Abstract: Abstract
Introduction: The initial diagnosis of intussusception in adults very often can be missed
and cause delayed treatment and possible serious complications. We report the case of
an adult patient with complicated double ileoileal and ileocecocolic intussusception.
Case presentation: A 46-year-old Caucasian man was transferred from the
gastroenterology service to the abdominal surgery service with severe abdominal pain,
nausea, and vomiting. An abdominal ultrasound, barium enema, and abdominal
computed tomography scan revealed an intraluminal obstruction of his ascending colon.
Plain abdominal X-rays showed diffuse air-fluid levels in his small intestine. A double
ileoileal and ileocecocolic intussusception was found during an emergent laparotomy. A
right hemicolectomy, including resection of a long segment of his ileum, was performed.
The postoperative period was complicated by acute renal failure, shock liver, and
pulmonary thromboembolism. Our patient was discharged from the hospital after 30
days. An anatomical pathology examination revealed a lipoma of his ileum.
Conclusions: Intussusception in adults requires early surgical resection regardless of
the nature of the initial cause. Delayed treatment can cause very serious complications
Abstract: Introduction: Nonparasitic splenic cysts are uncommon clinical entity and because of it, there is no
information regarding their optimal surgical treatment.
Case presentation: A 41-years-old female with incidentally diagnosed nonparasitic splenic cyst
which initially was asymptomatic. After two years of follow up, the patient underwent surgery; subtotal
cystectomy and omentoplasty as an additional procedure. Postoperative course was uneventful.
Conclusion: Short and mid term results showed that near total cystectomy with omentoplasty was
a safe successful procedure for treatment of epidermoid splenic cyst.
Abstract: ABSTRACT: INTRODUCTION: An ingested foreign body often passes the gastrointestinal tract without any complications. Foreign bodies, such as dentures, fish bones, chicken bones, and toothpicks, have been known to cause perforation of the GI tract. CASE PRESENTATION: We are presenting a case of a fifty-year-old male with acute abdomen; diffuse fibro purulent peritonitis, i.e. ileum perforation, caused by accidentally ingesting a chicken wishbone. He was treated surgically with ileum resection, and temporary ileostomy. After four months, intestinal continuity was established in the second operation. CONCLUSION: Intestinal perforation by a chicken bone is rare and affects the left colon or distal ileum. The lack of information of ingestion and detection of chicken bones preoperatively are of interest to be considered in the differential diagnosis of acute abdomen, which in this case was treated surgically.
Abstract: Background: Last two decades healthcare system in Kosovo functioned under specific circumstances. During this period malignant diseases were not properly registered and treated as well.
Aim: To analyze trends of incidence and treatment of colorectal cancer in Kosova for the period 1999-2004.
Methods: A retrospective study based on data collected from all histo-pathology laboratories and also from the operative protocols of the single tertiary care hospital in the country. Results were analyzed and compared with the period 1989-1994. Results: A total number of new cancers of colon and rectum for the period 1999-2004 was 528, 7.5 % of a total number of new cancer cases for that period. Incidence rate of colorectal cancer has had a gradual increase (12.6%) from the average), that was significantly higher compare to 1989-1994. Surgical procedures with radical intention increased by years, and overcome palliative surgical procedures in 2004 with the ratio 73.4%: 26.4%.
Conclusion: Incidence trend of colorectal cancer in Kosova has been increased during the analyzed period. The percentage of diagnosis in advanced stage of disease is still very high, but the trend of surgical treatment with radical intention was increased from 37.5% in 1989 to 73.3% in 2004. It is an immediate need to setup the infrastructure for implementation of complete therapeutic options in the country.
Abstract: Abstract
Nosocomial infections constitute an important public health problem in developing and transitional countries.
Kosova is the poorest country in Europe and communicable diseases are a major health problem. The annual
per capita government expenditure in health care is only 35 €. Infection control in Kosova is in its infancy.
The main challenges in this field are the lack of financial support and political commitment, an inadequate
number of trained personnel, overcrowded wards, poor management and technological gap. In the past,
infection control was limited to passive monitoring. Nosocomial infections were denied or hidden by hospital
administrators. The public and mass media have had a great impact on the initiation of governmental activities
in the field of safety and quality in health care institutions. A turning point in the approach to infection control
was pressure from the mass media after an MRSA outbreak in the ICU during December 2005. Government has
institutionalized infection control through the National Committee for Prevention and Control of Nosocomial
Infections. Although devoid of any funding, the committee is making small steps towards ensuring safer care
in health care institutions. Future steps in infection control should ensure the sustainability of any initiated
activities.
