Dimitar Hadzhiev | Medical University, Plovdiv, bulgaria (original) (raw)

Papers by Dimitar Hadzhiev

Research paper thumbnail of Еntero-Atmospheric Fistulas as Complication of Laparostomy

Научни трудове на Съюза на учените – Пловдив. Серия Г: Медицина, фармация и дентална медицина, 2018

Research paper thumbnail of Conventional and laparoscopic appendectomy

Научни трудове на Съюза на учените – Пловдив. Серия Г: Медицина, фармация и дентална медицина, 2018

Research paper thumbnail of Necrotizing fasciitis of anterior abdominal wall

Necrotizing fasciitis of the abdominal wall is a rare condition with high morbidity and mortality... more Necrotizing fasciitis of the abdominal wall is a rare condition with high morbidity and mortality. Early diagnosis and aggressive treatment are key for achieving good therapeutic results. In our study we analyze cases of diagnosed and treated necrotizing fasciitis of the abdominal wall in the Surgical Unit of UMHAT "Eurohospital"-Plovdiv and First Surgery of UMHAT "St. George"-Plovdiv. For the period of 06.2012 until 09.2017 34 patients with this diagnosis were operated on. Five of them had primary infection and the rest 29 had a postoperative complication. In 26 of the cases vacuum therapy was used.

Research paper thumbnail of Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)

Updates in Surgery

Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical... more Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild–moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild–moderate IC were reported such malignancy (753–100%), diabetes (103–13.7%), malnutrition (26–3.5%) and uremia (1–0.1%), while severe IC causes were steroids treatment (14–16.3%); neutropenia (7–8.1%), malignancy on chemotherapy (71–82.6%). Preoperative risk classification were reported as follow: mild–moderat...

Research paper thumbnail of Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

British Journal of Surgery

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...

Research paper thumbnail of Correction: Surgeons’ perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

World Journal of Emergency Surgery

Research paper thumbnail of Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

World Journal of Emergency Surgery

Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of ... more Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involvin...

Research paper thumbnail of Surgeons’ perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

World Journal of Emergency Surgery

Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based app... more Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons’ knowledge and perception of using AI-based tools in clinical decision-making processes. Methods An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society’s website and Twitter profile. Results 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidel...

Research paper thumbnail of Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

Techniques in Coloproctology

Background Immunocompromised patients with acute diverticulitis are at increased risk of morbidit... more Background Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. Methods We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). Results Data from 482 patients were analyzed—229 patients (47.5%) [M:F = 1:1; median age: 60 (24–95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26–94) years] in group B. There was a significant difference between the two groups in grade distribution:...

Research paper thumbnail of Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

The Lancet

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as ind... more Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45•6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84•5 (95% CI 84•1-84•9), which varied between HIC (88•5 [89•0-88•0]), MIC (81•8 [82•5-81•1]), and LIC (66•8 [64•9-68•7]) settings. In the third phase, 1217 (74•6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51•4%) were from HIC, 538 (44•2%) from MIC, and 54 (4•4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3•6% (95% CI 3•0-4•1; p<0•0001) increase in SVR. This was consistent in HIC (4•8% [4•1-5•5]; p<0•0001), MIC (2•8 [2•0-3•7]; p<0•0001), and LIC (3•8 [1•3-6•7%]; p<0•0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.

Research paper thumbnail of Clinical presentation and diagnosis of colonic perforative peritonitis

INTRODUCTION: Colonic perforative peritonitis (CPP) is a life-threatening surgical emergency wher... more INTRODUCTION: Colonic perforative peritonitis (CPP) is a life-threatening surgical emergency where timely diagnosis is of ultimate impact on outcome. MATERIALS AND METHODS: For a five-year period (2014 – 2018), 62 patients with CPP were treated in First Clinic of Surgery in St. George University Hospital - Plovdiv. Males were 48 (77.42%) and females 14 (22.58%), with a ratio of 3.4:1. Patients’ age ranged from 14 to 92 years, with an average age of 71 years ± 2.4. Colonic perforative peritonitis was more common in patients over 80 years of age (n=21; 33.87%). The main causes of CPP were: perforated colon diverticulitis (n=19), perforated colon cancer (n=18), perforation in incarceration (n=9), sigmoid volvulus (n=6), mesenteric ischemia (n=5) and miscellaneous (n=5). There were 12 patients with local peritonitis (19.36%), with diffuse peritonitis - 21 patients (33.87%), and with total peritonitis - 29 patients (46.77%). The following surgical procedures were performed: Hartmann’s pr...

