Lublin iNternational Students’ Surg

Lublin International Students’ Surgical Congress 2025 Abstract Book

LUBLIN INTERNATIONAL STUDENTS’ SURGICAL CONGRESS 2025, 3-5 April

2025, Lublin

Editor: Jakub Barczuk, Bartłomiej Goch

Oprawa graficzna: Jakub Barczuk, Bartłomiej Goch

Publisher: Uniwersytet Medyczny w Lublinie, students’ Scientific Association of

the 2nd Department of General and Gasteointestinal Surgery and Surgical Oncology
of the Alimentary Track.

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4.0
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własnością ich odpowiednich właścicieli i zostały użyte wyłącznie w celach
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Spis treści:
1. Oncology & Surgery
…7
1.1. Liver Transplantation as a Therapeutic Approach for
Undifferentiated Embryonal Sarcoma of the Liver in an Adult: A Case
Report
1.2. Non-small-cell lung cancer: Is radio-frequency ablation
better than stereotactic body radiation therapy?
1.3. A Rare Cause of Acute Abdomen: Ruptured Uterine
Leiomyosarcoma with Secondary Peritonitis
1.4. Retroperitoneal paraganglioma
1.5. Post-cholecystectomy biliary leakage – evaluation of the efficacy
and safety of endoscopic transpapillary drainage by ERCP
1.6. Recognizing the elusive: A Radiologist’s Challenge in Diagnosing
Intracystic Papillary Carcinoma
1.7. Pancreatic cancer biom arkers – analysis of the modern
measurement methods and a review of new alternative markers
1.8. Could a lingstanding asymptomatic parotid mass be malignant? - a
case report of a 15-year-old patient
1.9. Oncologic Surgery – Ally or Foe? Exploring the Mechanisms of
Postoperative Accelerated Metastasis

2. Vascular surgery …
17
2.1. Genicular artery embolization as an emerging therapy for
osteoarthritis – first case in Poland
2.2. Hartmann's procedure and aortic reconstruction in a
patient with dissecting AAA and bowel infarction
2.3. Never-Ending Story of Ruptured Abdominal Aortic
Aneurysm – Case Report
2.4. From One Graft to Another: The Complexities of Vascular
Infections
2.5. Ureteral compression by aortic prosthesis following
aortofemoral bypass- a case report
2.6. Unusual migration of occluder after percutaneous closure of
atrial septal defect - a case report.
2.7. Rapid Expansion of Abdominal Aortic Aneurysm: A Case of
Unexpected Growth and Urgent Intervention

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2.8. Reperfusion injury in patient with acute abdominal aortic

occlusion due to gastric dilatation caused by pyloric stenosis: a
case report
2.9. When Every Flow Counts – Endovascular Repair of Post-Transplant
Vascular Complications - a case repor
2.10. Total Endovascular Repair of Extensive Type A Aortic
Dissection: A Case Report
2.11. Type I Endoleak - Silent Threat Following Aorto-Biiliac Stent Graft
Implantation.
2.12. Atypical Presentation of Ruptured Common Iliac Artery
Aneurysm- Challenges in Diagnosis and Importance of Timely
Surgical Intervention
2.13. When Every Flow Counts – Endovascular Repair of Post-Transplant
Vascular Complications - a case report

3. Laryngolgy & opthalmology

…31
3.1. Eyes Wide Open: Preventing Complications Requiring
Surgical Intervention in Herpetic Keratitis – A Case Report
3.2. A Rare Case of Bilateral Internal Laryngocele Causing
Acute Airway Obstruction
3.3. Subcutaneous dirofilariasis of the eyelid
3.4. Cystoid macular edema after cataract surgery in patient
with PEX glaucoma: the correct clinical decision
3.5. Pleomorphic adenoma of the parotid gland: extracapsular
dissection, total or superficial parotidectomy?
3.6. Surgical treatment of the nasocutaneous fistula resulting
from necrosis of the nasal cavity

4. Urology & Gynecology

…38
4.1. Recurrent renal artery stenosis with ‘string of beads’ appearance:
a case study
4.2. Treatment of Ruptured Renal Artery Aneurysm with
Endovascular Stenting
4.3. The domino effect of diagnostic delays in a complex oncological
case.
4.4. Echoes of the past: When salpingectomy is not enough -
case report
4.5. Fertility treatment in a patient with PCOS and endometrial
carcinoma
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4.6. Ovarian transposition – protecting fertility from oncologic

pelvic radiation therapy
4.7. Infection and Graft Instability: The Hidden Threat to Kidney
Transplant Success
4.8. Treatment of patients with Fouernier’s gangrene: Early
Intervention as the Key to Success
4.9. Metoidioplasty vs Phalloplasty: a choice dilemma
4.10. Extensive Fournier's gangrene as a result of perineal trauma

5. General Surgery …
49
5.1. Understanding Anatomical Differences as an Essential
Element of Hepatopancreatic Surgery.
5.2. Risk factors for recurrence in patients undergoing pancreatic
resection
5.3. When Standard Approaches Fail: A Case of Blunt Abdominal
Trauma
5.4. Echinococcosis located in the liver, Is Surgical treatment
always necessary?
5.5. Atypical complication during routine procedure in the Angio
suite - a case report.
5.6. Laparoscopic sleeve gastrectomy - fewer trocars, better
outcomes
5.7. Review of Augmented reality to help surgeons - what the
future brings
5.8. Determining the true purpose of the use of abdominal binders
after incisional hernia repair: to reduce the stress forces along the
suture line, to increase compression around the mesh, or to
maintain the trunk circumference
5.9. Unveiling the Unusual: Laparoscopic Resolution of a Rare
Gallbladder Hydatid Cyst with Acute Cholangitis
5.10. Infectious complications Associated with Central Vascular Access
Devices
5.11. Not Just Another Liver Mass: A Case Report on Primary Hepatic
Neuroendocrine Tumors
5.12. Recurrent Bilateral Pneumothorax in Langerhans Cell
Histiocytosis: The Role of Comprehensive Surgical Intervention
5.13. When Two Thyroid Malignancies Coexist: A Case of Differentiated
High-Grade Thyroid Carcinoma and Poorly Differentiated Thyroid
Carcinoma
5.14. Artificial Intelligence in Surgical Decision-Making. Applications,
Challenges, and Implications for Patient Outcomes
5.15. Looking Past the Psyche: A Case of Sigmoid Colon Perforation in a
Psychiatric Patient
5.16. Bariatric Surgery – is It a Good Choice of Treatment for Young
People With Obesity?
5.17. Malnutrition as a factor worsening the prognosis in patients with
pancreatic tumor.

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5.18. Non-technical Skills in General surgery

6. Surgery & Pediatrics

…69
6.1. A case of hepatocellular carcinoma metastases
6.2. A case of hepatocellular carcinoma metastases”
6.3. Under Pressure: Managing Temporary Abdominal Closure in
Postoperative Compartment Syndrome
6.4. Advancing the Management of Pediatric Appendicitis- A Scarless
Approach
6.5. Massive true thymic hyperplasia in a 4-month-old infant - case
report
6.6. Permanent complication of a critical condition - two pediatric
cases of amputation due to sepsis
6.7. Persistent thymus in a young person – case report
6.8. PRIMARY HYDATID CYST OF THE PANCREAS – LAPARASCOPIC
APPROACH
6.9. Silent Threat: Internal Hernia with Necrosis as a Late Complication
of Roux-en-Y Gastric Bypass
6.10. From Scar to Function: Surgical Management of Pediatric
Post-Burn Hand Contracture – Case Report with Follow Up

7. Neurosurgery …
83
7.1. Obstructive hydrocephalus due to hemorrhage into a pineal cyst –
a surprising cause of worsening headache.
7.2. Dysregulation of the kynurenine pathway in patients with orbital
proliferative lesions- preliminary study
7.3. The Point of No Return: A Case of Self-inflicted Intracranial Injury
by Arrow
7.4. Chronic Venous Ulcer with Underlying Follicular Lymphoma: A Case
of Complex Wound Healing
7.5. A Novel Approach to Treating Chiari Malformation Type I in Adults:
The Interlayer Dural Split Technique
7.6. Central hypoventilation syndrome as a complication after surgical
treatment of choroid plexus papilloma.
7.7. Comprehensive Management of Severe Traumatic Brain Injury: A
Case Report
7.8. Hyperacute Klebsiella Infection Following Brain Surgery: A Fatal
Case Report and Neurosurgical Lessons
7.9. Optimizing Surgical Outcomes in Olfactory Groove Meningioma: A
Case of Minimally Invasive Resection
7.10. ORGANIZATION OF THE DORSAL ROOT OF THE SPINAL NERVE –
SYSTEMATIC LITERATURE REVIEW AND OWN OBSERVATIONS
7.11. Severe Spinal Cavernous Hemangioma: Surgical Risks,
Complications, and the Reality of Long-Term Management
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7.12. Title: Temporal lobe abscess as the complication of cholesteatoma

and otitis media: A case report

8. ORTHOPEDICS AND TRAUMA

…96
8.1. Genicular Artery Embolization – A Breakthrough Solution for
Chronic Knee Pain
8.2. Reconstruction of a Proximal Humerus Anatomical Neck Fracture
with a Femoral Head Osteochondral Allograft: A Case Report
8.3. Application of 3D printing in orthopedics – literature review
8.4. Unequal battle with the unknown – Case report: Recurrent
infection with an unknown pathogen after anterior cruciate
ligament (ACL) reconstruction
8.5. Exploring Approaches: Surgical Incisions in Hip Replacement
8.6. The fracture that hid the disease - the case of a 14-year-old
patient with osteosarcoma.
8.7. Rupture of an accessory spleen caused by blunt trauma

9. Plastic Surgery & Breast

Surgery …104
9.1. Clinical Management of Luminal B Breast Cancer: A Case Report
9.2. Fasciocutaneous flap reconstruction in the treatment of radiation
necrosis: a case report
9.3. Juvenile gynecomastia – surgical treatment
9.4. Surgical approach to large and neglected melanoma
9.5. Adjusted treatment of invasive breast cancer in a young patient
with a history of Non-Hodgkin lymphoma
9.6. The Journey of Delayed Multistage Breast Reconstruction
Following Invasive Ductal Carcinoma: a Case Report
9.7. Posterior Thigh Flap as Decubitus Ulcer Treatment for a Patient
with
9.8. Arnold-Chiary type II Malformation

10. Cardiac Surgery &

Interventional Cardiology
…112
10.1. First use of the True Flow balloon as a bridge to TAVI via central
access in Poland in a patient with an LVEF of 13% and an AVA of 0.2
cm².
10.2. Intraoperative vasoplegic shock as a complication of
cardiopulmonary bypass
10.3. Neurological disorders after successful surgery of post-myocardial
infraction ventricular septal defect
10.4. Mitral valve surgery without aortic cross-clamping – a new gold
standard?
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10.5. Penumbra system usage in acute PE: a review paper

10.6. Aortomitral Curtain Reconstruction Technique with Aortic and
Mitral Valve Replacement in Native Bi-valvular Endocarditis – Case
Report
10.7. A Rare Case of Unrecognized Thymic Squamous Cell Carcinoma
Discovered During Coronary Artery Bypass Grafting
10.8. Cardiac tamponade disguised by pulmonary embolism in an
oncology patient - a case report

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ONCOLOGY &
SURGERY

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Liver Transplantation as a Therapeutic Approach for Undifferentiated

Embryonal Sarcoma of the Liver in an Adult: A Case Report
Authors: Katarzyna Biedrzycka, Jakub Rochoń
Supervisor: Marcin Morawski
Affiliation:
1. Students’ Scientific Group at the Department of General, Transplant and
Liver Surgery, Medical University of Warsaw

Background: Undifferentiated embryonal sarcoma of the liver (UESL) is a

rare hepatic mesenchymal tumor usually occurring in children and young
adults. Its occurrence in adults is exceptional, and definitive diagnosis is
often challenging. UESL is a highly aggressive malignancy of mesenchymal
origin, with a tendency for both local and distant metastases. Furthermore,
its clinical manifestation is non-specific, often leading to a delayed
diagnosis at an advanced stage in adult patients. There is no consensus on
how to manage this type of tumor in adults. According to the literature,
the highest overall survival rate is observed in patients who undergo a
combination of chemotherapy and surgical resection. In patients who meet
the criteria for liver transplantation, this treatment approach for UESL has
a very favorable prognosis.

Case report: A 53-year-old female patient was admitted to the clinic to be

qualified for liver transplantation due to liver cirrhosis of HBV, HCV and
primary biliary cholangitis (PBC) etiology with a focal lesion in 6/7 th
segment of the liver measuring 50x36 mm. Imaging studies and core
needle biopsy results were inconclusive. After the transplantation, the
lesion in the explanted liver was subjected to histopathological
examination, which identified it as an undifferentiated pleomorphic
sarcoma. Following an oncological consultation, it was determined that the
patient did not require chemotherapy, and she was advised to undergo a
control abdominal CT scan every 3 months. The latest follow-up studies
indicate no signs of recurrence, and the transplanted liver appears normal.

Discussion and conclusion: UESL in adults poses a significant diagnostic

challenge due to its non-specific clinical and radiological features, often
leading to delayed recognition. Liver transplantation may serve as a
curative option for some cases. This case underscores the importance of a
multidisciplinary approach, early detection, and rigorous post-transplant
surveillance to mitigate the risk of recurrence and optimize long-term
outcomes.

