Browsing by Author "Vasin, Dragan (56946704000)"

Amyand's hernia is a condition where the vermiform appendix is contained within an inguinal hernia sac. An inguinal hernia with an appendix in the hernia sac is extremely rare and almost exclusively occurs on the right side. The mechanism of developing appendicitis with hernia is most likely the compression of the appendix at the level of the neck of the sac or due to impaired vascular supply leading to infection. Despite technological advances in radiology modalities, the preoperative diagnosis of and hernia is challenging: the role of abdominal ultrasound and computed tomography is very important and is essential in planning surgical management and approaches. In our case, we made a rare preoperative diagnosis of Amyand's hernia using ultrasound showing a typical appearance only without wall hyperemia probably due to vascular compression of the inguinal ring, which was confirmed by CT. CT is more sensitive to the detection of radiological signs of appendiceal inflammation and perforation in the hernia sac and is most often used in the case of an inconclusive ultrasound findings. Due to the prompt radiological diagnosis of acute appendicitis in the hernia sac provided by ultrasound, our patient underwent laparoscopic appendectomy. © 2024 Australasian Sonographers Association.

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A trichobezoar is an intraluminal mass of hair growing continuously with additional ingestion, while Rapunzel syndrome refers to a giant gastric trichobezoar that extends from the stomach into the small intestine. We present a case of Rapunzel syndrome as an uncommon cause of upper gastrointestinal (GI) symptoms in a young adult woman who denied trichotillomania and trichophagia. Preoperative radiological assessment was pivotal in planning a preferable therapeutic approach. The patient underwent laparotomy and prepyloric gastrotomy, resulting in satisfactory postoperative outcomes. Trichobezoars are extremely rare and predominantly affect young women with underlying psychiatric conditions. Although uncommon, they cause severe upper gastrointestinal symptoms and may even lead to various complications. This case report helps in understanding the presentation of gastric trichobezoar and Rapunzel syndrome, including their range of symptoms, radiological appearance, and associated findings, to make an accurate diagnosis and guide an appropriate treatment approach. Copyright © 2025 Mijović, Vasin, Hasanagić, Vukmirović, Tomić, Tošić, Pavlović, Mašulović and Đurić Stefanović.

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Background/Objectives: Mild traumatic brain injury (mTBI) is a leading cause of pediatric emergency department visits, particularly among children under three years old. Although computed tomography (CT) is the gold standard for diagnosing intracranial injuries, its use in young children poses radiation risks. Identifying reliable clinical indicators that justify CT imaging is essential for optimizing both patient safety and resource utilization. Objective: This study aimed to evaluate CT findings in children under three years of age with mTBI and no focal neurological deficits, as well as to identify clinical predictors associated with skull fractures and intracranial injuries. Methods: A retrospective analysis was conducted on 224 children under 36 months who presented with mTBI to a tertiary pediatric hospital from July 2019 to July 2024. Demographic data, injury mechanisms, clinical presentation and CT findings were evaluated. Univariate and multivariate regression analyses were performed to identify risk factors associated with skull fractures and intracranial injuries. Results: Falls accounted for 96.4% of injuries, with the majority occurring from heights of 0.5–1 m. The parietal region was the most frequently affected site (38%). Skull fractures were present in 46% of cases and were primarily linear (92.8%). Intracranial hematomas were identified in 13.8% of cases, while brain edema was observed in 7.6%. Significant predictors of skull fractures included age under 12 months (p < 0.001), falls from 0.5–1 m (p = 0.005), somnolence (p = 0.030), scalp swelling (p = 0.001) and indentation of the scalp (p = 0.016). Parietal bone involvement was the strongest predictor of both skull fractures (OR = 7.116, p < 0.001) and intracranial hematomas (OR = 4.993, p < 0.001). Conversely, frontal bone involvement was associated with a lower likelihood of fractures and hematomas. Conclusions: The findings highlight key clinical indicators that can guide decision-making for CT imaging in children with mTBI. Infants under 12 months, falls from moderate heights and parietal bone involvement significantly increase the risk of fractures and intracranial injuries. A more refined diagnostic approach could help reduce unnecessary CT scans while ensuring the timely identification of clinically significant injuries. © 2025 by the authors.

