Mediastinal tumors represent a wide spectrum of epithelial, mesenchymal, neuroectodermal, embryonal, germ cell, and mixed neoplasms. Nevertheless, their incidence is low, accounting for approximately 1% of all neoplasms, and clinical presentation is often nonspecific usually reflecting advanced-stage disease. Primary mediastinal tumors must be distinguished from secondary tumors and so-called pseudotumors. From the perspective of their classification, diagnostics, and therapy, the anatomical--topographical division of the mediastinum into compartments is essential, as it may facilitate identification of individual lesions based on their typical localization and imaging characteristics. Surgical resection represents the first-line therapeutic modality for the majority of mediastinal lesions, with the exception of lymphomas and germ cell tumors. Authors present an overview of mediastinal tumors in adults, including their diagnosis and treatment.
BACKGROUND:Monteggia lesion (ML) is a complex and rare injury in children that requires expert diagnosis and treatment. Failure to recognize or insufficiently diagnose this condition can be catastrophic for the child in terms of upper-limb motor function. The aim of this study is to analyze retrospective data of patients with ML treated at the Department of Pediatric Surgery, Comenius University and National Institute of Children's Diseases in Bratislava between 2010 and 2020, and to evaluate treatment outcomes. MATERIAL AND METHODS:A retrospective analysis of 131 patients with ML was performed and categorized according to the timing of management: acute (within 24 hours), subacute (after 24 hours), and chronic (after more than 3 weeks). Treatment outcomes were evaluated using the Anderson scoring system. For statistical analysis, non-parametric methods were used: the Wilcoxon paired test to compare pre- and postoperative changes, and the Kruskal-Wallis test to assess differences among the three groups. RESULTS:Out of the 131 patients, 95 were diagnosed with ML (72.5%) and 36 with Monteggia equivalent lesions (EML; 27.5%). In the acute group, 63 patients received treatment with excellent outcomes. Patients with EML achieved satisfactory results, but with a higher rate of surgical intervention. Among chronic ML cases, functional outcomes improved in 13 out of 15 patients (86.6%). CONCLUSION:Rapid and accurate diagnosis and treatment of ML are essential to prevent complications and to ensure optimal outcomes. Chronic ML often leads to poorer results, underscoring the importance of early recognition and prevention.
INTRODUCTION:Acute mesenteric ischemia is a rare but serious vascular complication often accompanied by intestinal damage. Treatment typically involves surgical and endovascular procedures. Proper diagnostic and interventional techniques are critical for preventing complications, resulting in short bowel syndrome, sepsis or need for repeated surgeries. Based on the case report, our publication provides an overview of managing acute mesenteric ischemia with intestinal involvement, highlighting both conventional and modern treatment approaches. CASE REPORT:A 57-year-old woman with thyrotoxicosis suffered from acute visceral ischemia, caused by subtotal obstruction of the superior mesenteric artery along with small bowel infarction. After surgical arterial recanalization and intestinal resection, despite palpable pulsations in the hepatic region, a new occlusion of the accessory right hepatic artery was diagnosed.Following the second revision, blood flow was restored. During follow-up, abdominal complaints recurred, requiring ileocecal resection due to delayed ischemic changes. CONCLUSION:Causes of visceral ischemia are multiple. Effective diagnosis and treatment require an interdisciplinary approach. This includes open, endovascular, or hybrid techniques combined with intestinal resection.