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Non-small-cell lung cancer: Is radio-frequency ablation better than

stereotactic body radiation therapy?
Authors: Gavra Marta1, Giurgiu Alexandru-Radu2
Supervisor: Bercea Bogdan-Sorin³
Affiliation:
1.UMF “Iuliu Hatieganu” Cluj-Napoca
2.University Emergency County Hospital Cluj-Napoca

Introduction:
Non–small-cell lung cancer (NSCLC) accounts for most lung cancers and
carries a 5-year survival rate of 15%. Radiofrequency ablation (RFA) is a
minimally invasive technique that shrinks the size of tumors, nodules or
other growths in the body. This review aims at analysing if radio-frequency
ablation (RFA) is better than stereotactic body radiation therapy (SBRT).

Materials and methods:

A search was conducted on PubMed for articles published after 2010 using
the key words “non-small-cell lung cancer”, “radio-frequency ablation”,
“stereotactic body radiotherapy”. Studies were selected based on the
following inclusion criterias: overall survival rate, cost efficiency, tumor
shrinkage. Exclusion criterias were overlapping of information and lack of
inclusion criterias. Bias risk was not evaluated and PRISMA guidelines were
used for data synthesis.

Results:
Out of 20 initial articles, 10 were selected, counting 6195 patients who
participated in clinical trials and reviews. Li M et al. showed that 5 years
post-treatment overall survival (OS) for patients who had RFA is 29.1%
( 95% CI, P=0.8738) and 27.4% (95% CI, P=0.7663) for SRBT. Regarding
cost-efficiency, a study conducted by Damian E. et al. showed that SBRT
costs 4.25 times more than RFA (17.000 $ vs 4.000 $). RFA has shown
better results only in tumors sized between 1 and 2 cm or lower
(p<0.0001).

Conclusion:
Nonsurgical NSCLC patients receiving RFA seemed to have a better five-
year survival rate than those receiving SBRT and studies also showed that
RFA is much more cost-efficient. Regarding tumor shrinkage, RFA is much
more efficient for tumors under 1 cm, but long-term comparative studies
are needed to support an evidence based decision.

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A Rare Cause of Acute Abdomen: Ruptured Uterine

Leiomyosarcoma with Secondary Peritonitis

Authors: Lucija Dobrić1, Nives Samaržija1, Ana Andrilović2

Supervisor: Robert Kliček2,3
Affiliations:
1 – Clinical Hospital Dubrava, Emergency medicine department
2 – Clinical Hospital Dubrava, Colorectal surgery department
3 – School of Medicine, University of Zagreb

Background: Acute abdomen is a surgical condition characterized by signs and

symptoms that require urgent surgical intervention. Although gynecological
pathologies are a common cause, a rare but possible etiology of acute abdomen
is the rupture of uterine neoplasm, leading to peritoneal tumor dissemination and
secondary peritonitis.
Case report: A 69-year-old nulliparous female was admitted to emergency room
for intermittent abdominal pain that had lasted for several months, followed by
nausea for the past seven days and a recent worsening of symptoms. Upon
examination, she was septic but hemodynamically stable, presenting with
abdominal distension, reduced bowel sounds on auscultation, and signs of diffuse
peritoneal irritation. Urgent MSCT of the abdomen showed an enlarged uterus
with a thickened, tumor-involved wall, accompanied by an extensive nearby
abscess collection, pneumoperitoneum and areas of free fluid in the abdomen,
suggesting peritoneal dispersion of the tumor. Based on this finding, the patient
was indicated for emergency surgery. The patient became hemodynamically
unstable at the beginning of surgery, requiring inotropic support with
norepinephrine. A medial laparotomy was used to access the abdominal cavity,
which was filled with brown-colored tumor detritus. An extensive abscessing
neoplasm was verified on the uterus that infiltrated several sections of the
intestines, including the appendix. Segmental resection of the jejunum,
appendectomy, omentectomy and total hysterectomy with bilateral adnexectomy
was performed.
Discussions and Conclusions: Postoperatively, patient was placed in the ICU
where she remained unstable for five days. She was stabilized on day six and
transferred to the colorectal surgery department where she showed gradual
clinical improvement. Histopathological analysis confirmed high-grade
leiomyosarcoma, and she was referred to a gynecologic oncologist for further
treatment. This case highlights the principles of emergency surgery, where
urgent gynecologic oncologic procedures may be necessary in unstable, septic
patients unfit for transfer. Early diagnosis and interventions are crucial to
preventing fatal complications.

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Retroperitoneal paraganglioma

Authors: Nives Samaržija1, Lucija Dobrić 1

Supervisor: Stjepan Mesarov1
Affilitation:
1 – Clinical Hospital Dubrava, Department of Urology, Zagreb, Croatia

Background: Paragangliomas are rare tumors that occur near blood

vessels and nerves, outside the adrenal glands. These tumors, which can
be benign or malignant, share similarities with pheochromocytomas.
Diagnosing and managing non-functional paragangliomas is often
challenging. This case report highlights a paraganglioma found during an
investigation of long-term hypertension.

Case report: A 68-year old female with a history of arterial hypertension

for the past seven years, for which she had been receiving appropriate
therapy, was referred to the nephrology outpatient clinic due to poorly
controlled blood pressure. During a properly conducted arterial pressure
measurement, her systolic blood pressure peaked at 223 mmHg and
diastolic at 102 mmHg. An ultrasound of the kidneys revealed normal
position, shape and size on both sides. Additionally, Doppler imaging of
the renal arteries showed normal flow velocity with no signs of significant
renal artery stenosis. Further investigations were indicated, including
adrenal hormones and an abdominal CT scan. Laboratory results showed
metanephrines at 0,8 µg/L (<2,0) and normetanephrines 23,0 µg/L (<4,4).
The abdominal CT scan revealed a 40x38x38mm solid, hypervascular
lesion on the left side, located retroperitoneally, paraaortic and
infrarenallly. A cytological biopsy of the lesion was performed under CT
guidance, and pheochromocytoma/paraganglion is considered in the
differential diagnosis. A laparoscopic extirpation of the left retroperitoneal
ganglion was performed, utilizing a minimally invasive approach that
facilitated a quicker recovery and reduced postoperative complications for
the patient. During a follow-up examination, the patient reported feeling
well, with normal blood pressure.

Discussion and Conclusion: Retroperitoneal paragangliomas are rare,

challenging tumors to diagnose and treat. Given their malignant potential
and location near vital structures, laparoscopic surgery is preferred.
However, complete removal can be difficult, particularly for large or
vascular tumors, requiring careful planning. Surgery not only controls the
tumor but also helps manage hypertension, improving long-term
outcomes.

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Post-cholecystectomy biliary leakage – evaluation of the efficacy and

safety of endoscopic transpapillary drainage by ERCP

Author: Agata Grochowska

Supervisor: Tomasz Klimczak, MD
Affiliation:
1. Students' Scientific Association at the Department of General and
Transplant Surgery, Faculty of Medicine, Medical University of Lodz, Lodz,
Poland

Introduction
Biliary leakage after cholecystectomy is a significant postoperative complication
that can lead to a prolonged hospital stay, rehospitalization, and the need for
additional therapeutic interventions. Endoscopic retrograde
cholangiopancreatography (ERCP) with stent implantation has become the gold
standard for diagnosis and treatment. The purpose of this study was to evaluate
the efficacy and safety of endoscopic transpapillary drainage by ERCP in the
treatment of leaking cystic duct stump after cholecystectomy.

Materials and methods

Patients treated in the Department of General and Transplant Surgery who were
diagnosed with bile leakage from the stump of the cystic duct after
cholecystectomy between 2017 and 2024 were included in the study. Patients
underwent an ERCP procedure combined with biliary stenting. Their medical
records were retrospectively analyzed. The primary success was evaluated during
the ERCP procedure itself, and secondary success evaluation was conducted
during the stent removal.

Results
Twenty-nine patients, with a mean age of 64.14 years and BMI 28.53 kg/m², were
studied. The main indications for cholecystectomy were stones without
inflammation (48%). Endoscopy was the first choice in 89.7% of patients. SEMS
stents were used in 69% and Amsterdam stents in 31%. The average time to
ERCP was 12.4 days. Primary success was achieved in 89.7% of patients.
Secondary success was evaluated in 27 patients, 96.4% of whom had no biliary
fistula after stent removal. Complications after ERCP: pancreatitis (2 patients),
stent migration (2 patients). Surgical complications: wound infection (3 patients),
intestinal fistula (1), appendicitis (1), and sepsis (1).

Conclusions
Endoscopic transpapillary drainage is a highly effective and relatively safe
method of treating leaking vesical duct stump after cholecystectomy. Given its
minimally invasive nature and high success rate, ERCP should be considered the
treatment of choice for this complication after cholecystectomy.

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Recognizing the elusive: A Radiologist’s Challenge in Diagnosing

Intracystic Papillary Carcinoma

Authors: Eleonora Suvaljko1; Lea Paradinović2; Dino Šola3; Antonela Šarić4; Fran
Popović2
Supervisor: Kristina Bojanić5,6,7
Affiliation:
1 - Institute for Emergency Medicine of Zadar County, Zadar, Croatia
2 - Family Medicine Specialist Practice, Health Center Osijek Baranja
County, Osijek, Croatia
3 - Family Medicine Specialist Practice, Health Center Vinkovci, Vinkovci,
Croatia
4 - Family Medicine Specialist Practice, Health Center of the Primorsko-
goranska County, Mali Lošinj, Croatia
5 - Health Center Osijek Baranja County , Head of Radiology Department,
Osijek, Croatia
6 - Faculty of Dental Medicine and Health, Josip Juraj Strossmayer
University of Osijek, Osijek, Croatia
7 - Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek,
Croatia

Introduction: Papillary breast lesions are a biologically, clinically, and

histologically heterogeneous group of tumors, united by the presence of papillae
—structures not characteristic of normal breast tissue. Radiologists must
meticulously analyze the morphological and functional characteristics of such
lesions whereby contrast mammography stood out as crucial for establishing a
timely diagnosis.

Case report: This case report describes a 75-year-old postmenopausal patient

diagnosed with intracystic papillary carcinoma of the breast, initially identified as
an incidental finding during thoracic CT imaging. Mammography with
tomosynthesis revealed a sharply defined lesion, angulated in one part of the
posterior contour (20 × 18 × 20 mm). Subsequent diagnostic workup, including
CEM and ultrasound (BI-RADS 4C), revealed a lobulated lesion with
inhomogeneous enhancement, partially cystic in nature. The patient was referred
for core-needle biopsy, however, fine-needle aspiration cytology was performed.
The aspirated fluid was sent for cytological analysis, which revealed papillary
proliferation of suspicious cells (C4) with a recommendation for histopathological
verification, which the patient initially declined. Over a one-year period, the
lesion demonstrated significant progression (33 × 28 × 23 mm), leading to
confirmation via CNB and subsequent segmental mastectomy. Retrospective
analysis using iCAD software indicated a 49% likelihood of breast malignancy.

Discussions and Conclusions: These rare tumors, accounting for only 0.5% of
all cases, pose a significant challenge due to frequent misinterpretations that can
result in both over- and under-diagnosis, particularly in postmenopausal patients
presenting with atypical clinical signs. With typically favorable prognostic
features, such as high estrogen and progesterone receptor expression and HER-2

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negativity, intracystic papillary carcinoma demonstrates excellent long-term

survival rates, provided timely and accurate diagnosis is achieved.

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Pancreatic cancer biomarkers – analysis of the modern measurement

methods and a review of new alternative markers
Authors: Szymon Folusz, Michał Flis, Wiktoria Bojarska
Supervisor: Justyna Wyroślak-Najs, MD PhD
Affiliation:
1.Students’ Scientific Association at the 2nd Chair and Department of
General and Gastrointestinal Surgery and Surgical Oncology of the
Alimentary Tract
2.Medical University of Lublin

Introduction: Pancreatic cancer (PC) is one of the most deadly cancers. The
most frequent type is ductal adenocarcinoma (PDAC). The ‘golden standard’ for
diagnosing PC is histopathology analysis and/or cytology, often combined with
biological tumour markers like CA19-9, CEA and others. Sensitivity and specificity
of those are not enough for early screening, thus PC is usually diagnosed at
advanced or metastatic stage. The need for more accurate measuring methods
or alternative markers becomes essential to improve therapeutic outcomes.
Material and methods: The aim of this review is to present probable ways of
improving the sensitivity and specificity of markers used so far and to gather the
most promising alternative markers from the research from years 2022-2024,
using words: ‘pancreatic cancer biomarkers’, ‘tumour markers pancreatic cancer’.
Results: CA19-9 is the only official marker for the diagnosis and prognosis of
health in PC. Unfortunately, it has poor sensitivity and specificity, and 10% of the
population does not synthesize it. Knowledge of the genes responsible for the
synthesis of CA19-9 and its precursors, e.g. DUPAN-2, provides a chance to
bypass this limitation. Another marker – CEA - has lower specificity and sensitivity
alone, but is a great solution in combination with CA 19-9. Cell-free DNA is an
another important marker detected in blood, which half-life time can be treated
as a real-time reflection of disease progression. The KRAS mutation is one of the
most common mutations associated with PC and its precursors. Among other
mutations can be distinguished: CDKN2A, TP53, and SMAD4.
Conclusions: Creating an effective and specific early screening method is crucial
to improve the detectability, and consequently the survival rate among patients
with pancreatic cancer. Since the best known marker so far, CA19-9, fails in this
respect, the need for more accurate methods of us ing this marker or for finding
alternatives becomes essential.

