening, and more effective therapeutic drugs are urgently needed. Early-stage detection and treatment greatly improve the 5-year survival rate. In the era of targeted therapies for all types of cancer, a complete metabolomic profile is mandatory before neoadjuvant therapy to assign the correct drugs and check the response to the treatment given. The aim of this study is to discover specific metabolic biomarkers or a sequence of metabolomic indicators that possess precise diagnostic capabilities in predicting the efficacy of neoadjuvant therapy. After searching the keywords, a total of 108 articles were identified during a timeframe of 10 years (2013-2023). Within this set, one article was excluded due to the use of non-English language. Six scientific papers were qualified for this investigation after eliminating all duplicates, publications not referring to the subject matter, open access restriction papers, and those not applicable to humans. Biomolecular analysis found a correlation between metabolomic analysis of colorectal cancer samples and poor progression-free survival rates. Biomarkers are instrumental in predicting a patient's response to specific treatments, guiding the selection of targeted therapies, and indicating resistance to certain drugs.

Intestinal Obstruction as Initial Presentation of Idiopathic Portal and Mesenteric Venous Thrombosis: Diagnosis, Management, and Literature Review.

It is quite common for portal vein thrombosis to occur in subjects who present predisposing conditions such as cirrhosis, hepatobiliary malignancies, infectious or inflammatory abdominal diseases, or hematologic disorders. The incidence of idiopathic portal vein thrombosis in non-cirrhotic patients remains low, and despite the intensive workup that is performed in these cases, in up to 25% of cases, there is no identifiable cause. If portal vein thrombosis is untreated, complications arise and include portal hypertension, cavernous transformation of the portal vein, gastroesophageal and even small intestinal varices, septic thrombosis, or intestinal ischemia. However, intestinal ischemia develops as a consequence of arterial thrombosis or embolism, and the thrombosis of the mesenteric vein accounts for about 10% of cases of intestinal ischemia. Although acute superior mesenteric vein thrombosis can cause acute intestinal ischemia, its chronic form is less likely to cause acute intestinal ischemia, considering the possibility of developing collateral drainage. Ileus due to mesenteric venous thrombosis is rare, and only a small number of cases have been reported to date. Most patients experience a distinct episode of acute abdominal pain due to ischemia, and in the second phase, they develop an obstruction/ileus. Acute superior mesenteric venous thrombosis is a rare condition that is still associated with a high mortality rate. The management of such cases of superior mesenteric venous thrombosis is clinically challenging due to their insidious onset and rapid development. A prompt and accurate diagnosis followed by a timely surgical treatment is important to save patient lives, improve the patient survival rate, and conserve as much of the patient's bowel as possible, thus leading to fewer sequelae.

Enteroscopy versus Video Capsule Endoscopy for Automatic Diagnosis of Small Bowel Disorders-A Comparative Analysis of Artificial Intelligence Applications.

BACKGROUND: Small bowel disorders present a diagnostic challenge due to the limited accessibility of the small intestine. Accurate diagnosis is made with the aid of specific procedures, like capsule endoscopy or double-ballon enteroscopy, but they are not usually solicited and not widely accessible. This study aims to assess and compare the diagnostic effectiveness of enteroscopy and video capsule endoscopy (VCE) when combined with artificial intelligence (AI) algorithms for the automatic detection of small bowel diseases. MATERIALS AND METHODS: We performed an extensive literature search for relevant studies about AI applications capable of identifying small bowel disorders using enteroscopy and VCE, published between 2012 and 2023, employing PubMed, Cochrane Library, Google Scholar, Embase, Scopus, and ClinicalTrials.gov databases. RESULTS: Our investigation discovered a total of 27 publications, out of which 21 studies assessed the application of VCE, while the remaining 6 articles analyzed the enteroscopy procedure. The included studies portrayed that both investigations, enhanced by AI, exhibited a high level of diagnostic accuracy. Enteroscopy demonstrated superior diagnostic capability, providing precise identification of small bowel pathologies with the added advantage of enabling immediate therapeutic intervention. The choice between these modalities should be guided by clinical context, patient preference, and resource availability. Studies with larger sample sizes and prospective designs are warranted to validate these results and optimize the integration of AI in small bowel diagnostics. CONCLUSIONS: The current analysis demonstrates that both enteroscopy and VCE with AI augmentation exhibit comparable diagnostic performance for the automatic detection of small bowel disorders.

Risk factors for and prevention of chronic pain and sensory disorders following inguinal hernia repair.

