Intraoperative enteroscopy: ten years' experience at a single tertiary center.

BACKGROUND AND METHODS: Intraoperative enteroscopy is an invasive technique for small bowel investigation. It enables us to investigate the entire small intestine and to treat pathological findings by endoscopic or surgical means at the same time. The investigation is invasive and that is why the proper indication is mandatory. RESULTS: Forty-one intraoperative enteroscopies were performed at our center within a 10-year period. The procedure was diagnostic in 37/41 patients (90.2%); in 3 patients no pathology was found, and in 1 patient we found only previously diagnosed celiac disease. The investigation was therapeutic in 35/41 (85.4%) patients; 2 patients with small bowel ulcers did not require any intraoperative therapy. The pathological findings were arteriovenous malformations (found in 12 patients), small bowel NSAID-induced or Crohn's ulcers (8 patients)--ulcerations and arteriovenous malformations were simultaneously found in three patients; carcinoid of the small intestine (5 patients); Peutz-Jeghers syndrome (5 patients); bleeding polyps (2 gastrointestinal stromal tumors, 1 paraganglioma, and 1 lipoma--in 4 patients); Rendu-Osler-Weber disease (2 patients); multiple cavernous hemangiomas in blue rubber bleb nevus syndrome (1 patient); Henoch-Schönlein purpura (1 patient); aortoenteral fistula (1 patient); and retrograde intussusception of Meckel's diverticulum (1 patient). In five patients with Peutz-Jeghers syndrome, 6-22 hamartomas (median of 18 per session) were removed by means of endoscopic polypectomy during intraoperative enteroscopy. There were no major procedure-related complications in our series. CONCLUSIONS: Intraoperative enteroscopy is accepted as the ultimate diagnostic procedure for complete investigation of the small bowel. Despite the introduction of double-balloon enteroscopy into clinical practice, intraoperative enteroscopy will be reserved for those cases where double-balloon enteroscopy cannot be performed or fails to investigate the entire small intestine, especially to prevent excessive bowel resection.

[Intraoperative enteroscopy--personal experience from 1995 to 2002]. / Intraoperacní enteroskopie--vlastní zkusenosti z období 1995-2002.

Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.

[An uncommon cause of acute abdomen--hemorrhage into an accessory hepatic lobe]. / Nezvyklá prícina náhlé príhody brisní--krvácení do akcesorního jaterního laloku.

The author presents the case-history of a young female who was hospitalized because suspicion of acute abdomen. The condition did not call for an urgent operation, during the subsequent examination a hepatoma was suspected. On operation a congenital accessory liver lobe was found, the size of a fist, and was removed. The cause of manifestations of acute abdomen was haemorrhage into its parenchyma.

[Conclusions from the clinical trials of TachoComb, a hemostatic]. / Závery z klinických zkousek hemostyptika TachoComb.

The authors present a report on their very favourable experience assembled during clinical tests of a new haemostatic TachoComb of the company HAFSLUND NYCOMED PHARMA AG Linz Austria which were made at their department before the preparation was introduced in the Czech Republic. Despite the high price the authors recommend that the preparation should be available in every operation theatre in particular for haemostasis of injured parenchymatous organs.

[Ultrasonography in the diagnosis of acute appendicitis]. / Cena UZ vysetrení v diagnostice akutní appendicitis.

By analysis of as group of 147 patients operated in 1996 at the Surgical Clinic of the Faculty Hospital in Hradec Králové on account of acute appendicitis the author evaluates the importance of ultrasonographic examination for the diagnosis. Its sensitivity was, consistent with data in the literature, 64.1%. US examination is valuable in particular in doubtful clinical diagnosis, the clinical examination remains however the basis in the diagnosis of acute appendicitis.

[Colonoscopy in the diagnosis of hemorrhage in the colorectal area]. / Koloskopie jako príspevek k diagnostice a lécbe krvácení z kolorektální oblasti.

The authors submit a retrospective study based on their own material, pertaining to experience with coloscopies in acute and chronic haemorrhage from the colorectal region. They analyze the causes of haemorrhage, and give a detailed histological classification in particular of polyps as possible precancerous conditions. They also compare the clinical value of coloscopy with other examination methods according to their own experience and data in the literature.

[Endoscopic sclerotization as a method of treatment of esophageal varices]. / Endoskopická sklerotizace jako zpusob lécby jícnových varixu.

In the retrospective study of 23 patients the authors are rendering and evaluating their experiences in treating oesophageal varices by endoscopy sclerotization. On the basis of both proper experience and literature sources, they compare the efficiency of their approach with other conservative and surgical procedures. Their own modest experience is collated with the latest literature data. Far from estimating this method as an exclusive one in treating the portal hypertension complications, the authors believe it to be a considerable contribution to improve further destiny of the patients so treated.

[Post-resection states after surgery for gastroduodenal ulcer disease]. / Poresekcní stavy po operaci pro gastroduodenální vredovou chorobu.

A total of 115 patients with gastroduodenal ulcers submitted to surgery at the Department of Surgery in Hradec Králové between 1975 and 1979 had been reported on retrospectively. Authors emphasized the long term postgastrectomy results providing minimally 10-year-lasted intervals since. After a detailed clinical examination of patients, postgastrectomy results may be evaluated as good ones and comparable to a number of literary experiences. Therefore, they estimate this surgical modality of treatment to be justified and appropriate in respect with contemporary indicatory criteria as well as other therapeutic modalities known to exert influence on gastroduodenal ulcers.