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Could a lingstanding asymptomatic parotid mass be malignant? - a case

report of a 15-year-old patient

Author: Joanna Najbar

Supervisor: lek. Krystian Golon
Affiliation:
Studenckie Koło Patomorfologiczne, University of Warmia and Mazury in
Olsztyn

Background: Five-year survival rates for pediatric patients with salivary gland
tumors vary by age group: they are 100% for patients under 1 year old, 97.0% for
those aged 10 to 14, and 95.0% for the 15 to 19 age group. These statistics
highlight the importance of early detection and accurate evaluation of salivary
gland tumors in children.

Case report: A 15-year-old female patient was admitted to the pediatric surgery
ward for a scheduled biopsy of a tumor in the right parotid gland region. The
mass had been observed since the age of 5 and was asymptomatic. MRI revealed
a cyst measuring 29x24x33 mm near the right angle of the mandible, containing
high-protein fluid and adjacent enhancing tissue, raising suspicion of a branchial
cyst. The mass had gradually increased in size over the past two years. A non-
radical surgical procedure was performed.Histopathological samples were taken.
The analysis showed a neoplasm with varied architecture, characterized by nuclei
with mild atypia and eosinophilic secretion in the glandular lumens. No cancer
cells were found in lymphatic vessels and there were no evidence of necrosis.
Immunohistochemical studies showed CK7 (+++), S100 (-), CK5/6 (+/-), GATA39
(-), and DOG1 (-), as well as positive expression of SOX10 and p40. Molecular
analysis using FISH revealed a break in the MAML2 gene. The final diagnosis was
established as right mucinous carcinoma of the parotid gland, grade G2, with
oncocytic metaplasia. A decision was made to expand the scope of the surgery.

Discussions and Conclusions: Salivary gland tumors represent a rare category of

neoplasms in the pediatric population, so there are no standardized guidelines for
diagnosis and treatment in children. Oncologists and pediatric surgeons typically
follow adult protocols, which primarily recommend complete surgical resection
with appropriate margins.

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Oncologic Surgery – Ally or Foe? Exploring the Mechanisms of

Postoperative Accelerated Metastasis
Authors: Chiru Ștefan, Stratone Miruna-Elena
Supervisor: Assoc. Prof. Dr. Constantin Aleodor Costin, MD, PhD
Affiliation:
Departament of Histology of “Grigore T. Popa” University of Medicine and
Pharmacy“Grigore T. Popa” University of Medicine and Pharmacy, Iași,
Romania

Introduction: The gold standard for diagnosing and treating neoplasms is

surgery, including biopsy and tumor excision, which also improves patient
outcomes. Nevertheless, there is increasing evidence that even minimal surgical
trauma might affect a number of pathophysiological processes that may
encourage tumor recurrence and subsequent metastatic dissemination.

Material and methods: A review of the literature has been performed through
PubMed and Scopus in order to identify articles regarding the induction of
accelerated metastasis by primary tumor resection. Publications from 2015-2025
were selected using the following keywords: “tumor resection”, “trigger for
metastases”, “biopsy”, “metastasis”.

Results: The stimulation of neuronal, inflammatory, and proangiogenic signaling

pathways is part of the physiological stress response after surgery, which
promotes wound healing and functional recovery. Paradoxically, the same
mechanisms also encourage the growth of residual cancer and the spread of
metastasis. Tumor cell seeding along the needle track into the surrounding
tissues has been linked to fine needle aspirations. Surgical procedures alter the
local tumor microenvironment in addition to their effects on tumor cell seeding.
Tumor cells frequently produce an immunosuppressive microenvironment that
promotes tumor growth and metastasis in order to evade immune surveillance by
anti-tumoral effectors. Even more immunosuppressive infiltrates in the remaining
tumor mass can be encouraged by surgical procedures including tumor excision
and biopsy. In reaction to surgical trauma, invading immune cells produce growth
factors, chemokines, and inflammatory cytokines in addition to producing an
immunosuppressive environment. These elements are recognized for their
capacity to stimulate the migration, differentiation, and proliferation of tumor
cells.

Conclusions: Both biopsies and tumor resections can have a variety of effects
that promote tumor growth and metastasis, according to preclinical and clinical
data. The findings from these research, however, cannot be applied generally due

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to the range of surgical techniques, tumor types and stages that are seen in
clinical practice.

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VASCULAR SURGERY

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Genicular artery embolization as an emerging therapy for osteoarthritis

– first case in Poland
Authors: Julia Kucharzewska¹, Jan Krzowski², Julia Jabłońska³
Supervisor: M.D., Ph.D. Maciej Szmygin⁴
Affiliations:
¹,²,³ Students’ Scientific Society at the Department of Interventional
Radiology and Neuroradiology, Medical University of Lublin.
⁴Department of Interventional Radiology and Neuroradiology, Medical
University of Lublin.

Background
Osteoarthritis of the knee (OA) is one of the most common musculoskeletal
disorders. According to World Health Organization (WHO) statistics, in 2019,
approximately 528 million people worldwide were living with osteoarthritis. This
type of disease is characterized by significant pain and a considerable reduction
in the quality of life. In many cases, traditional therapy and surgical methods do
not provide sufficiently satisfactory results. Knee artery embolization (GAE) is a
new type of therapy aimed at reducing patient pain by closing abnormal blood
supply to the knee joint in areas of inflammation and pain.
Case report
A 39-year-old female patient, who had been struggling with knee osteoarthritis
for 3 years and was resistant to conservative and laparoscopic treatments, was
referred for endovascular therapy. The procedure was performed under local
anesthesia with a puncture of the groin. Initial contrast diagnostic imaging
confirmed hyperemia of the synovial membrane, primarily in the lateral
compartment of the knee. Selective catheterization and occlusion of the
pathological blood vessels were carried out using 250 μm particles. The patient
was discharged the following day in good clinical condition. Follow-up visits at 1
and 3 months after the procedure showed a favorable course of treatment. KOOS
scores were 61 and 67, with a significant reduction in pain. Ultrasound
examination confirmed successful reduction of blood vessels both in microflow
and contrast-enhanced imaging.
Discussions and Conclusions
Genicular artery embolization is a relatively recent procedure. Its minimally
invasive nature and the small number of contraindications for performing this
type of procedure make it a method with many benefits. The subsequent
procedures that bring the expected results confirm its effectiveness. The
presented case may serve as a basis for promoting the use of knee artery
embolization in patients who are resistant to conservative treatment but are not
candidates for surgery.

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Hartmann's procedure and aortic reconstruction in a patient with

dissecting AAA and bowel infarction

Authors: Mila Kostić1, Jakov Kožić1, Marta Krpan1, Mirta Košćak 1

Supervisor: Ivan Đureković
Affiliations:
1- School of Medicine, University of Zagreb, Zagreb, Croatia
2- Department of Anesthesiology and Intensive Care, University Hospital
Merkur, Zagreb, Croatia
Supervisor: Ivan Đureković

INTRODUCTION:
Abdominal aortic aneurysm (AAA) is a life-threatening condition with a high risk
of complications such as rupture, dissection and mesenteric ischemia, which are
associated with high mortality. CT angiography is a diagnostic method for
aneurysms and their complications. When bowel infarction occurs, urgent
vascular and colorectal surgical intervention is required to prevent multi-organ
failure. Hartmann’s resection, a procedure involving resection of the affected
bowel segment with the creation of a colostomy, is often performed to manage
ischemic damage and restore gastrointestinal function.
CASE REPORT:
A 78-year-old man presented to the emergency department with abdominal and
pelvis pain, hypotension, and a soporific state. CT imaging confirmed infrarenal
AAA with luminal dissection. Additionally, the rectosigmoid colon contained
impacted fecal matter, thickened walls, and a dilated lumen, with signs of
impaired passage. Emergency exploratory laparotomy was performed, revealing
a dissecting AAA and extensive necrosis of the rectosigmoid colon and rectum.
Surgical procedures included evacuation of thrombotic deposits within the AAA,
reconstruction of the infrarenal aneurysm using the InterGrad prosthesis and
Hartmann’s resection of the necrotic rectosigmoid colon. Additionally, a unipolar
colostomy of the descending colon was performed in the left hemiabdomen, and
an abdominal drain was placed in the pelvis. Postoperatively, the patient required
intensive support with mechanical ventilation, continuous infusion of vasopressin
and hydrocortisone due to hemodynamic instability, while coagulopathy was
corrected with a prothrombin complex concentrate.
DISCUSSIONS AND CONCLUSIONS:
This case emphasizes the critical role of urgent surgical intervention in the
management of AAA with bowel ischemia. Open surgical repair with an InterGrad
prosthesis effectively restored vascular integrity, while Hartmann's resection was
essential to remove necrotic bowel tissue and prevent further complications. The
combined vascular and colorectal surgical approach was critical in preventing
multiple organ failure. Early recognition and multidisciplinary surgical
management remain essential to reduce mortality and improve outcomes in
these high-risk cases.

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Never-Ending Story of Ruptured Abdominal Aortic Aneurysm – Case

Report

Author: Kamila Mozga

Supervisor: dr hab. n. med. Michał Sojka
Affiliation:
Students’ Scientific Association of Vascular Surgery at the Department of
Vascular Surgery, University Clinical Hospital No. 4, Medical University of
Lublin, Lublin, Poland

Background: Mortality from ruptured abdominal aortic aneurysm (AAA)

reaches up to 90%, with 50% of patients dying before reaching the
hospital. Endovascular aneurysm repair (EVAR) of AAA in elderly patients
with multiple comorbidities presents a significant challenge in modern
vascular surgery. Medical professionals must carefully consider anatomical
variations. One of the most common complications following stent graft
implantation is endoleak.
Case report: An 81-year-old man was hospitalized due to raptured AAA.
Clinical evaluation and diagnostic imaging revealed an additional
aneurysm in the internal iliac arteries. Due to multimorbidity, the decision
was made to proceed with EVAR. Bilateral embolization of the internal iliac
arteries was performed, followed by the implantation of a Gore C3 stent
graft subrenally. The iliac limbs of the stent graft terminated bilaterally in
the external iliac arteries, and modeling was performed using a latex
balloon.
Four days post-operation, the patient experienced abdominal pain, and a
CT angiography revealed a type I endoleak. The leak was treated with
embolization using free coils and thrombin administration to the aneurysm
sac. Three days later, after the necessary equipment arrived, an
extension cuff of the stent graft was implanted to seal the leak below the
renal arteries and connect with the previously implanted stent graft. The
patient remained stable, with efficient respiratory and circulatory function.
One week after the final procedure, a follow-up CT angiography revealed a
leak from the inferior mesenteric artery. Embolization of the artery was
performed, and the retroperitoneal hematoma was evacuated. The
remainder of the hospitalization was uneventful.
Discussion and Conclusions: The management of ruptured AAA in
elderly patients with multiple comorbidities presents significant
challenges. In this case, the use of endovascular techniques enabled
effective and minimally invasive treatment of various endoleaks. This case
underscores the importance of individualized treatment strategies and
continuous imaging surveillance in the post-operative period.

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From One Graft to Another: The Complexities of Vascular Infections

Author: Oskar Makuch
Supervisor: Dr. n. med Piotr Malinowski
Affiliation:
Department of Vascular Surgery, University of Warmia and Mazury

Background:
With rising cases of multiple comorbidities, vascular graft procedures have
become more frequent. Aortic graft infections, occurring in 1-5% of cases,
are among the most severe complications, with mortality rates reaching
50% and limb loss in 25% of patients. These alarming statistics emphasize
the need for better treatment strategies to improve outcomes.
Case Report:
A 66-year-old man was admitted with worsening symptoms of a vascular
prosthesis infection, including severe lower back pain, intermittent
polyuria, and fever. His medical history included extensive vascular
disease. Eighteen years earlier, he underwent surgery for an abdominal
aortic aneurysm, receiving a straight prosthesis. Nine years later, a
bifurcated stent graft was implanted above the prosthesis.
He had multiple treatments for acute lower limb ischemia, including
thrombolytic therapy for left iliac axis thrombosis, an embolectomy for
right popliteal artery occlusion, and a stent graft for a right common iliac
artery aneurysm. Upon admission, he was on antibiotics, but Angio-CT
showed worsening inflammation. Initial treatment provided temporary
relief, but follow-up imaging revealed further deterioration around the
stent graft.
Despite being advised to undergo surgery, the patient initially refused.
Later, he sought treatment elsewhere, where surgeons removed the
infected prosthesis and stent graft. A colonic fistula was discovered,
requiring an aortic graft from a deceased donor. Unfortunately, the patient
did not survive postoperatively.
Discussion and Conclusion:
This case underscores the importance of early detection, timely
intervention, and a multidisciplinary approach. The lack of standardized
protocols and clinical trials remains a challenge in managing aortic graft
infections. Further research is crucial to developing effective treatment
strategies and preventing similarly fatal outcomes.