Research paper thumbnail of Incarcerated Amyand’s Hernia with Destructive Appendicitis Complicated with Myocardial Infarction. A Case Report and Review of the Literature

Albanian Journal of Trauma and Emergency Surgery, 2021

Amyand hernia is a rare presentation in inguinal hernias (less than 1% of cases with inguinal her... more Amyand hernia is a rare presentation in inguinal hernias (less than 1% of cases with inguinal hernias) which is evidenced when in herniated masses the presence of inflamed appendix is ​​ascertained or not. It was named after a French surgeon, Claudius Amyand (1660-1740), who performed the first successful appendectomy in 1735, where he found an acute appendicitis in a herniated mass. Most cases are diagnosed intraoperatively, as an accurate preoperative diagnosis rarely becomes evident. Management is individual depending on the stage of inflammation of the appendix, the presence of abdominal sepsis and concomitant factors. The decision should be based on factors such as the patient's age, the size and anatomopathological shape of the appendix, and in the case of an inflamed appendix, standard appendectomy and retinal herniorrhage should be the gold standard of treatment. Amyand hernia is usually misinterpreted as a common incarcerata hernia. Symptoms that mimic appendicitis may ...

Research paper thumbnail of Experience on the treatment of anorectal abscesses with primary or ligation fistulotomy

Scripta Scientifica Medica, 2017

Research paper thumbnail of Supralevator abscess – clinic, diagnosis and treatment

INTRODUCTION : The supralevator abscess, though uncommon, is a significant issue in the emergent ... more INTRODUCTION : The supralevator abscess, though uncommon, is a significant issue in the emergent colorectal surgery, due to its atypical symptoms, surgical tactics and frequent postoperative failure. AIM: The aim of this article is to analyze the frequency, the diagnostic difficulties and the clinical features by improving the results of their treatment through the timely diagnosis and rational surgical tactics. MATERIALS AND METHODS : For a period of 15 years, from 2004 to 2018, a retrospective analysis of 845 urgently admitted patients, with an acute anorectal abscess (ARA) was done. Depending on the localization, we established four types of ARA: perianal – 392 patients (46.39%), ischiorectal – 287 patients (33.96%), intersphincteric – 93 patients (11.01%), and supralevator – 73 patients (8.64%). Superficial localization was determined in 450 patients (53,25%) and deep - in 395 (46.75%). Males were 53 (72.60%) and females were 20 (27.40%), with a ratio of 2.65:1. The age of the...

Research paper thumbnail of Supralevator Abscess Complicated by Necrotic Fasciitis of Peritoneum, Genitalia, Anterior Abdominal Wall and Retroperitoneum

Albanian Journal of Trauma and Emergency Surgery

A supralevator anorectal abscess may lead to a rare clinical complication, such as perineal necro... more A supralevator anorectal abscess may lead to a rare clinical complication, such as perineal necrotizing fasciitis. A 57-year-old man was admitted on an emergency basis with evidence of a deep anorectal abscess of 5-day duration. The clinical presentation involved an unbounded purulent destructive inflammation spreading onto the adjacent areas, with the development of a septic condition. Following a short preparation, a radical surgical debridement of a subfascial purulent necrotic phlegmon of the pelvic space was performed. Since the lower part of the abdomen, retroperitoneum and scrotum were involved, 4 additional subsequent necrectomies were performed at 48-hour intervals. The aggressive radical operative treatment and the combined intensive therapy were the main contributors to the favorable outcome of the disease.

