Clinical Case Of Surgical Treatment Research Articles

Sacrococcygeal pilonidal cyst with the disease onset as an anterior perianal abscess: a clinical case

The aim. To analyze the clinical case of surgical treatment of a patient with a pilonidal cyst (PC) of the sacrococcygeal area, which manifested as an anterior perianal abscess, and to justify the need for an in-depth differential and diagnostic search in patients with corresponding clinical manifestations of perianal pathology. Description of a clinical case. The article describes a clinical case of successful treatment of a 24-year-old patient with a pilonidal cyst of the sacrococcygeal area and a purulent secondary fistula that mimicked a perianal abscess with an incomplete external fistula of the rectum. Data are given on the step-by-step performance of the diagnostic process and the choice of optimal surgical treatment tactics. Results and discussion. The described clinical case is interesting for specialists and its detailed coverage due to: a) the presented atypical course of PC; b) selected diagnostic tactics; c) the selected method of operative treatment of the patient. The points mentioned above are described in detail in the section, with coverage and visualization of possible alternative options for the patient's diagnosis and the use of various tactics for surgical treatment. Conclusions. Conducting an extended differential diagnostic search using additional instrumental imaging methods is justified in patients with pilonidal disease with an atypical or blurred course. Performing a complete perioperative set of examinations allows for choosing the correct surgical tactics for treating such patients. The use of a full-fledged invasive examination of the perianal area using methods of regional or general anesthesia is reasonably justified in case of suspicion of insufficient informativeness of clinical-instrumental, laboratory, and imaging methods of examination

A clinical case of surgical treatment of appendiceal stump abscess

In Ukraine, the share of patients with acute appendicitis is 89.1% of the total number of patients with acute surgical pathology. In modern surgical practice, early and late complications occupy the first place in the structure of acute surgical diseases of the abdominal organs, regardless of the age and gender of the patients, and the postoperative mortality is on average 0.15%. In the remote period after an appendectomy, despite the progress of modern surgery, a very rare complication known as inflammation of the stump of the appendix can occur. The patient, 25 years old, turned to the department of purulent surgery with complaints of a «small wound» at the site of the postoperative scar in the right inguinal area and minor purulent discharge from it. Four months ago, in July, he was operated on for acute phlegmonous appendicitis. On November 1, after physical exertion, the wound reappeared, and on November 3, the patient independently sought a consultation at the reception department of the Clinical City Hospital No3. He was examined by a surgeon and hospitalized. During the revision of the wound, a tumor‑like formation measuring 2.5x3.0x2.5 cm, as well as the parietal peritoneum, was revealed. Appendectomy was performed by the method of pouch ligation with drainage of the abdominal cavity through a separate contraperture with polyvinyl chloride drainage. After the operation, a diagnosis was established: abscess of the stump of the appendix, and external fistula of the anterior abdominal wall. The postoperative wound healed with primary tension, and the sutures were removed. The diagnosis of appendicitis may be mistakenly excluded from the clinical search due to the presence of a postoperative scar after appendectomy. A clear clinical picture of acute appendicitis or the opening of a fistula at the site of a postoperative scar in the right iliac region indicates the need for a computer tomography of the abdominal organs with contrast to establish an accurate diagnosis and choose the correct treatment tactics. The only treatment for inflammation of the appendiceal stump is a complete appendectomy with appendix removal either by open or laparoscopic surgery, which should be performed urgently to avoid further complications.

Surgical treatment of locally advanced desmoid tumor of the anterior abdominal wall

Desmoid tumor (DO) is a rare monoclonal connective tissue tumor arising from deep soft tissues, characterized by invasive growth and a tendency to local relapses and incapable of metastasis [1].The purpose of presenting this clinical case is to assess the significance of timely diagnosis, the choice of an individually correct treatment method, tactics of further observation, therapy.To achieve this goal, a number of literature sources were studied, a clinical case of surgical treatment of a desmoid tumor of the anterior abdominal wall was presented in our medical institution (Northwestern State Medical University named after I.I.Mechnikov, St. Petersburg).The difficulty of the case was the significant size of the indolent tumor, insensitive to systemic therapy, in a young man, and therefore the decision on surgical treatment tactics was also ambiguous. In each clinical case, it is worth taking an individual approach to treatment tactics. When choosing observational tactics, strict outpatient monitoring and regular follow-up should be performed.