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Ureteral compression by aortic prosthesis following aortofemoral

bypass- a case report

Author: Aleksandra Skórka2

Tutor: Pilip Markau MD1
Affiliations:
1
Clinical Vascular Surgery Department, The Regional Specialist Hospital in
Olsztyn
2
Collegium Medicum, School of Medicine, University of Warmia and Mazury
in Olsztyn

Background: Ureteral stricture and hydronephrosis are rare but clinically

significant complications following aortofemoral bypass surgery, a
procedure performed to restore perfusion to the lower limbs in patients
with advanced aortoiliac or femoral arterial occlusive disease.
Case Report: A 70-year-old female was admitted to the Vascular Surgery
Department due to a non-healing wound over the left medial malleolus
and resting pain in the left foot for over three months. Her medical history
included peripheral arterial disease, hypertension, and multiple vascular
interventions: left-sided aortofemoral bypass graft, two thrombectomies of
the aortofemoral graft, repair of a distal pseudoaneurysm, vascular graft
anastomosis, insertion of an interposition graft, and percutaneous
recanalisation of the left superficial femoral artery. Physical examination
revealed a 4 cm ischemic ulcer with necrosis at the base over the left
medial malleolus. CT angiography showed a patent but stenosed common
iliac artery, occlusion of the external iliac artery, 50% stenosis at the
femoropopliteal junction, and left-sided hydronephrosis with ureteral
dilatation up to the crossing with iliac vessels. Recanalised the left limb of
the aortobifemoral graft and implantation of a left femoropopliteal
crossover bypass were performed. During hospitalisation, the patient
developed urosepsis. Follow-up CT identified inflammatory collections near
the proximal graft and left inguinal-femoral region, with suspected
ureteritis. Targeted antibiotic therapy was initiated, and urological
management was planned.
Discussions & conclusions: In rare cases, aortic prostheses may
compress the ureter, causing urinary obstruction, hydronephrosis,
infection, and eventual renal impairment. Regular follow-up examinations,
including renal ultrasound, are essential to avoid such complications.

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Unusual migration of occluder after percutaneous closure of atrial

septal defect - a case report.

Authors: Julia Szewczyk, Anna Szuciak, Michał Świta

Supervisor: dr hab. n. med. Michał Sojka
Affiliations:
Students’ Scientific Association of Vascular Surgery at the
Department of Vascular Surgery, University Clinical Hospital No. 4

Background:
Atrial septal defect (ASD) is one of the most frequent congenital heart
defects, affecting approximately 10% to 25% of individuals. Small defects
may close spontaneously, while larger ones require intervention to prevent
complications like stroke or pulmonary hypertension. The most common
type is a secondary defect (ASD II), located in the fossa ovalis region.
Percutaneous closure of the defect is the preferred therapeutic option,
showing a better safety profile than surgical treatment. Despite its
numerous advantages, this procedure is associated with the risk of
complications, including occluder migration, as illustrated by the case
below.

Case report:
We present the case of a 44-year-old man hospitalized due to a stroke of
the left cerebellar hemisphere, presenting with dysphasia, dizziness, and
balance disorders. Thrombophilia and arrhythmias were excluded in tests.
Transesophageal echocardiography revealed a hemodynamically
insignificant ASD II with a diameter of 7 × 9 mm with a left-to-right shunt.
Due to the classification of the incident as a crossed stroke, the patient
was qualified for percutaneous ASD closure. The occluder implantation
procedure was uneventful. A follow-up examination after six months
revealed its migration into the abdominal cavity. Fluoroscopy showed the
device had moved into the abdominal cavity, and computed tomography
showed its location in the abdominal aortic bifurcation. It was successfully
removed using minimally-invasive techniques from the femoral approach,
without complications.

Discussions and Conclusions:

Occluder migration during ASD closure is a rare but serious complication,
occurring in 0.5–3.0% of patients undergoing percutaneous closure of the
defect. It usually migrates to the heart chambers or pulmonary trunk, but
in this case it was unusually located in the aortic bifurcation. This case
highlights the need for strict, long-term monitoring after the procedure. In
the event of complications, endovascular techniques allow for effective
and safe management, minimizing the need for open surgery.

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Rapid Expansion of Abdominal Aortic Aneurysm: A Case of

Unexpected Growth and Urgent Intervention

Authors: Dora Petričević1; Ivan Dulić2; Dino Šola3; Marko Mešin4; Stjepan Ištvanić4;
Vedran Farkaš4
Supervisor: Vedran Farkaš (Mentor)4
Affiliations:
1 –Emergency Department, Clinical Hospital Centre Osijek, Osijek, Croatia
2 – Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek,
Croatia
3 – Family Medicine Special Practice, Health Care Center Vinkovci,
Vinkovci, Croatia
4 – Department of Vascular Surgery, Clinical Hospital Centre Osijek, Osijek,
Croatia

Background: Abdominal aortic aneurysm (AAA) is a permanent dilation of the

aorta beyond 50% of its normal diameter. It is a serious, often asymptomatic
condition that can lead to life-threatening rupture if not recognized and treated
promptly. This case report presents a patient whose aneurysm grew significantly
within four months, emphasizing the importance of regular monitoring and
patient education.
Case Report: A 63-year-old female patient with a known AAA and right iliac
artery subocclusion (AIC) presented in 2020 with right leg pain and a reduced
walking distance of 20 m. Digital subtraction angiography showed AIC
subocclusion and right AII occlusion, leading to balloon-expanding stent
placement. In November 2024, she reported worsening leg pain after 5 m of
walking. CDI revealed occlusion of the previous AIC stent and left AIC stenosis,
requiring intraoperative angiography, common and external iliac artery stenting,
and bilateral AIC kissing stents. A concurrent CT scan confirmed a stable AAA
with a lumen width of 43 mm. After four months, the patient developed sharp,
pulsating periumbilical pain radiating to the back. An emergency CT scan
revealed a giant infrarenal AAA with a lumen width of 90 mm and length of 120
mm. Aneurysmectomy and bilateral AIC stent removal were performed, with
aortic reconstruction using an aortic prosthesis extending into the iliac arteries.
The patient recovered well postoperatively without complications.
Discussion & Conclusion: This case highlights the importance of early
symptom recognition and routine AAA surveillance, as growth can accelerate
unexpectedly. While aneurysms of this size typically expand at 3-4 mm per year,
rapid enlargement remains possible, stressing the need for continuous
monitoring and timely intervention to prevent life-threatening complications.

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Reperfusion injury in patient with acute abdominal aortic

occlusion due to gastric dilatation caused by pyloric stenosis: a
case report

Authors: Marek Misiak1, Aleksandra Maciejowska1

Supervisor: prof. Krzysztof Bojakowski
Affiliation:
Department of Vascular Surgery, National Medical Institute of the Ministry
of the Interior and Administration, Warsaw

Background:
Obstruction of blood flow in large arteries is uncommon and usually seen in
visceral arteries in patients with bulimia or anorexia after overeating episodes.
We report on the case of an acute aortic occlusion that resulted in death in a non-
bulimic patient who experienced acute gastric dilatation caused by pyloric
stenosis.
Case presentation:
A 62-year-old woman was hospitalized with severe abdominal pain. Upon
admission, her condition was critical, and the physical examination revealed a
distended abdomen, pale and cold lower limbs, and absent femoral pulses. Acute
bilateral limb ischaemia (Rutherford-IIB) was diagnosed. The general assessment
revealed BP 109/55 mmHg, HR, severe acidosis (pH 7.184), elevated lactate level
(13.3 nmol/l). Due to the patient's critical condition, an ultrasound and abdominal
CT scan was ordered, which showed that the abdominal aorta, inferior vena cava,
and superior mesenteric artery were being compressed and obstructed by an
extremely distended stomach. Attempts to place a nasogastric tube were
unsuccessful, followed with laparotomy and gastric decompression, nasogastric
tube placement with manual control. It resulted in an immediate restoration of
aortic flow and the reappearance of pulses in the femoral and superior
mesenteric artery and leg reperfusion. Due to the patient's critical condition, she
was transferred to intensive care for conservative treatment, where, despite
therapeutic efforts, she developed a multi-organ failure and acidosis, followed by
further decrease in pH(7.037), and lactate elevation to 28 nmol/L, resulting in
circulatory arrest and patients death, 7h post-admission.
Discussions and conclusions:
Urgent treatment is vital for acute aortic occlusion, an uncommon complication of
pyloric stenosis. Due to its rarity, diagnosis and treatment may be delayed. In
spite of treatment, the patient experienced complications related to acute
reperfusion syndrome. Even when prognosis is poor, immediate and aggressive
intervention remains crucial.

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When Every Flow Counts – Endovascular Repair of Post-Transplant

Vascular Complications - a case report
Authors: Anna Szuciak, Julia Szewczyk, Michał Świta
Supervisor: dr n. med. i n. o zdr. Jan Sobstyl
Affiliation:
Students’ Scientific Association of Vascular Surgery at the Department of
Vascular Surgery, University Clinical Hospital No. 4, Medical University of
Lublin, Lublin, Poland

Background:
Kidney transplantations are increasing due to demographic changes and are the
treatment of choice for end-stage renal disease. Non-vascular and vascular
complications may occur in the early phase after transplantation and at later
stages. Vascular complications after renal transplantation occur in 3 % to 15 % of
patients.
Case Report:
Patient admitted to hospital for kidney transplantation due to renal failure. A year
earlier, the patient had a transplanted kidney that took up function. Two days
later, a follow-up examination showed no flow through the transplanted kidney. A
revision was performed. It was decided to remove the graft. During the current
hospitalization, another kidney transplant was performed. A post-transplant
examination showed renal vein stenosis. It was decided to perform balloon
angioplasty of the renal vein. A slight improvement in renal parameters was
achieved. Renal function improved after a second treatment that involved
stenting the renal vein of the transplanted kidney. In light of the insufficient
response in renal parameters following the initial intervention, a second
procedure—consisting of stenting the renal vein of the transplanted kidney—was
performed, resulting in a marked improvement in renal function.
Discussion and Conclusion:
Transplant renal vein stenosis is a rare vascular complication of renal transplant.
In this case, a combination of balloon angioplasty and renal vein stenting proved
to be a safe, minimally invasive and effective method. Early detection, early
diagnosis and early treatment of post-transplant vascular complications are very
important in maintaining the function of the transplanted kidney. Timely
detection, accurate diagnosis, and prompt treatment of post-transplant vascular
complications are crucial for preserving the function of the transplanted kidney.
Multidisciplinary collaboration including transplant medicine and vascular surgery
supported by the use of imaging studies has been essential in achieving early
diagnosis, favorable treatment outcomes and delivering tangible benefits to
patients.

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Total Endovascular Repair of Extensive Type A Aortic Dissection: A

Case Report
Authors: Karol Ludwinek1, Kamila Falana1, Michał Siwko1, Kamila Satławska1
Scientific Supervisor: Assoc. Prof. Michał Sojka 2, MD, PhD, MSc in Health Sciences
Affiliation:
1
Student Scientific Club of Vascular Surgery at the Interventional
Radiology Department SPSK4, Medical University of Lublin, Lublin, Poland
2
Department of Interventional Radiology and Neuroradiology, Medical
University of Lublin, Lublin, Poland

Background
Aortic dissection is a life-threatening condition caused by an intimal tear, allowing
blood to enter the aortic wall and create a false lumen. This process can lead to
severe complications, including malperfusion syndromes, aortic rupture, and
cardiac tamponade. The Stanford classification divides dissections into Type A,
involving the ascending aorta, and Type B, affecting only the descending aorta.
Type A dissections, requiring urgent surgical intervention, account for 60–70% of
cases.
Case report
We report a 56-year-old male with extensive Type A aortic dissection involving the
thoracoabdominal aorta. Initially, cardiac surgeons performed open ascending
aorta replacement. However, persistent dissection of the aortic arch, descending
thoracic, and abdominal aorta led to mesenteric ischemia. Due to worsening
symptoms, vascular surgeons from the Department of Vascular Surgery at the
University Clinical Hospital No. 4 in Lublin performed an urgent total endovascular
aortic repair.
The procedure involved complete endovascular reconstruction with branched
stenting of the aortic arch and thoracoabdominal stent graft placement, ensuring
full aortic revascularization in a single stage. This approach, performed in
selected centres, represents a significant advancement in the treatment of
extensive aortic dissections.
Postoperatively, the patient remained under close monitoring. Certain
complications, including pericardial and pleural effusions, occurred therefore
drains of the pleural cavities and pericardial sac were performed. Despite the
patient's potentially fatal condition, the measures taken were effective and his
current condition is good.
Discussions and Conclusions
This case underscores the importance of prompt intervention in extensive aortic
dissection with malperfusion. Single-stage total endovascular repair minimizes
the risks associated with staged procedures and provides a viable alternative for
complex aortic pathology. Close postoperative surveillance remains crucial,
particularly for organ malperfusion such as mesenteric ischemia.

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Type I Endoleak - Silent Threat Following Aorto-Biiliac Stent Graft

Implantation.

Authors: Hubert Jedynasty

Supervisor: dr n. med. Natalia Dowgiałło-Gornowicz, MD, PhD
Affiliations:
Student Scientific Association of General, Minimally Invasive, and Geriatric
Surgery

BACKGROUND: An 79-year-old woman presented to the emergency

department with progressively worsening abdominal pain over several
days. She described it as severe, rated 8/10 on the pain scale, worsened
by physical activity and unrelieved by paracetamol.
CASE REPORT: Patient’s medical history included arterial hypertension,
coronary artery disease and hypothyroidism (treated with L-thyroxine).
She had a penicillin allergy. In 2017, she underwent aorto-biiliac stent graft
implantation for an 8 cm abdominal aortic aneurysm. In 2019, she
required endovascular repair of a leak from the inferior mesenteric artery.
Recently, she had been treated for an urinary tract infection for a week,
but her abdominal pain persisted.
Upon hospital admission, a CT scan was performed. It revealed a
significantly enlarged abdominal aortic aneurysm measuring
approximately 15 cm with an active leakage into the aneurysm sac,
classified as a Type I endoleak. In response, laparotomy was performed,
reinforcing the aneurysm neck. Postoperatively, the patient remained
stable, with normal vital signs. Due to pre-existing anemia, she received a
transfusion of two units of packed red blood cells, without complications.
After ten days of close monitoring, she was discharged in stable condition.
DISCUSSION AND CONCLUSIONS: Close postoperative monitoring is
essential for patients who have undergone aorto-biiliac stent graft
implantation, as they are at risk for various complications, including Type I
endoleak. Early detection through routine imaging, such as CT
angiography or ultrasound, is critical. Among endoleak types, Type I is
considered the most severe due to its potential to cause further aneurysm
expansion, increasing the risk of rupture and necessitating urgent surgical
intervention.

