Recent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. The early prophylactic use of antibiotics in AP remains controversial. The role and need for new markers in stratification of acute pancreatitis is also uncertain. This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis (AP). Prospective study was conducted in four clinical centers. The diagnosis and severity assessment of AP was established according to the revised 2012 Atlanta classification. Adipokines, IL-6 and CRP levels were measured at admission and on 3rd day of hospital stay and compared with the control group. The predictive accuracy of each marker was measured by area under the receiver operating curve. Forty healthy controls and 102 patients were enrolled in to the study. Twenty seven (26.5 %) patients had mild, 55 (53.9 %) - moderate and 20 (19.6 %) - severe AP. Only resistin (cut-off value 13.7 ng/ml) and IL-6 (cut-off value 473.4 pg/ml) were reliable early markers of SAP. IL-6 with cut-off value of 157.0 pg/ml was a predictor of necrosis. The peripancreatic necrosis volume of 112.5 ml was a marker of SAP and 433.0 ml cut-off value could be used to predict the need of interventions. The prognostic value of adipokines in AP is limited. Only admission resistin levels could serve as an early predictor for SAP. The Lithuanian Regional Ethics Committee approved the study protocol (permission No. L-12-02/1/2/3/4) and all the patients and the control group provided written informed consent.

Background and objective: Rectus sheath haematoma (RSH) is an uncommon condition that may vary from contained haematoma to life-threatening bleeding. Timely diagnosis and treatment is crucial in this patient population. The aim of the current study was to investigate the results of the different RSH treatment strategies among patients admitted to a surgery department. Materials and methods: A retrospective analysis of 29 patients treated for RSH in surgery departments of two medical centres from 1 January 2007 to 30 September 2017 was conducted. The patient’s age, sex, ASA (American Society of Anesthesiologists; physical status classification system), use of anticoagulants, cause of haematoma, radiological data, vital signs, blood investigations, and type of treatment were extracted. The results were analysed according to the type of treatment. Results: The patients’ mean age was 67.6 ± 14.3 years, and the mean duration of in-hospital stay was 10.7 ± 6.7 days. All patients were on anticoagulant treatment, and 82.8% of them had spontaneous haematoma. Nine patients (31%) needed transfusion of packed red blood cells with an average of 2.6 units (range: 1–4). Five patients (17.2%) presented with symptoms and signs of hypovolemic shock, and four of them underwent embolisation. Embolisation was successful in all cases. Open surgery was performed in 6 patients, 8 patients underwent percutaneous drainage, and 10 patients were treated conservatively. Two patients (6.7%) died in our series. Both of these patients had type III RSH. Patients in the conservatively treated group had the shortest hospital stay. There were no readmissions due to repeated haematoma or infection. Conclusions: Embolisation of epigastric arteries is a useful tool to stop bleeding into RSH in patients with unstable haemodynamics. Conservative treatment is comparable to ultrasound (US) drainage of RSH but results in a shorter hospital stay. Type III RSH is associated with a higher death rate.

Introduction. Both mesenteric cysts and cystic lymphangiomas are scarce and clinically and radiologically almost identical derivatives, but their histological structure is fundamentally different. Case Presentation. A 52-year-old woman was consulted by a surgeon for a derivative felt in her abdomen. The patient said she felt a growing derivative in the abdomen about a month ago. After consulting and testing, a sigmoid colon mesenteric cyst (13 cmx11 cmx10 cm) was found. Complete excision of the cyst within healthy tissues was performed through laparotomy. The surgery had no complications. The initial pathological answer was a simple mesothelial cyst (a rare histological finding). However, immunohistochemical tests were performed that showed that diagnosis was mesenteric cystic lymphangioma (ML). Cystic lymphangiomas that have a link to the mesentery have been described less than 200 times. Conclusions. Final differential diagnosis between different cystic derivatives is possible only based on histopathological examinations. Mesenteric lymphangioma is most common at a very young age, but in rare cases, it also occurs in adults. All clinicians should increase their awareness of the disease.

