Introduction. Intussusception is a leading cause of acute intestinal obstruction in young children, most commonly occurring between 6 months and 2 years of age. However, it becomes increasingly rare in older pediatric populations and often presents with atypical features. Among the uncommon variants, ileo-ceco-colo-colic intussusception – where the terminal ileum, cecum, and segments of the colon invaginate into the distal colon – represents an extremely rare and complex entity. Prompt recognition and timely intervention are essential to prevent complications such as bowel ischemia and necrosis. Case presentation. We present the case of a 12-year-old previously healthy female who arrived at the emergency department with acute onset abdominal pain, bilious vomiting, and rectal bleeding. Abdominal ultrasound and contrast-enhanced CT scan revealed a long-segment intussusception involving the terminal ileum, cecum, ascending colon, and extending into the transverse colon. Attempts at non-operative (pneumatic) reduction were unsuccessful. Due to clinical signs of peritonism and suspected bowel ischemia, an emergency exploratory laparotomy was performed. Intraoperative findings confirmed a non-reducible intussusception with segments of non-viable bowel. A right hemicolectomy with primary ileocolic anastomosis was carried out. Histopathological analysis demonstrated hypertrophied Peyer’s patches as a possible lead point, without evidence of malignancy or other pathological lesions. Conclusions. This case illustrates a rare and advanced form of intussusception in an older pediatric patient. Given its atypical presentation and increased likelihood of underlying pathology, older children with suspected intussusception warrant thorough evaluation and early surgical consideration. This report emphasizes the importance of maintaining a high index of suspicion, utilizing appropriate imaging modalities, and pursuing timely surgical management when non-operative reduction fails or complications arise.
Various techniques are used for nipple reconstruction. Based on recent publications, this paper reviews the four most used local flap reconstruction methods: C–V, Star, Arrow, and Skate flaps. All these techniques are relatively simple to perform, associated with few complications, and significantly contribute to patient well-being. They can be performed as a separate procedure or during the same surgery as breast reconstruction. The main challenge common to all these flaps is the gradual loss of nipple projection over time. Therefore, these methods are continually being refined to address emerging issues and improve their applicability in various clinical situations.
Introduction. Cylindroma of the breast is a rare disorder, and only a few cases have been reported in the literature. Due to its rarity, this article was drafted to study the cases published over the last decade and thereby try to explain the current patterns in clinical presentation, diagnosis, treatment, and outcomes. Methods. A systematic literature search was conducted through electronic databases applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results. There were 9 case reports with 10 female patients, ranging in age from 55 to 80 years. Local excision was the most common modality of treatment. The outcome was excellent with no recurrence. Conclusion. Cylindroma of the breast is rare with an excellent prognosis. It needs to be kept in mind as a differential diagnosis of triple-negative breast tumours or the solid basaloid variant of adenoid cystic carcinoma to avoid unnecessary overtreatment with associated morbidity.
Foreign body incidents are common in children, primarily involving ingestion or inhalation. However, transcutaneous migration of sharp objects like sewing needles into the thoracic cavity is exceptionally rare and potentially dangerous. We report a unique case of an intrathoracic sewing needle in a six-month-old infant, highlighting the diagnostic challenges, imaging findings, surgical approach, and the clinical outcome.
Introduction. Acquired arteriovenous malformations (AVMs) often result from minor trauma. AVMs exhibit diverse clinical manifestations and an unpredictable clinical course. This document addresses the management challenges associated with restoring mobility in a patient who experienced severe extension lock of the right knee following repeated sclerotherapy for an extensive arteriovenous malformation of the right vastus lateralis muscle. Main symptoms and important clinical findings. The patient sustained a contusion of the right thigh after a trivial trauma, subsequently developing an extensive arteriovenous malformation in the right vastus lateralis over several years. The patient underwent multiple sclerotherapy sessions with 10% polidocanol for AVM control over one year. Gradually, the patient’s right knee became locked in extension, resulting in functional disability. The main diagnoses, therapeutic interventions, and outcomes. Clinical examination revealed a 10x8 cm stony hard swelling in the lateral aspect of the right thigh. MRI indicated a low-flow venous malformation involving the right vastus lateralis with atrophy of the proximal portion. A CT-angiogram identified a feeder from the medial circumflex femoral artery. The patient underwent surgical exploration and excision of the sclerosed vastus lateralis and part of the vastus intermedius muscle, with a Tensor Fascia Lata graft applied to the exposed femoral bone surface. The patient recovered well, achieving an active knee flexion of 110 degrees, and is now able to sit and drive comfortably. Conclusion. The treatment of AVMs presents significant challenges. Minimally invasive methods are foundational to management but can lead to severe soft tissue fibrosis and functional disability. Surgery becomes necessary in complicated cases and for managing complications arising from minimally invasive procedures. Optimal outcomes require individualized multi-departmental management for all patients.
