[Types and management of perforations occurring during endoscopic retrograde cholangiopancreatography]. / Az endoszkópos retrográd cholangiopancreatographia során kialakult perforációk típusai és kezelésük.

The authors discuss the incidence of perforation related to endoscopic retrograde cholangio-pancreatography, which is relatively uncommon (0.3-1%) among other types of complications. Perforations can be classified into three types based on their forms and locations. Having reviewed the literature the authors conclude that the most common type is periampullary perforation and the less frequent one is peritoneal perforation. The former usually heals after conservative treatment, while the latter needs an operation. The authors emphasize the important prognostic role of timely diagnosis and surgical treatment if alarming signs (peritoneal, septic) are present. Known predisposing factors, when the procedure needs more careful attention, are also summarized (postoperative status, needle knife papillectomy, intramural contrast media, long lasting examination). After reviewing their own cases, the authors establish that the incidence of perforation in their own centre was four per thousand (10/2400), out of which nine were periampullar and one peritoneal type. In 6 cases operation was necessary, and there was no mortality. The authors conclude that individually tailored therapy can largely reduce the 30-40% mortality rate reported in earlier studies.

[Penetrating atheromatous ulcer of the thoracic aorta. Treatment options]. / A mellkasi aorta penetráló atheromás ulcusa. Kezelési lehetoségek.

INTRODUCTIONS: Atherosclerosis is a generalized degenerative disease of arteries. A rare manifestation of that is the penetrating atheromatous aortic ulceration of the aortic wall which may be complicated by subintimal hematoma, dissection, false aneurysm and rupture (acute aortic syndrome). AIM: The aim of the authors was to analyse their experience with this rare disease. METHOD: In the department of the authors 10,212 patients underwent surgery for cardiovascular diseases. Among these, 18 patients were diagnosed with penetrating atheromatous aortic ulceration located in the thoracic aorta (ascending aorta 2, aortic arch 8, descending aorta 6 and thoracoabdominal aorta 2 patients). Severe comorbidities were present in the majority of patients. RESULTS: Depending on the localisation the authors used various treatment options such as open surgery (4 patients), hybrid techniques (7 patients) and pure endografting (7 patients). One patient died on postoperative day 3. Two patients had late complications due to endoleaks treated successfully by open surgery. CONCLUSIONS: The authors conclude that when this dangerous condition detected in time, a wide variety of open, hybrid and endovascular methods can be applied with good results.

[Diagnosis and treatment of traumatic esophageal perforation.] / A traumás nyelocso-perforáció diagnosztikája, kezelési stratégiája egy konzervatívan sikeresen kezelt eset kapcsán.

Traumatic esophageal injuries are extremely rare and challenging both from a diagnostic and therapeutic point of view. As regards one of their patients, the authors review the etiology and the pathophysiology of esophageal perforations. They present the case of a 36-year-old patient with a penetrating chest trauma. During an acute surgery, the foreign body was removed from the mediastinum, but in the early postoperative period, an oesophageal rupture was recognized. After conservative management, the patient was discharged from the hospital without any complications 82 days after the injury. Considering that the traumatic esophageal rupture is rare and the mortality of these patients is very high, it is important to make a good decision in time. The authors would like to highlight that even in the case of severe penetrating esophageal injury, the right therapeutical decision can lead to complete recovery. Orv Hetil. 2023; 164(43): 1719-1724.

Oesophagus stricture caused by late metastasis of breast cancer / Emlodaganat nyelocsoszukületet okozó késoi áttéte

Oesophageal strictures due to mediastinal metastases from breast cancer mean a significant diagnostic and therapeutic challenge, since they are relatively rare, difficult to identify and detect. In our case, slowly progressive dysphagia developed 19 years after mastectomy. During dilatation of the stricture, which was thought benign first, the oesophagus was perforated. We were compelled to perform an acute transhiatal oesophagectomy with orthotopic replacement and gastric bypass. The treatment method we applied under pressure of necessity differed from our routine protocol at many points, nevertheless, it resulted in the recovery of the patient. Histopathological tissue analysis of the resected oesophagus helped to discover the real pathological reason: mediastinal breast cancer metastasis causing circular and almost complete occlusion.

Complications of endoscopic retrograde cholangiopancreatography / Az endoszkópos retrográd cholangiopancreatographia szövodményei

During the more than 50-year history of endoscopic retrograde cholangiopancreatography (ERCP), it has become an almost exclusively therapeutic procedure from a diagnostic method. This was the result of the evolution of far less invasive diagnostic procedures and the identification of its complications. Nowadays, being aware of these complications is fundamental. Remarkable knowledge has been gathered over the past decades about the risk factors, preventive methods and endoscopic treatments. A significant number of relevant publications from Hungarian authors can be found in this field. In our article, we summarize the complications of ERCP, their definitions, severity classifications, risk factors, prophylactic methods and endoscopic treatments.

[Operative treatment of non-malignant esophageal perforations - a summary of our experiences]. / Nem tumoros nyelocso-perforáció mutéti kezelésével szerzett tapasztalataink.

INTRODUCTION: Despite significant development in surgical and intensive therapy, esophageal perforation is still a severe, life-threatening condition. Successful therapy depends on several clinical factors, available medical equipments, but most of all on the available expertise and experience. PATIENTS AND METHODS: We retrospectively evaluated patients' data operated at the 1st Department of Surgery at Semmelweis University between 2005 and 2017 due to esophageal perforation of non-malignant origin. RESULTS: During the period above 77 patients were treated. All of them were referred to us from an external institute. 15 patients (19%) arrived in shock. The patients developed perforation in 29 cases spontaneously (38%), in 32 cases (41%) during endoscopy, in 12 cases (16%) due to food bolus impaction, and in 4 cases (5%) following balloon tamponade of esophageal variceal bleeding. Patients were sent to our clinic 2.7 days after the presentation of the symptoms. In 2 patients (2%) drainage, in 6 patients (8%) suture, in 8 patients (12%) funduplication, in 19 patients (28%) esophageal exclusion, and in 33 patients (50%) total esophageal extirpation had to be done. 27 patients (35%) died. Discussion, conclusion: Surgical treatment of esophageal injuries is basically influenced by two factors: observation time before surgery and the presence of sepsis symptoms. We have to perform radical surgery basically due to delay. Waste of time is caused by the non-uniform diagnostic strategy and the delay in the true diagnosis.