INTRODUCTION:Infective endocarditis (IE) is a serious disease with a high mortality rate. Complications of IE are frequent and serious, most of them manifesting as various forms of ischemia. Its rare, but equally serious complications include development of mycotic pseudoaneurysms of peripheral arteries. Total incidence of these aneurysms in connection with IE is approximately 2%. Out of this number, the majority affect intracranial arteries, while the remaining lesions occur equally in visceral and limb locations. We present a case report of a rapidly progressing popliteal artery aneurysm with a fistula into the venous system in a patient after mitral valve replacement. CASE:We present the case of a 70-year-old man with a history of diabetes, hypertension, and post-STEMI who underwent mitral valve replacement for infective endocarditis. A complication occurred postoperatively in the form of a multidrug-resistant polymicrobial respiratory infection. Ten days after transfer to the local hospital from the cardiovascular center, deep vein thrombosis of the right lower extremity developed despite effective anticoagulation. Subsequent diagnostics revealed a rapidly progressing aneurysm of the popliteal artery with destruction of the vascular wall and arteriovenous fistula. The patient underwent urgent resection and reconstruction of the artery and deep vein with autologous vein grafts. The case demonstrates rapidly progressive complication of polymicrobial sepsis after infective endocarditis emphasizing the need for early diagnosis and aggressive surgical and antimicrobial therapy for mycotic aneurysms. RESULTS:Autologous vein replacement in mycotic aneurysm is considered the method of choice. However, regular lifelong follow-up is necessary to monitor possible late complications.
Pneumoperitoneum due to lower gastrointestinal perforation is an acute clinical situation requiring rapid dia-gnosis and treatment. This condition is often the result of dis-eases such as diverticulitis, malignant tumors, Crohn's dis-ease, or complications of endoscopic examination methods and surgical procedures. If this condition is not treated promptly, it can lead to life-threatening complications. Dia-gnosis relies mainly on imaging techniques such as X-ray, ultrasound, and CT, which allow the detection of free gas in the peritoneal cavity and the localization of the perforation. Treatment is usually surgical and its success depends on the speed of intervention and the general condition of the patient. This article discusses the etiology, dia-gnostic approaches, treatment strategies, and prognostic factors associated with pneumoperitoneum from lower gastrointestinal perforation, with emphasis on current clinical practices and recommendations.
The exclusion of free intraperitoneal gas (pneumoperitoneum) is one of the most common indications for imaging in patients presenting with clinical signs of acute abdominal pain. Among radiological methods, upright abdominal and chest radiographs are commonly used for the dia-gnosis of pneumoperitoneum; however, they have the lowest reported sensitivity for detecting free intraperitoneal air. Native or contrast-enhanced computed tomography is considered the gold standard in this dia-gnostic setting, although it exposes patients to the highest levels of ionizing radiation. Ultrasonography is also used in the dia-gnosis of pneumoperitoneum, but it is a highly operator-dependent modality, relying significantly on the examiner's experience. This article presents typical imaging features of pneumoperitoneum across various modalities, as well as less common and potentially misleading findings.
Postoperative pneumoperitoneum is a relatively common finding on imaging examinations after intra-abdominal surgery, and its correct interpretation is of fundamental clinical importance. The key task is to distinguish between clinically insignificant pneumoperitoneum and findings indicating a serious postoperative complication, particularly anastomotic leak or gastrointestinal perforation. The mere presence of free gas in the abdominal cavity is not an indication for surgical intervention; the decisive factors are the clinical situation, dynamics of changes, and correlation with laboratory and imaging findings. The paper summarizes the incidence, natural course, and localization of postoperative pneumoperitoneum, discusses its surgical and non-surgical causes, and evaluates the significance of individual imaging methods, with an emphasis on the high sensitivity of CT examination. Special attention is paid to risk factors and warning signs that increase the likelihood of a complicated course.
Pneumoperitoneum is defined as the presence of free air within the peritoneal cavity. In approximately 90% of cases, it results from gastrointestinal perforation and requires urgent surgical intervention. The remaining 10% represent nonsurgical (spontaneous) pneumoperitoneum, in which no perforation is detected and conservative management is usually sufficient. Etiologically, nonsurgical pneumoperitoneum can be classified into pseudopneumoperitoneum, intrathoracic, abdominal, gynecological, and idiopathic categories. Intrathoracic causes include air migration from the chest during mechanical ventilation, cardiopulmonary resuscitation, or spontaneous pneumothorax. Abdominal causes involve rupture of cysts in pneumatosis cystoides intestinalis, perforation of hepatic or splenic abscesses, barotrauma, endoscopic complications, and infections by gas-producing bacteria. Gynecological causes are associated with vaginal insufflation, sexual intercourse, or instrumentation. In a minority of cases, the etiology remains idiopathic. Differentiating between surgical and nonsurgical pneumoperitoneum is crucial, as unnecessary laparotomies are reported in up to one quarter of patients. Decision--making requires comprehensive clinical evaluation, thorough physical examination, and imaging studies, particularly contrast-enhanced CT. In the absence of peritonitis or sepsis, conservative management with observation, antibio-tics, and symptomatic therapy is recommended. Accurate dia-gnosis and awareness of the rare, nonsurgical causes of pneumoperitoneum are essential to prevent unnecessary surgical interventions and to optimize patient care in this potentially critical condition.
