Navigating Challenges: Managing Upper Gastrointestinal Bleeding From Cholecystoduodenal Fistula in an Elderly Patient.

Cholecystoduodenal fistula (CDF) is an uncommon condition characterized by an abnormal connection between the gallbladder and the duodenum, often linked to cholelithiasis. It typically presents with nonspecific symptoms such as abdominal pain and jaundice but can occasionally result in severe upper gastrointestinal (GI) bleeding. This report describes the case of a 94-year-old female who presented with hypovolemic shock and multiple episodes of hematemesis. An upper GI endoscopy confirmed a CDF with active hemorrhage. Due to her comorbidities and poor performance status, an endoscopic approach using hemostatic spray was chosen, resulting in a favorable clinical outcome. The development of CDF is typically a result of chronic gallbladder inflammation and cholecystitis, leading to adhesion and erosion into the duodenum. Diagnosis involves imaging and endoscopic techniques, and management varies based on the patient's condition, encompassing surgical, endoscopic, or conservative approaches. This case highlights the necessity of considering CDF in the differential diagnosis of upper GI bleeding, especially in patients with recurrent cholecystitis, and emphasizes the importance of individualized management strategies. It is notable for the use of a minimally invasive endoscopic technique to manage a high-risk patient, highlighting an alternative to surgical intervention.

A Huge Asymptomatic Urachal Mucinous Cystic Carcinoma: A Case Report With Differential Diagnosis and Surgical Considerations.

Cystic mucinous neoplasms of urachal origin cover a wide spectrum of benign and malignant lesions arising from the remnants of the urachus. They display various degrees of tumor cell atypia and local invasion, with no reported cases of metastasis or recurrence after complete surgical resection. We present a 47-year-old man who referred to our Surgical Department due to an abdominal cystic mass incidentally found upon abdominal ultrasound. He underwent en block resection of the cystic mass along with partial bladder dome cystectomy. The histopathology of the resected specimen revealed a cystic mucinous epithelial tumor of low malignant potential with areas of intraepithelial carcinoma. The patient showed no evidence of disease recurrence or distant metastasis 6 months after resection and is scheduled for follow-up with serial MRI or CT scans and blood tumor markers over the next 5 years.

The Impact of the COVID-19 Pandemic on Surgical Activities: A Single-Center Experience and Literature Review.

Aim The aim of this article is to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on our surgical department, which is situated in Athens, Greece, as well as to review published literature on the COVID-19 pandemic's impact on surgical activities in our department.  Material and methods We retrospectively reviewed the surgical procedures that were performed in the surgical department of a tertiary University hospital in Athens, Greece, before and during the pandemic. Furthermore, we performed a literature review evaluating articles on surgical activity and COVID-19 published from the beginning of the pandemic up until the January of 2022 on the PubMed database.  Results In total, 894 patients were included in the study. Of those, 264 (29.5%) underwent surgery during the control period and 630 (70.5%) in the pandemic period. Overall, we performed 20.5% fewer surgeries in the post-sanitary period. In particular, elective surgeries decreased on average by 23.9%, emergency procedures decreased by 8.9%, and oncology surgeries increased by an average of 6.4% after the year 2020. Concerning the review of literature, 51 studies were selected for this review. According to them, the main effect of the pandemic on the surgical sector was reflected in the reduction of total surgeries, mainly due to the postponement of elective surgical procedures, which showed a median reduction of 54% compared to the pre-COVID-19 period. A smaller decrease was observed in the number of emergency and oncological surgeries. Conclusions Reduced surgical activity during the pandemic, due to the health measures imposed, requires courageous corrective interventions to avoid its adverse effects, such as disease progression, increased treatment costs, reduced quality of life, and ultimately the survival of the patients.