Omental torsion as a rare cause of pain in the right subcostal space - a case report.

Omental torsion is a rare cause of abdominal emergency. Due to its clinical presentation and according to its localisation it is seldom diagnosed preoperatively as it imitates other more common diagnoses leading to surgical revision quite precisely. In this case report the authors present omental torsion with partial omental necrotisation in the right upper quadrant, imitating acute cholecystitis. The condition was managed by laparoscopic resection with a good clinical course postoperatively.

[Myxoid liposarcoma localised in the peritoneal cavity case report]. / Myxoidní liposarkom v brisní dutine kazuistika.

INTRODUCTION: Liposarcoma is one of rare soft tissue tumours. Usually, it is localised in soft tissues of the extremities, can however be localised even in body cavities. The prognosis depends on the localisation and differentiation of the tumour. CASE REPORT: We present a patient indicated for surgical revision due to recurrence (or persistence) after previous surgery and debulking of a myxoid liposarcoma. Laparotomy with debulking, low anterior rectal resection with coloanal anastomosis, and protective ileostomy were done. No adverse events occurred in the postoperative period. However, another recurrence was observed in the subsequent follow-up. CONCLUSION: Myxoid liposarcoma is a rare tumour with a relatively good prognosis when radically removed; in case of intraperitoneal localisation it however remains a virtually unsolvable problem.Key words: liposarcoma - debulking recurrence.

[Intraoperative sentinel lymph node detection in colon cancer resection - preliminary results]. / Peroperacní detekce sentinelové uzliny pri resekci pro karcinom kolon - predbezné výsledky.

INTRODUCTION: The aim of this paper is to evaluate the results of intraoperative sentinel node detection in colon cancer patients and to compare the number of nodes retrieved per specimen in comparison with standard resection. METHODS: Patients undergoing elective colon cancer resection were included in the study. The specimen and the sentinel lymph node were sent for histopathological examination. A group of patients from 2011 who underwent elective resection served as the study control. RESULTS: The control group comprised 56 patients. The average node count was 12.73 (4-27). The study group included 102 patients; 29 patients had to be excluded because of protocol deviation. Out of the remaining 73 (46 male and 27 female) patients, 24 were N-positive and 2 of them were pN1c. In the remaining 22 patients, the sentinel node was positive in 8 cases, corresponding to a sensitivity of 36.36%. The average lymph node count was 15.97(3-30) after patent blue dye injection. CONCLUSION: Intraoperative sentinel lymph node detection is an easy and feasible method. Despite the low sensitivity, the main positive effect of the method is the increased lymph node count per resection specimen.

Evaluation of three purely polypropylene meshes of different pore sizes in an onlay position in a New Zealand white rabbit model.

BACKGROUND: The aim of the study was to evaluate the influence of the pore size of a polypropylene mesh on the shrinkage and elasticity of the mesh-tissue complex and the inflammatory reaction to the implant in an open onlay hernia repair. MATERIALS AND METHODS: Twenty-one 10 × 10 cm samples of polypropylene meshes of a different pore size (3.0 × 2.8 mm-PP3, 1.0 × 0.8 mm-PP1 and 0.6 × 0.5 mm-PP.5) were implanted in an onlay position in 21 New Zealand white rabbits. After 90 days of implantation the shrinkage, elasticity and foreign body reaction (FBR) were assessed. RESULTS: The shrinkage of PP3 was 30.6 ± 4.3 %, PP1 49.3 ± 2.9 % and PP.5 49.5 ± 2.6 %. The shrinkage of PP3 was significantly lower (PP3 × PP1 p = 0.007, PP3 × PP.5 p = 0.005), PP1 and PP.5 were similar. The elasticity was similar. The strength of FBR in mesh pores was similar. The width of foreign body granuloma layers at the mesh-tissue interface was significantly reduced with increasing pore size (inner: PP3 10.1 ± 1.2; PP1 12.5 ± 2.9; PP.5 17.4 ± 5.2 and outer: PP3 21.2 ± 2.5; PP1 30.6 ± 6.3; PP.5 60.4 ± 14.9). All differences between the widths of granuloma layers were statistically significant (p < 0.010). One animal (PP1) was excluded because of a mesh infection. CONCLUSIONS: Implantation of polypropylene mesh of a pore size of 3 mm in an onlay position is associated with a significant reduction of shrinkage in comparison to a 1 mm pore lightweight and 0.5 mm pore heavyweight mesh. A pore size increase to 3 mm is not sufficient for an improvement of mesh-tissue complex elasticity in comparison to a 1 mm pore lightweight and 0.5 mm heavyweight mesh. Polypropylene mesh with enlarged pores to 3 mm is associated with a similar strength of FBR in mesh pores and a reduced foreign body granuloma in comparison to a 1 mm pore lightweight and 0.5 mm pore heavyweight mesh.