Charcot-Marie-Tooth (CMT) disease is a genetic neurological disorder that affects the peripheral nerves, leading to impaired muscle strength and sensory function [1]. The disease is characterized by motor and sensory disturbances in the limbs, as well as foot deformities, most commonly pes cavus [2]. Due to amyotrophy in CMT, the muscles are unable to stabilize the joints, resulting in deformities. Improper joint positioning leads to abnormal loading, accelerated cartilage wear, osteoarthritis, and deformities such as equinus, cavus, varus, and valgus [3]. As there is no specific treatment for CMT, symptomatic management and rehabilitation are applied [4]. Surgical intervention is recommended in cases of severe deformities and joint osteoarthritis. Surgical options include soft tissue procedures, corrective osteotomies, arthrodeses, or ankle joint arthroplasty [7, 9, 10]. Early surgical intervention can halt the progression of deformities [17]. This article presents two cases of patients with CMT. The first patient developed cavovarus deformity and end-stage osteoarthritis of both the ankle and subtalar joints. Surgical treatment involved tibiotalocalcaneal (TTC) arthrodesis with an intramedullary nail. The second, younger patient developed cavovarus deformity, which was corrected through early surgical interventions, including bilateral calcaneal axis-correcting osteotomies, subtalar joint arthrodeses with screws, Achilles tendon lengthening, closed wedge osteotomies of the first metatarsals, and lateral ankle ligament reconstruction of the left foot due to ankle joint instability.
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare pancreatic neoplasm with low malignant potential, most commonly occurring in young patients. Although this condition is more frequently diagnosed in adults, it accounts for approximately 8–12% of all pancreatic tumors in children. The diagnosis of SPN is challenging due to its often asymptomatic nature, with tumors typically remaining undetected until they reach a considerable size of 5–7 cm. Furthermore, some patients may present with nonspecific symptoms, which can complicate the diagnosis. The treatment of choice is formal pancreatic resection, during which the tumor is radically removed. Although the long-term prognosis for SPN is generally favorable, postoperative complications such as pancreatic fistulas are common. Treatment of these complications may require antibiotic therapy and drainage of peripancreatic fluid collections. This article presents a clinical case in which a 15-year-old girl was incidentally diagnosed with a solid pseudopapillary carcinoma located in the tail of the pancreas, and underwent formal pancreatic resection. We discussed the importance of close postoperative monitoring and the potential causes of postoperative complications.
Background. Presacral tumors are rare and anatomically complex lesions located between the rectum and the sacrum. Due to their often asymptomatic nature, most cases are diagnosed incidentally. Although typically benign, these tumors are surgically removed due to the risk of complications or malignant transformation. Successful treatment depends on the choice of surgical approach and the preservation of sacral nerves, both of which directly impact patients’ quality of life. This article aims to review the classification, diagnosis, treatment of presacral tumors and the impact of surgical decisions on patients’ quality of life. Methods. A literature review was conducted using databases such as PubMed, Scopus, Web of Science and ScienceDirect. The included studies provide an overview of classification, diagnosis, treatment of presacral tumors, the impact of complications on quality of life and possible strategies for managing postoperative complications and improving patient well-being. Results. Presacral tumors are most commonly congenital, originating from remnants of embryonic tissue. The primary treatment modality is surgical resection, with the approach depending on tumor location and size. While minimally invasive techniques help reduce the risk of complications, surgery may still result in urinary, bowel, and sexual dysfunction, particularly when sacral nerves are affected. To mitigate these complications and preserve quality of life, nerve-sparing strategies, rehabilitation, and individualized postoperative care play a crucial role. Conclusions. The success of presacral tumor treatment depends on early diagnosis, appropriate surgical strategy, and effective management of functional complications. To ensure long-term quality of life, it is essential to integrate nerve-preservation principles, apply minimally invasive techniques, and provide specialized rehabilitation.