Reikšminiai žodžiai: ūminis pankreatitas, prognozavimas, C-reaktyvus baltymas, hematokritas. Darbo tikslas. Nustatyti CRB ir hematokrito prognostines galimybes, prognozuojant ūminio pankreatito eigą. Medžiaga ir metodai. Multicentrinė perspektyvinė studija buvo vykdoma keturiose Vilniaus ir Kauno gydymo įstaigose. Tirtas ūminiu pankreatitu sirgusių pacientų kraujo serumas 1-ą ir 3-ią hospitalizacijos parą, siekiant nustatyti CRB ir hematokrito vertes. Remiantis atnaujintu Atlantos sutarimu, visi pacientai buvo suskirstyti į tris grupes pagal ligos eigą: lengvo, vidutinio sunkumo ir sunkaus ūminio pankreatito. CRB ir hematokrito vertės lygintos tarp grupių, ir, braižant ROC kreives, nustatytos kritinės reikšmės, kuriomis remiantis galima prognozuoti sunkios eigos ūminį pankreatitą. Rezultatai. Tyrime dalyvavo 102 ūminiu pankreatitu sirgę pacientai. Iš jų lengvu ūminiu pankreatitu sirgo 27 (26,5 proc.), vidutinio sunkumo – 55 (53,9 proc.) ir sunkiu – 20 (19,6 proc.) asmenų. Nustatyta, jog kritinė CRB reikšmė, statistiškai patikimai atskirianti sunkų ūminį pankreatitą nuo lengvo bei vidutinio sunkumo, trečią hospitalizacijos parą yra 301,1 mg/l (jautrumas 70,7 proc., specifiškumas 80 proc., AUC 0,79). Pirmą hospitalizacijos parą sunkios eigos pankreatitą patikimai atskiria ribinė 44,3 proc. hematokrito vertė (jautrumas 68,3 proc., specifiškumas 85 proc., AUC 0,77). Išvados. Hematokritas yra gana ankstyvas ir tikslus žymuo, diferencijuojantis sunkų ūminį pankreatitą nuo lengvo bei vidutinio sunkumo. CRB ankstyvam prognozavimui nelabai tinka, nes geriausiomis prognostinėmis savybėmis pasižymi praėjus kelioms paroms nuo susirgimo pradžios.

Reikšminiai žodžiai: blužnies cista, neparazitinė blužnies cista, blužnies pseudocista, splenektomija. Blužnies cistos – reta liga. Jos klasifikuojamos į tikrąsias, kurios išklotos epiteliu, ir pseudocistas. Pastarosios dažniausiai nesukelia simptomų ir sietinos su buvusia blužnies trauma, infekcija ar infarktu. Šiame straipsnyje pateikiame retą gigantinės simptominės blužnies pseudocistos klinikinį atvejį. Pacientė hospitalizuota į Vilniaus miesto klinikinės ligoninės (VMKL) Abdominalinės chirurgijos skyrių dėl kliniškai ir ultragarsu diagnozuoto lėtinio kalkuliozinio cholecistito. Iš anamnezės prieš 2 metus pilvo organų kompiuterinės tomografijos metu buvo nustatytas 10 x 8 x 9 cm dydžio blužnies cistinis darinys apkalkėjusia kapsule. Stebint ambulatoriškai, darinys nedidėjo. Pacientė buvusias pilvo traumas neigė. Echinoccocus gr. IgG antikūnų titras buvo neigiamas. Pacientė operuota, atlikta laparoskopinė cholecistektomija su simultanine totaline splenektomija atviru būdu per pjūvį kairėje pošonkaulinėje srityje. Pathistologinis tyrimas patvirtino neparazitinės blužnies pseudocistos diagnozę. Dalinė splenektomija, tausojanti blužnies parenchimą, yra „auksinis standartas“ gydant simptomines ar dideles blužnies pseudocistas. Totalinė splenektomija, laparoskopiniu arba atviru būdu, turėtų būti atliekama, kai blužnies cistos lokalizacija ar dydis neleidžia jos saugiai pašalinti.