Treatment of a multimorphic form of vertebral infection (clinical case)

A clinical case of surgical treatment of a patient with a multimorphic form of vertebral infection is presented (spinal epidural abscess, paraspinal abscess, subdural epiema, iliopsoitis, purulent meningitis, complicated by sepsis and bilateral pneumonia). The patient underwent three surgical interventions and underwent targeted antibacterial therapy.

Surgical treatment of Ahmed glaucoma valve’s tube protrusion relapse. Clinical observations

In the practice of an ophthalmic surgeon, patients with a large number of concomitant conditions after repeated surgical interventions are seen with increasingly frequency. One of the grave complications in such patients is secondary glaucoma with a refractory type of course. After successful compensation of intraocular pressure in such patients, the risk of complications increases many times, for example, protrusion of the Ahmed valve drainage tube, which becomes the entrance gate for infection, which can lead to endophthalmitis. This article presents clinical cases of surgical treatment of recurrent protrusion of the Ahmed valve drainage tube.

Clinical case of surgical treatment of a malignant tumor from the sheaths of peripheral nerves of retroperitoneal localization

Clinical case. The article presents a clinical case of malignant retroperitoneal schwannoma, which was a diagnostic finding. The clinical picture of the disease was dominated by pain in the lower abdomen and lower back, frequent urination. After a diagnostic examination and preliminary preparation, the patient was operated on in a hospital at the oncogynecology department of the Tashkent City branch of the Republican Specialized Scientific and practical Medical Center of Oncology and Radiology with a preliminary diagnosis of an ovarian tumor. Interrooperatively, a tumor of the retroperitoneal space with lesions of the obturator nerve was revealed. Subsequently, immunohistochemical analysis clarified the histological type of the tumor, which turned out to be a malignant schwannoma of the retroperitoneal space.Conclusion. These data may help in the management of patients with this pathology and improve the diagnosis of patients with small pelvic tumors.

A clinical case of surgical treatment of a large kidney cyst in a 9-year-old girl with autosomal dominant polycystic kidney disease

BACKGROUND: Autosomal dominant polycystic kidney disease is currently the most common inherited form of cystic kidney disease, the frequency of which is about 1 per 400–1000 newborns, what makes the problem relevant. Its progressive course in patients with polycystic disease is primarily associated with the ischemic component, the severity of which depends on the number, location and size of cysts. Arterial hypertension, which is an autosomal dominant polycystic kidney disease complication, plays a leading role in renal failure progression. Given the current lack of specific treatment, the main therapeutic goal is to prevent complications, postpone the development of renal failure. Therefore, if there are large and giant cysts, surgical treatment is an effective modality and should be performed in a timely manner.
 CLINICAL CASE DESCRIPTION: The authors present a clinical case of a successful endovideosurgical cyst excision in a -year-old patient with a giant cyst in the right kidney, autosomal dominant polycystic disease, and hypertension of renal genesis.
 Endovideosurgical cystectomy in the patient with autosomal dominant polycystic kidney disease has become an important pathogenetic link in the treatment of this pathology. Currently, the patient is under dynamic follow-up for more than one year. During the follow-up period, the patient demonstrates relief of urinary syndrome in the form of disappeared haematuria, stabilization of albuminuria indices, improvement of blood flow parameters in the renal parenchyma, as well as stabilization of arterial pressure.
 CONCLUSION: The given clinical example demonstrates that reasonable surgical intervention with the choice of a rational method of access, taking into account the anatomical localization and size of the cystic formation, allowed to obtain a good result in the form of stabilization of renal hemodynamics in a patient with autosomal dominant polycystic kidney disease.

Promontofixation Using Titanium Mesh Implant in a Patient with Genital Prolapse: A Clinical Case

Introduction. Pelvic organ prolapse is increasingly spreading around the world. Therefore, surgical interventions in this pathology are becoming more frequent. Non-mesh surgery for pelvic organ prolapse is reported to have a higher incidence of disease recurrence, and polypropylene mesh implants appear to cause implant-associated complications, thereby limiting their application in clinical practice. Materials and methods. When a patient with an apical prolapse and high risk of postoperative complications sought medical care in the Clinic, the specialists decided to perform promontofixation using a titanium mesh implant. Results and discussion. The present paper describes a clinical case of surgical treatment of genital prolapse using a titanium mesh implant. Since the patient who was admitted for surgical treatment had a family history of genital prolapse, an application of non-mesh technologies implied a high probability of genital prolapse recurrence, as well as a high risk of the vaginal erosion after surgery. Therefore, a promontofixation was performed using a titanium mesh implant, and the 6-month follow-up period showed no postoperative complications. Conclusion. Analysis of postoperative complications demonstrated a considerable potential of using titanium mesh implants for the prevention of implant-associated complications.