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Atypical Presentation of Ruptured Common Iliac Artery Aneurysm-

Challenges in Diagnosis and Importance of Timely Surgical
Intervention

Author: Agnieszka Kowalczyk2

Supervisors: Piotr Malinowski MD, PhD1, Wojciech Barczak MD1
Affiliations:
1
Department of Vascular Surgery, The Voivodal Specialistic Hospital
in Olsztyn
2
Collegium Medicum, School of Medicine, University of Warmia and
Mazury in Olsztyn

BACKGROUND: A common iliac artery (CIA) aneurysm is asymptomatic in

65–70% of cases. When it ruptures, it usually causes intense, localized
pain. This case study highlights atypical symptoms of CIA aneurysm
rupture and emphasizes the crucial role of a thorough clinical assessment,
as well as surgery intervention.

CASE REPORT: A 53-year-old male with a history of diabetes mellitus,

obesity, and hypertension presented to the emergency department with
lumbar spine, lower abdomen, and left lower limb pain lasting for 6 hours.
Initially, he was misdiagnosed with a urinary tract infection and treated
accordingly, but his condition did not improve. Three days later, he arrived
at another hospital, presenting with acute symptoms. A thorough
examination revealed the absence of a pulse in the left groin. CT
angiography (CTA) and blood tests (showing low hematocrit, erythrocytes,
and hemoglobin levels) confirmed a ruptured common iliac artery (CIA)
aneurysm with a massive retroperitoneal hematoma. The patient was then
scheduled for surgery, during which an aorto-bi-iliac stent-graft was
implanted successfully. However, during his recovery, swelling of the left
lower limb developed, diagnosed as iliac vein compression syndrome due
to the hematoma. Thrombosis was ruled out by CTA and Doppler
ultrasound test. The patient was discharged in stable condition 7 days
later.

DISCUSSIONS AND CONCLUSIONS: Pain in the lower abdomen and

lumbar spine are non-specific symptoms of ruptured CIA aneurysm. This
case underscores the importance of maintaining a high level of suspicion
while evaluating patients with risk factors. Prompt diagnosis and proper
surgical intervention are essential, as delayed treatment can lead to
serious complications.
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 Lublin International Students’ Surgical Congress 2025 Abstract Book

When Every Flow Counts – Endovascular Repair of Post-Transplant

Vascular Complications - a case report

Authors: Anna Szuciak, Julia Szewczyk, Michał Świta

Supervisor: dr n. med. i n. o zdr. Jan Sobstyl
Affiliation:
Students’ Scientific Association of Vascular Surgery at the
Department of Vascular Surgery, University Clinical Hospital No. 4,
Medical University of Lublin, Lublin, Poland

Background:
Kidney transplantations are increasing due to demographic changes and
are the treatment of choice for end-stage renal disease. Non-vascular and
vascular complications may occur in the early phase after transplantation
and at later stages. Vascular complications after renal transplantation
occur in 3 % to 15 % of patients.
Case Report:
Patient admitted to hospital for kidney transplantation due to renal failure.
A year earlier, the patient had a transplanted kidney that took up function.
Two days later, a follow-up examination showed no flow through the
transplanted kidney. A revision was performed. It was decided to remove
the graft. During the current hospitalization, another kidney transplant was
performed. A post-transplant examination showed renal vein stenosis. It
was decided to perform balloon angioplasty of the renal vein. A slight
improvement in renal parameters was achieved. Renal function improved
after a second treatment that involved stenting the renal vein of the
transplanted kidney. In light of the insufficient response in renal
parameters following the initial intervention, a second procedure—
consisting of stenting the renal vein of the transplanted kidney—was
performed, resulting in a marked improvement in renal function.
Discussion and Conclusion:
Transplant renal vein stenosis is a rare vascular complication of renal
transplant. In this case, a combination of balloon angioplasty and renal
vein stenting proved to be a safe, minimally invasive and effective
method. Early detection, early diagnosis and early treatment of post-

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transplant vascular complications are very important in maintaining the

function of the transplanted kidney. Timely detection, accurate diagnosis,
and prompt treatment of post-transplant vascular complications are crucial
for preserving the function of the transplanted kidney. Multidisciplinary
collaboration including transplant medicine and vascular surgery
supported by the use of imaging studies has been essential in achieving
early diagnosis, favorable treatment outcomes and delivering tangible
benefits to patients

Laryngology and
Ophthalmology

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Eyes Wide Open: Preventing Complications Requiring Surgical

Intervention in Herpetic Keratitis – A Case Report
Author: Joanna Najbar
Supervisor: lek. Patrycja Kuklo
Affiliation:
Studenckie Koło Naukowe Okulistyki Klinicznej "Ophthalmologica,
University of Warmia and Mazury in Olsztyn

Background: Ophthalmic herpes simplex virus (HSV) infection can lead to a

range of ocular manifestations, from superficial epithelial disease to
stromal keratitis and endotheliitis. The risk of recurrence in herpetic
keratitis is high, with approximately 35% of patients experiencing a
relapse within the first year, and 65% within two years if prophylactic
treatment is not implemented. Long-term antiviral prophylaxis plays a
crucial role in preventing relapses and potentially avoiding the need for
surgical intervention.

Case Report: 65-year-old male patient sought medical attention due to

pain and blurred vision in his right eye. His medical background included
hypertension, polycythemia vera, and recurrent herpes infections. Upon
ophthalmologic examination, his visual acuity was measured at 0.6 in the
affected eye, revealing corneal dendritic ulcerations, peripheral marginal
ulcers, and marked conjunctival hyperemia. The anterior chamber
appeared clear, and the left eye showed no abnormalities. He received a
diagnosis of epithelial keratitis of herpetic origin and was treated with oral
acyclovir, an antiviral ointment, and lubricating drops. At the follow-up
visit, the patient reported an absence of symptoms, and his visual acuity
had improved to 1.0 in both eyes. The examination indicated no
conjunctival discharge, corneal staining, or significant abnormalities. The
patient was instructed to maintain oral acyclovir at a dosage of twice daily
for six months, alongside dexamethasone eye drops twice daily and
lubricating drops.

Discussions and Conclusions: Ocular infection with HSV and its

complications can significantly impact vision and quality of life. Prolonged
acyclovir therapy plays a crucial role in reducing the recurrence of herpetic
keratitis and preventing severe complications that may require surgery.
These include corneal scarring, which may lead to a corneal transplant,
corneal perforation and neurotrophic keratitis.

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A Rare Case of Bilateral Internal Laryngocele Causing Acute

Airway Obstruction
Authors: Miruna-Elena Stratone1, Ștefan Chiru1
Supervisor: Assist. Univ. Florentina Severin1
Affiliations:
1
Faculty of Medicine, “Grigore T. Popa” University of Medicine and
Pharmacy Iasi, Romania

Background
A laryngocele is a space that develops as a result of the pathological
dilatation of the laryngeal saccule. It can extend upwards within the false
vocal fold communicating with the larynx. In some cases, internal
laryngoceles can represent an acute airway emergency causing
obstruction of the air flow.

Case report
A 70-year-old smoker female patient was admitted to the Oto-Rhino-
Laryngology clinic because of dysphonia and inspiratory dyspnea. Video
laryngoscopy revealed a polypoid formation covering the anterior half of
the glottis, accompanied by edema. Due to the severity of airway
obstruction, a sub-isthmic tracheotomy was performed to ensure adequate
airflow. A cervico-thoracic computed tomography (CT) scan identified a
moderately vascularized tumoral mass with a polypoid appearance,
causing approximately 90% obstruction of the laryngeal lumen, with no
evidence of thoracic metastases. The lesion was surgically excised through
suspension microlaryngoscopy, and histopathological examination
confirmed the diagnosis of an internal laryngocele with bilateral
localisation. The patient was discharged in stable condition, and after 30
days, she returned for evaluation. At that time, the tracheostomy was no
longer necessary for airway support, allowing for its successful closure.

Discussions and Conclusions

This case highlights the importance of thorough diagnostic evaluation and
prompt surgical intervention in patients presenting with laryngeal masses
leading to airway obstruction. The significant airway obstruction required
urgent tracheotomy, highlighting the potential severity of this condition.
Surgical excision remains the definitive treatment, and histopathological
confirmation is crucial for accurate diagnosis and management.

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Subcutaneous dirofilariasis of the eyelid

Author: Tomasz Jankowski.
Supervisor: Dr Beata Rymgayłło-Jankowska
Affiliation:
Student Science Club of Orthopedics and Traumatology of the
Musculoskeletal System at the Clinic of Traumatology and Emergency
Medicine

Background: To present an unusual case of Dirofilaria repens infestation in

60 year-old man.
Case report: In March 2020 a 60 y.o. man presented to the Department of
Ophthalmology in Lublin with a painless, firm nodule localized at the left
upper eyelid. The patient was a professional truck driver, regularly working
in the transport of goods to and from Ukraine. The patient recalled
multiple mosquito bites during his business trips to Ukraine, especially at
nights while sleeping in his truck on forest parking lots.
Ocular examination of the right and left eye (anterior and posterior
segments) were normal. Periocular examination of the left eye revealed a
cherry-sized tumor situated slightly temporally on the left upper eyelid.
There was no local erythema. Few days later the tumor was completely
surgically removed.
Microscopic examination revealed a dirofilariasis infestation of Dirofilaria
repens.
The postoperative course was uneventful. The last patient's follow up visit
took place in May 2020. The patient presented with a totally healed
postoperative scar on the upper left eyelid.
Discussions and Conclusions: Dirofilariasis infections in humans can
cause subcutaneous nodules, local swelling through subcutaneous
migration of the worm, and even severe clinical manifestations affecting
various organs (e.g., brain or lung). The most common are ocular and
periocular infections, which are found in particular during the migratory
phase of the parasites. The nematode may be placed subconjuctivally as
well as in periocular tissues (eyelids, orbit) and in anterior chamber,
vitreous body. Dirofilariasis should be considered in the differential
diagnosis of non-inflammatory and inflammatory mass lesions of the
periocular tissue. Ophthalmologists must be aware of uncommon
presentations of parasitic infestation when they consider infections of
ocular adnexa.

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Cystoid macular edema after cataract surgery in patient with PEX

glaucoma: the correct clinical decision

Authors: Marko Đurišević1, Ivan Đuran1, Anja Đurđević1

Supervisor: Sonja Jandroković, MD, PhD 1,2
Affiliations:
1. School of medicine, University of Zagreb, Croatia
2. Department of Ophtalmology, University Hospital Centre Zagreb,
Croatia

Background: Cystoid macular edema (CME) implies fluid accumulation in

the retinal macula due to the release of inflammatory mediators. It can be
triggered by various factors, such as cataract surgery and elevated
intraocular pressure. Pseudoexfoliative (PEX) glaucoma is a secondary
open-angle glaucoma caused by the deposition of fibrillar extracellular
material in the trabecular meshwork of the eye. It is characterized by
higher intraocular pressure levels and faster progression compared to
other forms of glaucoma.
Case report: A 77-year-old patient was found to have elevated
intraocular pressure of 25 mm Hg in both eyes. Perimetry revealed
bilateral scotomas , and gonioscopy revealed significant dusty material
obstructing Schlemm's canal. She was recommended to use a beta-blocker
and prostaglandin analogues .After surgical treatment of the left eye
cataract, patient complained about poor vision, therefore optical
coherence tomography (OCT) was performed, showing intraretinal fluid
collection in the left eye macula, which suggested CME. Since it is an
inflammatory condition, non-steroidal anti-inflammatory drugs (NSAIDs)
were introduced instead of prostaglandin analogues, in combination with
carbonic anhydrase inhibitors. A follow-up OCT of the macula was
performed, showing stable retinal findings. Despite this, intraocular
pressure was above the targeted pressure and therefore selective laser
trabeculoplasty (SLT) was performed bilaterally , improving the outflow of
aqueous humor and normalizing intraocular pressure. Meanwhile, a
cataract developed in the right eye, and the surgery is planned for the
next years.
Discussions and Conclusions: Cataract surgery poses a risk of CME, and
in patients with pseudoexfoliative glaucoma, this risk is heightened.
Aditionally, cataract surgery is more challenging due to increased lens
friability and instability caused by pseudoexfoliation material
accumulation. Therefore, timing of the upcoming right eye cataract
surgery is crucial: performing the surgery may risk lens capsule rupture
and CME, while delaying it may lead to worsened vision and uncontrolled
intraocular pressure.

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Pleomorphic adenoma of the parotid gland: extracapsular dissection,

total or superficial parotidectomy?

