[Percutaneous drainage of abdominal fluid collections guided by computer tomography]. / Perkutana drenaza tecnih kolekcija u abdomenu vodena kompjuteriziranom tomografijom.

During the war, June 1992,-August 1994, at the Institute 20 percutaneous fluid collections and abscesses drainages in the belles were done, controlled by the CT. The percutaneous drainage we started in 1984, until now we had 141 cases, 20 cases in the war time, 14 of them were wounded, while the rest was suffering from a malignant process in stomach, pancreas, kidneys. Both groups had post-operative complications after liver injuries. 7 underwent the percutaneous drainage. The length was 1-64 days, drainage contents quantity was 60-5.000 m. The drainage was successful with 14 patients, while in 5 cases we had to repeat, change the catheter place. Only with 1 patients the drainage was not done, but an aspiration. The contents were send to microbiologic analysis. It was a retro-peritoneal abscess collection. Based on our ten-years experience, we are of an opinion that the CT controlled percutaneous drainage is a very efficient, simple and acurata urgent radiology procedure. According to our experiences, nearly all cases were successful.

[Injuries of the liver]. / Povrede jetre.

In first 9 months of the war, on our Clinic we accepted 138 wounded with injury of liver, diagnosed during the operation. Injuries of liver are classified (Moor) on 5 groups. Harder injuries are treated using: deep sutturae of liver or debridman with haemostasis, with deep sutturae, resection of liver, tamponade of hepatotomia. Each surgery is analysed. The most frequent way of treating was with deep sutturae with or without debridman. Concerning the small mortality 7.2%, and rare complications 3.2%, this way of treating is accepted under condition to analyse indications for using this method.

[Castleman's angiofollicular lymphoma as a cause of anemia and splenomegaly with indications for splenectomy]. / Castlemanov angiofolicularni limfom kao uzrok anemije i posljedicne splenomegalije s indikacijom za splenektomiju.

The physiology of the spleen is very complex and has a series of factors, which request a more detailed explanation. With different blood diseases, namely, the reticulo endothelium system the spleen more or less, plays the central part in the general pathological events. Indication for splenectomy requests many internal, haemotologic, immunologic examinations and a close cooperation with the surgeon. The failure of a performed splenectomy is seldom related, directly to the surgical techniques, more frequent with a bad ante operationem assessment, namely predictable assessory spleen, which continues to play the splenogenous disfunction. Such a "clinical misunderstanding" we had in the case presented in the paper. We spoke of our experiences with a patient who suffered from anaemia and an enormous enlargement of the spleen. After the splenectomy anaemia, unfortunately, was persistent. During the operation we found a tomefact (as big as a nut) located on the right side, paravertebral in peritoneum. The probatory cutting off was sent to the pathologist, we asked for a verification. We were warned by the pathologist to extract in toto. Only in that way the mentioned symptoms might disappear, the existing anaemia, too.

[The Mirizzi syndrome in biliary surgery]. / Mirizzi sindrom u bilijarnoj kirurgiji.

In the paper are 2 cases of the so called Mirizzi's syndrome presented, as a special clinical entity in the surgery of the biliary tract. Pablo Mirizzi (Cordoba, Argentina, 1948) performed the basic scientific observations, so the syndrome was named after him. There are 4 basic components: 1. Anatomic variations of the gall entrance, namely ductus cystic with the main gall canal, while ductus cystic has a prolonged parallel course with choleductus, 2. Impacted concrement in the gall throat or even ductus cystic, 3. A part of entire choleductus compression with extra luminar pathologic substrate, and 4. The consequences of the gall recurrent cholangitis, namely cholangitis cirrhosis. A long lasting compression of the choleductus wall due to the jammed concrement, sooner or later, may bring to the wall necrosis and penetration of the concrement into the choleductus lumen (make a bilio-biliary fistula) with all the perils. The mentioned circumstances, in the course of the operation being a number of serious post-operative complications (being obvious from the presented cases). Now days, a great importance is given to the Mirizzi's syndrom in the prevention of the post-operative complications relating to the outstanding clinical entity.

[Rare anomalies in the development of the appendix]. / Neke rijetke anomalije u razvoju crvuljka.

Anomalies of the appendix are extremely uncommon. Cases of complete agenesia have been reported only few times. Even "lucky" surgeons usually do not have the opportunity of seeing in more than once in ca career. Abnormal development of the appendix usually takes the form of a double appendix. About 60 such cases have been reported so far describing several types of the abnormality. Type A is described as a single appendix with the body or tip branching, or, alternatively, completely divided like a double-barreled gun. Type Bis described as occurrence of completely separated appendices with bases also being located on different sites of the cecum (the avian type) or with both bases springing from the intestinal tenia (tenia-coli type). Type C is a doubled cecum, each containing its own appendix. Type D is a horseshoe appendix with two openings at the common cecum All these anomalies are of great practical importance, and a surgeon has to bear them in mind during an operation, since in case he overlooks them the operated patient may experience grave consequences. They also may be the forensic issue in cases when repeated explorative laparotomy reveals "previously removed" vermiform appendix. We report a case of a horseshoe appendix with mesenterial incarceration of the terminal ileum and resulting partial intestinal gangrene necessitating intestinal resection and terminolateral ileotransversostomy. The postoperative course was characterised with partial gangrene of the cecom and fistula of the intestines on a completely intact part of the intestinal wall which could be explained by possible presence of anomalous vascularization in the area.

[Problems in the diagnosis of rupture in echinococcosis of the spleen due to trauma]. / Problemi dijagnostike rupture ehinokoka slezine kod traume.

Success of surgical therapy with urgent states in abdomen depends upon giving indication for operation in right time, which is possible owing to quick diagnosis of acute abdomen caused both by trauma. The presented case of perforation of echinococcus of spleen on the occasion of indirect trauma of abdomen, was not diagnosed in consideration of non-symptomatic development before trauma. CT was determinant in the early diagnose.