A clinical case of surgical treatment of a child with aneurysms of the abdominal aorta and aortic bifurcation, superior mesenteric artery and multiple aneurysms of the main arteries

A brief literature review on abdominal aortic aneurysms in children and our own observation of surgical treatment of a 5-year-old child with an aneurysm of the abdominal aorta and aortic bifurcation, an aneurysm of the superior mesenteric artery, and multiple aneurysms of the arteries of the lower extremities has been presented in the paper. Staged replacement of the aortic aneurysm and superior mesenteric artery with synthetic polytetrafluoroethylene prostheses was performed. The features of surgical interventions, difficulties and complications that the authors encountered during the treatment of the child are described.

A specific course of tuberculous spondylitis with concurrent HIV infection

The article describes a clinical case of surgical treatment of tuberculous spondylitis and tuberculous pleurisy in a HIV positive patient with disseminated pulmonary tuberculosis. A severe pain syndrome in tuberculous spondylitis was the fi rst clinical manifestation of generalized multiple drug resistant tuberculosis.Surgical treatment of spinal deformity relieved the pain syndrome, microbiological results of surgical biopsy of the vertebrae and pleura allowed prescribing the eff ective treatment for generalized tuberculosis

A clinical case of surgical treatment of duodenal diverticulum in a 15-year-old girl

Introduction. Duodenal diverticula account for about 10% of all diverticula in the gastrointestinal tract and occupy the second place in the incidence structure after colon diverticula. They are characterized by the asymptomatic course, as a result of which they are often detected by chance. Clinical manifestations of duodenal diverticula inflammation are not typical, and this diagnosis is a diagnosis of exclusion. Most often, they are revealed after developed complications: first place - strictures of the diverticulum with intestinal obstruction as a result of chronic inflammation, then - bleeding associated with the possible ectopia of pancreatic tissue and peritonitis in case of diverticulum perforation.Material and methods. Since 1972, 19 patients have been treated for duodenal diverticula at Rostov State Medical University (Rostov-on-Don) and Regional Children's Clinical Hospital (Rostov-on-Don). The main clinical manifestation, almost in all cases, was bleeding. X-ray with contrast examination of the gastrointestinal tract was made almost to all patients. If the contrast leakage into the duodenum was seen at the examination, plus clinical manifestations, it was an indication for surgical management. A clinical case of girl I. ,15 y.o., is given as an example.Conclusion. Duodenal diverticulum is extremely rare in childhood. So as to verify the diagnosis, it is necessary to follow the examination algorithm, which promotes the choice and tactics of treatment. To the authors' opinion, the key role in the diagnostics of the discussed pathology belongs to fibrogastroduodenoscopy. An indication for surgical treatment is the combination of instrumental diagnostic findings and clinical manifestations. During the duodenal diverticulum resection, surgeons must have a clear visualization of large duodenal papilla localization relative to its mouth.

Perfusion Computed Tomography in the Choice of Treatment Tactics for Chronic Critical Tandem Lesion of the Internal Carotid and Middle Cerebral Artery (Case Report)

A clinical case of surgical treatment in patient with tandem ipsilateral lesion of the right internal carotid artery: (95–99 % stenosis at the ostium) and the middle cerebral artery (occlusion) described in the article. Further treatment tactics could be determined with the help of PKT performed on the patient during hospitalization. Changes in the blood supply to the cerebral hemisphere revealed by PKT were of decisive importance in determining the further treatment tactics for this patient. The patient was operated in the range of right side carotid endarterectomy. Control brain tomography perfusion, performed 6 months after surgery, demonstrated the absence of areas with impaired blood flow in the cerebral hemispheres.