Pneumoperitoneum is a clinically significant and dia-gnostically important finding that most commonly indicates perforation of a hol-low organ within the gastrointestinal tract. Within the upper gastrointestinal tract, the most frequent cause of pneumoperitoneum is gastroduodenal perforation. However, less common etiologies must also be considered, including perforation of the distal esophagus, gallbladder, or bile ducts resulting from inflammatory dis-ease, trauma, or iatrogenic injury. Dia-gnosis is based on a combination of clinical assessment, imaging modalities, and supportive laboratory parameters. Plain abdominal radiography has limited sensitivity in detecting small amounts of free intraperitoneal gas; therefore, contrast-enhanced computed tomography is currently considered the dia-gnostic standard. Management of free gastrointestinal perforation is primarily surgical, whereas selected forms of pneumoperitoneum may be treated conservatively or endoscopically. The choice of surgical procedure depends on the affected organ, intraoperative findings, and the patient's overall clinical condition. Early recognition of the condition is essential for improving clinical outcomes and reducing patient morbidity and mortality.
INTRODUCTION:Liver resection ranks among the most technically demanding abdominal procedures, requiring detailed knowledge of complex three-dimensional anatomy. Augmented reality (AR) represents an innovative technology that overlays digital information on the surgical field and may serve as a tool for perioperative navigation. METHODS:A systematic search of PubMed, MEDLINE, and Cochrane databases was conducted for studies published between January 2022 and August 2025. Only articles in En-glish focusing on human subjects and describing the use of AR during liver resection were included. A total of 133 studies were identified; after removing duplicates, 67 remained. Based on predefined criteria, 10 studies were finally considered relevant for analysis. RESULTS:The analyzed studies involved 649 patients, of whom 245 underwent liver resection with AR assistance. Five were retrospective with control groups, three were single-arm, and one was prospective. Most studies demonstrated that AR improved intraoperative orientation, facilitated lesion localization, and could reduce blood loss and operative time. In cases of deep-seated lesions, AR was associated with wider resection margins, higher R0 resection rates, and fewer conversions. Conversely, long-term oncologic outcomes and postoperative complication rates were not consistently affected. CONCLUSION:AR appears to be a safe technique with the potential to enhance the precision of liver resections and support intraoperative decision-making. Nevertheless, large prospective trials and further technological advances in registration and tissue deformation correction are required before routine clinical implementation.
INTRODUCTION:Sexual and reproductive health remains under-recognized in surgical care despite its decisive impact on quality of life and overall outcomes. METHODS:Narrative synthesis of recent guidance (EAU 2025, AUA 2024, ISSM/ESSM, NCCN/ASCO) and clinical evidence on sexual and reproductive sequelae after colorectal, vascular, and spinal procedures. KEY FINDINGS:Core mechanisms include autonomic denervation, vascular/hormonal factors, pain/scarring, and altered body image. Pelvic oncologic surgeries (low anterior resection, radical prostatectomy/cystectomy) are high-risk procedures. High-value interventions include early penile rehabilitation (PDE5 inhibitors ± vacuum device) and fertility preservation (gamete cryopreservation), local estrogens/lubricants and pelvic-floor physiother-apy in women, and psychosexual support within coordinated multidisciplinary care across both sexes. CONCLUSION:Embedding sexual and reproductive health into standard perioperative pathways (six-step algorithm: education, risk stratification, fertility preservation, nerve-sparing, discharge instructions, 6-12-week follow-up) is feasible in Czech practice and improves functional outcomes and patient satisfaction.