Aim. NPWT therapy (Negative-Pressure Wound Therapy) or VAC therapy (Vacuum-Assisted Clousure) – a modern method of wound healing, which significantly improves the course of all stages of the wound process and is relevant today due to the large number of wounded during hostilities in eastern Ukraine. Often these injuries are combined and lead to the formation of large soft tissue defects. The aim of the study. Improving the results of treatment of the wounded with extensive defects of the soft tissues of the torso and extremities through the use of NPWT therapy. Materials and methods. Under our supervision in the period from 2017 to 2023 there were 60 wounded who were hospitalized in the surgical departments of the Military Medical Clinical Center of the Southern Region, who received vacuum therapy in the treatment of wounds. 63.3% had gunshot wounds to the extremities, and 36.7% had soft tissue injuries to the torso. The age of the wounded ranged from 19 to 58 years, among them young people under 30 years of age. Before installing the device, it was necessary to perform surgical treatment with excision of necrotic tissue and removal of fibrin layers. Negative pressure was set at –125 mmHg (arterial) in the non-stop mode for soft tissue defects of the extremities and variable pressure in the –40 mmHg (arterial) mode; –70 mmHg (arterial) for wounds of the anterior abdominal wall. The duration of treatment with NPWT therapy was from 5 to 25 days. The systems were replaced at least once every 3–5 days. Criteria for discontinuation of NPWT therapy were: cleansing the wound of necrotized tissues and fibrin, improving clinical performance, filling the wound defect with granulation tissue. Results and discussion. The use of this method of treatment allowed to close wound defects by autodermoplasty in 35% patients, primary-delayed sutures in 18%, secondary sutures in 25% and local tissue plastics in 22%. Complications after NPWT therapy in the form of re-suppuration of the wound, bleeding or perforation of hollow organs and large vessels were not observed. Conclusions. The use of NPWT therapy can significantly increase the effectiveness of comprehensive treatment of the wounded with damage to the soft tissues of the torso and extremities. It allows you to quickly clean the wound surface, fill the wound defect with granulation tissue and prepare the wound for plastic closure.
Uterine smooth muscle tumors are usually classified as benign or malignant. According to the WHO, there is another group of intermediate neoplasms, known as uterine smooth muscle tumors of uncertain malignant potential. These are rare tumors that display some characteristics of malignancy, but do not fully meet the criteria of leiomyosarcoma. A 71-year-old female with complaints of left-sided abdominal pain was referred to a gynecologist. MRI revealed a heterogenous, ill-defined large mass (10x11,5 cm) with radiologic findings suggestive of leiomyosarcoma. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy. Histological examination revealed only atypical coagulative necrosis with no other signs of malignancy, excluding leiomyosarcoma and leading to the diagnosis of STUMP. Given the possibility of recurrence, close follow-up was recommended. Eight months later, the patient came for a check-up with complaints of lower abdominal pain. A whole-body CT scan was performed, but no signs of tumor recurrence were found. The patient was advised to continue monitoring every 12 months. There are no internationally accepted guidelines for diagnosing and treating of these neoplasms. Total hysterectomy with bilateral salpingo-oophorectomy is considered the most effective surgical treatment for women who are postmenopausal. Given the tumor’s potential to recur as either STUMP or leiomyosarcoma, with a recurrence rate of up to 20%, close follow-up is crucial.
Background. Colorectal cancer is one of the most common and deadly oncological diseases worldwide. Current early diagnostic methods, such as the fecal occult blood test, often lack sufficient sensitivity and specificity, making them potentially unreliable for detecting the disease at an early stage. Recently, an increasing number of studies have highlighted the influence of the microbiota, particularly oral bacteria, on colorectal oncogenesis and their potential use in early diagnostics. The aim of this review is to discuss alterations in the oral microbiota as potential diagnostic biomarkers for colorectal cancer and to assess their reliability and clinical applicability. Methods. This is a literature review analyzing the latest scientific studies selected from the Web of Science, PubMed, Scopus, and ScienceDirect databases. The review examines the translocation of oral microbiota to the gut, their association with intestinal dysbiosis, chronic inflammation, changes in immune response, and the development of colorectal cancer. Results. It was found that certain oral bacterial species, such as Fusobacterium, Porphyromonas, Parvimonas, Faecalibacterium, Rothia, and Tannerella, are frequently detected in colorectal tumor tissues compared to healthy intestinal mucosa. Studies show that these bacteria can migrate from the oral cavity to the gut, colonize the intestinal mucosa, trigger chronic inflammation, and disrupt immune responses and oncogenic regulatory pathways through various mechanisms. Diagnostic models based on oral microbiota taxonomy demonstrated high accuracy (AUC 0.83–0.94) in detecting colorectal cancer, especially when combining saliva and stool samples. Furthermore, some studies suggest that identifying specific oral bacteria may also aid in detecting early precancerous lesions, such as colorectal adenomas, emphasizing their value in early-stage diagnosis. Conclusions. Oral microbiota bacteria hold significant potential as non-invasive and sensitive biomarkers for the early detection of colorectal cancer. In the future, integrating these findings into clinical practice may considerably enhance early diagnostic capabilities for this disease.
