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Open access

Andrzej Ratajczak, Jacek Szmeja, Mirosław Łukaszuk and Przemysław Majewski

Lymphatic Angioma of Mesentery of the Small Intestine - A Case Report

The authors presented a rare case of lymphatic angioma of mesentery of the small intestine. The patient underwent successful surgery. The study presents clinical symptoms, diagnostic and therapeutic problems in patients with lymphatic angiomas.

Open access

Wiktor Meissner, Waldemar Szabłoński, Piotr Krokowicz, Iwona Ignyś, Jacek Szmeja and Michał Drews

Surgery for Inflammatory Bowel Disease in Children and Adolescents

Recent decades have seen a constant rise in the incidence of IBD in both adults and children. Despite considerable progress in the pharmacological treatment of this disease, surgery has become the more frequently used treatment modality in younger patients. In the presence of massive haemorrhage, free perforation, fulminate colitis or acute obstruction, only surgical intervention has a chance of saving the patient's life.

The aim of the study was to present the results of surgical treatment of IBD in children and adolescents who were operated on in a department which copes with "adult surgery" in its everyday practice.

Materials and methods. 235 patients were operated on for IBD in the years 1998-2005. There were 18 (7,66%) children in this group, 10 girls and 8 boys. 12 patients were diagnosed with ulcerative colitis (66.7 %) and (6) patients were diagnosed with Crohn's disease (33.3%). The age of the patients ranged from 12 to 17 years (mean 15.6). Among the 18 children, 10 (55.6%) were operated on for elective reasons and 8 (44.4%) of the interventions were emergencies (three perforations, two obstructions, one acute haemorrhage and one fulminate colitis). In all cases of ulcerative colitis, a two-step restorative proctocolectomy with J pouch anal anastomosis was performed. Patients with Crohn's disease were treated by limited (sparing)[it seems that either limited or sparing works here, pick one] bowel resection and/or strictureplasty.

Results. There were no postoperative deaths in the study group. Postoperative complications were observed in 6 (33.3%) patients, the complications were ileus in 3 patients (1 patient demanded relaparotomy), pneumonia in 2 patients and wound suppuration with subsequent dehiscence in 1 patient. In one patient treated preoperatively with large doses of Imuran, the postoperative histology revealed a malignant lymphoma. Hospital stays ranged from 8 to 19 days (mean 12 days).

Conclusions. Surgery for IBD in children and adolescents has become a widely accepted method, and it is often the only treatment modality that offers a chance of a cure. Restorative proctocolectomy should be considered earlier in many cases of younger patients with ulcerative colitis, prior to conservative treatment, as imunosupression and steroid therapy in particular produce undesired side effects. A consulting surgeon should be involved in the treatment of younger patients with IBD at a much earlier stage of therapy than is currently practiced.

Open access

Honorata Stadnik, Katarzyna Brzuzgo, Jacek Szmeja, Małgorzata Janicka-Jedyńska, Przemysław Majewski and Michał Drews

Assesment of Diagnostic and Prognostic Value of Transduodenal Fine Nedle Biopsy in Patients with Tumors of the Pancreatic Head in the Material of Deparment of General, Gastroenterological and Endocrinological Surgery, Medical University in Poznań

Pancreatic cancer is the thirteen leading most common malignancy, accounting for up to 2% of all malignancies. In majority of cases pancreatic cancer is diagnosed when local progression of the malignancy makes radical surgical treatment impossible. The extent of surgical treatment of tumors of the pancreatic head is planned on the basis of preoperative imaging studies and endoscopic studies and the final decision depends on intraoperative assessment of the lesion progression and results of cytological or histopathological examination of intraoperatively collected specimens. Fine needle aspiration biopsy (FNAB) is performed before possible resection of the tumor of the pancreatic head.

The aim of the study was to compare results of FNAB with final histopathological assessment of collected specimen and survival of patients with negative cytological examination and patients in whom transduodenal fine needle aspiration biopsy confirmed the presence of cancer cells.

Material and methods. This retrospective study involved 63 patients hospitalized due to tumor of the pancreatic head in Department of General, Gastroenterological and Endocrinological Surgery between 2000 and 2007. All patients underwent fine needle aspiration biopsy during the laparotomy. In some patients, an intraoperative decision was taken to proceed to core biopsy from suspected malignancy sites despite negative result of cytological examination. This analysis included only patients with evaluable material collected for cytological examination. Long-term results of treatment were obtained basing on clinical examination of patients who attended a follow-up visit and telephone survey conducted among patients and their families in the event of patients who did not attend a followup visit.

Results. The longest overall survival of patients with positive cytological examination who underwent a palliative procedure was 10 months, while in patients who underwent radical treatment amounted to 2 years. Sensitivity of fine needle aspiration biopsy (FNAB) in our study was 85.7%

Conclusions. FNAB is an indispensible part of diagnostic workup in the pancreatic cancer and cannot be omitted even in inoperable cancers confirmed by imaging studies. FNAB not only guides surgical treatment but also dictates adequate adjuvant and neoadjuvant systemic therapy - radio- and chemotherapy.

Open access

Robert Burdyński, Tomasz Banasiewicz, Ryszard Marciniak, Maciej Biczysko, Jacek Szmeja, Jacek Paszkowski, Marcin Grochowalski, Jakub Maik, Przemysław Majewski, Piotr Krokowicz and Michał Drews

Intestinal Pouch Complications in Patients Who Underwent Restorative Proctocolectomy for Ulcerative Colitis and Familial Adenomatous Polyposis in 1985-2008

Restorative proctocolectomy is considered a surgical treatment of choice in ulcerative colitis (UC) and familial adenomatous polyposis (FAP).

The aim of the study was to evaluate postoperative complications in patients who underwent surgery for familial adenomatous polyposis and ulcerative colitis, on the basis of a retrospective data analysis.

Material and methods. Data of 138 patients after restorative proctocolectomy performed between 1985 and 2008 were collected at routine follow-up visits in 2004-2008. We evaluated the presence of pouchitis, the degree of ileal pouch mucosa atrophy, the presence of ileal pouch mucosal metaplasia, the presence of ileal pouch malignancies, the necessity for diverting ileostomy, the necessity for pouch resection, and severe faecal incontinence.

Results. Complications were observed in 45 (32.4%) patients. Thirty-seven patients developed pouchitis (26.6%). Low-degree dysplasia, severe dysplasia or malignancies were observed in total in 20 patients (14.4%). Six (4.3%) operated patients developed other analysed complications.

Conclusions. The most common complications of restorative proctocolectomy were dysplasia and pouchitis. The most common complication in patients operated for UC was pouchitis. The low observed incidence of intestinal pouchitis may be attributed to the implemented prophylaxis of inflammation. Dysplasia was the most common complication in patients undergoing proctocolectomy for FAP. Due to an increased risk of dysplastic lesions as compared with UC patients, careful endoscopic follow-up examinations are obligatory in this patient group. Other analysed complications were uncommon and were mostly a consequence of chronic pouchitis. Clinical symptoms of pouch-related problems were similar in both analysed groups.