Faculty of Medicine

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Start date: 2025Subject: search.filters.subject.acute abdomen

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    The suprising stories of the acute abdomen:Tosion of the appendix vermiformis
    (2025-04)
    Srbakovska, Bisera
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    Ognenoska, Biljana
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    Acute appendicitis is the most common cause of acute abdominal pain needing surgical treatment. However, it can be clinically and radiologically mimicked by other conditions, some of them with an extremely rare occurrence. A two year old boy presented to our hospital with a history of abdominal pain and vomiting in the last 48 hours. On physical examination, the patient was found to be dehydrated, with a dry mouth and a white-coated tongue. Tenderness was noted throughout the entire abdomen, with rigidity and guarding, especially in the right lower quadrant. Laboratory results showed an elevated Creactive protein level of 50.2 mg/L and a white blood cell count of 25,800/μL. Under the suspicion of acute complicated appendicitis, emergency McBurney laparotomy was performed. Operative findings revealed an enlarged, dark purple, congested appendix, twisted 720° around its base at the cecum in the anticlockwise direction. There was no evidence of perforation. A typical appendectomy was performed. The postoperative course was uneventful and the patient was discharged home on the fourth post-operative day. Microscopic examination confirmed the hemorrhagic infarction and ischemic necrosis of the appendix, followed by an inflammatory reaction caused by the torsion. To our knowledge only 22 cases of torsion of the vermiform appendix in children have been reported in literature, with our case being the 23rd. Though extremely rare, it should be considered as a potential diagnosis in patients presenting with right lower abdominal pain. Histopathology is crucial in differentiating primary from secondary causes of appendicular torsion.
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    Clinical Management and Surgical Outcomes of Wandering Spleen with Splenic Torsion in Pediatric Patients: A Case Report
    (Albanian Society for Trauma and Emergency Surgery, 2025-01)
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    Kuci, Saimir
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    Lazar Todorovic
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    Kamilovski, Marijan
    Introduction: Wandering Spleen is a rare condition in which the splenic ligaments are abnormally loose or absent. This makes the Spleen more mobile and increases the risk of torsion. This case report outlines the clinical presentation and management of a 10-year-old female patient who presented at our clinic with acute abdominal pain, vomiting episodes, and a severe fever. Imaging tests, such as abdominal ultrasonography and computed tomography, confirmed the diagnosis of splenic torsion by showing a hemorrhagic infarction and a large spleen. We performed a splenectomy to remove the damaged organ, a partial omental resection to remove the dead tissue and removed the mesenteric lymph nodes for further pathological examination. After the surgical procedure, the intensive care unit carefully observed the patient and treated her with intravenous electrolyte replacement, broad-spectrum antibiotics, pain management, and measures to prevent thrombosis. This case highlights the critical need for early diagnosis and timely surgical intervention in cases of wandering Spleen to prevent serious complications, including splenic infarction. By presenting this case, we seek to elevate awareness of wandering Spleen among healthcare professionals, mainly within pediatric groups. We emphasize the importance of timely diagnosis and appropriate management to optimize patient outcomes. Conclusion: Early detection and prompt intervention are crucial in preventing severe complications in pediatric patients. This case emphasizes the necessity of rapid diagnosis and increased awareness in clinical practice. Due to the Spleen's impaired viability, a splenectomy was required. Following surgery, we provided comprehensive monitoring and pharmaceutical assistance to control pain, prevent infection, and maintain nutritional stability.
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    DIAGNOSIS OF OVARIAN TORSION
    (Македонско лекарско друштво = Macedonian medical association, 2025-04)
    Asllani, Sherimet
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    Ognenoska, Biljana
    Ovarian torsion is a rare but serious condition in young children, often presenting with nonspecific symptoms, leading to diagnostic delays. It is an uncommon but urgent condition in pediatric patients which arises from partial or complete twisting of the ovary and/or fallopian tube, leading to vascular compromise. Early diagnosis is crucial to prevent irreversible ovarian damage.