Introduction. Vulvar carcinoma is a rare malignancy, whereas rectal cancer is a more common oncological condition. However, the simultaneous occurrence of these two diseases is exceptionally rare. Case presentation. A 76-year-old woman presented with rectal bleeding and was previously diagnosed with keratinizing squamous cell carcinoma G1 of the vulva, unrelated to HPV. Imaging revealed tumor-like masses in the vulva and rectum, with pathological lymph nodes. Biopsy confirmed rectal adenocarcinoma in situ. She underwent obstructive rectal resection, colostomy formation, vulvar resection, and lymphadenectomy. Postoperative antibiotic therapy was administered and discontinued after seven days due to stable inflammatory markers. The patient was discharged in good condition, with planned rehabilitation in a sanatorium. Conclusion. Rectal adenocarcinoma and vulvar keratinizing squamous cell carcinoma concurrent occurrence is very rare. The risk factors for vulvar cancer (HPV, smoking, immunosuppression, lichen sclerosus) and rectal cancer (genetic predispositions, lifestyle factors (e.g., smoking, alcohol consumption), inflammatory bowel diseases) differ. However, genetic syndromes and certain interactions between lifestyle factors may lead to the concurrent occurrence of these two tumors. Given the complexity of managing two primary tumors, a multidisciplinary surgical approach was essential in our case. Further research is needed to explore possible biological links and optimize diagnostic and treatment strategies for such rare oncological presentations.
Background. Hydrocele is the most prevalent cause of painless scrotal swelling. Hydrocelectomy is the gold standard of management for symptomatic hydrocele, but in recent years, aspiration and sclerotherapy have been tried as minimally invasive treatment modalities. Aim of the study. The study aims to evaluate the efficacy, safety, and cost-effectiveness of percutaneous aspiration and sclerotherapy with sodium tetradecyl sulfate (STS) compared to the standard open hydrocelectomy procedure for the treatment of symptomatic hydroceles. Methods. A retrospective analysis of the cases that were treated for symptomatic hydroceles between January 2019 and December 2023 with either open hydrocelectomy or percutaneous aspiration followed by sclerotherapy with a sodium tetradecyl sulfate-based solution was conducted. This study was undertaken after obtaining formal permission from the ethics committee. Primary outcomes included patient satisfaction and procedural success, while secondary outcomes focused on complications and the comparative costs of the procedures. Results. Thirty-seven patients were treated with aspiration and sclerotherapy, and these patients were compared with 34 patients who underwent hydrocelectomy. The mean follow-up for the aspiration and sclerotherapy group was 10.6 months, and for the hydrocelectomy group, it was 18.2 months. The patient satisfaction rate was 76% for aspiration and sclerotherapy and 90% for hydrocelectomy. The overall success rate for aspiration and sclerotherapy was 76%, compared to 86% for hydrocelectomy. The complication rate was significantly lower for aspiration and sclerotherapy (12%) compared to hydrocelectomy (29%). The cost of hydrocelectomy was almost twelve times higher than aspiration and sclerotherapy. Conclusions. Aspiration and sclerotherapy with sodium tetradecyl sulfate provide a minimally invasive, cost-effective, and safe alternative to open hydrocelectomy. Although the success rate is slightly lower than that of hydrocelectomy, its simplicity, lower complication rate, and significantly reduced cost render it a cost-effective and practical first-line approach for managing hydroceles in appropriately selected cases.
