An unusual case of gastrointestinal tract occlusion, Ladd's syndrome and neuroendocrine tumour of the appendix in a 19-year-old female patient.

Ladd's syndrome is a complex gastrointestinal anomaly that occurs based on congenital intestinal malrotation and leads to midgut volvulus and intestinal obstruction. It is mostly discovered in paediatric patients and presents itself in 90% of cases within the first year of life. It is a rare diagnosis in adult patients. We present the case report of a 19-year-old female patient with chronic abdominal pain and upper-type dyspeptic syndrome. MRI examination of the abdomen showed an abnormal location of the loops of the small intestine predominantly in the right part of the abdomen, caecum and c. ascendens in the epigastrium, duodenojejunal transition compressed and stenotized between upper mesenteric vessels and the aorta, with prestenotic dilatation of the duodenum and stomach and the "whirlpool sign" in mesentery. The patient was indicated for operational procedure and Ladd's operation was successfully performed laparoscopically, where "Ladd's bands" were divided; the procedure also included adhesiolysis, mobilization of the duodenum with its straightening, widening of the base of the mesentery, appendectomy and removal of an incidental solitary mesothelial cyst. A highly differentiated incidental neuroendocrine tumour of the apex of appendix was confirmed by histology. In the discussion, we focus on the rarity of intestinal malrotation in adulthood, clinical manifestation of the disease, diagnostic options and surgical treatment.

Analysis of clinical efficiency and early postoperative complications after cranioplasty.

INTRODUCTION: Despite of being considered a routine procedure, cranioplasty is associated with a substantial risk of failure, or postoperative complications. PATIENTS AND METHODS: Postoperative clinical course and rate of complications was assessed in patients undergoing cranioplasty during years 2015-2019 in a retrospective fashion. RESULTS: The most frequent condition requiring cranioplasty was a presence of bone defect after a decompressive craniectomy for traumatic brain injury (45 patients). Revision was needed in 9 cases (12.68 %), removal of the bone flap was necessary in 5 patients (7.04 %). The most common complication observed was an unintended intraoperative durotomy, occurring in 9 patients (12.68 %), which was, however, not associated with an increased risk of reoperation. Postoperative improvement of motor functions was observed in 7 patients (9.86 %). Improvement of consciousness occurred in 8 patients (11.27 %). Early cranioplasty was associated with significantly higher odds for surgical revision, patients after previous craniectomy for traumatic brain injury had significantly increased odds for the overall occurrence of complications. CONCLUSIONS: After a cranial reconstruction, complications with a various degree of severity may occur and even the result in need of the implant removal. Postoperative improvement of focal neuro-deficit is possible as well as improvement on the level of patient's consciousness (Tab. 2, Fig. 2, Ref. 61).