Research paper thumbnail of Еntero-Atmospheric Fistulas as Complication of Laparostomy

Научни трудове на Съюза на учените – Пловдив. Серия Г: Медицина, фармация и дентална медицина, 2018

Research paper thumbnail of Conventional and laparoscopic appendectomy

Научни трудове на Съюза на учените – Пловдив. Серия Г: Медицина, фармация и дентална медицина, 2018

Research paper thumbnail of Necrotizing fasciitis of anterior abdominal wall

Necrotizing fasciitis of the abdominal wall is a rare condition with high morbidity and mortality... more Necrotizing fasciitis of the abdominal wall is a rare condition with high morbidity and mortality. Early diagnosis and aggressive treatment are key for achieving good therapeutic results. In our study we analyze cases of diagnosed and treated necrotizing fasciitis of the abdominal wall in the Surgical Unit of UMHAT "Eurohospital"-Plovdiv and First Surgery of UMHAT "St. George"-Plovdiv. For the period of 06.2012 until 09.2017 34 patients with this diagnosis were operated on. Five of them had primary infection and the rest 29 had a postoperative complication. In 26 of the cases vacuum therapy was used.

Research paper thumbnail of Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)

Updates in Surgery

Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical... more Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild–moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild–moderate IC were reported such malignancy (753–100%), diabetes (103–13.7%), malnutrition (26–3.5%) and uremia (1–0.1%), while severe IC causes were steroids treatment (14–16.3%); neutropenia (7–8.1%), malignancy on chemotherapy (71–82.6%). Preoperative risk classification were reported as follow: mild–moderat...

Research paper thumbnail of Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

British Journal of Surgery

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...

Research paper thumbnail of Correction: Surgeons’ perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

World Journal of Emergency Surgery

Research paper thumbnail of Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

World Journal of Emergency Surgery

Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of ... more Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involvin...

Research paper thumbnail of Surgeons’ perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

World Journal of Emergency Surgery

Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based app... more Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons’ knowledge and perception of using AI-based tools in clinical decision-making processes. Methods An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society’s website and Twitter profile. Results 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidel...

Research paper thumbnail of Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

Techniques in Coloproctology

Background Immunocompromised patients with acute diverticulitis are at increased risk of morbidit... more Background Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. Methods We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). Results Data from 482 patients were analyzed—229 patients (47.5%) [M:F = 1:1; median age: 60 (24–95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26–94) years] in group B. There was a significant difference between the two groups in grade distribution:...

Research paper thumbnail of Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

The Lancet

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as ind... more Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45•6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84•5 (95% CI 84•1-84•9), which varied between HIC (88•5 [89•0-88•0]), MIC (81•8 [82•5-81•1]), and LIC (66•8 [64•9-68•7]) settings. In the third phase, 1217 (74•6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51•4%) were from HIC, 538 (44•2%) from MIC, and 54 (4•4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3•6% (95% CI 3•0-4•1; p<0•0001) increase in SVR. This was consistent in HIC (4•8% [4•1-5•5]; p<0•0001), MIC (2•8 [2•0-3•7]; p<0•0001), and LIC (3•8 [1•3-6•7%]; p<0•0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.

Research paper thumbnail of Clinical presentation and diagnosis of colonic perforative peritonitis

INTRODUCTION: Colonic perforative peritonitis (CPP) is a life-threatening surgical emergency wher... more INTRODUCTION: Colonic perforative peritonitis (CPP) is a life-threatening surgical emergency where timely diagnosis is of ultimate impact on outcome. MATERIALS AND METHODS: For a five-year period (2014 – 2018), 62 patients with CPP were treated in First Clinic of Surgery in St. George University Hospital - Plovdiv. Males were 48 (77.42%) and females 14 (22.58%), with a ratio of 3.4:1. Patients’ age ranged from 14 to 92 years, with an average age of 71 years ± 2.4. Colonic perforative peritonitis was more common in patients over 80 years of age (n=21; 33.87%). The main causes of CPP were: perforated colon diverticulitis (n=19), perforated colon cancer (n=18), perforation in incarceration (n=9), sigmoid volvulus (n=6), mesenteric ischemia (n=5) and miscellaneous (n=5). There were 12 patients with local peritonitis (19.36%), with diffuse peritonitis - 21 patients (33.87%), and with total peritonitis - 29 patients (46.77%). The following surgical procedures were performed: Hartmann’s pr...

