Faculty of Medicine

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Perforated solitary mid-rectal diverticulum diagnosed with colonoscopy: a case report and literature review
(Oxford University Press (OUP), 2025-12-24)
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Avramoski, Vladimir
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Gjinoska, Klaudia
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Kostovska, Irena
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Stoicovski, Emil
Rectal diverticulum is an exceedingly rare clinical entity, typically occurring as a solitary lesion or, less frequently, as up to three diverticula. Its development is often associated with underlying conditions such as obstructive defecation syndrome, rectal malignancy, pelvic floor weakness, chronic rectal impaction, obesity, or infection-related muscular atrophy. Although uncommon, rectal diverticulitis represents a surgical emergency requiring timely recognition and management. In this case, a female patient presented with rectal bleeding and secondary anemia. During the clinical course, the patient developed pelvic sepsis secondary to rectal diverticulitis. Appropriate surgical intervention, combined with antimicrobial therapy and supportive management, led to a favorable outcome. Rectal diverticulitis is a rare but potentially life-threatening condition. Awareness of this entity and early diagnosis are essential to prevent severe complications such as perforation and pelvic sepsis. This case highlights the importance of considering rectal diverticulum in the differential diagnosis of lower gastrointestinal bleeding and pelvic infections.
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A giant desmoid tumor of the abdominal wall presented as a panniculus morbidus: case report and literature review
(Oxford University Press (OUP), 2025-12)
Kocevski, Zhivorad
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Jović, Goran
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Grujevski, Viktor
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Stoicovski, Emil
The abdominal wall's desmoid-type fibromatosis (desmoid tumor) is a rare, locally aggressive mesenchymal tumor with no potential for distant metastases. It can occasionally grow to a considerable size, leading to diagnostic confusion and presenting as a challenging surgical problem. This is a case of a giant desmoid tumor of the abdominal wall, which manifested as a panniculus morbidus (apron belly), thus causing an adult-acquired buried penis and reduced quality of life.
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Multiseptate gallbladder accompanied by an incomplete annular pancreas in a 19-year male patient: A case report
(Elsevier BV, 2025-10)
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Misimi, Shqipe
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Trpeski, Stanko
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Atanasov, Zvonko
Multiseptate gallbladder (MG) is a rare congenital malformation that may occur as an isolated anomaly or in conjunction with other abnormalities of the pancreaticobiliary, urinary, and gastrointestinal systems. The coexistence of MG with an annular pancreas is an exceedingly rare phenomenon. The diagnosis is typically established using abdominal ultrasound; however, further imaging modalities are often required to delineate the detailed anatomy and to identify any associated anomalies within the pancreaticobiliary system. We present a case of a symptomatic MG associated with an incomplete annular pancreas. This case underscores the importance of considering additional congenital anomalies in patients diagnosed with MG, as such associations may influence clinical management and outcomes.
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Radiation-induced rectal leiomyosarcoma in a cervical cancer survivor: a case report
(Oxford University Press (OUP), 2025-08)
Sulejmani, Haris
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Vasilevski, Filip
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Rectal leiomyosarcoma (LMS) is an exceptionally rare malignancy, representing ˂0.5% of all rectal cancers. Even more uncommon are the cases of radiation-induced LMS arising as an independent malignancy following pelvic radiotherapy. We report a case of a 56-year-old female patient with a history of high-grade large cell neuroendocrine cervical carcinoma treated 12 years earlier with radical hysterectomy and adjuvant chemoradiotherapy. The patient presented with rectal discomfort and altered bowel habits. A colonoscopy revealed a near-obstructing polypoid rectal mass, and a biopsy confirmed LMS. Surgical treatment via abdominoperineal resection with total mesorectal excision was performed. Adjuvant chemotherapy was conducted by an oncologist. Given the long latency period and absence of metastases, the tumor was stated as a radiation-induced primary malignancy. This case emphasizes the importance of awareness in cancer survivors previously treated with pelvic radiotherapy and highlights the critical role of surgery in the management of rectal LMS.
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FIRST-LINE IMMUNOCHEMOTHERAPY FOR FOLLICULAR LYMPHOMA PATIENTS- SINGLE CENTER EXPERIENCE
(Macedonian Association of Anatomists, 2024)
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Ridova, Nevenka
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Stojanovska Jakimovska, Simona
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Giant (complex) inguinal hernia in female patient left untreated for 40 years: a case report
(Oxford University Press (OUP), 2024-11)
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Gjinoska, Klaudia
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Kocevski, Zhivorad
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Stoicovski, Emil
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Mitrev, Zan
A giant inguinal hernia is a rare clinical presentation in patients refusing hernia repair for different reasons during a long period. The appearance is remarkable, and the preoperative preparation and the surgery itself might be challenging. They can present in an emergency (hernia incarceration) or elective setting. Most of the patients are male, but exclusions exist. This is a rare case of a female patient with a giant inguinal hernia left untreated for 40 years.
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Unexpected intraoperative finding of a hyalinizing cholecystitis in a patient with gallbladder calculi
(Oxford University Press (OUP), 2024-10)
Gjinoska, Klaudia
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Stoicovski, Emil
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Mitrev, Zan
Hyalinizing cholecystitis is a rare subtype of chronic cholecystitis in which the gallbladder tissue is replaced with hyaline sclerosis, more or less, and has a characteristic intraoperative appearance. Preoperative diagnosis is hard to establish. The entity is strongly associated with gallbladder carcinoma. Therefore, the pathologist should perform a thorough microscopic analysis. We present a case of an unusual intraoperative finding in a male patient with chronic cholecystitis which was proved to be a hyalinizing cholecystitis.
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Chevrel's procedure for midline incisional hernia repair-not to be abandoned or forgotten
(Oxford University Press (OUP), 2024-10)
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Cako, Dajana
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Argirov, Ivan
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Limani, Nimetula
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Ulusoy, Cemal
The Chevrel technique is a well-established procedure for open repair of midline incisional hernia. This retrospective single-center case series aims to present the outcome of patients with midline incisional hernia treated with a modified Chevrel technique. The modification itself comprehended the use of a single-layer continuous suture for the inverted anterior rectus abdominis muscle sheet for the creation of the "new linea alba" without overlapping. Between January 2017 and December 2023, 40 patients were operated. The overall postoperative morbidity rate was 65%. Hernia recurrence occurred in three patients (7.5%). When the basic principles of the Chevrel technique are respected and conducted, this leads to satisfactory results. The postoperative outcome of this case series showed rates of complications and recurrences in concordance with the already published literature. Therefore, this technique should always be considered for the open approach for midline incisional hernia repair.
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Perianal endometrioma presented as perianal abscess: report of two cases
(Oxford University Press (OUP), 2024-05)
Zafirovikj, Elena
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Nane, Nikola
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Perianal endometriosis is a rare clinical presentation of the extrauterine appearance of endometrium reported in <1% of the cases. The condition is accompanied by perianal cyclic pain and a palpable mass. If diagnosed by physical examination only, the condition may be easily misinterpreted as a perianal abscess and treated improperly with incision, thus resulting in "abscess recurrence." Additional diagnostic imaging such as endoanal ultrasonography and magnetic resonance imaging should be mandatory to provide an accurate diagnosis and proper treatment resulting in low recurrence rates. We present two cases of perianal endometriomas initially diagnosed and treated as perianal abscesses.
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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)
Gelevski, Radomir
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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.

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