Журнал хирургии

Parotid gland tumors account for 80% of all salivary gland neoplasms, 20% of these are malignant, but in daily clinical practice most parotid masses are operated on before obtaining the final histological diagnosis. This clinical setting further complicates the critical point of parotid surgery, which is the management of the facial nerve. We present the case of 54 years old male patient diagnosed with parotid tumor. He underwent a parotidectomy and the postoperative course was uneventful. Different key points of management and of the surgical procedure are highlighted and discussed.

Background: Intestinal malrotation is a rare condition resulting from an incomplete midgut rotation and fixation; most of the cases were diagnosed in the newborn and the presentation at adulthood is traditionally considered as rare. In the same time appendicitis is a very common surgical condition with different clinical presentations and the diagnosis can be challenging especially when there is an alteration to the normal position of anatomical structures.

Case report: We present the case of 19 years old patient admitted for diffuse abdominal pain and dyspepsia. The physical exam revealed peri umbilical rebound tenderness. The biochemical tests revealed an inflammatory syndrome, with leucocytosis (WBC at 12,000/mm3) and elevated CRP (62 mg/L). The ultrasound exam was not contributive. A CT scan was performed and revealed the inflammation of ileo-caecal aria and aspect of intestinal malrotation, the common mesentery. An exploratory laparoscopy was performed and confirmed the acute appendicitis and intestinal malrotation. Appendectomy was performed; the postoperative course was uneventful, and the patient was discharged at 3 postoperative days.

Conclusion: The intestinal malrotation in adults is a relatively rare condition and often asymptomatic. On the other hand, appendicitis is a common condition with various clinical presentations; in cases where peritoneal signs were located elsewhere other than the right iliac fossa, surgeons could bear in mind the possibility of underlying intestinal malrotation, as this could be the first presentation of this congenital condition. The laparoscopic approach is feasible and allows the diagnosis of the intestinal malrotation type and treatment of associated condition.

Patent vitellointestinal duct (VID) can present to us in many variety of congenital intestinal malformations. Patient presents with either anomaly alone or complications secondary to the anomaly. Most common reported anomaly of residual vitelline duct is Meckel’s diverticulum with different presentations like bleeding, intestinal obstruction or diverticulitis. Prolapsed ileal loops through a patent VID is a rare presentation of the above. To date only fifteen cases of this presentation have been reported in the English medical literature but none reported in a premature newborn baby presenting with it from the time of birth, which to the best of our knowledge has not been reported before and therefore this the youngest reported case of its nature in the current English medical literature.

Gall bladder volvulus or twisting is a rare condition and occurs due to rotation of gall bladder. Preoperative diagnosis is exception and usually misdiagnosed as cholecystitis before surgery. It is potentially fatal condition unless diagnosed and treated early leading to gangrene and biliary peritonitis. It has been reported in only about 500 cases in the literature ranging in age given 2-100 years old. We report a rare case of middle aged female 56 years old with volvulus of gall bladder having concomitant cholelithiasis treated with laparoscopic cholecystectomy.

Introduction: Anastomotic leakage (AL) remains one of the most feared complications after colorectal surgery with high mortality rates, prolonged hospitalization, highly risk of readmission, finally generating important costs for any healthcare system. AL prediction and early detection are a considerable challenge for each surgeon as no wellestablished and reliable predictors and diagnosis protocols are currently available.

Aims: To determine the incidence and mortality of AL after colorectal surgery, with identification of possible predictors and improvement points in the management of this complication.

Material and methods: We included 431 patients with colorectal cancer who underwent surgical resection and restoration of the digestive tube’s continuity, at the 2nd Department of Surgery, Emergency County Clinical Hospital of Targu-Mures, from January 2010-December 2015. The patients have been divided in two groups: AL group including 21 patients and no leak group with 410 patients. Demographic characteristics and comorbidities were recorded with clinical and laboratory follow-up in the postoperative period.

Results: There were no significant differences between the two groups in terms of demographic characteristics and comorbidities. The average age of patients with AL was 65.9 ± 11.6 vs. 65.0 ± 10.3 without AL. Male gender was predominant in both groups. No significant differences were recorded in terms of the localization and type of intervention between the two groups. Elevated C reactive protein levels were significantly more frequent in patients with AL (p=0.03). The mortality rate in patients with AL was significantly higher compared to the no leak group 28.6% vs. 1.9% (p<0.0001).

Conclusions: AL remains the most feared complication in colorectal surgery, with high mortality rates, regardless of the localization of the anastomosis and type of intervention. Elevated C reactive protein levels may predict AL being helpful for the early detection and treatment of this complication.

Objective: Sepsis is a common syndrome with devastating implications for health care systems worldwide. Biomarkers may play an important role in highlighting the presence, absence or severity of sepsis.

Materials and methods: This study is an retrospective study, performed on patients with suspected sepsis (81 patients) from a total of 10,483 patients who where presented themselves in the Emergency Department-"Sf. Spiridon" Hospital-Iasi between 01.09.2014-30.10.2014. The study aims was to establish the following aspects: determining the validity of presepsin as a biological diagnostic and prognostic marker of sepsis and mortality at 30 days after presentation moments in the Emergency Department.

Results: The mean age of patients was 64.52 years. Determination of presepsin sensitivity in early diagnosis of sepsis was calculated by generating the ROC curve, the AUC values (Area Under the Curve) obtained were: AUC=0.709, with a standard error of 0.065 for sepsis prediction; AUC=0.866, with a standard error of 0.080 for severe sepsis; AUC=0.864, with a standard error of 0.053 in the case of septic shock. The AUC calculated for presensin susceptibility to mortality was 0.764, with a standard error of 0.062.

Conclusion: Presepsin, determined by using quantitative dosing methods, can be of real use in the staging of patients diagnosed with sepsis, and may be indicative of initiating intensive care to prevent the onset of septic shock. Presepsin may be an early marker of mortality in the septic patient.