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Introduction. Neuroendocrine neoplasms (NENs) of the gastrointestinal tract (GIT) are slow-growing and rare tumors with different clinical, histological, and biological characteristics with an increased incidence in recent years. Most of them are indolent and colonic NENs are rare among all GIT-NENs. Compared to colorectal adenocarcinoma neuroendocrine tumors of the colon and sigmoid colon are uncommon. Case outline. We present a 25-year-old female patient, who was admitted to our department in hemorrhagic shock due to life-threatening bleeding from a tumor on the sigmoid colon, and after unsuccessful endoscopic hemostasis during colonoscopy. The complaints started the day before admission to the ward with hematochezia. The patient had no complaints before that. Emergency operation and colon resection with terminal colostomy were performed. Pathohistological and immunohistochemical analysis of the tumor showed unclear histogenetic origin from the group of neuroendocrine tumors. Conclusion. Regardless of the asymptomatic period of the disease, these tumors can cause severe bleeding as the first symptom, which can be life-threatening.

Introduction. In healthy adults, accidental ingestion of foreign bodies is uncommon. Intestinal perforation by ingested bone fragments is rare, but can be presented as a life-threatening condition, especially when the diagnosis is delayed. Case outline. We present an uncommon case of a 73-year-old female with acute abdominal symptoms due to ileal perforation caused by accidentally ingested animal bone. Pneumoperitoneum revealed by abdominal X-ray and abdominal free fluid revealed by abdominal ultrasound as well as the general condition of the patient required urgent laparotomy, when the diagnosis of ileal perforation was made. A foreign body was removed from the intestine, along with partial resection of the intestine and endto- end anastomosis. Conclusion. Surgical treatment of life-threatening complications arising after ingestion of foreign bodies is the only method of choice in the treatment of such patients.

Introduction. Gallstone ileus is a complete or partial mechanical bowel obstruction due to gallstone impaction in the bowel lumen and most commonly occurs after stones migrate through the cholecystoenteric fistula. Case outline. We present a patient with signs of gallstone ileus after stone migration through the cholecystoduodenal fistula into the duodenum with hematemesis as the first symptom. Conservative treatment had been started, to which the patient initially responded well. On the eighth day from the onset of the disease, the condition worsened. Signs of the Rigler triad were identified on computed tomography and magnetic resonance imaging of the abdomen. Enterolithotomy was successfully performed by the open surgical method. Postoperative recovery was orderly, without any biliary problems. Conclusion. Physical examination, upper endoscopy, and radiological diagnostic procedures are complementary and necessary in monitoring the dynamics of stone movement and deciding on when to perform surgery.

Introduction. Necrotizing fasciitis is a rare, severe, aggressive infection, life-threatening surgical emergency that spreads quickly, characterized by extensive necrosis of the deep and superficial fascia, associated with significant morbidity and mortality. Case outline. We are presenting two case reports with necrotizing fasciitis: a 54-year-old male patient, obese, with hypertension and untreated perianal fistula with severe infection of perianal region, perineum and scrotum, and a 64-year-old female patient with diabetes mellitus and heart disease, with severe infection of the lower extremity, anterior abdominal wall, inguinal and gluteal region, in which the entry point of infection were microlesions of the skin after shaving. Both patients were treated by emergency extensive surgical necrectomy with eradication of the deep infection source, with all conservative treatment measures. One patient was treated with hyperbaric oxygen therapy, the other was not because of cardiac and pulmonary contraindications. Conclusion. Better treatment outcome requires a multidisciplinary approach (cardiologist, endocrinologist, nephrologist, orthopedist, surgeon). Rapid and extensive surgical necrectomy is necessary to increase the success of the treatment of patients with this infection.

