Browsing by Author "Kaitović, Marko (37048782600)"

Introduction: Biliobronchial fistula is rare. Very rarely it may be congenital, more frequently it is acquired as a complication of the hydatide cyst of the liver, pyogenic abscess, serious trauma and resection of the liver as well as recurrent cholangitis due to benign bile duct stricture or cholangtolithiasis. The main causes of the biliobronchial fistula are billiary obstruction and infectious lesion (abscess) in the liver. Case Outline: We present a 56-year-old man with benign stricture of the hepaticojejunostomy performed after operative common bile duct injury, who developed biliobronchial fistula following repeated percutaneous drainage of the liver abscess and percutaneous dilatation of the strictured anastomosis. Over the years the patient developed atrophy/hypertrophy complex, portal hypertension, grade II esophageal varicosities, ascites and splenomegaly. Although biliobronchial fistula was solved by a successful surgical reconstruction (new wide hepaticojejunostomy), the operation had a limited value as it was performed late after permanent lesions of the liver and intrahepatic bile ducts had already developed. Conclusion: Surgical reconstruction of strictured biliodigestive anastomosis should be considered on time as a possibly better solution than percutaneous dilatation. According to the authors' knowledge, a similar case of biliobronchial fistula as a complication of percutaneous dilatation of the benign biliary stricture has not been reported before in the literature.

Introduction/Objective Even with the current treatment, mortality from aortic dissection remains high. The study aimed to evaluate the early postoperative outcome of patients with aortic dissection and identify which factors could influence it. Methods The study included all consecutive patients who underwent surgery for acute aortic dissection type A from 2012 to 2017. We registered all parameters that could potentially impact the outcome (general data, medical history, clinical and cardiological diagnostic test findings, preoperative complications, type of cannulation and the operation performed, additional surgical procedures, operation duration, etc.). The patients were surgically treated according to the current protocols. The main outcome measures were complications and mortality during a one-month postoperative period. All data collected pre-, intra-, and postoperatively were compared and statistically analyzed. Results The study included 246 patients, 57.54 ± 12.88 years old on average, and mostly of male sex (74%). Early postoperative mortality occurred in 17% of the patients. Preoperative chronic kidney insufficiency (p = 0.005) and cerebrovascular insult (p = 0.047) and tamponade (p = 0.036) were the major risk factors for postoperative complications and mortality. Long hypothermic cardiac arrest (p = 0.001), cross-clamp (p = 0.017) and cardiopulmonary bypass time (p = 0.036) increased postoperative compli-cations. Postoperative complications started occurring after ≥ 33.5 minutes hypothermic cardiac arrest and ≥ 67.5 minutes cross-clamp time. Postoperative complications occurrence increased (p = 0.034), while performing anterograde cerebral perfusion decreased the frequency of lethal outcome (p = 0.001). Conclusion The majority of patients surgically treated for acute aortic dissection had good postoperative outcome. However, numerous pre-, intra-, and postoperative factors can impact patient survival. © 2021, Serbia Medical Society. All rights reserved.