BACKGROUND: Inguinal hernia repair is one of the most common surgical procedures in man. Immediate postoperative pain is an important issue that can delay hospital discharge. Besides, the presence of chronic pain after herniorrhaphy, which can affect up to 50% of patients, is a growing concern. However information regarding the precise etiological factors of this chronic postoperative pain is lacking. One factor thought to contribute to post herniorrhaphy chronic pain is the surgical procedure for inguinal hernia repair used by the surgeon. MATERIALS AND METHOD: The study was conducted over a period of 5 years and included 1000 consecutive patients operated with inguinal hernia. Each patients completed a questionnaire about the presence or absence of pain or sensory disorders. After completed only 365 of patients remains in the study. From this patients, a total of 38 had different intensity of pain. From those, 13% were operated through an tissular procedure, whereas the laparoscopic procedure was responsible only for 7% of the patients with chronic postoperative pain. Most of the patients had mild or moderate pain and only one patient experienced severe pain. According to the type of procedure performed, in 25 patients were used the tissular procedure and only 12 patients with laparoscopic hernia repair had chronic pain. CONCLUSION: The etiology of chronic groin pain post hernia repair is related in part to nerve injury. This is supported by the high frequency of sensory symptoms and numbness in these patients. However other factors including the role of tissue injury and inflammatory postoperative changes need to be considered. KEY WORDS: Chronic postoperative pain, Inguinal hernia repair, Open surgery, Laparoscopic surgery.

Risk factors for acute cholecystitis and for intraoperative complications.

BACKGROUND: Acute cholecystitis is still frequent in emergency surgical departments. As surgical technique, nowadays laparoscopy is widely used and with low complications and with low postoperative morbidity. MATERIAL AND METHODS: We perform an analytical study about the safety of laparoscopic surgery in patients with acute cholecystitis in a single Surgical Department with an experience of over 20 years in laparoscopic surgery. We included 193 patient admitted in our department during 2014 and 2015. RESULTS: Of the 193 patients, 43% were diagnosed with acute lithiasic cholecystitis (ALC) whereas 56% had chronic lithiasic cholecystitis (CLC). We assessed the comorbidities of the patient via Pearson's Chi-Square test and we found out that there is a significant relationship between acute cholecystitis and high blood tension, obesity and diabetes. Surgical techniques performed were in 95% of cases laparoscopic cholecystectomy and only in 5% we performed open surgery. DISCUSSIONS: Experienced surgeons have a lower conversion rate as compared to less experienced surgeons. For this reason, postoperative assessment criteria have been proposed, with a view to identify the risk of conversion CONCLUSION: In our study laparoscopic surgery for acute cholecystitis is a safe procedure with low intraoperative complication rate and with a reduced hospital stay. KEY WORDS: Acute cholecystitis, Intraoperative adhesion, Intraoperative bleeding, Laparoscopic cholecystectomy.

The Surgical Treatment of Inguinal Hernia Using the Laparoscopic Totally Extra-Peritoneal (TEP) Technique.

UNLABELLED: The surgical repair of inguinal hernia represents one of the most frequent procedures used in general surgery. The new surgical techniques are simpler, with a lower morbidity and recurrence of less than 2%. The laparoscopic totally extra-peritoneal (TEP) technique is contraindicated in complicated hernias (occlusion, incarceration) and in voluminous inguino-scrotal hernias. PURPOSE: The evaluation of the TEP technique, of the risk factors and of the postoperative results on the group of patients who have undergone surgery in the Surgical Clinic 2 Cluj Napoca. MATERIAL AND METHOD: The study is prospective, on a group of 40 patients operated with the TEP technique in the Surgical Clinic 2 during the period May 2013 - July 2014. The following have been assessed: the demographic data, the risk factors, the immediate complications, the recurrence of the hernias. RESULTS: The average duration of hospitalization was 6.79 days. The intraoperative incidents were: 7 minimal peritoneal lesions with pneumoperitoneum and a hemorrhagic lesion of the epigastric vessels repaired endoscopically by the clipping of the lesion. There were 2 recurrences, 24 hours and 1 year after surgery, solved by the Lichtenstein technique. After 30 interventions, the average duration of the surgery was of 64 minutes, being longer in the case of bilateral hernias and being influenced by the team's learning curve. CONCLUSIONS: The TEP technique is a safe option followed by a low rate of complications, a low recurrence rate and low intensity postoperative pain.

The multimodal treatment of central and peripheral cholangiocarcinoma - analysis based on a single center experience.

UNLABELLED: The hilar and intrahepatic location represents the most frequent positioning of cholangiocarcinoma. Late diagnosis, tumour resection - as the sole method of radical treatment require a multimodal approach of this form of malignancy. MATERIAL AND METHODS: The paper is based on a retrospective study conducted on a series of 56 patients diagnosed with hilar and peripheral cholangiocarcinoma admitted and treated in the 3rd Surgical Clinic Cluj-Napoca between September 2004 - December 2010. The series included patients treated with radical or palliative surgical treatment, or patients who underwent minimally invasive treatment of biliary endoscopic or percutaneous drainage followed or not by surgery. We analyzed the data on the postoperative morbidity and mortality, surgical re-interventions, the percentage of patients who received curative resection with radical intention or palliative treatment. CONCLUSIONS: Cholangiocarcinoma is an aggressive form of cancer and commonly diagnosed late. The cholangiocarcinoma resectability results are comparable to those in literature and may be improved by increasing the number of tumor resections with negative resection margins. The main goal of the palliative procedures is the improvement and remission of the obstructive jaundice, in most cases being successful. The multimodality of the cholangiocarcinoma treatment is a reality, but also a goal in the group of patients studied, the number of patients in which the sequential treatment biliary drainage - surgical treatment were applied being still low.