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Spontaneous Rupture of the Spleen - A Rare Case

100%
Matykiewicz J., Głuszek S.
Polish Journal of Surgery
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2011
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vol. 83
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issue 2
105-107
EN
The study presented two cases of spontaneous rupture of the spleen. Both patients were treated at the Department of General, Oncological, and Endocrinological Surgery. The first patient underwent splenectomy. The postoperative course was uneventful. The second patient was subject to pharmacological treatment because of non-acceptance to surgical intervention. The patient died during the following hospitalization. Both patients received oral anticoagulants, due to atrial fibrillation and an implanted heart valve. History of previous trauma was absent. The study presented a detailed description of the clinical course of splenic rupture.
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Gastrointestinal Bleeding in Patients Aged 85 Years and Older

81%
Kozieł D., Matykiewicz J., Głuszek S.
Polish Journal of Surgery
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2011
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vol. 83
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issue 11
606-613
EN
The aging of the population is associated with the increased risk of chronic diseases, and greater consumption of drugs used in their treatment, which may lead towards gastrointestinal bleeding.The aim of the study was to analyze the reasons, treatment results, complications and mortality connected with gastrointestinal bleeding in patients aged 85 years and older.Material and methods. The study comprised the retrospective analysis of 84 patients, aged between 85 and 97 years admitted to the Department of General Surgery with diagnosis of gastrointestinal bleeding, during the period between 2005 and 2010. The results were compared to a younger control group of 151 patients (mean age-53 years) with gastrointestinal bleeding, admitted to the department during the same period. Diagnosis was based on the history, physical examination, endoscopy, morphology and biochemical lab results. Analysis considered the therapeutic method used, treatment results, complications and hospital mortality. The endoscopic picture and risk of recurrent bleeding in patients with upper gastrointestinal hemorrhage was evaluated by means of the clinical Forrest scale. Results were subject to statistical analysis.Results. Most of the gastrointestinal bleeding cases considering patients aged 85 years and older concerned the upper gastrointestinal tract (41.67%). Thirty (35.71%) patients were on drugs affecting the coagulation system. On admission, the average hemoglobin concentration level in the elderly was comparable to results observed in case of the control group. Considering patients aged 85+, drugs affecting the coagulation system were used statistically more frequently, as compared to younger patients. Recurrence of bleeding was observed in 10 (11.9%) study group patients.Overall mortality due to gastrointestinal bleeding in elderly patients amounted to 20.24% and was statistically higher, as compared to the control group- 7.2%.Conclusions. Treatment results in case of gastrointestinal bleeding in the elderly patients (above 85 years) are burdened with a higher mortality rate. Different diagnostic and therapeutic methods should be applied in case of elderly patients (above 85 years), in order to increase their chance of survival. The problem of aging is an epidemiological phenomenon and gastrointestinal bleeding will become an increasing problem, needing to be solved in everyday clinical practice.
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The Influence of Splenectomy Performed Simultaneously with Gastrectomy on Postoperative Complications in Patients with Gastric Cancer Undergoing Surgery with the Intention to Treat

81%
Głuszek S., Kot M., Kuchinka J., Matykiewicz J.
Polish Journal of Surgery
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2015
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vol. 86
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issue 7
312-318
EN
Despite the growing understanding of the pathophysiological processes in the perioperative period and significant advancements in surgical techniques, operative treatment for gastric cancer remains a challenge for surgeons, especially because the primary procedure of total or nearly total gastrectomy must at times be extended by the resection of other organs. The aim of the study was to asses the influence of concomitant splenectomy in patients undergoing curative surgery for gastric cancer on postoperative complications. Material and methods. The study population consisted of 258 patients who underwent surgical treatment for gastric cancer with the intention to treat. The study assessed the influence of extending the surgical intervention by splenectomy on postoperative complications, both general and surgical, including the most severe of these, i.e. oesophago-gastric anastomotic leakage, duodenal stump leakage and peritoneal fluid infections. Results. Among the 258 gastric cancer patients receiving curative surgical treatment, the most common simultaneous intervention was splenectomy: 42/258 (16.3%), which was also accompanied by partial pancreatectomy in 8 cases. The number of surgical postoperative complications, major and minor, was similar in both subgroups: with and without splenectomy. Minor general complications, such as pyrexia with no clinically apparent reason, atelectasis, pneumonia and pleural effusion were statistically significantly more common in the subgroup with splenectomy (p=0.0001). Conclusion. Splenectomy performed concomitantly with gastrectomy for gastric cancer increases the risk of minor general complications. However, it does not increase the risk of severe surgical complications, such as oesophago-intestinal anastomotic leakage and does not increase the risk of death
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The Influence of Anti-Platelet and Antithrombotic Treatment on the Clinical Course of Bleeding into the Lumen of Alimentary Tract Upper Segment

