Browsing by Author "Tadić, Boris (57210134550)"

Introduction Accessory spleen represents ectopic spleen tissue separated from the body of the spleen, with the percentage share of 10–15% in a population. Case outline We present a female patient in which immune thrombocytopenic purpura was diagnosed 12 years previously and, after a failed initial treatment, it was decided by a hematologist to perform a laparoscopic splenectomy. The mentioned operation was carried out in a safe and efficient manner wherein the accessory spleen was detected and removed intraoperatively. The operative and postoperative course passed without any complications. The definitive histopathological findings confirmed previously set hematological diagnosis. Conclusion The laparoscopic approach is a superior modality in terms of diagnostic and therapeutic procedures when it comes to surgical removal of the accessory spleen. Taking into consideration the advantages of this approach presented and proven in literature, even in the case of diagnostically or intraoperatively overlooked accessory spleen or de novo discovered after the operation, there should be no dilemma which surgical approach should be applied. © 2020, Serbia Medical Society. All rights reserved.

Introduction According to the guidelines of the European Association of Endoscopic Surgery, any case where the maximum craniocaudal splenic diameter exceeds 20 cm is considered massive splenomegaly. In addition to metabolic, hematological, and hemodynamic problems, enlarged spleen may cause mechanical difficulties due to the pressure to surrounding organs and vascular structures. The aim of this paper is to present the surgical challenges and technique applied in massive splenomegaly, in a patient who had neglected the importance of regular medical checkups. Case outline We present a 62-year-old male patient who was admitted to hospital for treatment of previously clinically and radiologically verified splenomegaly but who neglected the importance of regular checkups and medical treatment. Splenectomy was performed with a splenic specimen 38 cm in its maximal diameter. Conclusion Taking into consideration all the possible benefits and possible complications of surgical treatment, including the quality of life of splenectomized patients, comprehensive preoperative assessment should be made, and surgical treatment selectively applied. © 2022, Serbia Medical Society. All rights reserved.

Spleen artery aneurysm represents the most common visceral aneurysm and the third most common splanchnic aneurysm. Most patients have no symptoms and are diagnosed as a part of other diagnostic focuses and examinations. In our study, we present a patient who, due to a spleen artery aneurysm localized in the spleen hilum, underwent laparoscopic splenectomy safely and effectively, without complications, with the use of hem-o-lok clips as a hemostatic technique for vascular elements of the spleen hilum. Our cases show that in addition to numerous advantages of the minimally invasive approach, there is the possibility to improve the laparoscopic technique in terms of safety and economic reasons by using hem-o-lok clips as a hemostatic technique for the vascular elements of the spleen hilum. © 2020, Association of Surgeons of India.

SUMMARY Introduction Cystic echinococcosis or hydatid disease is a parasitic disease, zoonosis, and is most commonly caused by Echinococcus granulosus larvae. It mainly occurs in endemic areas. The most common localization is the liver. Case outline In this paper, we will present our experience with a 67-year-old female patient diagnosed with an echinococcal cyst in the right lobe of the liver, as confirmed by computed tomography examination of the abdomen. The patient underwent laparoscopic partial pericystectomy with omentoplasty. The operation went without complications, as well as the postoperative period. Conclusion Laparoscopic partial pericystectomy is a safe and effective treatment of available hepatic hydatid cysts. Considering all the benefits of minimally invasive surgery, laparoscopic partial pericystectomy of hepatic hydatid cysts may be the treatment of choice, over the classical open surgery approach. © 2020, Serbia Medical Society. All rights reserved.

