[Spontaneous rupture of ductus choledochus in acute pancreatitis--a case report]. / Spontánna perforácia ductus choledochus pri akútnej pankreatitíde--kazuistika.

Spontaneous perforation of biliary tree is a rare disease. There are only a few case- reports published in the literature. Due to little success in the preoperative diagnosis, surgical treatment is delayed, which in a high percentage results into fatal complications. Surgeons' opinions of operative treatment in such cases are controversial, but the primary choice is decompressing drainage of biliary tree. Authors of this report present a case of 71 years old woman admitted to the second surgical clinic with the diagnosis of acute pancreatitis. Because of developing signs of peritoneal irritation, the patient was referred for a surgical procedure with the finding of biliary peritonitis and the rupture of ductus choledochus. In the above case, the diagnosis was made peroperatively, where the surgical treatment consisted of drainage of ductus choledochus by Kehr T drain and cholecystestomy by inserting Malecoat catheter into gallbladder. Postoperative period was without complications, the T drain was removed on the 28th day after operation and Malecoat catheter was also removed two days later. Three years after the operation, the patient is in good physical condition with free bile passage according to ERCP. The aim of this report is to bring the attention to this rare, but more importantly serious cause of origin of sudden abdominal event, in order to increase the interception rate concerning preoperative periods and consequent satisfactory treatment.

[Biliary ileus--a rare complication of cholecystolithiasis]. / Biliárny ileus--zriedkavá komplikácia cholecystolitiázy.

The diagnosis of ileus caused by biliary stones occurs very rarely, with the range of 2 % worldwide. This complication of cholecystolithiasis caused by the stone fistulation into gastrointestinal tract and its subsequent obstruction occurs mostly in elderly and has a high mortality rate. During the course of ten years (1996-2006) in the 2nd surgical clinic FNLP in Kosice, 1640 cholecystectomies and 255 operations, due to the obstruction ileus, were performed. Biliary ileus was recorded in four cases. In two cases, the reason being an obstruction caused by a travelled stone into jejunum, one event was caused by a mechanic wedge of a stone in duodenum and in the last event rectosigma was obturated. The diagnostic is relatively difficult because of a nonspecific symptomatology and often negative anamnesis of previous problems with gallstones. According to literature, the most reliable diagnostic method is computer tomography (CT). In our case, abdominal ultrasonography was successful, which pointed out this diagnosis. Gastroscopy localized the place of obstruction, but not its cause and X-ray image showed aerobilia two times. By the use of magnetic resonance cholangiopancreatography (MRCP) the diagnosis was not positively confirmed. Only in one out of four cases, there was a suspicion of the diagnosis of the biliary ileus, which makes its detectability 25%. The aim of this retrospective analysis is the comparison of diagnostic method-options and their range of success in the diagnosis of acute abdomen in our clinic and the entries in the world literature.

[An uncommon localized form of retroperitoneal fibrosis]. / Neobvyklá lokalizovaná forma retroperitoneálnej fibrózy.

The authors describe an uncommon case of a localized form of idiopathic retroperitoneal fibrosis in a 70-year-old patient. They considered the tumour in the right hypogastrium (20 x 18 x 10 cm) malignant. The result of histological examination was surprising--Ormond's disease. The process could not be removed without damaging the common iliac artery. Simple suture of the artery proved unsuitable. During the postoperative period occlusion of the artery developed which was successfully resolved by an aorto-femoral bypass. Half a year after surgery the patient did not suffer a relapse.

[A splenic abscess of unknown etiology]. / Absces sleziny neznámej etiológie.

The authors describe the case-history of a 7-year-old female patient with a lienal abscess of unknown etiology. The patient was treated by classical splenectomy with a very good final outcome. The authors draw attention to the serious character of the disease even nowadays and to contemporary diagnostic and therapeutic possibilities.

[When and how we perform surgery for inguinal hernia in children]. / Kedy a ako operujeme inguinálne hernie u detí.

In the course of 15 years in the authors department 4,694 operations of inguinal hernias and hydrocele were performed in children at the age of 0-15 years. Most frequently children aged 2-5 years were involved (45%). There were 4.5 times more boys than girls and the lateral distribution was also consistent with data in the literature. A relapse of hernia occurred in 33 children (i.e. 0.7%) operated in the authors department and in 19 children originally operated elsewhere. The total percentage of relapses in the group is 1.1%. In 25 children factors were identified which predispose for relapses. Relapses were most frequent in children operated before the age of one year (52%). The authors recommend therefore that operations of these children should be entrusted to a paediatric surgeon.

[Incarcerated scrotal hernia containing a sigmoid colon carcinoma]. / Inkarcerovaná skrotálna prietrz s obsahom karcinómu colon sigmoideum.

The authors describe the case-history of a 65-year-old patient with an incarcerated scrotal hernia on the left side. An unexpected finding in the sac of the scrotal hernia was the sigmoid colon with an obturating tumour. The patient was subjected to two-stage surgery with a favourable final effect.