INTRODUCTION:Colorectal surgery is associated with a high risk of postoperative complications, particularly infections. In recent years, the role of the microbiome in this context has been increasingly discussed. Probiotics and synbiotics are being investigated as potential tools for modulating the microbial environment and improving surgical outcomes. AIM:This review article summarizes the available evidence from randomized con-trolled trials, meta-analyses, and systematic reviews evaluating the effects of probiotics and synbiotics on the incidence of complications and postoperative recovery in patients undergoing colorectal surgery. Current studies indicate that the administration of probiotics and synbiotics may reduce the risk of infectious complications, modulate systemic inflammatory responses, accelerate the restoration of bowel function, and shorten the duration of antibiotic therapy. Data regarding their impact on anastomotic leakage remain limited. The intervention appears to be well tolerated and safe. CONCLUSION:Perioperative administration of probiotics or synbiotics represents a promising and cost-effective intervention in colorectal surgery. However, larger and more standardized trials are required to prove the effect, determine the optimal composition, dosage, and duration of therapy before routine clinical implementation.
Immediate breast reconstruction (IBR) with implants has become an integral part of comprehensive care for patients undergoing mastectomy for breast cancer. This review summarizes current evidence on indications, contraindications, surgical techniques, complications, and clinical outcomes of IBR with an implant. Properly selected pa-tients benefit from enhanced psychological well-being, shorter recovery, and improved cosmetic results. IBR is primarily indicated in women with stage T1-T2 tumors without metastases. Contraindications include advanced disease, the requirement for adjuvant radiotherapy, comorbidities such as diabetes mellitus, obesity, or smoking, and poor skin flap qual-ity. The most widely used surgical approach is the direct-to-implant (DTI) technique, allowing definitive reconstruction in a single operation. Potential complications include infection, seroma, capsular contracture, skin necrosis, and implant exposure. Their incidence depends on tissue quality, surgical exper-tise, and patient-related risk factors. Current studies demonstrate that IBR does not adversely affect oncologic safety nor delay adjuvant treatment. In addition, IBR has been shown to be cost-effective and to yield high patient satisfaction, particularly in domains of body image, sexuality, and psychosocial adjustment. In conclusion, IBR with implants represents a safe and effective reconstructive option for appropriately selected patients.
Pancreatic pseudocysts, as one of the many complications of pancreatitis, are usually asymptomatic and are not commonly considered in the differential diagnosis of acute abdominal events. A pancreatic pseudocyst with its aggressive juices tends to damage nearby organs, leading to their fibrotic changes and low-quality healing. Such organ changes are more prone to follow up complications. The most dangerous bleeding source in pancreatic pseudocyst patients is splenic artery aneurysm, often solved by endovascular interventions. In other cases, mainly in haemodynamic stable patients, maximum conservative approach is preferred. In this case report, we present hemorrhage into a pancreatic pseudocyst in a gastric serosa rupture as a rare cause of sudden-onset abdominal pain and hemoperitoneum, which led to urgent surgical exploration and necessitated a more extensive resection of organs damaged during the rupture of the pancreatic pseudocyst.
This article focuses on gynecological causes of acute abdominal emergencies, which represent serious conditions requiring prompt diagnosis and treatment. It describes their pathogenesis, clinical presentation, diagnostic procedures, and therapeutic options. As a review paper, its aim is to identify the most common indications for urgent gynecological intervention and to facilitate differential diagnosis in acute zone, particularly within surgical outpatient departments. Gynecological causes are categorized into three main groups: non-infectious, infectious, and emergencies associated with early pregnancy. The article provides a detailed overview of expected findings from lab-oratory tests and transvaginal gynecological ultrasound examination. For each condition, surgical management is described, with laparoscopy being the preferred ap-proach in gynecological cases.