[Clostridium colitis at a surgical department]. / Problematika klostridiové kolitidy na chirurgickém pracovisti.

INTRODUCTION: The aim of our study was to identify risk factors associated with the development of Clostridium difficile colitis and determining the severity of clostridial colitis in a group of surgical patients. Identification of its predispositions is necessary for preventive interventions and effective treatment. MATERIAL AND METHODS: 51 patients diagnosed with clostridial colitis were included in our study. The inclusion criterion was based on laboratory detection of clostridial toxin in each patient. We analysed age, concomitant malignancy, recent surgical intervention, antibiotic and proton pump inhibitors treatment. The severity of clostridial colitis and its correlation to possible risk factors mentioned above was described and statistically evaluated. Non-parametric Fischer test was used for the statistical evaluation. RESULTS: We confirmed the importance of potential risk factors in the evaluated group of surgical patients with Cl. difficile colitis. The course of the disease was described as serious in 39.2% of patients in the study group. Recurrent attack of colitis was diagnosed in 4 patients, in 2 of them the second recurrence, in 1 patient the third relapse occurred. 2 patients with clostridial colitis evaluated in our group died, but the relation of their death to the clostridial GIT infection was not causal and the primary cause of death in both of them was multiple organ failure caused by serious comorbidities. We did not indicate any surgical intervention and no toxic megacolon developed in our study group. We did not detect any statistical correlation between the described risk factors and the severity of colitis. CONCLUSION: Clostridium difficile colitis needs to be recognised as a serious complication, especially in hospitalised patients. Its increased frequency and severity should not be underestimated. Although we can identify potential risk factors, we cannot exclude some of them completely (e.g. antibiotic and PPI treatment). On the other hand, a rational approach to antibiotic treatment in particular can be helpful in reducing the frequency and severity of clostridium difficile colitis.

[Rare internal hernia in the falciform ligament as a rare course of abdominal emergency and infrequent cause of ileus]. / Raritní vnitrní kýla v ligmentum falciforme hepatis jako vzácná prícina náhlé príhody brisní

Intestinal obstruction caused by an internal hernia is considered to be a rare cause of ileus. The rarest of these is herniation through the falciform ligament. In our article we present the case of a 45-year old female patient operated on for small bowel herniation through a defect in the falciform ligament. The loops were laparoscopically repositioned into the free abdominal cavity and the defect was removed by electrocautery. After the operation the patient was stabilised and discharged into outpatient care. Our article also analyses relevant literature and the diagnostic methods because the abovementioned diagnosis is rare and often established as late as postoperatively. Key words: internal hernia - the falciform ligament - iatrogenous defect in the falciform ligament.

[Mirizzi syndrome with cholecystoduodenal fistula--a rare complication of cholecyctolithiasis]. / Mirizziho syndrom s cholecystoduodenální pístelí--vzácná komplikace cholecystolitiázy.

Mirizzi syndrome is a rare complication of the long-term gallbladder stone disease. It's caused by a gallbladder stone impression to the common bile duct wall. The clinical appearance is an obstructive jaundice, pain in right subchondrium and dyspepsia. Higher pressure in the extrahepatal bile ducts leads to biliobiliary or enterobiliary fistula formation. In the described case a cholecystoduodenal fistula was found. Preoperative diagnosis of MS is a medical challenge, and majority of the diagnosis is set introperatively. Surgery is the treatment of first choice. Ignoring the possibility of MS can seriously damage patient's health by injuring bile ducts during the surgery.