Introduction Neuroendocrine tumors of the pancreas are rare neoplasms. They are divided into two groups: functional and non-functional. Non-functional tumors represent a diagnostic challenge, given that they often remain asymptomatic and are diagnosed as an incidental finding. Case outline We present a patient in whom the tumor was discovered at the junction of the body and the tail of the pancreas, on the dorsal side. The patient had no specific symptomatology, there was no loss in body weight. Considering the diagnostic procedures conducted and the condition of the patient, we decided to perform laparoscopic enucleation. The procedure was carried out in a safe and efficient manner, so that operative and postoperative recovery was uneventful. The definitive histopathological examination confirmed the finding of a non-functional pancreatic neuroendocrine tumor. Conclusion Laparoscopic enucleation is an effective and safe treatment modality for neuroendocrine tumors of the pancreas with well-known advantages, as compared to open surgery, but there is always a tendency to improve the already existing results and thus to contribute, not only to treatment, but to the greater comfort of the patient. Keywords. © 2021, Serbia Medical Society. All rights reserved.

Introduction Splenic artery aneurysm is the most common visceral aneurysm with a prevalence of 0.2–10%. It is the third most frequent abdominal aneurysm as well. It can be true or false. It occurs more often in women than in men. We present our experience with a 34-year-old female patient who underwent laparoscopic splenectomy due to the splenic aneurysm located in the splenic hilum. Case outline We present a case of a 34-year-old female patient diagnosed with an enlarged splenic artery during a routine abdominal ultrasound examination. Abdominal scan and computed tomography angiography showed saccular aneurysm of the splenic artery located in the hilum of the spleen, 24 × 17 mm in size. Given the good general condition and age of the patient, we decided to perform laparoscopic splenectomy. The operation was performed without complications, which was also the case with the postoperative flow. The patient was discharged from the hospital on the third postoperative day. Conclusion Laparoscopic splenectomy is a safe and effective modality for the treatment of splenic artery aneurysm, localized in the splenic hilum. Considering all the benefits of minimally invasive surgery, laparoscopic splenectomy should be the treatment of choice, over the classical open approach. © 2019, Serbia Medical Society. All rights reserved.

Introduction Choledochal cysts are congenital anomalies manifested as focal or diffuse cystic dilatation of the bile ducts. They are mostly diagnosed in childhood. The magnetic resonance and surgical management are the gold standard diagnostic and treatment modality. Case outline We present a male patient who was presumed to have Mirizzi syndrome. This presumption was discarded by additional imaging procedures and by later surgical treatment. It was confirmed that it was a large choledochal cyst filled with stones. Considering the diagnosis and good patient’s general condition, we opted for surgical treatment. Conclusion There are several surgical techniques that can be used in the treatment of choledochal cysts, wherein each is intended as a complete resection of the cyst with histological confirmation. Operative techniques do not affect the outcome of the treatment, but the time and extent of surgical resection, as well as any metaplasia of the epithelium, do. © 2020, Serbia Medical Society. All rights reserved.

Introduction The most common indications for placing a biliary stent are benign and malignant diseases that interfere with the normal flow of bile through the extrahepatic bile ducts. This procedure carries the risk of developing early and late complications. Case outline We present a case of a 63-year-old female patient admitted to our hospital for additional diagnostics and treatment. At admission the patient reported the onset of the following symptoms several days prior to hospitalization: severe abdominal pain, predominantly in the upper quadrants, nausea, vomiting, and icterus. With the initial idea of carrying out non-surgical treatment of this condition, the patient was referred for endoscopic retrograde cholangiopancreatography for the purpose of endoscopic calculi extraction. However, due to technical difficulties, the aforementioned procedure was not carried out. Instead, upon endoscopic papillotomy, a plastic biliary stent was placed. The second day after the procedure, the patient reported passing dark stools. After that, an esophagogastroduodenoscopy was performed, which revealed a biliary stent in the duodenum, but without active bleeding. As part of the same procedure, the biliary stent was removed, and the next day the patient underwent surgical treatment. Conclusion In order to prevent and reduce the incidence of adverse effects and complications, special caution should be applied when performing the procedure. It is even more important to timely recognize the occurrence of complications and to treat them promptly, in order to achieve the best treatment outcomes possible. © 2023, Serbia Medical Society. All rights reserved.

