Umbilical endometriosis associated with large umbilical hernia. Case report.

Umbilical endometriosis is a rare condition, usually following laparoscopic and surgical procedures involving the umbilicus.Spontaneous umbilical endometriosis occurring without any previous abdominal or uterine surgery is extremely rare. The maximal depth of penetration of the umbilical endometriosis described is up to fascial level. There have been only two cases of endometriosis reported arising within umbilical hernia. The authors report a case of a patient with spontaneous umbilical endometriosis associated with a large umbilical hernia, treated by surgical excision and mesh repair of the abdominal wall. To the best of our knowledge, this is the first described case of the association of umbilical endometriosis with a large umbilical hernia that requires prosthetic mesh repair of the abdominal wall defect.

Tuberculous lymphadenitis as a cause of obstructive jaundice.

Obstructive jaundice secondary to abdominal tuberculosis is extremely rare. We present a patient with jaundice secondary to compression of the common bile duct by TB lymphadenitis. A 49-year-old woman was admitted to our department for nausea,epigastric pain and jaundice. Abdominal ultrasonography and computer tomography scan were suggestive of stenosis of the distal common bile duct caused by a retro pancreatic mass. At laparotomy, an enlarged lymph node behind the head of the pancreas was found, causing compression and stenosis of the distal parts of the choledochus. The lymph node frozen section analysis showed epithelioid granuloma with caseous necrosis,strongly suggesting tuberculous origin. Choledochoduodenal anastomosis was performed. Definitive pathohistological examination confirmed TB lymphadenitis. ATB should be considered as a potential cause of jaundice especially in immuno compromised patients and endemic areas. Diagnosing abdominal tuberculosis can be a challenging task. No satisfactory diagnostic gold standard is available so that in most cases the diagnosis cannot be reached before exploratory laparotomy.Early detection enables successful conservative treatment and eliminates the necessity of surgery.

[D-dimer in the early detection of deep vein thrombosis in the lower extremity]. / D-dimer u ranom otkrivanju tromboze dubokih vena donjih ekstremiteta.

Deep vein thrombosis is important social and health care problem for its high incidence, pulmonary embolism-related mortality, and long-term sequelae which may be disabling (post-thrombotic syndrome and ulceration). The aim of our work was to determine the diagnostic potential and importance of D dimer in the early detection of deep vein thrombosis of lower extremities. Prospectively we have analyzed a group of 47 patients who were admitted to vascular department of Surgical Clinic in Nis during the period from 1.8.2001. to 31.3.2003. with echosonographically verified deep vein thrombosis of no more than 48 hours of duration. D dimer was measured before anticoagulant treatment started using commercial Nycomed test. The activation of coagulation process was detected with increase in D dimer values in 44 out of 47 examined patients (93.61%). D dimer is highly sensitive diagnostic tool that should be routinely used in the patients with suspected deep vein thrombosis of leg.