Introduction Familial adenomatous polyposis (FAP) is an autosomal dominant disorder characterized by the presence of 100 or more adenomatous polyps in the mucosal lining of the large intestine, with a significant risk of colorectal cancer development. Case outline This article presents a case report of previously undiagnosed FAP in a patient admitted to the surgical emergency department with suspected sigmoid carcinoma. On computed tomography (CT), the findings of the colonic mucosa were inconclusive due to inadequate distension of the bowel lumen and insufficient preparation. Edema of the bowel wall was clearly observed, a CT characteristic of the carcinoma that had formed at the level of the sigmoid colon, while the two other foci of malignant transformation were obscured by a diffuse, uniform thickening of the wall, which was clearly diagnosed as FAP on subsequent colonoscopy. The patient underwent a total proctocolectomy, after which he continued his oncological treatment. Conclusion Computed tomography is inadequate for the diagnosis of diffuse polyposis of the colonic mucosa, especially in emergency situations when patients are not prepared for the examination, i.e., without sufficient dilation of the bowel lumen. Since the underlying disease in this patient masked two of the three malignant lesions of the colon, we point out the diagnostic inferiority of the CT examination in the regular emergency settings, compared to CT and MR colonography and especially to colonoscopy as the gold standard in the detection of colorectal cancer. © 2025, Serbia Medical Society. All rights reserved.

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Background: Intrahepatic mass-forming cholangiocellular carcinoma (IMC) is the second most common primary liver tumor. The differentiation between IMC and solitary hypovascular liver metastases (SHLM) represents a diagnostic challenge due to many overlapping magnetic resonance imaging (MRI) features. Purpose: To determine the value of diffusion-weighted imaging (DWI) in addition to conventional MRI for the distinction between intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases. Material and Methods: Fifty-three patients with pathologically proven IMC (n = 31) and SHLM (n = 22) who had undergone MRI and DWI before surgery or percutaneous biopsy were enrolled in this study. The following MRI features were analyzed: the size and shape of the lesion, presence of capsular retraction and segmental biliary dilatation, T2-weighted (T2W) signal intensity, the presence of target sign on DWI and enhancement pattern. Apparent diffusion coefficient (ADC) values were calculated for each lesion (b = 800 s/mm2). Univariate and multivariate logistic regression analyses were used to identify significant differentiating features between IMCs and SHLMs. Results: Univariate analysis revealed that following parameters favor diagnosis of IMCs over SHLMs: lobulating shape, heterogeneous T2W signal intensity, capsular retraction, segmental biliary dilatation, target sign on DWI and rim-like enhancement on arterial phase followed by progressive enhancement in delayed phases. ADC values measured in the periphery of the lesion were significantly lower in IMCs in comparison to SHLMs. Multivariate analysis revealed that target sign on DWI was the most significant predictor of IMCs. Conclusion: Qualitative DWI analysis with target sign significantly improves diagnostic accuracy for differentiation among IMC and SHLM lesions. © 2017, © The Foundation Acta Radiologica 2017.

Background: Intrahepatic mass-forming cholangiocellular carcinoma (IMC) is the second most common primary liver tumor. The differentiation between IMC and solitary hypovascular liver metastases (SHLM) represents a diagnostic challenge due to many overlapping magnetic resonance imaging (MRI) features. Purpose: To determine the value of diffusion-weighted imaging (DWI) in addition to conventional MRI for the distinction between intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases. Material and Methods: Fifty-three patients with pathologically proven IMC (n = 31) and SHLM (n = 22) who had undergone MRI and DWI before surgery or percutaneous biopsy were enrolled in this study. The following MRI features were analyzed: the size and shape of the lesion, presence of capsular retraction and segmental biliary dilatation, T2-weighted (T2W) signal intensity, the presence of target sign on DWI and enhancement pattern. Apparent diffusion coefficient (ADC) values were calculated for each lesion (b = 800 s/mm2). Univariate and multivariate logistic regression analyses were used to identify significant differentiating features between IMCs and SHLMs. Results: Univariate analysis revealed that following parameters favor diagnosis of IMCs over SHLMs: lobulating shape, heterogeneous T2W signal intensity, capsular retraction, segmental biliary dilatation, target sign on DWI and rim-like enhancement on arterial phase followed by progressive enhancement in delayed phases. ADC values measured in the periphery of the lesion were significantly lower in IMCs in comparison to SHLMs. Multivariate analysis revealed that target sign on DWI was the most significant predictor of IMCs. Conclusion: Qualitative DWI analysis with target sign significantly improves diagnostic accuracy for differentiation among IMC and SHLM lesions. © 2017, © The Foundation Acta Radiologica 2017.