There has been significant progress made in the diagnosis and treatment of the primary uveal melanoma during the past decades and despite that, survival rate of uveal melanoma patients is still stable. Treatment options for uveal melanoma include phototherapy, brachytherapy, proton beam therapy, stereotactic radiotherapy, local resection, anti-angiogenic therapy, immunotherapy, and enucleation. Genetic analysis of tumors provides us with valuable prognostic information although effective therapies are lacking at this moment. It is not established yet whether prolonged survival is the result of treatment or whether it merely reflects earlier detection of metastases. Also, there are indications that survival after treatment of uveal melanoma probably does not depend on the method of treatment but rather on many clinical, histological and genetic risk factors. New studies are needed to provide a better understanding of of ocular treatment impact on survival in patients whose prognosis can be estimated according to the clinical stage, histological grade and genetic type. Therefore, the patients should be treated in experienced multi-disciplinary teams that must include these patients in clinical trial.

Serpiginous choroiditis is a rare clinical entity. The clinical course of serpiginous choroiditis is very variable, there is no universal marker of treatment success, and even among experts there is debate about what is the most appropriate treatment. The aim of this paper is to describe a case of serpiginous choroiditis treated with Cyclosporine A at a tertiary uveitis referral centre.

Recognising shock due to haemorrhage in trauma patients is about constructing a synthesis of trauma mechanism, injuries, vital signs and the therapeutic response of the patient. The treatment of bleeding patients who have exsanguinating injuries is aimed at two major goals: stopping the bleeding and restoration of the blood volume with correct coagulation. Abdominal ultrasound has replaced diagnostic peritoneal lavage for detection of haemoperitoneum. With the development of multi-sliding computer tomography, rapid evaluation by CT-scanning of the trauma patient is possible during resuscitation. The concept of damage control surgery with 'blind' transfusion or 'damage control resuscitation' in treatment of severe trauma, has proven to be of vital importance in the treatment of exsanguinating trauma patients and is adopted worldwide. Pharmacotherapeutic interventions may be a promising concept to limit blood loss after trauma. The role of thromboelastography as point-of-care test for coagulation in massive blood loss is emerging, providing information about actual clot formation and clot stability, shortly after the blood sample is taken.

Although appendiceal tumours are rare, they may be encountered unexpectedly in any emergency abdominal operation. Many of these tumours are not recognized intraoperatively and are diagnosed only during formal histopathological analysis of an appendectomy specimen. We present a rare case of appendiceal adenocarcinoma which caused acute bowel ob struction. The patient presented with abdominal pain, distension and constipation. Abdominal radiography showed large bowel obstruction. On laparotomy the appendix was abnormal, with a tumor growing in to the ileal loop and creating a bowel obstruction. An appendectomy was performed with enbloc bowel segment resection and end ileostomy. Pathology specimens showed that the primary neoplasm was the appendiceal mucinous adenocarcinoma infiltrating the ileal loop. Patient underwent a right hemicolectomy, and recovered afterwards with no evidence of local recurrence or metastatic disease as confirmed by the standard follow-up. Physicians should keep in their minds that appendiceal neoplasm may have various and nonspecific presentations, but only an accurate diagnosis will lead to correct patients treatment, healing and long-term survival.

The liver is a vital gland with a wide range of functions and complex anatomy. Liver anatomy can be described using different aspects: morphological anatomy and functional anatomy and now, the real anatomy, when ultrasound allows a precise intraoperative display in individual cases. The traditional morphological anatomy is based on the external appearance of the liver and does not show the internal features of vessels and biliary ducts branching which are of obvious importance in hepatic surgery. Functionally the liver is divided into eight functionally independent segments, each segment has its own vascular inflow, outflow and biliary drainage. This description, initiated by J. Cantlie in 1898, was followed by works of J. Healey and P. Schroy, N. Goldsmith and R. Woodburne, C. Couinaud, and H. Bismuth. In 1998. Federative Committee on Anatomical Terminology (FCAT) suggested using the liver Couinaud's classification. In 2000, International Hepato-Pancreato-Biliary Association (IHPBA) in Brisbane presented their recommendations of terminology of liver anatomy and liver resections. A single, worldwide-accepted classification of the liver still does not exist, however progress in the study of functional anatomy of the liver is a powerful impulse for development of modern liver surgery.