Комбинированная операция на переднем и заднем отрезках глаза с дооперационным разрывом задней капсулы

Nowadays intravitreal drug administration occupies one of the leading places in the structure of the treatment of eye diseases. the technique for performing this manipulation is simple and universal. however, there may be complications during it. among them are transient ophthalmohypertension, uveitis, endophthalmitis, as well as damage to the lens and retina. a clinical case of surgical treatment of patient d., aged 81, with damage to the posterior lens capsule and fast cataract development was analyzed. Тhe operation was performed on the device EVa (dorc). retrobulbar anesthesia with ropivacaine (ropivacaine Kabi) FrESEnIUS KaBI norgE, aS (norway) 5.0 ml. paracentesis was performed at 2 and 10 o’clock, tunnel 2.2 mm, introduction of viscoelastic discoVisc (alcon). Сapsulorhexis 4 mm was performed using capsular tweezers. the swollen lens masses were washed with an irrigation-aspiration system. 25g ports were installed 3 mm from the limbus in the lower outer, upper outer, upper inner segments of the eyeball. Тotal vitrectomy was performed in the usual mode (vitreotome cuts 10 thousand per minute and irrigation 70 mm hg). the dislocated lens was also removed using a vitreotome with a frequency of 4,000 cuts per minute. Implantation of the intraocular lens rayone hydrofobic aspheric +22.0 diopters (rayner Intraocular lenses limited, United Kingdom) on the anterior capsulorhexis. Fixation of the Iol was not required because the diameter of the anterior rexis of 4 mm (which is smaller than the diameter of the Iol optics of 6 mm) made it possible to hold the lens. Interrupted 7/0 vicryl sutures were put on the sclera. Тhe approach to surgical treatment chosen by us, based on the patient’s history, examination, tactics of performing surgical intervention, showed its timeliness and effectiveness. Keywords: intravitreal injections, complications, damage of the lens capsule, lens luxation

A case of surgical treatment of an aneurysm of the internal carotid artery with severe angulation

The leading role among causes of CVA (cerebrovascular accident) is occupied by pathology of the internal carotid artery. The most common etiological factor is a pronounced atherosclerotic process in the area of carotid artery bifurcation. Significantly less common factors are non-atherosclerotic causes of internal carotid artery disease, which include aneurysm and pathological tortuosity. Their combination significantly increases the risk of cerebral events, which requires timely surgical treatment. Surgical treatment is associated with certain intraoperative difficulties. The following is a clinical case of surgical treatment of an aneurysm of the internal carotid artery extracranial segment in combination with its deformation correlated with hemodynamic stenosis of more than 70%. A resection of the tortuosity-aneurysm complex with the formation of an end-to-end anastomosis of the internal carotid artery was performed.

Thoracoscopic removal of a retrosternal parathyroid adenoma

Primary hyperthyroidism is a common endocrine pathology, with parathyroid adenoma being the most frequent cause of this condition. A number of patients have deep-seated mediastinal adenomas which poses certain challenges in diagnostics and impose serious limitations for performing a surgery using a traditional transcervical approach. Nonetheless, the combination of modern tools of topical diagnostic investigations along with mini-invasive surgical methods allow to perform a radical operation in this group of patients with reduced injury rate. In this article we present a clinical case of surgical treatment of a 65-Year-Old female patient with primary hyperthyroidism caused by retrosternal parathyroid adenoma located in the aortic-pulmonal window. Preliminary diagnosis was based on Chest Computed Tomography (CCT scan) and technetium-99mTC scintigraphy. Considering complex anatomical and topographical location of the tumour it was decided to perform a thoracoscopic parathyroidectomy. The postoperative period was uneventful, with the laboratory values of parathormone being within reference range after the surgery. On the third day after the operation the patient was discharged. Further follow-up has not shown any signs of relapse.

Clinical cases of surgical treatment of dirofilariasis in the Tomsk region

The paper reports on surgical cases of treatment of dirofilariasis Dirofilaria repens in the Tomsk Region. Dirofilariasis - transmissible tissue helminthiases, characterized by damage to the skin, subcutaneous tissue, mucous membranes (Dirofilaria repens) or internal organs: heart, lungs, bronchi and large blood vessels (Dirofilaria immitis). Until recently, the disease was considered exclusively zoospecific, so doctors did not study it. To date, little is known about it and it is not immediately possible to make a diagnosis. Due to the fact that in recent years cases of infection of people in the territory of the Russian Federation, including in the Tomsk Region, have become more and more frequent, the description of the clinical picture, methods of diagnosis and surgical treatment of this disease is relevant.