Pleural effusions represent a common clinical problem with broad etiological variability encompassing benign, infectious, and malignant causes. Accurate diagnosis, proper classification, and selection of optimal therapeutic intervention in accordance with current guidelines are crucial for successful treatment. This review article summarizes contemporary knowledge in the diagnosis and management of pleural effusions from the thoracic surgery perspective. The management of empyema based on disease stages, therapeutic strategy for malignant effusions with emphasis on lung expandability assessment, and implementation of minimally invasive techniques are discussed in detail. The presented recommendations are derived from recent guidelines of international professional societies (European Respiratory Society, European Society of Thoracic Surgeons, British Thoracic Society) and are supplemented with practical aspects from clinical practice. The aim of this article is to provide readers with a comprehensive tool for effective clinical decision-making in everyday care of patients with various types of pleural effusions.
This case study refers to an example of a 79-year-old woman with periumbilical inflammation caused by bilioumbilical fistula. This case presents a very rare form of a direct communication between the gallbladder and skin. The origin is usually based on cholecystolithiasis, cholecystitis, bile duct obstruction or a gallbladder carcinoma. In certain cases it can occur iatrogenically as a result of percutaneous drainage of a hydropic gallbladder in patients considered high-risk for surgical intervention. The clinical picture is dominated by abdominal pain and inflammatory involvement of the abdominal wall mimicking an abscess. The main position in the diagnostic process belongs to CT examination with fistulogram. Firstly, we initiate treatment by using antibiotics, but the final solution is represented by surgical operation. There are still several cases referring to healing up without surgical intervention.
Introduction: Primary hyperparathyroidism (PHPT) is most commonly caused by a solitary parathyroid adenoma. The relationship between parathyroid hormone (PTH) lev¬els and adenoma size remains unclear. Methods: A retrospective analysis of 377 PHPT patients who underwent surgery at Third Department of Surgery, First Faculty of Medicine, Charles University and Motol University Hospital (2022–2023). Adenoma volume was calculated as an ellipsoid. The cor¬relation between PTH and adenoma volume was assessed using regression analysis. Results: A weak to moderate correlation was found (R = 0.315; P < 0.001). Linear regres¬sion showed that a 1 pmol/L increase in PTH corresponded to an average adenoma volume increase of 104 mm³. Conclusion: Preoperative PTH levels partially correlate with adenoma volume, but their predictive value is limited.
Introduction: Principles of complete mesocolic excision with central vascular ligation were first published by Hohenberger with promising oncological results of right-sided colon carcinoma. Nowadays preserving of mesocolon is a gold standard; however, ¬there is a lack of definitive answer about the extent of lymphadenectomy. Our modified D3 lymphadenectomy can reach higher count of lymph nodes retrieval, and therefore can lead to upstaging in the patient. Nevertheless, more complex procedure can lead to various perioperative complications. Methods: A total of 28 patients were operated by robotic assisted approach with modified D3 lymphadenectomy in the period 1/2023–12/2024 for carcinoma of the cecum and ascending colon. As a control group, 59 patients were enrolled from the period 1/2020–12/2022 operated by an open approach with standard D2 lymphadenectomy. In each input parameter, both groups were comparable. Results: An operating time was significantly longer in robotic assisted group (P < 0.001). Blood losses were comparable for both groups. Postoperative hospital stay was lower in robotic assisted group and reached a significant threshold (P = 0.011). The re¬trieved lymph node count was significantly higher in the group of modified D3 lymphadenectomy (P = 0.002). There were no surgical site infections in the miniivasive group, while in the open group they reached 17%. The occurrence of paralytic ileus was lower in the robotic assisted group (10 vs. 27.1%; P = 0.146). Conclusion: The results of this pilot study indicate that complete robotic assisted mesocolic excision with modified D3 lymphadenectomy at right-sided colorectal carcinoma is a safe method, and does not increase the risk of peroperative vascular injuries and postoperative complications, such as paralytic ileus or surgical site infection, which leads to a shorter hospital stay.