Abstract: BACKGROUND: Abdominal surgical site infections (SSI) cause substantial morbidity and mortality for patients undergoing operative procedures. We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo (UCCK). METHODOLOGY: Prospective surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006. CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance (HELICS) protocol. RESULTS: A total of 253 surgical interventions in 225 patients were evaluated. The median age of patients was 42 years and 55.1% of them were male. The overall incidence rate of SSI was 12%. Follow-up was achieved for 84.1% of the procedures. For patients with an SSI, the median duration of hospitalization was 9 days compared with 4 days for those without an SSI (p < 0.001). Surgical procedures were classified as emergent in 53.3% of cases. Superficial incisional SSI was most common (55%). Clinical infections were culture positive in 40.7% of cases. Duration of operation, duration of preoperative stay, wound class, ASA score > 2, use of antibiotic prophylaxis and NNIS class of > 2 were all significant at p < .001. The SSI rates for the NNIS System risk classes 0, 1 and 2-3 were 4.2%, 46.7% and 100%, respectively. CONCLUSIONS: SSI caused considerable morbidity among surgical patients in UCCK. Appropriate active surveillance and infection control measures should be introduced during preoperative, intra-operative, and postoperative care to reduce infection rates.
Abstract: Gastric lipomas are rare tumors, accounting for 2%-3% of all benign gastric tumors. They are of submucosal or extremely rare subserosal origin. Although most gastric lipomas are usually detected incidentally, they can cause abdominal pain, dyspeptic disorders, obstruction, invagination, and hemorrhages. Subserosal gastric lipomas are rarely symptomatic. There is no report on treatment of subserosal gastric lipomas in the English literature. We present a case of a 50-year-old male with symptomatic subserosal gastric lipoma which was successfully managed with removal, enucleation of lipoma, explorative gastrotomy and edge resection for histology check of gastric wall. The incidence of gastric lipoma, advanced diagnostic possibilities and their role in treatment modalities are discussed.
Abstract: INTRODUCTION: Although intestinal anastomoses are mainly made by staplers, manual anastomoses are still in use worldwide. In previous studies, single layer anastomosis has shown better results compared to double layer techniques. PURPOSE: To test experimentally some aspects of three different single layer anastomotic techniques in order to identify advantages and disadvantages of each. MATERIAL AND METHODS: The study was done on Sprague Dawley rats. Animals were randomly divided into four groups. Three experimental groups consisted of 21 animals each, and the fourth sham group contained 10 animals. By 7 animals of each group were sacrificed on the 4th and the rest of 14 animals on the 7th postoperative day. In all groups the resected distal part of the colon was anastomosed using Halsted, Gambee and Gambee-Halsted technique. To evaluate each specific technique the following were used: postoperative complication frequency, biomechanical measurements, adhesion density, condition of intestinal lumen and histological parameters of the healing process. RESULTS: The complication frequency was not significantly different between the tested techniques. The average bursting pressure and tensile strength were higher on both the 4th and 7th postoperative days with the Gambee technique. In the colon segments removed on the 4th postoperative day 97% of pressure induced ruptures occurred in the anastomotic line, whereas on the 7th postoperative day 76% of ruptures occurred about 1cm distal to the anastomotic line. CONCLUSION: The Gambee technique had significantly better biomechanical and histological results compare to the other two anastomotic techniques. Adhesion density was significantly lower in the control group (p<0.001).
Abstract: INTRODUCTION: Hepatic hydatidosis has been a common pathology for decades in our department. In the past were used different surgical methods to manage liver hydatidosis, but, a method of choice still is not found, especially for treatment of large liver hydatid cysts. OBJECTIVE: To analyze the outcome of different surgial methods used for treatment of large hepatic hydatid cysts in our department over a period of 12 years. MATERIAL AND MEDTHODS: A retrospective random chart review of patients with liver hydatid cysts treated surgically during 1981-1990 and 2000-2001. RESULTS: A total of 183 patients were studied: 110 (60.1% = female, 73 (39.9%) male; the medican age was 37 years (range 17 to 81); the mean preoperative ultrasonographic diameter of cysts was 13.05 cm (median 11.3 cm and maximal 22.3 cm). 72.7% of cysts were localized in the right hepatic lobe and 27.3% in the left hepatic lobe in 21 (11.5%) patients two different cysts in both hepatic lobes were found. Following surgical methods were performed; in 50 (27.3%) patients endocystectomy and capitonnage, in 10 (5.4%) patients external drainage, in 115 (62.8%) endocystectomy and partial pericystectomy with omentoplication according Papadimitris and in 8 (4.4%) opatients complete pericystectomy or atypical liver resection. In 31 (16.9%) choledochal T-tube was placed. Mean postoperative hospital stay was 15.7 days (minimum 5, maximum 71). Overall complication rate was 18.8%, there was no mortality. CONCLUSIONS: Enucleatin of endocysts and partial pericystectomy witzh omentoplication accroding Papadimitris was most often used last years. Endocystectomy with capitonnage as well as external drainage that were used in the past for treatment of large hydatid hepatic cysts, had a more postoperative complications and longer hospital stay compared to the method of Papadimitris.
