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Ascites with no fluid in Morison’s pouch?

100%
Marjanovic Z., Vacic N., Dobanovacki D., Slavkovic A.
Open Medicine
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2012
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vol. 7
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issue 4
564-566
EN
Omental cysts are the least common cystic lesions of the abdomen. Large intraabdominal cysts can mimic ascites. The incidence of 1 in 20000 pediatric hospital admissions makes them hard to diagnose. We report a three year-old boy with accidentally discovered intraperitoneal fluid collection on ultrasonography. The patient was scheduled for operative treatment with working diagnosis of ascites, but finding of no fluid in Morison’s pouch brought to massive cystic intraabdominal lesion as differential diagnosis. The cyst was emptied; altered parts of the greater omentum were completely excised. Final pathology confirmed lymphangioma. Explorative laparotomy led to correct diagnosis and proper surgical treatment.
2
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Rectal duplication, rare cause of constipation - case report

100%
Marjanovic Z., Djordjevic I., Slavkovic A., Krstic M.
Open Medicine
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2012
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vol. 7
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issue 5
621-623
EN
Digestive tract duplications are uncommon congenital anomalies, encountered mostly in the first 3 months of life. Overall the rectum is the least common site of alimentary duplications. We represent a case of large cystic non-communicating duplication that manifested with constipation and profuse rectal bleeding. When diagnosis was established, surgery was planned and the cyst was enucleated completely. Histopathology examination confirmed the diagnosis.
3
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Surgical treatment of gastrointestinal autonomic nerve tumors (GANT) in children-2 case reports

88%
Marjanovic Z., Slavkovic A., Krstic M., Djodjevic I., Dimov D.
Open Medicine
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2011
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vol. 6
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issue 4
395-399
EN
Gastrointestinal autonomic nerve tumors form an uncommon subcategory of stromal tumors of the intestinal tract although their histologic appearance is similar to other gastrointestinal stromal tumors. Our aim was to evaluate our experience in the diagnosis and therapy of these kinds of tumors. Two patients were admitted to the Pediatric Surgery Clinic in Niš with abdominal pain and a palpable mass in the abdomen. After excision, the tumor tissue was sampled, sent for histopathological diagnosis, and examined by light microscopy, immunohistochemistry, and electron microscopy. Postoperatively, both patients recovered without complications. The patient with the tumor bulk in the mesentery of the small bowel had no evidence of tumor progression 6 years after surgery. In the second case, a giant tumor was present along the greater curvature of gaster. Even with a tumor of this size, there were no signs of progression 10 years after surgery. Radical surgical resection of gastrointestinal autonomic nerve tumors seems to be the curative approach to date, and long-term survival is possible even with large tumors.
4
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A rare case of intestinal obstruction due to ascariasis in Niš, south Serbia

88%
Stojanovic M., Slavkovic A., Stojanovic M., Marjanovic Z., Bojanovic M.
Open Medicine
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2011
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vol. 6
|
issue 4
390-394
EN
Ascariasis is a helminthic infection of global distribution, and intestinal obstruction is its most common gastrointestinal complication. This is a case of a 7-year-old boy admitted to Pediatric Surgery because of intestinal obstruction caused by ascariasis. On admission, the patient presented with colicky abdominal pain, bile-stained vomiting and meteorism. On physical examination, the patient was thin, pale, and dehydrated. An abdominal examination showed distention and diffuse tenderness. After admission, the patient had fecal vomiting and expulsion of worms through the mouth. Laboratory-test results showed leucocytosis, eosinophilia, hypoalbuminaemia, and hypochloremia. Abdominal radiographs and ultrasound studies were indicative of small-bowel obstruction due to roundworms, which led to the performance of an exploratory laparotomy. On bowel exploration, an intraluminal mass, 10 by 6 cm in diameter, consisting of roundworms in the middle third of the ileum was found. A longitudinal enterotomy was performed, and the worms were meticulously extracted manually. Postoperatively, broad-spectrum antibiotics and antihelminthic drugs were administered. Our case of intestinal obstruction caused by ascariasis is the first to be reported in Serbia, according to the Serbian literature.
5
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Rapunzel syndrome - a case report

88%
Stojanovic M., Slavkovic A., Marjanovic Z., Stojanovic M., Zivanovic D.
Open Medicine
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2010
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vol. 5
|
issue 3
354-357
EN
Bezoars are collections of indigestible materials found in the gastrointestinal tract. Rapunzel syndrome is a rare complication of a gastric trichobezoar in which the mass of hair extends through the pylorus into the small bowel and can even reach the colon. A 12-year-old girl with severe pain and a feeling of “fullness” in the upper abdomen was admitted to Pediatric Surgery. Two days before admission, the patient presented with vague abdominal pain, vomiting with a little blood, and black stool. On physical examination she was pale and listless with patchy alopecia. Abdominal examination showed a mobile, palpable mass in the epigastrium. The initial hematocrit was 7,1%, and the erythrocyte count was 1,12×1012 cells per liter. Abdominal ultrasound and computed tomographic (CT) examinations confirmed the presence of a tumor-like formation in stomach. A giant bezoar with ulceration on the back wall of the stomach was verified by upper gastrointestinal endoscopy. Endoscopic extraction was not possible because of the size of the bezoar. Gastrotomy was performed to remove the bezoar that occupied most of the stomach, with a long tail that extended deeply into the duodenum (Rapunzel syndrome). The bezoar, 35 by 10 cm in diameter, was black and consisted of hair and synthetic fibers. Prompt diagnosis and treatment of trichobezoars are important to avoid a possible fatal outcome.
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