Gallstone ileus: analysis of eight cases and review of the literature.

OBJECTIVE: We hereby analyzed a series of gallstone ileus cases operated on in our department starting from a Bouveret syndrome case. METHOD: Retrospective analysis of all gallstone ileus cases who underwent surgery in our department during the last 26 years. We took into consideration diagnostic elements, time from admission to surgery, type of surgery and post-operative outcome. RESULTS: During this period 9,143 gallstones were deferred to surgery; 27 biliary-digestive fistulae were discovered during surgery; gallstone ileus complicated fistula in 8 patients. Gallstone ileus was exclusively present in elderly women with associated comorbidities. Diagnosis was suggested by clinical features of acute or incomplete intestinal obstruction; it was sustained by imagistic studies with different degrees of relevance. The average time from admission to surgery was 2.6 days. Surgical approach varied from simple enterolithotomy to additional fistula repair. The outcome was uneventful in most of the cases with only one exception. CONCLUSIONS: gallstone ileus is a rare condition, occurring in elders with important comorbidities. The choice for surgical procedure depends on the obstructive syndrome's gravity and associated comorbidities; the type of intervention does not significantly influence post-operative morbidity and mortality rates.

Pelvic and abdominal-wall actinomycotic infection by uterus gateway without genital lesions.

We hereby aim to account on a case of actinomycotic infection occurred in a female patient with an intrauterine contraceptive device (IUCD). The infection occurred as a pseudo-tumour which raised differential diagnosis issues with a malignant tumour. The diagnosis has been eventually established following the pathologic examination of paraffin-embedded tissues. Although the infection's gateway was the uterus, the subsequent invasion of the parietal, urinary bladder and lateral rectal walls did not seem to affect the fallopian tubes or the ovaries.

["The fate" of a peri-cystic-jejunostomy in the treatment of the hydatid liver cysts]. / "Soarta" unei anastomoze perichistojejunale a cavitatii posthidatice hepatice.

The persistence of a hepato-jejunal fistula after 9 years from a peri-cystic-jejunostomy in the treatment of hydatid liver cysts is an amazing condition. We discover this kind of fistula during the operation for cholelithiasis. This association between fistula and a "after-hydatid" choledocholithiasis is an opportunity to discuss some pathogenic and evolutive mechanisms about both of two entities.

[The main utility of trans-anastomosis external drainage in the hydatid liver cysts treatment by peri-cystic-jejunostomy]. / Importanta drenajului extern transanastomotic dupa tratmentul chistului hidatic hepatic prin perichistojejunoanastomoza.

We purpose to make a metanalysis of a external drainage and his role in the treatment of the hydatid liver cysts when it was made a anastomosis between peri-cystic cavity and a isolated loop of jejunum. The paper watch 74 cases which were operated in "I. Juvara" surgical clinic and in which it was used the external drainage of peri-cystic cavity. The drainage roles consist in follow up of peri-cystic cavity evolution, but, more than that, in early diagnosis and treatment of secondary infection of cavity, the main postoperative complication. The drainage excludes the possibility of unfavourable evolution of postoperative infection, in which case the result of operation may be compromised.

Predictors for length of hospital stay after inguinal hernia surgery.

AIM: identifying the variables that can help in quantifying/ predicting duration of hospital stay after inguinal hernia surgery. METHOD: 257 patients who were diagnosed with inguinal hernia underwent surgery between January 2013 and October 2014 and were prospectively registered and statistically analyzed by using linear regression with the aim of emphasizing, calculating and validating the predictors for duration of hospital stay. RESULTS: out of 257 patients, 50,7% underwent laparoscopic surgery (TAPP and TEP) and 49,7% had an anterior approach by using the technique described by Lichtenstein in most of the cases. From the variables registered in the study (age, recurrence, emergency surgery, ASA [American Society of Anesthesiologists] risk classification, surgery duration, local and general complications) only the age and presence/absence of complications were statistically associated with the modification of the duration of hospital stay in this pathology. CONCLUSIONS: the duration of hospital stay can be evaluated preoperatory by using a mathematical model, which takes into consideration factors that depend on the patient or the procedure, with results that can have a significant impact on planning the local resources.