Faculty of Medicine
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Item type:Publication, Amyand's hernia with gangrenous perforated appendicitis and diffuse peritonitis-case report(Oxford University Press (OUP), 2025-11); ; ; Manevska, Vesna JovanovskaAmyand's hernia, the presence of the vermiform appendix within an inguinal hernia sac, is a rare clinical entity (0.2%-1.7% of inguinal hernias). Acute appendicitis within the sac is rarer still, occurring in only 0.1% of cases. We describe a male patient presenting with an incarcerated right inguinal hernia, who developed diffuse peritonitis after manual reduction. Laparotomy revealed gangrenous perforated appendicitis with purulent peritonitis. Appendectomy, partial omentectomy, and peritoneal lavage were performed. The patient recovered uneventfully. Amyand's hernia complicated by perforated appendicitis is an exceptional surgical emergency. Early recognition and prompt surgical management are crucial for favorable outcomes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Pancreas and duodenum herniation in a giant inguinal hernia sac in a patient with severe scoliosis: a rare case report(Oxford University Press (OUP), 2025-07); ; ; Giant inguinal hernias (GIHs) are rare clinical entities, typically containing omentum or small bowel. Involvement of retroperitoneal organs, such as the pancreas and duodenum, is exceedingly uncommon due to their fixed anatomical positions. We report a unique case of a 52-year-old male with a longstanding right GIH and severe scoliosis, in whom preoperative imaging and surgical exploration revealed herniation of the pancreatic head and duodenum into the hernia sac. Contributing factors included altered retroperitoneal geometry from spinal curvature, reduced abdominal wall tone, and congenital right hip displacement with associated functional limitation. Incidental findings of multiple left hepatic duct calculi raised concerns for biliary stasis due to chronic duodenal displacement. This case highlights the importance of considering atypical hernia content in patients with longstanding hernias and complex musculoskeletal deformities, and underscores the role of comprehensive imaging and multidisciplinary assessment in surgical planning. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Uncommon degloving intestinal injury accompanied by complete disruption of the rectus muscles in patient with seat belt sign: a case report(Oxford University Press (OUP), 2025-07); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Laparoscopic cholecystectomy in situs inversus totalis: A case report(Centre for Evaluation in Education and Science (CEON/CEES), 2021); ; Situs inversus totalis represents a rare autosomal recessive morphological anomaly of the internal viscera, equally affecting both genders. The genetic defect occurs in the 2nd week of embryonic life, when a 270-degree clockwise rotation of the primitive digestive tube occurs. The incidence of calculosis of gallbladder in patients with situs inversus is the same as in the general population. A 61-year-old female patient with a history of four episodes of colicky, left hypochondrium and epigastric pain, without fever and jaundice, was admitted for elective laparoscopic cholecystectomy. CT of abdomen confirmed situs inversus totalis that was previously known to the patient. The patient was positioned in supine position and a mirror image configuration of the operating room was obtained, with surgeon and scrub nurse on the right side and assistant on the left side of the patient. Four trocars were introduced mirroring the standard position of the 5 mm trocars. During the dissection, second assistant was introduced for the laparoscope, due to the surgeon's limited motor skills in his left hand for delicate dissection, rendering him inapt to perform precise and safe dissection. The total operating time amounted to 110 minutes, which is three times longer than the standard operating time at our institution. The most critical point of the operation in constellation of situs inversus totalis is applying the clips, which requires precision and strength in the same moment. In the available literature, 40 open cholecystectomies before introduction of laparoscopy and 92 laparoscopic cholecystectomies were reported. To our knowledge, this is the first and the only reported laparoscopic cholecystectomy for situs inversus in North Macedonia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Opioid sparing effect of transversus abdominis plane (TAP) block in open ventral hernia repair: case series(Wolters Kluwer, 2022-06); Background: Open ventral hernia repair surgery is characterised with pain that arises from skin, muscles of the anterior abdominal wall and parietal peritoneum. Transversus abdominis plane (TAP) block can be suitable for these operations and can lower usage of opioids during surgery and in the postoperative period. Case report: We represent five patients, all ASA classification 2, scheduled for open ventral hernia repair surgery. After induction to standard general anesthesia with 2 mg midazolam, 100 µgr fentanyl, propofol 2 mg/kg, and rocuronium bromide 0.6 mg/kg, ultrasoundguided TAP block was performed with 20 ml 0.25% bupivacaine + 4 mg dexamethasone on both sides before surgical midline incision. Anesthesia was maintained with sevoflurane 0.7-1 MAC. Pain was measured first 48 hours after surgery with numeric rating score (NRS) from 1 to 10, where for NRS 4-6/10 1 gr metamizol was given, and for NRS 7-10/10 1 mg/kg tramadol was administered. Opioid consumption during surgery and in the postoperative period was measured too. The first three patients have pain 22 hours after surgery with NRS 4/10, other two patients have pain 25 hours after surgery with NRS 6/10 and all received 1 gr metamizol. Next complaint was 34 and 46 hours after surgery in all patients with NRS 4-5/10 and 1 gr metamizol was given. Total opioid consumption during surgery in all patients was 150 µgr fentanyl and none of the patients received opioids in the postoperative period. Discussion: Pain in open ventral hernia repair operations is from somatic origin and can lead to high pain scores in the postoperative period, bigger opioid consumption and prolonged stay in hospital.1 Bilateral TAP block is ideal for treatment of somatic pain and given together with dexamethasone can prolong analgesia in first 48 hours after surgery. References: 1. Zhang D, Zhou C, Wei D, Ge L, Li Q. Dexamethasone added to local anesthetics in ultrasound-guided transversus abdominis plain (TAP) block for analgesia after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE 14(1): e0209646. https://doi.org/10.1371/journal.pone.0209646 Learning points: TAP block given with steroids before surgical incision achieves prolonged analgesia during and after surgery, minimise opioid consumption and better pain control. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Low-grade malignancy glomus tumor of the abdominal wall: a case report and literature review(Oxford University Press (OUP), 2023-12); ; ; ; Gelevski, RadomirGlomus tumors are painful neoplasms arising from the glomus body (responsible for body temperature and blood pressure regulation) in the skin. Although mostly present in the interdigital areas, glomus tumors can arise elsewhere. The vast majority of them are benign. Rarely, malignant variants are reported and are associated with the potential for local infiltration and metastatic dissemination. The abdominal wall location of glomus tumors is extremely rare regardless of whether they present as benign or malignant. We present a case of a 58-year-old female patient with a low-grade malignancy infiltrative glomus tumor of the abdominal wall. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Risk Factors for Early Postoperative Complications after Surgery for Crohn's Disease(Centre for Evaluation in Education and Science (CEON/CEES), 2014-09-01); ; ;