[Inguinal endometriosis: two case reports and literature review].

Endometriosis is a common gynecological disease that is characterized by the presence of endometrial glands and stroma outside the uterus. Ectopic endometrial tissue can be localized in all organs of the human body, but it affects most often organs in the pelvis. The localization in the inguinal canal is extremely rare - 0.3% -0.6% of all cases of endometriosis. We report two cases of inguinal endometriosis in patients with a history of previous surgery in the pelvis. Both patients is formation in the inguinal region of increasing volume, accompanied by severe pain especially in the premenstrual period. The diagnosis was based on an exact medical history and histological examination. The main methods of treatment of inguinal endometriosis is radical surgical excision of the lesion. We recommend hormone therapy as an adjunct to treatment.

PRINCIPLES, METHODS AND ALGORITHM BEHAVIOR IN THE TREATMENT OF COMPLICATED LEFT-SIDED COLORECTAL CANCER.

Colorectal cancer (CRC) is a widespread disease and represents an extremely important social--health problem caused by its increasing frequency in recent years, incl. our country. The current high level of development of medical science, oncology and surgery and achieved significant results in the treatment of colorectal cancer, there are still a number of unresolved problems--high morbidity and mortality, higher rates of complicated forms and frequent recurrences, as well as the absence of clear and accurate prognostic criteria defining an exact individual therapeutic and surgical conduct for each patient.

PRIMARY RETROPERITONEAL EXTRA-ORGAN TUMORS (PRET) - SURGICAL TACTICS.

INTRODUCTION: Retroperitoneal tumors, in general, are rare tumors which histopathological characteristics and biological behavior can be considered as benign or malignant. They originate from various tissue elements located in the retroperitoneal space. They often cover Anatomical structures of varying importance - mainly retroperitoneal vessels and organs, which determines the type of surgery - radical or palliative. They are composed of adipose tissue, vascular elements, smooth and striated muscle, neural elements germline structures. There are three main types of retroperitoneal tumors: mesodermal, neurogenic and teratosarcomas. As mentioned above each can be either benign and malignant. In most cases there are no specific symptoms except general weakness, heaviness in the abdomen, loss of appetite, progressive weight loss, headache and fever. The pain is most often located in the lumbosacral area. The tumor can also cause disturbances in urination. In patients with advanced stage can be observed significantly symmetrical or asymmetrical tumor growth in the abdominal area. The most commonly used techniques for the diagnosis of the disease are X-ray, CT-scan and MRI. MATERIAL AND METHODS: Retrospective study involving 112 cases operated in the clinic for 14-years period (2000-2014) - 101 patients, 11 of them were operated on twice in a different time interval on the occasion of relapsed malignant process. RESULTS: Out of all operated cases, 42% are males (47 cases) and 58% - women (65 cases). In most cases (72% - 81 cases) tumors are malignant. All patients were treated surgically. There were followed up a total of 89 patients over a period of 3 months to 8 years (96 months) as of the studied malignant cases 3 year survival was observed in 21 patients, and one patient has survived 96 months after total extirpation of fibrosarcoma. Early postoperative mortality (till 20th postoperative day) was registered in 3 patients - 2.67% of all operated cases. DISCUSSION: About 80% of primary retroperitoneal extra-organ tumors are generally malignant. People of all ages are affected equally and no statistically significant difference in the number of men and women is detected. There are many theories about the emergence of retroperitoneal tumors, but currently none of them has not been fully proven. Treatment depends on the type of the lesion. Surgery is the main approach and it should be applied to both benign and malignant lesions. In the case of malignancy other methods than surgical are chemo- and radiotherapy but they are less effective.

ANESTHESIA CHARACTERISTICS OF A PATIENT WITH HYPERKALEMIC PERIODIC PARALYSIS--CASE REPORT.

We report a case of a successfully conducted anesthesia, without complications of a patient with hyperkalemic periodic paralysis who underwent elective laparoscopic cholecystectomy for chronic calculous cholecystitis. The perioperative considerations, the characteristics of anesthesia, and the factors that can lead to complications in this rare genetic disorder are discussed.

Postoperative complications after Nissen fundoplication.

Anti-reflux laparoscopic operations replaced conventional surgery and are now widely available, because of the advantages of this type of surgery. One of the main reasons for the high complications rate in this type of operations is the lack of experience of the surgeons, although recently in the reports of most leading authors complications and increased mortality rate is due to the older patients undergoing this type of surgery. The main causes of death were gastrointestinal hemorrhage, necrosis with perforation of the esophagus or stomach, cardiac arrest, respiratory and inflammatory complications, and pulmonary thromboembolism.

[Complicated colorectal cancer--aspects of surgical tactics].

Over the period 2000-2011 (6th m) a total of 856 patients with complicated colorectal cancer are subjected to treatment in the Clinic of surgical diseases--Department of Surgery in University Hospital "Alexandrovska", Sofia. Obturation is the commonest form of complication--47 per cent, perforation within the tumor or diastasis noted in 74 cases (8.6 %), paratumor abscesses and infiltrates--in 7.6 per cent and rectohemorrhage--in 4.2 per cent. The therapeutic and operative approach, and the scope of surgery are dependent on a multitude of factors which should be given due consideration by the surgeon. In each patient presenting complicated colorectal carcinoma it is mandatory to make a precise and individual choice of the extent of operative intervention, consistent with the patient's general condition and contributing to eliminate the life-endangering underlying cause. Postoperative mortality in patients with complicated colorectal cancer is 17.1% whereas in radical operated patients without complicated cancer mortality is only 6.8%.

[10 years experience in treatment of rectovaginal fistulas].

We presented our experience in treating 109 patients with acquired rectovaginal fistula operating in the Clinic of Surgery ?? 2001-2009. In 56 patients the modified method used by Gabriel, at 20 a modified method by Gabriel with sphincterolevatorplasty, in 3 abdomino-anal resection with the fall of the sigma in demucosal anal canal, in 13 definitive anus preter and in 17 out temporary anus preter subsequent expression in Gabriel. To allow a conclusion that despite the small number of cases, our results of treatment of rectovaginal fistula are encouraging with good technical and operational performance is a reliable treatment.

[Obstructive syndrome caused by primary colon-rectal cancer].

This is a report on 311 patients presenting colorectal carcinoma with complication assuming the form of occlusive ileus, observed over the period 2005 through 2009. Obturation is the commonest complication of colonic carcinoma (48.9%) with the left colon being more often involved (58.3%). During the same period of time, occlusive ileus against the background of carcinoma of the rectum is diagnosed in 61 cases, representing 37 per cent of complicated forms of this malignant neoplasm. The scope of operative management and the procedure used are largely determined by the location of primary malignancy. The timing of undertaking one or another operative intervention depends on the efficacy of preoperative preparation, degree of occlusive ileus progress, patientr's age, concomitant diseases and the like. Failing to comply with or overlooking some of the aforementioned factors invariably exerts an unfavourable effect on the final outcome of treatment. In each patient presenting colorectal-carcinoma-induced occlusive ileus it is mandatory to precisely specify the scope of surgery, consistent with the patient's general condition, and eliminate the underlying cause jeopardizing his life.