81%
Matykiewicz J., Głuszek S., Szafran S.
Polish Journal of Surgery
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2010
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vol. 82
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issue 12
651-656
EN
The most frequently used drugs which may cause bleeding into the lumen of alimentary tract include: acetylsalicylic acid (ASA), ticlopidine/clopidogrel and acenocoumarol.The aim of the study was to analyze the frequency of the occurrence of bleeding into the lumen of alimentary tract upper segment (gopp) in patients taking anti-platelet drugs and oral anticoagulants, treated at the surgical department.Material and methods. The study covered a group of 164 patients treated at the Clinical Surgery Department of the Provincial Hospital in Kielce over the years 2006-2009. They were consecutive patients admitted to hospital with the initial diagnosis of bleeding into the lumen of gopp. The diagnosis was made on the basis of medical history, clinical examination and additional investigation. In all patients within 24-48 hours after the admission endoscopy of gopp was performed.Results. 164 patients with symptoms of bleeding into the lumen of gopp were treated. Among them there were 94 men (57%) as well as 70 women (43%). The average age was 61.8 years (from 23 to 91 years). In this group 24.4% (40/164) patients took drugs influencing coagulation system (acetylsalicylic acid, clopidogrel and/or acenocoumarol). In the subgroup taking the drugs mentioned above were 21 men (52.5%) and 19 women (47.5%). The average age was 73.6 years (from 48 to 91 years). Among patients taking drugs influencing hemostasis system 23 patients took ASA preparations, ticlopidine/clopidogrel - 5 patients and acenocoumarol - 12 patients. 8 patients took more than one drug, most frequently ASA and ticlopidine/clopidogrel, 1 patient took three drugs. 6 deaths were reported in the group taking drugs. Mortality rate was 15% (6/40). Among the deceased patients significantly lower (p<0.001) concentration of hemoglobin at the admission can be noticed (average concentration of Hb reached 6.1 g/dl) as well as non-interchangeably higher (p=0.13) average age of patients (average age of the deceased patients was 77.2 years). All the deceased patients were admitted to hospital with hypovolaemic shock. Results were statistically analyzed by the use of the test for comparison of two proportions and the t-Student test for the difference in expected values.Conclusions. Bleeding into the lumen of gopp induces considerable mortality, especially in patients with low hemoglobin concentration and hypotension at the admission to hospital. During the treatment of a patient with bleeding into the lumen of gopp a compromise between the risk of cardiovascular complications and the risk of death due to bleeding should be searched for.
5
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Digestive System Fistula - A Problem Still Relevant Today

71%
Głuszek S., Korczak M., Kot M., Matykiewicz J., Kozieł D.
Polish Journal of Surgery
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2011
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vol. 83
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issue 1
32-41
EN
Digestive system fistula originates most frequently as a complication after surgical procedures, less often occurs in the course of inflammatory diseases, but it can also result from neoplasm and injuries.The aim of the study was to analyze the causes and retrospectively assess the perioperative procedures as well as the results of digestive system fistula treatment.Material and methods. Own experience in digestive system fistula treatment was presented. The subject group consisted of 32 patients treated at the General Surgery, Oncology and Endocrinology Clinical Department between 01.05.2005 and 30.04.2010 due to different digestive tract diseases. The causes of the occurrence of digestive system fistula, methods and results of treatment were analyzed.Results. The analysis covered 32 patients with digestive system fistula, among them 15 men and 17 women. Average age for men was 57 years (20-78), and for women 61 years (24-88). In 11 patients idiopathic fistula causally connected with primary inflammatory disease (7 cases) and with neoplasm (4 cases) was diagnosed, in 19 patients fistula was the result of complications after surgery, in 2 - after abdominal cavity injury. Recovery from fistula was achieved in 23 patients (72%) with the use of individually planned conservative therapy (TPN, EN, antibiotics, drainage, and others) and surgery, depending on the needs of individual patient. 5 patients (16%) died, whereas in 4 left (12%) recovery wasn't achieved (fistula in palliative patients, with advanced stages of neoplasm - bronchoesophageal fistula, the recurrence of uterine carcinoma).Conclusions. Recently the results of digestive system fistula treatment showed an improvement which manifests itself in mortality decrease and shortening of fistula healing time. Yet, digestive system fistula as a serious complication still poses a very difficult surgical problem.
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Iatrogenic bile duct injuries – clinical problems

61%
Głuszek S., Kot M., Bałchanowski N., Matykiewicz J., Kuchinka J., Kozieł D., Wawrzycka I.
Polish Journal of Surgery
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2015
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vol. 86
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issue 1
17-25
EN
Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI) incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient. The aim of the study was analysis of iatrogenic bile duct injuries and methods of their repair,taking into consideration the circumstances, under which the injuries occur. Material and methods. The study group consisted of 16 patients who had suffered IBDI during surgery. The analysed parameters included sex, age, indications for surgery, the setting of the surgical procedure and the type of bile duct injury. Additionally, the time of injury diagnosis, type of repair and treatment outcome were assessed. The IBDI analysis used the EAES classification of injuries. The time of IBDI repair was defined as immediate, early or late,depending on the time that had passed from the injury. The analysis included complications seen after bile duct repair. Results. The study group consisted of 10 women and 6 men, aged 29-84. Patients underwent 6 classic cholecystectomies, 8 laparoscopic cholecystectomies, one gastrotomy to remove oesophageal prosthesis and one laparotomy due to peptic ulcer. IBDI was diagnosed intraoperatively in 4 patients. In 12 patients IBDI was diagnosed within 1-7 days. The diagnosis was based on endoscopic retrograde cholangiopancreatography and the results of biochemistry tests. According to the EAES classification, the injuries were of type 1 (4 patients), type 2 (8 patients), type 5 (3 patients) and type 6 (1 patients). Reconstruction procedures were performed during the same anaesthesia session in 3 patients, and in the early period in 13 patients. The main procedure was Roux-en-Y anastomosis (12 patients), with the remaining including bile-duct suturing over a T-tube (3 patients) and underpinning of an accessory bile duct in the pocket left after gallbladder removal (1 patient). The most common reconstruction complications included bile leak (3 patients), recurrent cholangitis (3 patients) and bile duct stricture (2 patients). Mortality in the study group was 12.5%. Conclusions. The procedures of laparoscopic and classic cholecystectomy are associated with a risk of IBDI, especially in the presence of inflammatory state of the gall-bladder. IBDI is a complex complication: its treatment poses a challenge for the operating surgeon, and even the most careful treatment adversely affects the patient’s lifedue to complications.
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