Authors: Chiru Ștefan, Stratone Miruna-Elena

Supervisor: Assoc. Prof. Dr. Constantin Aleodor Costin, MD, PhD
Affiliation:
Departament of Histology of “Grigore T. Popa” University of Medicine
and Pharmacy

Introduction: The most prevalent benign salivary gland tumor is

pleomorphic adenoma. It accounts for 45-75% of all salivary gland tumors
in the majority of studies. The superficial lobe of the parotid gland is
primarily affected by pleomorphic adenoma. The parotid gland is the site
of origin for about 84% of all pleomorphic adenomas. There is debate
regarding the best surgical approach for parotid pleomorphic adenoma.
The advantages and disadvantages of the different strategies will be
discussed in the current review.

Material and methods: We performed a review of the literature through

PubMed and Embase in order to identify articles regarding the surgical
treatment of pleomorphic adenoma of the parotid gland. Publications from
2015-2025 were selected using the following keywords: “pleomorphic
adenoma”, “parotid”, “parotidectomy”, “salivary neoplasm”.

Results: Extracapsular dissection is a minimal margin surgery.

Consequently, it may lead to increased recurrence rates when performed
by a novice or occasional parotid surgeon. A good compromise might be a
superficial parotidectomy. In contrast to extracapsular dissection, the
tumor is removed with a larger cuff of healthy parotid tissue, and trainee
surgeons can learn the skills of regular parotid surgery (facial nerve
dissection). This could minimize the rate of recurrence. However,
compared to a formal parotidectomy, there is less removal of healthy
parotid tissue, which reduces the risk of sequelae like Frey syndrome and
facial nerve dysfunction. The location of the parotid gland is aesthetically

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sensitive. When used appropriately, minimally invasive or hidden incisions

can greatly enhance postoperative patient satisfaction and quality of life.

Conclusions: Both total parotidectomy and more limited surgery serve a

legitimate purpose, and their domains do not overlap. A multicenter
prospective randomized study may be helpful in deciding the optimal
treatment of pleomorphic adenoma.
Surgical treatment of the nasocutaneous fistula resulting from
necrosis of the nasal cavity
Authors: Lea Paradinović1; Fran Popović1; Eleonora Suvaljko2; Antonela Šarić3;
Anamarija Šestak4,5
Supervisor: Hrvoje Mihalj4,5
Affiliation:
1 – Osijek – Baranja County Health Centre, Osijek, Croatia
2 – Institute for emergency Medicine of Zadar County, Zadar, Croatia
3 – Family Medicine Clinic, Health Centre of Primorje – Gorski Kotar County, Mali
Lošinj, Croatia
4 - Clinic for otorhinolaryngology and head and neck surgery, University Hospital
Centre Osijek
5 - Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia

Background: Nasocutaneous fistula (NCF) is a rare type of fistula

representing the communication between the nasal cavity and the outside
world through the skin, occurring congenitally or as a result of trauma,
surgery, radiotherapy, etc. This case report aims to show surgical
treatment of NCF resulting from necrosis of the nasal cavity.
Case report: We present a case of a 56-year-old man who came to the
emergency ENT clinic due to swelling and redness of the upper and lower
left eyelid, accompanied by mucopurulent nasal secretion (MNS) and
diplopia without bulbomotor disfunction. Nasal endoscopy revealed a black
mucous membrane of the inferior nasal concha with MNS on the left side.
CT scan of the paranasal cavities and orbit showed a left-sided
subperiosteal abscess with inflammatory shadowing in both left maxillary
and ethmoidal sinuses. The patient underwent surgery; FESS was
performed with left uncinectomy, anterior and posterior ethmoidectomy,
left antrostomy of the maxillary sinus, excision of necrotic mucosa and
lamina papyracea, and periorbital incision to evacuate MNS.
Postoperatively, MNS appeared in the left medial canthus with diplopia.
After an ophthalmological examination, a lateral canthotomy with
cantholysis was performed, which resulted in the disappearance of
diplopia after a few hours. A follow-up nasal endoscopy showed necrosis of
the left lateral wall with propagation to the lacrimal sac without MNS.
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Removal of necrotic tissue leaves an NCF in the medial corner of the eye
measuring 1x1cm. Two-step reconstruction was performed; firstly with a
composite graft, secondly with cartilage and perichondrium from the ear
along the glabellar flap. Signs of fistula are now absent in total.
Discussions and Conclusions: NCF can occur as a result of necrosis of
the nasal cavity, causing rhinological and ophthalmological symptoms.
Treatment consists of debridement of the necrosis and removal of the
MNS, and in the final step, reconstruction of the resulting fistula.

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Urology & Gynecology

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Recurrent renal artery stenosis with ‘string of beads’ appearance: a

case study

Author: Veronika Kobylianska (1)

Supervisor: dr. n. med. Maryla Kuczyńska (2), prof. dr. hab. n. med. Anna Drelich-
Zbroja (2)
Affiliations:
1. Students' Scientific Association at the Department of Interventional
Radiology and Neuroradiology of the Medical University of Lublin
2. Department of Interventional Radiology and Neuroradiology of the Medical
University of Lublin

Background
Fibromuscular dysplasia is a non-inflammatory non-atherosclerotic arterial
stenosis of an unknown etiology. It's further divided into multifocal FMD
responsible for 85% of cases, and focal FMD. In the last decade, the biggest
advancement has been made in understanding the disease pathomechanism,
though the development of the optimal treatment method is still ongoing. In this
case report we present a case of a patient with renal artery FMD treated with
balloon angioplasty twice.

Case report
A 24-year-old female with a history of drug-resistant hypertension. Computer
tomography revealed bilateral renal artery stenosis with ‘string of beads’
appearance. The patient underwent balloon angioplasty of stenosis which
resulted in a short-term normalization of arterial blood pressure. After a few
months, hypertension symptoms recurred and angiography in CT revealed a
recurrence of short-segment stenosis in renal arteries bilaterally. The intervention
was repeated, achieving only short-term improvement in the patient's condition.
In Doppler ultrasounds, respectively 4 and 6 months after the second procedure,
bilateral stenosis of the middle segment of the renal arteries with blood flow
accelerations at the threshold of hemodynamic significance (PSDV ~200 cm/s).
Systolic acceleration times recorded at the level of the intrarenal branches of
both renal arteries were normal, which further suggested the absence of clear
hemodynamic significance of the recurrent stenoses.

Discussions and conclusions

Depending on the histological type, renal artery FMD is compliant with
endovascular treatment with varying efficacy. The most common lesions with
‘string of beads’ appearance are less responsive to treatment than focal/short-
segment stenosis. Balloon angioplasty is a treatment of choice in clinically
significant renal artery stenosis, however stenting methods don't apply in FMD.
For patients with FMD, regular blood pressure control and imaging are crucial for
evaluating the disease course and early identification of restenosis.

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Treatment of Ruptured Renal Artery Aneurysm with Endovascular

Stenting

Author: Jan Krzowski¹,

Co-Authors: Julia Jabłońska², Julia Kucharzewska3,
Supervisor: Maciej Szmygin, MD, PhD4
Affilations:
1,2,3
Students' Scientific Society at the Department of Interventional Radiology and
Neuroradiology, Medical University of Lublin
4
Department of Interventional Radiology and Neuroradiology, Medical University
of Lublin

Background: Renal artery aneurysm (RAA) is a rare condition, often found

incidentally during imaging. It involves dilation of all layers of the renal artery
wall. The risk of rupture is low, and treatment can be either surgical or
endovascular, depending on the patient's health, aneurysm size, and
morphology.
Case report: A 37-year-old male with no relevant medical history presented to
the emergency room with acute right flank pain. Initial examination revealed a
blood pressure of 90/60 mm Hg and tachycardia. Blood tests showed hemoglobin
levels of 9.4 g/dl, with urinalysis detecting blood. Ultrasound revealed a right
renal artery aneurysm measuring 6 x 6 cm, with signs of blood extravasation on
color and power Doppler. The patient was urgently referred for computed
tomography angiography, which revealed active bleeding from the ruptured
aneurysm, with a hematoma spreading into the right retroperitoneum.
Emergency endovascular treatment was performed, and the patient underwent
successful implantation of a Viabahn stent (GORE, Delaware, USA). Selective
nephrography revealed a lack of flow through one of the segmental arteries,
caused by vasospasm from the guiding wire placement required for safe stent
implantation.
Discussions and conclusions: This rare case of renal artery aneurysm rupture
in a young male was successfully treated with endovascular methods. Stent
implantation necessitated selective catheterization of one of the renal segmental
arteries, resulting in its loss. However, post-procedure Doppler ultrasound
showed no ischemia and confirmed successful exclusion of the aneurysm.

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The domino effect of diagnostic delays in a complex oncological case.

Authors: Zuzanna Skiba, Aleksander Siwek

Supervisors: dr n. med. Patrycja Ziober-Malinowska, dr n. med. Krzysztof Kułak
Affiliations:
Students' Scientific Association at the 1st Chair and Department of Oncological
Gynecology and Gynecology, Medical University of Lublin

Background: Early detection and accurate histopathological assessment are

crucial for timely intervention and optimal oncological patient outcomes.
Diagnostic delays and treatment in a non-oncological center can accumulate,
potentially leading to a significant delay in accurate diagnosis and the initiation of
appropriate therapy.
Case Report: In 2019, during the third childbirth of a 39-year-old patient, rectal
evisceration with a suspicious 2 cm lesion occurred. Further colonoscopy showed
no abnormalities. In 2020, during another pregnancy, the patient reported
abdominal pain and bleeding. A follow-up colonoscopy detected a 2 cm rectal
tumor that was previously overlooked. Histopathology confirmed rectal
squamous cell carcinoma. The patient underwent chemotherapy with 5-
fluorouracil and mitomycin, followed by radical radiotherapy. Despite achieving
complete remission, in 2021, she underwent resection of anus and rectum with
the creation of a permanent colostomy. In March 2023, the patient presented to a
non-referral center with lower abdominal pain and was qualified for laparoscopic
fenestration of a 6 cm ovarian cyst. Histopathology was inconclusive. Close
observation was recommended. In September 2023, she presented to the
Clinical Hospital in Lublin with persistent lower abdominal pain. Gynecological
examination revealed vaginal deformation and a firm, immobile mass in the
pelvis. Imaging studies showed a lesion measuring 10.23 cm × 9.93 cm with the
uterus and adnexa indistinguishable as separate structures. A recurrence of
colorectal cancer or ovarian malignancy was suspected. Due to the lack of a
definitive diagnosis, she was qualified for laparotomy in December 2023.
Histopathological analysis of found lesion confirmed endometrioid
adenocarcinoma with partial mucinous differentiation of the ovary (G2, FIGO
stage IIA). Since January 2024, the patient had received six cycles of carboplatin
and paclitaxel.
Discussions and conclusions: Several stages of diagnostics and treatment
could have been approached differently in this case. Oncology patients should be
managed in highly specialized referral centers to optimize outcomes.

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Echoes of the past: When salpingectomy is not enough - case report

Author: Joanna Najbar
Supervisor: lek. spec. Ewa Butrymowicz-Brzeska
Affiliation:
Studenckie Koło Perinatologii i Ginekologii Onkologicznej, University of
Warmia and Mazury in Olsztyn

Background: Ectopic pregnancy, which accounts for approximately 1–2% of all

pregnancies, represents a significant health risk requiring urgent diagnosis and
surgical intervention. Women who have experienced an ectopic pregnancy are at
an increased risk of recurrence, estimated at approximately 15%. This paper
presents a rare case of a female patient with a second ectopic pregnancy in her
medical history.

Case report: 28-year-old female patient was admitted to the department with
lower abdominal pain and vaginal bleeding. Her medical history revealed a
previous left-sided salpingectomy due to an earlier ectopic pregnancy.
Ultrasonographic examination demonstrated free fluid in the peritoneal cavity
and an enlarged right fallopian tube with a cystic structure. Elevated β-hCG levels
confirmed the diagnosis of an ectopic pregnancy in the right fallopian tube, and
the patient was qualified for surgical management. During laparoscopy, a 2–3 cm
remnant of the left fallopian tube was identified, which appeared distended and
exhibited active bleeding with visible gestational tissue. The right ovary and
fallopian tube were unremarkable. A laparoscopic resection of the remnant left
fallopian tube was performed, along with the removal of the ectopic pregnancy
and drainage of blood from the peritoneal cavity. The procedure was completed
without complications. The patient was discharged in good general condition with
recommendations for a follow-up gynecological consultation.

Discussions and Conclusions: It is essential to emphasize that salpingectomy

does not entirely eliminate the risk of recurrent ectopic pregnancy on the same
side, underscoring the importance of surgical radicality for preventive purposes.
Incomplete or non-radical salpingectomy can lead to residual disease and this
condition may result in peritoneal bleeding and adhesions, further complicating
future fertility efforts. When fallopian tube preservation is essential for fertility,
patients should be informed about the increased risk of recurrence and the
necessity for regular monitoring.

