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Duodenal diverticulum perforation mimicking acute cholecystitis- case reports and literature review

100%
Łącka M., Hać S.
European Journal of Translational and Clinical Medicine
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2022
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vol. 5
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issue 1
64-70
EN
Background Duodenal diverticula affect a large part of the population. It is a congenital abnormality that develops over time. The incidence of duodenal diverticulum is estimated at 22% of the population in autopsies. Only 5% of patients present symptoms, and of those only 1%–2% require surgery.Material and methodsTwo patients are described who underwent surgery due to duodenal diverticulum perforation mimicking acute cholecystitis.ResultsPerforation of the duodenal diverticulum, combined the difficulty of treatment and potential for complications, is a disease with a high mortality rate. It is subtle and difficult to diagnose due to the lack of generalized peritonitis and unspecific symptoms. The rarity and the wide spectrum of the disease, in combination with additional factors to be considered in treating this disease, mean there is no standard treatment. Depending on the patient's general condition, disease advancement, age and pathological findings observable only during surgery, we can choose between conservative treatment and a wide spectrum of surgeries.ConclusionsDuodenal diverticular disease rarely gives any symptoms. However, even after the onset of symptoms, only 1-2% of patients require surgery. Our work is unique because we present two cases, each featuring different approaches - conservative and surgical.
2
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Acute cholecystitis in patients with diabetes mellitus - systematic review

71%
Łącka M., Spychalski P., Dobrzycka M., Rostkowska O., Kobiela J.
European Journal of Translational and Clinical Medicine
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2020
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vol. 2
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issue 2
71-79
EN
Introduction: According to the WHO, an estimated 422 million people are suffering from diabetes worldwide. Among them, the incidence of cholelithiasis is higher than in the healthy population. The aim of this literature review was to summarize the available evidence about acute cholecystitis in patients with diabetes. Materials and methods: This study adhered to the PRISMA guidelines. The course of hospitalization of patients with and without diabetes who underwent cholecystectomy due to acute cholecystitis was compared. Following information was abstracted from original studies: general study information, patient characteristics, complications, and recommendations for patients with diabetes. Results: Initial search provided 1632 results. After full text assessment, 40 studies met the inclusions criteria. Operative and postoperative complication rates were significantly higher among the diabetic patients. Diabetes is a risk factor for conversion from laparoscopic to open cholecystectomy method. The authors' opinions on elective surgery before the onset of acute cholecystitis symptoms are divided. Conclusions: Diabetic patients are at greater risk of developing complications. An individualized screening and treatment approach, as well as proper preparation of the diabetic patient for an elective cholecystectomy could have a positive effect on the outcome. However, the low quality of the data from the systematic review does not allow for meta-analysis, which is why we cannot draw strong conclusions.
3
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Costs of elective vs emergency cholecystectomy in diabetic patients

61%
Łącka M., Spychalski P., Obłój P., Łaski D., Rostkowska O., Wieszczy P., Kobiela J.
European Journal of Translational and Clinical Medicine
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2020
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vol. 3
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issue 2
37-43
EN
Introduction: Hospitalization costs of diabetic patients are estimated to be higher than non-diabetic. Literature on the topic is however limited. The aim of this study was to compare the costs of elective and emergency cholecystectomy of diabetic and non-diabetic patients. Material and methods: A retrospective analysis involved diabetic versus non-diabetic age- and sex-matched patients who underwent emergency and elective cholecystectomy at a single center in Poland between 2016-2019. Results: The total costs of an elective cholecystectomy were 739.31 ± 423.07 USD for diabetic patients and 797.14 ± 772.24 USD for non-diabetic patients (p = 0.51). Whereas emergency cholecystectomy total costs were 3950.72 ± 2856.83 USD (diabetic patients) and 2464.31 ± 1718.21 USD (non-diabetic patients) (p = 0.04). The difference in total costs between elective cholecystectomy vs emergency cholecystectomy in both groups (diabetic vs non-diabetic patients) was statistically significant (p < 0.01 vs p < 0.05 respectively). Conclusions: In this study we demonstrated that emergency cholecystectomy is associated with a significant increase in hospitalization costs, particularly in diabetic patients. This suggests that early qualification of diabetic patients for an elective cholecystectomy could be beneficial for both diabetic patients and public health insurers.
4
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Obesity in work-up of kidney transplant candidates – review of clinical practice guidelines

61%
Dobrzycka M., Spychalski P., Łącka M., Proczko-Stepaniak M., Dębska-Ślizień A., Kaska Ł., Kobiela J.
European Journal of Translational and Clinical Medicine
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2020
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vol. 3
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issue 2
72-79
EN
Background: Incidence of morbid obesity is rising worldwide. Current clinical practice guidelines for the pre-transplant evaluation of end-stage kidney disease (ESKD) patients lack clear recommendations on morbid obesity. Material and methods: The aim of this review was to summarize the current guidelines on the role and treatment of obesity in kidney transplant recipients. Eight current national and international clinical practice guidelines were identified in a comprehensive literature search. Results: All guidelines underline early detection of obesity and obesity-related comorbidities in ESKD patients. Only two guidelines explored the role of weight-loss surgery, however due to the lack of sufficient evidence no formal recommendation of surgical procedure was given. Conclusions: Diagnosis and treatment of obesity remains underappreciated in the current guidelines, most of which do not include pharmacological and surgical interventions. High-quality evidence is warranted to assess the role of weight-loss including surgery in ESKD patients and to update the recommendations in future guidelines.
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