Introduction Primary, “pure” squamous cell carcinoma (SCC) is an exceptionally rare pancreatic malignancy that has been described in sporadic case reports. The appearance of this rare entity created a diagnostic dilemma for us, therefore, in this case report, we are focused on the radiological detection and characterization, pathogenesis, and therapeutic options of pure pancreatic SCC. Case outline In an 80-year-old female patient, a partially necrotic mass in the tail of the pancreas was detected by computed tomography, which is the rarest localization of this tumor. On the performed imaging, the tumor showed predominantly malignant features with a surprising definitive histopathological diagnosis in the direction of pure SCC. Distal pancreatectomy with splenectomy was performed because of the infiltration of lienal vascular structures. Conclusion Due to the very aggressive form of this tumor and poor prognosis, early detection, risk factors control, genetic burden, and optimization of surgical and therapeutic management can improve the quality of life and prolong the overall survival period. © 2024, Serbia Medical Society. All rights reserved.

Introduction The radical antegrade modular pancreatosplenectomy (RAMPS) procedure was introduced as a modification of standard retrograde pancreatosplenectomy (SRPS). It was designed to establish a new surgical approach, with intension to increase possibility of achieving negative posterior (retroperitoneal) resection margin, as well as to provide complete N1 lymph node clearance. Outline of cases We present two cases with diagnosed left-sided pancreatic tumors, who were surgi-cally treated in our hepato-pancreato-biliary department. Both patients underwent posterior RAMPS procedure. Postoperative course was uneventful in both patients. Conclusion RAMPS is a safe procedure because it provides complete vascular and bleeding control. It is a superior procedure in oncologic terms compared to SRPS, as it increases the rate of R0 resection, and provides larger number of lymph nodes harvested. Furthermore, RAMPS is associated with better overall survival. © 2021, Serbia Medical Society. All rights reserved.

Introduction Myoid angioendothelioma of the spleen is an extremely rare form of a benign splenic tumor. There is no characteristic symptomatology for this disease. Case outline We present four patients operated on for myoid angioendothelioma of the spleen. Three patients were without problems while one had nonspecific problems. Two patients underwent laparoscopic surgery and two underwent open splenectomy. In all patients, the definitive diagnosis was confirmed by histopathological examination. By reviewing the aforementioned medical databases of published papers in English, we found a total of eight cases of myoid angioendothelioma of the spleen. In addition to the mentioned number, we have added our series of cases. Conclusion Twenty-one years after the discovery of myoid angioendothelioma of the spleen, the small number of cases presented in the literature is still a limiting factor in making conclusions and in learning lessons about this disease. © 2021, Serbia Medical Society. All rights reserved.

Introduction Posttraumatic splenic cysts are most commonly the result of blunt force trauma to the abdomen. They usually develop from subcapsular or intraparenchymal hematomas and are typically asymptomatic. Diagnostics includes clinical history and radiological imaging procedures. Surgical treatment is the only curative modality of treatment. Case outline A 43-year-old female patient, without comorbidities, was admitted to the health institu-tion for additional diagnostics and surgical treatment. Laboratory test results were within the reference ranges, while serological test results for hydatid disease were negative. An abdominal CT examination was subsequently performed confirming a splenic cyst positioned in the central part of the spleen. After a laparoscopic partial pericystectomy of the cyst, we identified another smaller cyst of the spleen. Ac-cording to the estimation of the surgical team, the intraoperative appearance of the remaining tissue of the spleen was less than a third of the entire spleen. The decision was taken to perform a splenectomy in the best interests of the patient, bearing in mind the possibility of complications Conclusion Accurate diagnosis of posttraumatic splenic cysts remains a challenge, despite state-of-the-art radiological imaging procedures that are applied. In addition to the well-known modalities of treatment, the laparoscopic surgical approach, i.e., minimally invasive treatment, should be the one of choice, if the situation allows it. The laparoscopic approach is a diagnostic and therapeutic method whose effect can especially be observed when the intraoperative finding differs from the preoperative radiological finding. © 2022, Serbia Medical Society. All rights reserved.