Faculty of Medicine

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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.
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HEPATIC PORTAL VENOUS GAS
(Macedonian Association of Anatomists and Morphologists, 2023)
Stavreski, Nacko
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Klinche, Shener
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Hepatic portal venous gas (HPVG), an ominous radiologic sign, in most of the cases is associated with a severe abdominal disease that requires an urgent surgical intervention. In the medical literature, HPVG has been commonly associated with severe or lethal conditions. The diagnosis of HPVG is usually made by plain abdominal radiography, ultrasonography, color Dopler flow imaging or computed tomography (CT) scan. The increased use of CT scan in the inpatient setting allows early and highly sensitive detection and also recognition of an increasing number of benign and non-life threating causes of HPVG. The prognosis is related to the pathology itself and is not influenced by the presence of HPVG.
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Torsion of a large ovarian cyst presented as an acute abdomen: Case report
(Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2022-09)
Sasho Pucakoski
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Nadezda Spiroska
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Patients with acute abdominal pain often end up in the emergency department for surgical treatment. Ovarian cysts can lead to an acute abdomen due to torsion (twisting) or rupture. In this case report we are going to present a 70 y/o female patient with left adnexal torsion, due to a presence of ovarian cyst, presented as an acute abdomen. The patient was enrolled in the emergency department with acute abdomen, nausea and vomiting. After the initial evaluation including a Computerized tomography [CT] scan, the cyst presented as a solid hypodense mass behind the front abdominal wall, with the dimensions of Anteroposterior diameter [APd] 13cm, Laterolateral diameter [LLd] 11cm and Craniocaudal diameter [CCd] 15cm. The possible differential diagnosis [DDx] included cystic tumor [TU] mass on the mesentery as well as a cystic TU on the Urogenital tract (UGT). Intraoperatively adnexal torsion due to an ovarian cyst was found. The cyst and the left adnexa were then removed. Histopathological report showed ovarian hemorrhagic infarction due to a cystic tumor and torsion in the left adnexa. The diagnosis in such cases is often challenging because often the initial CT report can confuse the surgeon whether the mass arises from the mesentery or the urogenital tract.

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