Research paper thumbnail of Incarcerated Amyand’s Hernia with Destructive Appendicitis Complicated with Myocardial Infarction. A Case Report and Review of the Literature

Albanian Journal of Trauma and Emergency Surgery, 2021

Amyand hernia is a rare presentation in inguinal hernias (less than 1% of cases with inguinal her... more Amyand hernia is a rare presentation in inguinal hernias (less than 1% of cases with inguinal hernias) which is evidenced when in herniated masses the presence of inflamed appendix is ​​ascertained or not. It was named after a French surgeon, Claudius Amyand (1660-1740), who performed the first successful appendectomy in 1735, where he found an acute appendicitis in a herniated mass. Most cases are diagnosed intraoperatively, as an accurate preoperative diagnosis rarely becomes evident. Management is individual depending on the stage of inflammation of the appendix, the presence of abdominal sepsis and concomitant factors. The decision should be based on factors such as the patient's age, the size and anatomopathological shape of the appendix, and in the case of an inflamed appendix, standard appendectomy and retinal herniorrhage should be the gold standard of treatment. Amyand hernia is usually misinterpreted as a common incarcerata hernia. Symptoms that mimic appendicitis may ...

Research paper thumbnail of Experience on the treatment of anorectal abscesses with primary or ligation fistulotomy

Scripta Scientifica Medica, 2017

Research paper thumbnail of Supralevator abscess – clinic, diagnosis and treatment

INTRODUCTION : The supralevator abscess, though uncommon, is a significant issue in the emergent ... more INTRODUCTION : The supralevator abscess, though uncommon, is a significant issue in the emergent colorectal surgery, due to its atypical symptoms, surgical tactics and frequent postoperative failure. AIM: The aim of this article is to analyze the frequency, the diagnostic difficulties and the clinical features by improving the results of their treatment through the timely diagnosis and rational surgical tactics. MATERIALS AND METHODS : For a period of 15 years, from 2004 to 2018, a retrospective analysis of 845 urgently admitted patients, with an acute anorectal abscess (ARA) was done. Depending on the localization, we established four types of ARA: perianal – 392 patients (46.39%), ischiorectal – 287 patients (33.96%), intersphincteric – 93 patients (11.01%), and supralevator – 73 patients (8.64%). Superficial localization was determined in 450 patients (53,25%) and deep - in 395 (46.75%). Males were 53 (72.60%) and females were 20 (27.40%), with a ratio of 2.65:1. The age of the...

Research paper thumbnail of Supralevator Abscess Complicated by Necrotic Fasciitis of Peritoneum, Genitalia, Anterior Abdominal Wall and Retroperitoneum

Albanian Journal of Trauma and Emergency Surgery

A supralevator anorectal abscess may lead to a rare clinical complication, such as perineal necro... more A supralevator anorectal abscess may lead to a rare clinical complication, such as perineal necrotizing fasciitis. A 57-year-old man was admitted on an emergency basis with evidence of a deep anorectal abscess of 5-day duration. The clinical presentation involved an unbounded purulent destructive inflammation spreading onto the adjacent areas, with the development of a septic condition. Following a short preparation, a radical surgical debridement of a subfascial purulent necrotic phlegmon of the pelvic space was performed. Since the lower part of the abdomen, retroperitoneum and scrotum were involved, 4 additional subsequent necrectomies were performed at 48-hour intervals. The aggressive radical operative treatment and the combined intensive therapy were the main contributors to the favorable outcome of the disease.