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The paper presents a patient with a traumatic combined injury of pancreas, duodenum and peripancreatic vessels successfully treated by performing duodenopancreatectomy with splenectomy. Severe complications developed in postoperative period: postoperative haemorrhage, intra-abdominal abscesses, biliary and intestinal fistula. The diagnostics and operative treatment of such injury were discussed.
A survey of the literature and of the present series demonstrate a distinct difference in surgical mortality and intestinal morbidity in the immediate postoperative periods. Resection of the intestine with anastomosis has a significantly higher complication rate than does bypass. In this study, the over-all advantage in resecting radiation injured small intestine with reference to reducing severe chronic intestinal signs and symptoms has not been demonstrated.
According to the author's data within a 7-year period in the Regional Hospital 1329 appendectomies were performed, in 7 per cent--for chronic appendicitis. Annually, 51 persons are operated upon per 10,000 population. Late terms of hospitalization were noted in 19.7%, preoperative complications--in 5.2%, mortality--in 0.08%. Some aspects of treatment and complications are discussed.
At the present time only two long-acting somatostatin (SS) analogs, octreotide and lanreotide, are commonly used in the routine therapy. Both analogs have a high affinity mainly to a somatostatin receptor subtype 2 (SSTR2). The established indications for SS analogs treatment include acromegaly, neuroendocrine tumors of the pancreas and gastrointestinal tract, and some gastro-enterologic diseases (pancreatitis, gastrointestinal bleedings, refractory diarrheas, pancreatic and intestinal fistulas). The recent investigations allow to predict the enlargement of therapeutic applications of SS analogs. It concerns pituitary tumors other than somatotropinoma, tumors of other endocrine glands like thyroid and adrenal gland, as well as some non-endocrine tumors. The progress depends on the introduction of new SS analogs with high affinity for SS receptor subtypes other than SSTR2, because some tumors present the high expression of SSTR1 (e.g. prostatic cancers) or SSTR5 (e.g. colonic cancers). Great hopes are connected with the coupling of SS analogs with the radioactive isotopes or non-radioactive cytotoxic agents to destruct the neoplastic cells highly expressing the specific subtypes of SS receptors. The pre- or postoperative in vivo imaging of SS receptors by means of the receptor scintigraphy, as well as the post-operative identification of SS receptor subtypes in the excised tumor tissues using immunohistochemistry, should play an important role in the prediction of the effects of SS analog treatment. Beside oncology, new therapeutic applications of SS analogs could be presumed among others in ophthalmology; it concerns the treatment of progressive Graves-Basedow ophtalmopathy, diabetic retinopathy, glaucoma and corneal diseases connected with corneal vascularization.
A case of an adult patient with intra-abdominal mass syndrome and acute surgical abdomen due to chronic intestinal ischemia with localized perforation and ileal necrosis associated to hepatic granulomatosis and mesenteric adenitis produced by Buerger's disease (thromboangiitis obliterans) is presented herein. The clinical presentation, diagnosis, handling and prognosis of this rare entity were examined.
An analysis of a 121-day of intensive-care therapy of peritonitis and concomitant complications in a patient with Pickwick syndrome and somnolent apnea syndrome is reported. Right hemicolectomy was implemented in the patient for peritonitis, which developed on the 2nd day as a result of perforation of the blind gut at a place of tumor removed in a scheduled colonofibroscopy (CFS). The attempts of intubation of the trachea for as long as one hour failed due to the anatomic peculiarities. Tracheostomy was made. The switching-on of the patient, postoperatively, to spontaneous breathing was highly complicated because of Pickwick syndrome and the appearing dependence in the patient on the respirator. The alternating methods of respiratory support by using apparatus "Servo Ventilator 900" (Vo. Control + PEEP, SIMV, PS, regime CPAP) were a key technique of intensive care during 121 days. The postoperative cause was complicated on the 12th postoperative day by a massive gastrointestinal hemorrhage, by subsequent relaparotomy and a revision of anastomosis. The intensive-care therapy enabled, on the 80th day to transfer the patient, for 3 days, to a spontaneous independent breathing and to feed him, for 2 weeks, in the natural way. The subsequent postoperative cause was complicated by the development of massive decubituses in the lumbosacral area, and by the formation of intestinal fistula with leakages phlegmon in the anterior abdominal wall. The average cost of one day of the complex intensive-care therapy topped 5000 rubles. Because of an overweight (190 kg) the medical care rendered to the patient was complicated. The patient died on the 121 day due to intoxication, renal insufficiency and growing respiratory insufficiency. Finally, it is concluded that there is a necessity to make a motivated collective decision for carrying out any diagnostic invasive methods of examination in such category of patients; and in case of surgical interventions, the intubation of the trachea should be implemented with local spray anesthesia involving the use of fibrolaryngoscope.
We present the clinical case of a 79 year-old patient with hypertension, treated with anticoagulants and known background of right renal angiomyolipoma that is admitted to the emergency ward due to pain and mass in right flank. The CT revealed retroperitoneal haematoma, active renal intratumoral bleeding and hemoperitoneum. A total emergency nephrectomy was carried out. The patient presented an upper intestinal fistula and died on the sixth day after surgery.
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