Introduction Isolated jejunal perforation (IJP) without any associated injuries is rare in blunt abdominal trauma (BAT). It most commonly occurs in decelerating trauma. Diagnosis of traumatic intestinal perforation may be difficult in the first hours after injury so unrecognized “missing” intestinal injuries incidences are as high as 24%. Unrecognized traumatic bowel perforation without adequate treatment leads to the intestinal leakage into the peritoneal cavity, leading to secondary peritonitis and potentially lethal complications. Case outline We presented the case of a 43-year-old woman injured in a road traffic accident. She was admitted to emergency surgery after diagnostic procedures according to the protocol for trauma. Initial examination, and body computed tomography (CT) revealed orthopedic injuries. Daily monitoring and follow-up examinations were done, she did not complain of any discomfort nor pain in the abdomen, and there were no signs of abdominal injury. Two days after trauma, follow-up abdominal CT revealed highly suspected jejunum perforation, still without signs of pneumoperitoneum. Laparotomy was performed and diagnosis of IJP was confirmed. Bowel perforation was surgically closed in two layers, followed by drainage of septic collections, abdominal saline lavage and primary abdominal closure. The patient was discharged on the seventh postoperative day without complications. Conclusion In the case of BAT due to severe traumatic force in patient with nonspecific clinical signs of abdominal trauma on initial clinical and radiological examination, follow-up in a short period is necessary, to detect hidden jejunal perforation. Surgery is a life-saving for those patients and treatment of these injuries usually require simple operative procedures. © 2021, Serbia Medical Society. All rights reserved.

BACKGROUND Low grade fibromyxoid sarcoma (LGFMS) is a rare and benign mesenchymal tumor with indolent course, most commonly found in young or middle-aged men. The majority of the LGFMSs are located in the trunk and deep soft tissue of the lower extremities. They appear as well circumscribed, although not encapsulated, which often leads to incomplete surgical resection. Despite their seemingly benign appearance, these tumors have aggressive behavior with high metastatic and recurrence rates. Accurate histopathologic examination of the specimen and its immunohistochemical analysis are mandatory for a precise diagnosis. CASE SUMMARY We report a case of a 38 year-old-man who presented with jaundice and upper abdominal discomfort. Multi-detector computed tomography and magnetic resonance imaging showed a large left liver tumor mass, extending to the hepatoduodenal ligament. Left hepatectomy was performed with resection and reconstruction of hepatic artery and preservation of middle hepatic vein. Histopathologic examination confirmed the tumor being a low-grade fibromyxoid sarcoma. Three and a half years after surgery, the patient died after being diagnosed with spine metastasis. CONCLUSION Due to poor response to all modalities of adjuvant treatment, we consider that the focus of treatment should be on surgery as the only option for curing the disease. ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

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Introduction Trichobezoars presents a rare form of bezoar made of swallowed hair, with clinical manifesta-tion of gastric or intestinal obstruction, gastric ulceration, bleeding, and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngsters, who eating their own hair which is clini-cally known as trichophagia. Patients often deny eating their own hair which makes diagnosis difficult. Case report We present a case of acute gastric outlet obstruction caused by a giant gastric trichobezoar made of a long thin hair, in a 20-year young female. Although patient had a long history of trichophagia, she did not think her behavior was unusual and she had not been treated before. Following the initial diagnostic procedures, exploratory laparotomy was indicated. After anterior gastrotomy was performed, a massive stomach-shaped trichobezoar was removed. Postoperatively, the patient had a psychiatric consult exam. She recovered well and was discharged without complications. She was referred for further psychiatric follow-up. Conclusion Trichobezoars are non-digestible collections that usually accumulates in stomach and can extend to small bowel, causing mechanical injury such as hollow viscus obstruction. Patients with acute gastric obstruction caused by a giant trichobezoar require urgent removal of the trichobezoar, to preserve the stomach and avoid further, catastrophic consequences. © 2023, Serbia Medical Society. All rights reserved.