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Fertility treatment in a patient with PCOS and endometrial

carcinoma

Authors: Anja Djurdjevic, Ivan Djuran, Marko Djurisevic

Supervisor: Ivan Bolanca
Affiliations:
Department of Human Reproduction, University Hospital Center Sestre
milosrdnice, School of Medicine Zagreb, Croatia

Background: There are numerous risks for developing endometrial cancer, some
of them being polycystic ovarian syndrome (PCOS), obesity and unopposed
estrogen therapy. Because of symptoms of heavy vaginal bleeding it is usually
found in the early stages, making it treatable. Depending on the age and
coexisting medical conditions we can treat the cancer either radically or
conservatively.
Case report: We present a case of a 31 year-old female with PCOS and
anovulation. In December 2022 she underwent a dilation and curettage (D&C)
procedure due to heavy vaginal bleeding. The results showed endometrial
adenocarcinoma. Histerectomy was not an option, for the patient wanted
children. A conservative treatment was started – an IUD-LNG was inserted and
the patient recieved oral megastrol acetate over the course of 5 months. In June
2023 another D&C procedure was done, this time the findings showed no
endometrial hyperplasia. Finally, ovarian induction procedure for in vitro
fertilization could begin. The procedure was done under control of the IUD-LNG.
After the total number of 8 blastocyst were collected the patient was planned for
a frozen embryo transfer. Due to chronic anovulation, we plan to induce ovulation
with letrozol.
Discussions and Conclusions: There are certain restrictions when it comes to
treating a patient with a history of endometrial cancer. In standard protocols
histerectomy is performed, but some young women opt for hormonal therapy to
preserve their fertility. However, further therapy should exclude hormonal
replacement therapy containing estrogen because of the risk of endometrial
cancer returning.
There are many ways to treat endometrial cancer but before starting treatment
the patient must always be consulted to make sure that the treatment is right for
them, not just for their disease.

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Ovarian transposition – protecting fertility from oncologic pelvic

radiation therapy

Authors: Miruna-Elena Stratone1, Ștefan Chiru1

Supervisor: Ana Teodora Balan MD PhD1,2
Affiliations:
1
Faculty of Medicine, “Grigore T. Popa” University of Medicine and
Pharmacy Iasi, Romania
2
Department of Morphofunctional Sciences I, “Grigore T. Popa” University
of Medicine and Pharmacy, 700115, Iasi, Romania

Introduction
Pelvic radiation therapy significantly damages reproductive health by
compromising the ovarian reserve. Used in the treatment of colorectal cancer,
Hodgkin’s and non-Hodgkin’s lymphoma, and cervical cancer, it frequently results
in premature ovarian failure, endocrine dysfunction, infertility, and fibrotic
changes within the ovaries. To minimise these adverse effects, ovarian
transposition associated with adjuvant fertility preservation strategies, offers a
viable prospect in ovarian function and reproductive potential in young women
undergoing pelvic irradiation.
Materials and Methods
For this study, we selected data from PubMed and Google Scholar databases,
focusing on the association between ovarian transposition and fertility rates in
patients who underwent RT. The reviewed literature encompasses studies
conducted on premenopausal patients who required radiotherapy for the
treatment of pelvic cancers, and who aimed to preserve their fertility and ovarian
function.
Results
Analysis of published research indicates that ovarian transposition is an effective
method to preserve fertility in young patients, indicating that over 79% of
patients retained ovarian function after transposition. Even though lower than the
general population, 19% of those with preserved ovarian function successfully
gave birth. Research indicated that this surgical method gives the best results
when associated with reproductive techniques like oocyte or embryo
cryopreservation, for higher rates of full-term pregnancies. Ovarian transposition
does not protect the ovaries from chemotherapy and is not indicated for patients
undergoing this type of oncologic therapy. Although literature mostly considers
the procedure safe, there are studies suggesting that it might represent a
metastasis risk for some types of cancers.
Conclusion
Ovarian transposition presents multiple benefits in preservation of fertility and
ovarian function of premenopausal patients undergoing pelvic radiotherapy.
Although the risks are not negligible, and the effectiveness is not guaranteed in
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all cases, this method proves to be a promising option, with notable success
rates, especially when combined with additional reproductive techniques such as
oocyte or embryo cryopreservation.

Infection and Graft Instability: The Hidden Threat to Kidney Transplant

Success
Author: Joanna Najbar
Supervisor: lek. Iwona Filipska
Affiliation:
Studenckie Koło Nefrologiczne, University of Warmia and Mazury in
Olsztyn

Background: Infections pose a significant risk to kidney transplant stability.

Surgical site infections affect 4% to 20% of transplant recipients, and while these
infections rarely lead to graft loss, they often result in prolonged hospitalizations.
Systemic infections, such as cytomegalovirus (CMV) infection, which occurs in 30-
80% of transplant recipients and is a leading cause of morbidity and mortality,
are particularly associated with an increased risk of graft rejection, further
complicating the overall management of kidney transplants.

Case Report: A 52-year-old male patient with a complex medical history

underwent four kidney transplants. His comorbidities included liver dysfunction,
nerve palsy, hypertension, hypercholesterolemia, hyperparathyroidism,
osteoporosis, hiatal hernia, gallstones, and diverticulosis, all of which complicated
the management of his renal failure and impacted the stability of his grafts. One
month following his fourth transplant, the patient developed a CMV infection.
During hospitalization, the patient also contracted COVID-19 for the third time in
his life. Laboratory findings revealed leucopenia, lymphopenia, and elevated
levels of C-reactive protein and urea. In response to these complications,
mycophenolate mofetil was discontinued, and the tacrolimus dosage was
reduced. Subsequent tests indicated elevated tacrolimus levels. The patient was
advised to discontinue this medicine until his follow-up visit.

Discussions and Conclusions: In such cases, it is challenging to determine the

primary inflammatory trigger for graft rejection, as the clinical picture is complex
and multifactorial. Patient’s medical history underscores the impact of various
infections - as significant risk factors for graft instability. Reducing
immunosuppressive medications due to infections may increase the risk of graft
rejection, highlighting the need for individualized treatment strategies. A
comprehensive approach addressing both infectious and immunological factors is
crucial for maintaining graft stability and optimizing patient outcomes following
transplantation.

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Treatment of patients with Fouernier’s gangrene: Early

Intervention as the Key to Success

Author: Antonela Šarić¹ Co-authors: Eleonora Suvaljko², Lea Paradinović³,

Franciska Tomas⁴
Supervisor: David Senjić⁵, MD
Affiliations:
1 - Family Medicine Clinic, Health Center of the Primorsko-goranska
County, Mali Lošinj, Croatia
2 - Institute for Emergency Medicine of Zadar County, Zadar, Croatia
3 -Family Medicine Specialist Practice, Health Center of the Osijek-Baranja
County, Osijek, Croatia
4 - Family Medicine Clinic, Health Center of the Osijek-Baranja County,
Vuka, Croatia
5 - Department of Plastic, Esthetic, Reconstructive and Hand Surgery, IMC
Priora, Čepin, Croatia

Abstract Text:
Background: Fournier’s gangrene, a relatively rare form of necrotizing
fasciitis, is a rapidly progressive disease that affects the deep and
superficial tissues of the perineal, anal, scrotal, and genital regions. It is
often associated with general signs of sepsis and rapid tissue destruction.
The disease is a true urological emergency, requiring prompt surgical
debridement and antibiotic therapy. This case report emphasizes the
importance of prompt diagnosis and proper treatment of this condition.
Case Report: A 59-year-old patient was urgently admitted to the Urology
Clinic due to swelling of the scrotum, followed by necrosis of the perineum
and perianal area, as well as an inability to urinate and defecate.
Immediately upon admission, parenteral antibiotic therapy was initiated,
and a urinary catheter was placed. After appropriate preoperative
preparation, necrotic skin and subcutaneous tissue of the scrotum are
excised to healthy tissue. A cystostomy catheter is placed intraoperatively.
The resulting defect is covered with a partial thickness skin graft taken
from the right thigh. The early postoperative course is normal, the donor
region has healed completely by secondary intention, without signs of
infection, and the graft was in the acceptance phase. In the ward, the
donor region is bandaged with Kaltostat, and the recipient region with
vaseline and wet gauze. The patient receives anticoagulant protection
during the stay. Before discharge, the graft had almost fully been taken.
Discussions and Conclusions: Improvements in the outcome of
Fournier's gangrene still require early diagnosis, aggressive surgical
debridement, and administration of appropriate antibiotics. A delay in the
surgical treatment of more than 12 hours is associated with an increased
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number of surgical debridements, a higher incidence of septic shock, and

resulting in higher mortality. This case report shows that Fournier's
gangrene is a true urological emergency and requires immediate surgical
treatment.
Metoidioplasty vs Phalloplasty: a choice dilemma
Authors: Adela Sobolewska, Kamila Mozga, Klaudia Ciupak, Klaudiusz Garbacki
Supervisor: dr n. med. Justyna Wyroślak-Najs
Affiliation:
Students’ Scientific Association at the II Chair and Department of General
and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract

Introduction: Metoidioplasty and phalloplasty are one of the most common

surgeries among transgender patients, yet still they do not have any specific
guidelines, how to perform each method. By synthesizing current evidence, this
review seeks to offer clarity on the factors influencing patient choice and the
relative advantages and disadvantages of gender affirming surgery.
The aim of this study is to elucidate the critical factors influencing the choice of
surgical method, with a particular focus on the prevalence of common
postoperative complications and their impact on sexual satisfaction.
Material and Methods: a total of 22 articles (nine metoidioplasty and 13
phalloplasty) were collected for the review and analyzed for postoperative urinary
tract complications, life satisfaction and sexual function of the patients. Nine
metoidioplasty articles presented a total of 2718 patients, while 13 articles
resolved about phalloplasty and provided 1300 cases.
Results: It may seem that although phalloplasty results in more male-like looking
genitalia, there is no significant difference in general satisfaction with the
appearance of the neopenis between phalloplasty and metoidioplasty. Both
methods however present postoperative complications connected to the urinary
tract such as fistulas and strictures.
Conclusions: This review has provided a comparative analysis of metoidioplasty
and phalloplasty as two principal gender-affirming surgical options for
transgender men. While each procedure offers unique benefits and drawbacks,
the selection between them should be individualized.

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Extensive Fournier's gangrene as a result of perineal trauma

Author: Tanishka Kaul

Supervisor: Dr. Maciej Przudzik
Affiliations:
Urology student scientific circle, University of Warmia and Mazury
in Olsztyn.

Background
Fournier's gangrene is a very rare but potentially life-threatening necrotizing
fasciitis of the perineum and genital area, which often results from a mixed
infection of several organisms. Prompt diagnosis and aggressive therapy are the
most important to enhance outcome, but often there is delay in presentation,
significantly enhancing morbidity and mortality.

Case Report
A 65-year-old male with a history of daily alcohol abuse presented with a
massive, painless scrotal hematoma persisting for a week. He was referred to the
emergency department due to progressive swelling. Suspecting Fournier's
gangrene, he was admitted to the urology department and underwent urgent
scrotal revision. Examination revealed necrotic tissue in the scrotal and perineal
regions, with prodromal signs of septic shock. Broad-spectrum antibiotics and
conservative treatment were initiated.
During surgery, extensive necrotic tissue was excised. Postoperatively, his
condition worsened, requiring ICU admission for septic shock, respiratory failure
needing mechanical ventilation, and circulatory collapse managed with
vasopressors. Labs showed acute renal failure, coagulopathy, anaemia, and
systemic inflammation. He received fluid resuscitation, sedation, analgesia, and
continued antibiotics. Cultures confirmed Klebsiella pneumoniae, sensitive to the
prescribed antibiotics. Regular surgical wound care and debridement were
performed. After extubating, he showed gradual improvement despite transient,
pharmacologically managed delirium. Once stable, he was transferred back to
urology.
Following conservative treatment, he was referred for skin grafting, which was
successfully performed. Afterward, he returned to the Urology Department for
rehabilitation. With well-granulating wounds and improved mobility, he was
discharged in good condition with follow-up recommendations.
Conclusion
This case underlines the critical importance of early recognition, multidisciplinary
management, and comprehensive postoperative care in Fournier's gangrene,
especially in those with comorbid conditions like alcohol abuse. All these
aggressive surgical interventions followed by intensive medical therapy and
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rehabilitation resulted in a reasonable outcome, given the acuteness of the

disease at admission.

GENERAL SURGERY

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Understanding Anatomical Differences as an Essential Element of

Hepatopancreatic Surgery.
Authors: , Firoz Rizvi, Mateusz Trubalski, Marta Żerebiec, Jakub Karczewski
Supervisor: Justyna Wyroślak-Najs, MD, PhD
Affiliation:
1. Students’ Scientific Association at the II Chair and Department of
General and Gastrointestinal Surgery and Surgical Oncology of the
Alimentary Tract, Medical University of Lublin
2. II Chair and Department of General and Gastrointestinal Surgery
and Surgical Oncology of the Alimentary Tract, Lublin

Introduction:
Hepatopancreatic surgery, which is an extension of general surgery,
requires profound anatomical knowledge. Despite the existence of
intricate structures of organs, one must also learn about anatomical
variations, which makes every other patient unique. This involves being
thorough with theoretical knowledge related to the liver, pancreas, and
proximal organs, as well as practical familiarity with the relevant surgical
anatomy. Over the years, there has been an increase in understanding
these anatomical differences through efforts of researchers, contributing
to greater efficiency in facing them during surgical procedures. Our article
aims to highlight these studies and categorize multiple anatomical
variations.
Materials & Methods:
A literature search was conducted on PubMed and Google Scholar for
articles published between January 2020 and December 2025. Keywords
used were 'anatomical sections' and 'hepatopancreatic surgery.' Articles
related to the application of anatomical sections in hepatopancreatic
surgical procedures were included.
Results:
This review elucidates the complex anatomical variations of the
hepatopancreatic region, emphasizing their clinical significance. The liver's
segmented structure, dual blood supply, and venous drainage exhibit
notable variations, including accessory hepatic veins and atypical portal
vein positioning, which are critical for surgical planning. Similarly, the
pancreas displays diverse arterial and venous anatomy, such as replaced
hepatic arteries and variable pancreaticoduodenal vein drainage. These
anatomical anomalies necessitate preoperative imaging and tailored
surgical approaches to approach complications and optimize patient
outcomes. A comprehensive understanding of these variations is
paramount for enhancing precision and safety in hepatopancreatic surgery.
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Conclusion:
To maximize efficiency during hepatopancreatic surgery, and to avoid
hurdles, anatomical variations of these organs must always be considered.
The approach to this requires the collaboration of researchers to record
and update information about existing, or new variations if encountered.