Surgical Treatment of Pulmonary Embolism Associated with COVID-19: First-Hand Experience

INTRODUCTION: Venous thromboembolic complications occupy one of the central positions in the structure of complications associated with CoronaVirus Disease 2019 (COVID-19). Characterized by high epidemiological threshold values, as well as an atypical clinical picture, they determine the need for new approaches to early diagnosis and active treatment. Surgical treatment of pulmonary embolism in itself is an extremely controversial method of reperfusion of the pulmonary arterial bed. Concerning pulmonary embolism associated with a new coronavirus infection, we did not find a single clinical case reported in the available literature. The article considers a clinical case of surgical treatment of pulmonary embolism against the background COVID-19 infection, demonstrates a comprehensive approach to treatment and describes peculiarities of the clinical picture.
 CONCLUSION: Based on the presented case, one should note the importance of the anticoagulant therapy in a group of people with a virus-specific intervention to prevent recurrence of thromboembolic complications. Complex surgical treatment in combination with the proposed methods of anesthesiological support are the methods of choice in a group of people at intermediate-high and high risk of early cardiac death.

A Clinical Case of Surgical Treatment of a Patient with Two Postinfarction Left Ventricular Aneurysms

Postinfarction left ventricular (LV) aneurysm develops as a result of untimely restoration of blood flow in the infarct-dependent artery and is associated with an increase in cardiac mortality. The presence of several postinfarction LV aneurysms of different localizations in one patient is a rare and casuistic case.
 Case description. Patient B., 53 years old, was urgently hospitalized in the National Amosov Institute with complaints of shortness of breath, pain behind the sternum with radiation to the left arm, occurring with minimal physical exertion. Electrocardiography showed scar changes in the anterior-apical-lateral area of the LV with a thrombosed aneurysm of the LV lateral wall. Echocardiography revealed a severe decrease in the global contractility of the LV with ejection fraction of 24% and aneurysms of the septal-apical and posterior-lateral segments of LV. Pericarditis was found, with a layer of fluid of 1.7 cm on the LV posterior wall and 2.0 cm on the LV apex. Emergency coronary angiography revealed an occlusion of the middle third of the left anterior descending artery and the middle third of the left circumflex coronary artery, 50-70% stenosis of the right coronary artery and confirmed widespread LV aneurysm. Cardiac magnetic resonance imaging with intravenous contrast confirmed the change in configuration and significant dilatation of the LV due to the formation of two LV aneurysms with mural thrombus in the cavity of the posterior-lateral LV aneurysm. After discussing the patient’s data, the cardiac team performed emergency on-pump coronary bypass surgery, resection of the LV aneurysm with thrombectomy. The operation took 5 hours, aorta cross-clamp time was 75 min, perfusion time was 117 min, intraoperative blood loss was 300 ml. The patient was extubated in 2 hours after the end of the operation, the length of intensive care unit stay was 2 days. On the 9th day after the operation, the patient was discharged from the Institute with positive clinical, electrocardiographic and echocardiographic (LV ejection fraction 38%) dynamics.
 Conclusions. This clinical case demonstrates successful surgical treatment of two LV aneurysms, a rare complication of acute myocardial infarction. Preoperative detailed diagnosis and discussion of the patient’s data by the heart team, selection of the optimal term and volume of the operation allowed to quickly stabilize the patient’s condition and achieve a positive immediate result.

The role of a multidisciplinary approach in the rehabilitation of a cardio-oncological patient over 65 years old (a clinical case)

Given the common risk factors and mechanisms of development, the radical treatment of colorectal cancer in patients with concomitant cardiovascular diseases (CVD) requires the integration of oncologists, cardiologists, and other specialists from related disciplines. For optimal monitoring of onco-cardiology patients, a multidisciplinary approach is required and, accordingly, the creation of professional cardio-oncological teams. The review presents a clinical case of surgical treatment of coronary heart disease and newly diagnosed adenocarcinoma of the ascending colon in a 75‑year-old patient. The features of the management and rehabilitation of the patient at all stages of inpatient surgical oncology treatment in a multidisciplinary surgical clinic are described.

Clinical case of surgical treatment of a patient with multivessel coronary artery disease and abdominal aortic aneurysm in combination with malignant tumor of the larynx

Combination of oncological and cardiological pathologies is a complex clinical problem requiring a multidisciplinary team of doctors for treatment of a patient. This article presents a case of successful treatment of a patient with serious concomitant pathologies.