Introduction. Coronavirus disease 2019 is an infectious disease that primarily affects the lungs. Since the pandemic of severe acute respiratory syndrome coronavirus 2 continues and a large number of cases are registered worldwide, the knowledge about the virus and virus-related complications is growing as well. Pleural complications, pneumothorax, and empyema are important issues affecting better patient survival. Bacterial superinfections may cause complications of coronavirus disease 2019. Knowledge about the incidence of superinfections, microbiological causes, treatment, and outcomes of the disease is incomplete. Case Report. We present two oxygen-dependent patients with coronavirus disease 2019 who developed pneumothorax and empyema during hospitalization, three weeks after the onset of coronavirus disease 2019 symptoms. Multidrug-resistant Acinetobacter spp. was isolated from the thoracic drain. Conclusion. Pneumothorax may occur at any stage of coronavirus disease 2019 and is not always associated with the severity of viral infection. Empyema due to coronavirus disease 2019 pneumonia is rare and occurs as a superinfection of the pleural effusion. Excessive use of antibiotics in the treatment of hospitalized patients with coronavirus disease 2019 may increase the risk of nosocomial infections caused by multidrug-resistant bacteria. [ABSTRACT FROM AUTHOR]

Introduction. Necrotizing soft tissue infection is a severe, life threatening infection, with high mortality rate, especially in patients with comorbidities. Case report. We are presenting a 53-year-old female patient with diabetes mellitus and a severe infection of the anterior abdominal wall resulting from a vulval infection. The treatment consisted of an extensive excision of the abdominal wall necrosis and surgical eradication of the deep infection source, hyperbaric oxygen therapy, and antibiotic conservative therapy. Conclusion. Prompt diagnosis, aggressive medical treatment and radical surgical debridement, as soon as possible, are the key to successful treatment. [ABSTRACT FROM AUTHOR]

Introduction. The aim of this study was to show the descriptive and histopathological analysis and applied surgical technique with early and late post-operative complications in patients with breast cancer who were hospitalized and treated at the General Hospital in Novi Pazar during the period 2009-2011. Material and Methods. During the period from 2009 to 2011, 59 patients were operated for breast cancer at the General Hospital in Novi Pazar. The study included the size and type of the tumor, disease stage, surgical techniques and complications, the age of the patients at the moment of surgery and its correlation with the number of metastatic lymph nodes in the axilla and the tumor size, as well as the correlation of the tumor size with the number of metastases in the axillary lymph nodes. Results. The difference in the tumor size in relation to the age among the women under 50 and over 50 years of age was not statistically significant (T = -1.203, p>0.05). There was no statistically significant difference between the number of positive lymph nodes in the women under and over 50 years of age (Mann-Whitney U test, p>0.05). A significant positive correlation between the tumor size and the number of positive axillary lymph nodes was found (r= 0.308, p<0.05). A significant positive correlation of the patient's age and breast cancer stage was also confirmed with nonparametric variance analysis by Spearman's Rho (r= 0.337, p<0.05). Conclusion. The majority of women from this study sample were with Stage II of breast cancer, which points out the necessity for better prevention and education of women in order to improve early diagnosis of breast cancer. The number of positive axillary lymph nodes appears to be an important prognostic factor and a significant positive correlation between the tumor size and the number of positive axillary lymph nodes has been found. [ABSTRACT FROM AUTHOR]

Trauma is among the leading causes of death. Undetected and untreated adequately and on time, traumatic small bowel injuries can be lethal. Case Report. We present a case of a small bowel perforation after a blunt abdominal injury, caused by an accidental self-inflicted hammer blow to the abdomen. The initial abdominal and chest x-rays and abdominal ultrasound did not indicate an injury to the abdominal organs. Due to the impaired clinical picture and the fact that the patient was hemodynamically stable, multi-detector computed tomography of the abdomen and small pelvis was performed, showing intraperitoneal free fluid and pneumoperitoneum, not seen by other imaging methods. A decision for surgical treatment was made. The intraoperative finding confirmed a small bowel perforation. Conclusion. Due to the possible false-negative imaging findings, clinical follow-up of patients with abdominal trauma is mandatory when making the decision for surgical treatment. [ABSTRACT FROM AUTHOR]