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Blunt abdominal aortic injuries are extremely rare, diagnosed in less than 0.05% of all trauma admissions. Aortic injury caused by a seat belt during a car accident is often referred as “seat-belt aorta”. We present a case of an 18-year-old woman, restrained back passenger involved in a vehicular collision, sustaining vertebral column and multiple rib fractures, mesenterium and colonic injury, and infrarenal aortic contusion with localized dissection and partial thrombosis. © 2018 Elsevier Inc.

Introduction Duodenal hematomas are commonly traumatic, caused by blunt abdominal trauma. Non-traumatic spontaneous intramural hematomas of the duodenum are rare, and in most cases induced by anticoagulant therapy. The diagnosis is based on clinical and biochemical parameters, endoscopy, and radiological examinations. The objective of this report was to present a clinical and radiological presentation of an intramural duodenal hematoma caused by anticoagulant therapy. Case outline A 43-year-old female was presented with epigastric pain, nausea, hematemesis, and melena. She had a positive medical history of deep venous thrombosis of the pelvis, which was diagnosed the previous month, for which she received oral anticoagulant therapy (coumarin). Physical examination revealed diffuse abdominal tenderness, while laboratory analyses showed markedly elevated international normalized ratio (INR) of prothrombin time (INR > 7), which indicated the anticoagulant intoxication. Computed tomography (CT) showed luminal narrowing with uniform circumferential wall thickening of the descendent and horizontal part of duodenum, which was hyper dense in the native series and slight and uniform ring-formed enhancement in post-contrast phases, a typical CT presentation of intramural duodenal hematoma. Periduodenal and right sided pararenal hematomas were also visualized. After stopping the anticoagulant therapy and performing conservative treatment (vitamin K) with good therapeutic effect being monitored by physical examination, laboratory analyses and transabdominal ultrasonography, spontaneous resolution of the duodenal hematoma was revealed by follow-up CT examination two weeks after the onset. Conclusion Ultrasonography and CT are useful diagnostic tools in recognition of the intramural duodenal hematoma and other locations of hemorrhage and in monitoring therapeutic effects. © 2019, Serbia Medical Society. All rights reserved.

Introduction Colon interposition is considered an effective option for esophageal replacement in children, particularly in cases of caustic esophageal stricture. The use of colonic tissue grafts for esophageal replacement can lead to late complications, including the development of precancerous lesions and malignant tumors. The aim of the paper is to describe a female patient who was diagnosed with adenocarcinoma of the right colon at the age of 71, 60 years after surgery for benign esophageal stricture. Case outline A 71-year-old female presented to our clinic in January 2023 with symptoms of abdominal pain. At the age of 11, the patient had bypass esophagocoloplasty with retrosternal esophagogastroco-lonic anastomosis due to esophageal stricture after accidental caustic ingestion. CT imaging revealed tumor of the ascending colon, estimated stage T4aN1M0. An upper digestive endoscopic examination revealed one polyp while a lower digestive endoscopic examination confirmed the presence of a stenotic tumor in the ascending colon. Furthermore, a polypoid alteration was identified in the descending colon. CT angiography revealed that the tumor was found to receive its vascular supply through the middle colic artery, while the colonic transplant received its vascular supply through the right colic artery. Conclusion It is recommended to implement lifelong endoscopic surveillance for patients who have undergone colon interposition. In cases such as this, it is crucial to establish a comprehensive treatment plan and employ effective diagnostic measures to ensure the preservation of the integrity and vascu-larization of the colonic graft. © 2024, Serbia Medical Society. All rights reserved.

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