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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    METHICILLIN-SENSITIVE STAPHYLOCOCCUS AUREUS BACTEREMIA AND MENINGITIS ASSOCIATED WITH SPINAL AND PSOAS MUSCLE ABSCESS – CASE REPORT
    (Peytchinski Publishing Ltd., Pleven, Bulgaria, 2024-10)
    Dimitrova, Emilija
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    Rangelov, Goran
    Methicillin-sensitive Staphylococcus aureus (MSSA) can cause a range of severe infections, including bacteremia and meningitis. While MSSA-related bacteremia and meningitis are serious on their own, they can also be associated with complex complications such as intraspinal and psoas abscesses. We report a case of a 72-year-old male with symptoms including lower back pain, leg weakness, malaise, fever and headache. Initial laboratory results showed leucocythosis, hyponatriemia and elevated CRP, while cerebrospinal fluid analysis indicated significant pleocytosis and neutrophilia. After admission, three blood cultures were obtained, all of which isolated MSSA. During hospitalization, a CT scan of the thorax and MR of the spine were performed, revealing bilateral pleural effusion, L5-S1 intraspinal abscess, and an abscess in the ileopsoas muscle. After 6 weeks of antibiotic therapy, a follow-up MRI was performed, which showed regression of the abscesses. This case underscores the severe complications of Staphylococcus aureus infection, including meningitis, sepsis and abscesses. Effective management relies on prompt diagnosis, comprehensive evaluation, and targeted antibiotic therapy. The patient’s positive outcome highlights the importance of early recognition and tailored treatment in complex infections.
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    Pyonephrosis complicated with spontaneous intraperitoneal rupture and diffuse peritonitis: Case report and literature review
    (Dustri-Verlag, 2024-01)
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    Misimi, Shqipe
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    Draskacheva, Nadica
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    Limani, Nimetula
    Pyonephrosis is a serious condition that can lead to kidney dysfunction, loss of the organ, and even fatal end due to its complications. The underlying etiologic factors include lithiasis, recurrent urinary infections, ureter stricture, ureteropelvic junction obstruction, malignancy, and retroperitoneal fibrosis. One of the rare possible complications of pyonephrosis is a retroperitoneal rupture with spontaneous communication to the abdomen causing secondary peritonitis. We present such a case which is the first video-documented report of the peritoneal rupture site within the abdominal cavity.
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    SPLENIC ABSCESS IN PATIENT WITH CHRONIC PANCREATITIS: A CASE REPORT
    (2019-06-05)
    Bozhinovska Beaka, Gordana
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    Noveska-Petrovska, Biljana
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    Bozinovska, Nadica
    <jats:p>The abscess of the spleen is a rare condition with diverse аetiologies and highly polymorphic clinical expression. It is more common in male than female patient, with a wide age range. Regarding varied and often unspecific symptomatology it poses a great problem for diagnostic and overall treatment with a very high mortality rate in untreated patients. Recent diagnosis and treatment are based on modern imaging techniques that enable precise and rapid diagnostics. The following is a presentation of a case that refers to a young male patient with splenic abscess. CASE REPORT. A 37-year-old patient with a history of hypertensive crisis and multiple previous admittances to the emergency room regarding acute attacks of pancreatitis and persistent reduction in body weight was admitted to the emergency room with nonspecific symptoms of abdominal pain, more prominent in the upper left quadrant. Laboratory findings revealed leukocytosis and elevated levels of CRP. Infective panel for hepatitis and HIV was negative. Additional ultrasound investigations were made which revealed hypoechogenic lesion in the spleen, clearly demarcated from the neighboring parenchyma and partially encapsulated, with near proximity to the tail of the pancreas. Hospitalization with additional MRI and surgical treatment was advised, but the patient refused and contrary to the advice of the doctor decided to leave the hospital. After 10 days he was again admitted to the emergency room with persistent leukocytosis and elevated CRP. Because of the worsening condition, he accepted the previously proposed treatment and was hospitalized. The conducted MRI investigation revealed three cystic lesions with dense content in the spleen, measuring from 5x3sm to 2sm in diameter with propagation towards the tail of the pancreas. Surgical splenectomy with partial pancreatectomy was performed, and the surgical specimen was forwarded for histopathological examination. The microscopic examination on the selected specimens revealed severe stasis in the splenic parenchyma with subcapsular abscess formation, and also confirmed the chronic pancreatitis condition. The postoperative course went well without any complications, as well as on the following regular checkups. DISCUSSION. Splenic abscess is very uncommon entity associated with versatile etiologies which covers primary immunocompromised patients, trauma or patients with infective endocarditis. As a potentially life-threatening condition it is essential to emphasize the need for fast detection and splenectomy as a choice of treatment. But also it is very important as a potential aetiology to have in mind other chronic conditions like pancreatitis, especially in young male patients, given that management of the underlying disease is of great importance.</jats:p>