Serous tubal intraepithelial lesion (STIL) is a rare benign lesion of the fallopian tube epithelium characterized by atypical epithelial cells with morphological anomalies, marked by the accumulation of p53 protein and normal or slightly increased proliferative activity. STIL is becoming an increasingly investigated type of fallopian tube neoplasm, with differential STIL diagnosis based on the morphology of the fallopian tube epithelium and immunohistochemical markers p53 and Ki-67. Benign intraepithelial changes of the fallopian tube occur in the distal third of the tube and are considered precursors to serous tubal intraepithelial carcinoma (STIC), which ultimately progresses to high-grade serous ovarian cancer (HG-SOC). More precise methods for investigating the fallopian tubes are emerging to detect epithelial changes and neoplasms as early as possible. So far, there are no accurate prognoses for this pathology or recommendations for the further monitoring and treatment of patients.
Background. Intestinal obstruction is a common surgical emergency with diverse etiologies. While adhesions, hernias, and malignancies are frequently implicated, rare anatomical anomalies can occasionally be the cause. Methods. We report a case of a 66-year-old female who presented with complete obstipation for three days. Radiological evaluation revealed dilated bowel loops with a transition point at the distal ileum. Biochemical investigations were notable for metabolic acidosis. Results. Intraoperatively, an anomalous right-sided fallopian tube was identified obstructing the distal ileum, approximately 7 cm proximal to the ileocecal junction. The fallopian tube was resected (salpingectomy). Due to t hinning and impending perforation of the distal ileum, a diversion ileostomy with a distal mucous fistula was performed. Conclusion. This case highlights an unusual cause of small bowel obstruction and emphasizes the importance of considering rare anatomical anomalies in the differential diagnosis of intestinal obstruction.
Background. Rectal cancer is one of the most common oncological diseases in the world. In recent years, robotic surgery has been increasingly used to improve the outcome of this disease. Aim. To review the latest scientific literature on the application of robotic surgery in the treatment of rectal cancer and to evaluate clinical outcomes in patients. Material and methods. The research method is a literature review. Publications were researched in the PubMed and Google Scholar databases using the following keywords and their combinations in English: rectal cancer, robotic surgery, laparoscopic surgery, open surgery. Based on the inclusion and exclusion criteria, 68 scientific publications were included in the review. Results. The average duration of robotic surgery was longer (164.5±47.5–275±60.5 minutes) and was more expensive than other surgical methods. However, patients recovered faster, lost less blood and the hospitalization was shorter (on average 7 days), complications (7.7–22.1%) and local recurrences (0–8.3%) were less frequent and this surgery had better survival rates. The incidence of R0 resection was 90.3–100%, while the incidence of distant metastases was 0–21.1%. No deaths were recorded during the surgery. Conclusions. Robotic surgery is a safe and effective method for treating rectal cancer. It is associated with a lower risk of bleeding, shorter hospitalization, fewer local recurrences, fewer post-operative complications, faster recovery and better quality of life in the long term but requires more economic resources than other surgical approaches.
Parathyroid adenomas, though uncommon, can pose significant challenges in diagnosis and management due to their elusive nature. We present a case report of a 47-years old female who presented with a constellation of symptoms indicative of hyperparathyroidism. Initial laboratory investigations revealed elevated serum calcium levels, corroborated by an increased parathyroid hormone (PTH) level. Further imaging studies, including neck ultrasonography and technetium-99m sestamibi scintigraphy, identified a solitary parathyroid adenoma. The patient’s clinical history, coupled with imaging findings, guided surgical approach towards a minimally invasive parathyroidectomy. Histopathological examination of the excised adenoma confirmed the diagnosis, displaying characteristic features of parathyroid tissue hyperplasia. Postoperatively, the patient experienced a rapid normalization of serum calcium and PTH levels, accompanied by a resolution of symptoms. This case underscores the importance of a multidisciplinary approach in the diagnosis and management of parathyroid adenomas, emphasizing the pivotal role of advanced imaging techniques in localizing these elusive lesions. Additionally, it highlights the efficacy of minimally invasive surgical interventions in achieving successful outcomes with reduced morbidity. The presented case contributes to the existing body of knowledge on parathyroid adenomas, providing insights into their clinical presentation, diagnostic challenges, and the significance of timely intervention. Improved awareness and understanding of such cases are crucial for optimizing patient outcomes and refining diagnostic and therapeutic strategies for this rare endocrine disorder.