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Risk factors for recurrence in patients undergoing pancreatic

resection

Authors: Sathwik Nayak, Sheikh Mohamed Nazer Sheikh Nabeel

Supervisor: Justyna Wyroślak-Najs, MD, PhD Prof UM
Affiliation:
1. Students’ Scientific Association at the II Chair and Department of
General and Gastrointestinal Surgery and Surgical Oncology of the
Alimentary Tract, Medical University of Lublin
2. II Chair and Department of General and Gastrointestinal Surgery
and Surgical Oncology of the Alimentary Tract, Lublin

Introduction: Even after surgical excision, pancreatic ductal

adenocarcinoma (PDAC), one of the most aggressive cancers, has a dismal
prognosis. After pancreatic resection, recurrence is frequent; many
patients relapse within the first few years. To improve patient outcomes, it
is essential to identify the pathological and clinical variables that predict
recurrence. With an emphasis on preoperative, perioperative, and
pathological factors, this study attempts to determine and evaluate the
risk factors for recurrence following pancreatic resection for PDAC.
Material and methods:The review was created based on retrospective
analysis of 12 articles related to Risk factors for recurrence in patients
undergoing pancreatic resection and was conducted using available
databases such as PubMed and Google scholar after searching for Risk
factors for recurrence in patients undergoing pancreatic resection
published between 2020 to 2025
Results:This study of 1,518 pancreatic ductal adenocarcinoma (PDAC)
patients following resection revealed a high recurrence rate, with 80%
experiencing recurrence during the follow-up. Early recurrence within six
months was associated with elevated preoperative CA19-9, positive
peritoneal cytology, and mGPS. Recurrence within a year correlated with
the absence of adjuvant therapy, lymph node metastases, and positive
cytology. Patients with recurrence exhibited a median overall survival of
15-21 months and recurrence-free survival of 5-16 months. High tumor
grade, positive lymph nodes, and a Ki67 index ≥5% were linked to
recurrence and reduced progression-free survival. Overall survival
decreased with an increasing number of risk factors.
Discussions and Conclusions:Early detection of recurrence risk factors
after resection is crucial for care and prognosis of PDAC patients.
Important indicators of recurrence include preoperative CA19-9 levels,
mGPS, positive peritoneal cytology, and lymph node metastases. These
results support more individualised treatment approaches by highlighting
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the necessity of customised follow-up plans based on individual risk

factors.

When Standard Approaches Fail: A Case of Blunt Abdominal

Trauma
Authors: Iga Wawrzyniak 1,2, Amir Nour mohammadi1,2,(presenting)
Supervisors: dr n. med. Michał Solecki Prof UM 2, dr n. med. Justyna
Wyroślak-Najs Prof UM 2,1
Affiliations:
1 Scientific Students Association at the II Chair and Department of
General and Gastrointestinal Surgery and Surgical Oncology of the
Alimentary Tract, Lublin, Poland.
2 II Chair and Department of General and Gastrointestinal Surgery
and Surgical Oncology of the Alimentary Tract, Lublin, Poland

Background: Blunt abdominal trauma is a leading cause of abdominal

injuries, often arising from motor vehicle accidents. The liver is among the
organs most susceptible to damage in such cases. Management of
patients with liver injury involves identification of the bleeding source and
usually requires surgical intervention for hemodynamically unstable
patients or those with ongoing bleeding. The American Association for the
Surgery of Trauma (AAST) liver injury scale is used to determine the
severity of liver injury and guide treatment. A commonly used method to
manage bleeding from behind the liver is packing. However, hemostatic
sealing patches and tissue glue are novel hemostatic agents that can be
used to control bleeding. A thorough review of the 2020 World Society of
Emergency Surgery (WSES) guidelines and the American College of
Surgeons' Advanced Trauma Life Support (ATLS) guidelines provides
valuable insights into the evolving management of these complex injuries,
regardless of the patient's hemodynamic stability.
Case Report: We report a case of a 26-year-old male after a motorcycle
accident resulting in multiorgan injury, mesenteric tears, and significant
intra-abdominal hemorrhage. Despite multiple relaparotomies and various
surgical procedures to control bleeding, the patient's condition remained
critical. Due to ongoing bleeding from a branch of the right hepatic vein,
perihepatic packing was employed and followed by a Vacuum assisted
closure (VAC) treatment.

Discussions and Conclusions: Management of blunt abdominal trauma

with liver injury can be complex and challenging. While surgical techniques
like packing play a vital role, the management of these cases requires a
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multifaceted approach. This case highlights the need for continued

research and exploration of novel hemostatic agents and surgical
techniques to improve outcomes. Raising awareness among clinicians
about the complexities of liver trauma and the potential for challenging
presentations is crucial for optimizing patient care and considering
alternative approaches when conventional methods fail.

Echinococcosis located in the liver, Is Surgical treatment always

necessary?

Authors: Kacper Bartosik, Ewa Bielska, Justyna Turczak

Supervisor: Justyna Wyroślak-Najs, MD, PhD Prof UM
Affiliation:
1. Students’ Scientific Association at the II Chair and Department of
General and Gastrointestinal Surgery and Surgical Oncology of the
Alimentary Tract, Medical University of Lublin
2. II Chair and Department of General and Gastrointestinal Surgery
and Surgical Oncology of the Alimentary Tract, Lublin

Introduction: Echinococcosis remains a severe zoonotic disease,

particularly in endemic regions. Its treatment modalities are still debated,
encompassing pharmacotherapy, percutaneous interventions, and surgical
procedures. If left untreated, the disease carries a 90% mortality rate. The
most common clinical manifestations include weight loss, discomfort in the
right upper quadrant, and, less frequently, jaundice complicated by
cholangitis.
Material and Methods: This study is a systematic review of literature
retrieved from PubMed, Scopus, and Google Scholar (2021–2025), focusing
on echinococcosis therapy. The keywords used included: Echinococcosis,
treatment outcomes, diagnostic methods, surgery.
Results: The choice of therapeutic approach depends on the stage of
disease progression at diagnosis. Radical surgical resection combined with
benzimidazole-based pharmacotherapy is the most frequently employed
strategy, demonstrating a low recurrence rate. However, surgical
intervention is associated with significant risks, including hemorrhage, bile
leakage, infectious complications, and intestinal obstruction. Despite these
risks, surgery remains the gold standard for eligible patients, providing
favorable long-term outcomes. In cases complicated by hydatid cyst
abscess formation, non-radical surgical intervention is preferred due to a
lower risk of postoperative complications. In advanced cases, including
liver cirrhosis or failure, liver transplantation may be a viable option,
provided the infection remains confined to the liver. Pharmacotherapy with
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albendazole is considered only for lesions smaller than 5 cm, prolonging

survival by up to 10 years in 80% of cases. However, due to the disease’s
prolonged latency and nonspecific early symptoms, surgical intervention is
required in most cases.
Conclusions: Pharmacotherapy alone is rarely sufficient for
echinococcosis management. Despite the associated risks, surgical
intervention remains the most effective modality, ensuring optimal
eradication of parasitic lesions and minimizing recurrence rates.

Atypical complication during routine procedure in the Angio suite

- a case report.

Authors: Anna Kuraś, Michał Flis

Supervisor: Krzysztof Pyra, MD, PhD
Affiliations:
1.Students' Scientific Society at the Department of Interventional
Radiology and Neuroradiology, Medical University of Lublin
2.Department of Interventional Radiology and Neuroradiology,
Medical University of Lublin

Background
Catheter knotting is undoubtedly a serious complication in the Angio suite
though it occurs rarely. It can arise during various medical procedures and
may be caused by several factors such as procedural technique and
patient’s anatomy. This complication can lead to procedure delay,the need
for corrective intervention, vascular injury or cardiac competitions.
Case report
A 68-year-old woman with a history of chronic three-vessel coronary
disease and hypertension underwent percutaneous coronary intervention
via radial access. During the procedure, a complication arose in which a
7.5 SheathLess Eucath guiding catheter became knotted at the level of the
right subclavian artery. Prior efforts to untie the knot, including pushing
and pulling the catheter, were unsuccessful and resulted in the iatrogenic
dissection of the right subclavian, right common carotid artery and
brachiocephalic trunk. Additionally, due to catheter related thrombosis the
right upper limb became acutely ischemic.The knotted catheter was
removed in the Department of interventional Radiology and
Neuroradiology. Subsequently, vascular dissections were treated with
stents. The circulation and sensation in the right upper limb was returned
after the procedure. However, approximately 7 hours later, the patient
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exhibited mild stroke symptoms (NIHSS score of 4). A computer

tomography scan revealed a small ischemic area in the distal part of the
middle cerebral artery.
Discussion and conclusion
Among the methods of removing knots we can list: passing the wire to
straighten it, intravascular maneuvering or immobilization catheter over
the knot with grasping forceps or snaring device. Surgical removal is also
possible, but it’s preferred in cases without extra dissection of the vessels.
This case emphasizes the importance of handling the catheter with care,
remaining composed and practicing dealing with such unwanted situations
which is crucial for optimizing the patient's recovery.

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“Laparoscopic sleeve gastrectomy - fewer trocars, better

outcomes”

Authors: Maksymilian Bednarek, Zofia Sorysz, Stanisław Szpakowski, Anna

Różańska-Walędziak MD, PhD, Prof.
Supervisor: Anna Różańska-Walędziak MD, PhD, Prof.
Affiliation:
Interdisciplinary Student Association "Salus Aegroti", Cardinal
Stefan
Wyszynski University of Warsaw, Warsaw, Poland

Introduction:
Laparoscopic sleeve gastrectomy, the most common bariatric procedure in
Poland, is the
optimum method of treatment for obesity, regarding long term results
measured by % excess weight loss and remission of co-morbidities. The
conventional surgical procedure demands five trocars to insert surgical
tools. The novel technique includes use of only three trocars. The study
aimed to compare outcomes between patients treated with conventional
five-trocar laparoscopic sleeve gastrectomy and three-trocar laparoscopic
sleeve gastrectomy.

Material and methods:

We analyzed the course of treatment in a group of 50 patients who had
undergone a five-trocar sleeve gastrectomy and 50 patients who had
undergone a three-trocar procedure within the time frame of twelve
months (between 2022 and 2023), with 1-year follow-up. The main
endpoints included surgery duration, early postoperative complications
and length of hospital stay. The additional endpoints were % excess weight
loss, postoperative incidence of gastroesophageal reflux disease and other
late complications.

Results:
No significant differences were observed between the two groups
regarding age, weight, BMI, and sex distribution. Related health conditions
were comparable between the two groups. The patients treated with the
three-trocar technique had a shorter surgery duration and comparable
length of hospital stay, lower rate of early postoperative complications.
Additionally, the % excess weight loss was higher in the three-trocar group
and the incidence of postoperative late complications was comparable
between the two groups.

Conclusion:

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The three-trocar sleeve gastrectomy is a feasible, safe, and effective

alternative to conventional five-trocar procedure, with shorter surgery
duration, lower rate of early postoperative complications and higher %
excess weight loss.

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Review of Augmented reality to help surgeons - what the future

brings

Authors: Danielle Martemucci1, Amir Nour Mohammadi1, Klaudia Żórow1

Supervisor: Justyna Wyroślak-Najs, MD, PhD Prof UM 1,2
Affiliation:
1. Students’ Scientific Association at the II Chair and Department of
General and Gastrointestinal Surgery and Surgical Oncology of the
Alimentary Tract, Medical University of Lublin
2. II Chair and Department of General and Gastrointestinal Surgery
and Surgical Oncology of the Alimentary Tract, Lublin

Introduction: Augmented reality (AR) is revolutionizing surgery by

overlaying digital data onto real-world fields, enhancing visualization and
precision. Traditional 2D imaging limitations hinder complex procedures,
requiring mental reconstruction. AR offers a dynamic, 3D view within the
surgeon’s field, improving spatial awareness and instrument manipulation.
This review synthesizes current research on AR’s surgical applications,
focusing on technological advancements and clinical efficacy.
Understanding AR’s potential and challenges is crucial for its wider
adoption and improved patient outcomes. This literature review critically
evaluates current findings across various surgical specialties.
Material & Methods: This literature review synthesized findings from 15
peer-reviewed articles published between 2021-2025. Searches were
conducted using PubMed and Google Scholar, employing the search terms
"Augmented Reality + Surgery." The selected articles focused on clinical
applications and technological advancements in AR-guided surgical
procedures.
Results: The analyzed studies reveal that AR is a valuable tool in surgery,
leading to enhanced patient outcomes across multiple specialties. AR
improves precision, planning, and navigation in areas like orthopedics,
liver surgery, and transsphenoidal procedures. Evidence suggests reduced
complications and improved patient prognoses, especially in complex
surgeries like hip and vascular procedures. Surgeons utilizing AR report
better landmark identification and experience. Additionally, AR, combined
with virtual reality (VR), shows potential in surgical education by
decreasing operation times and errors. Future integration with AI and
machine learning is poised to further revolutionize surgical practices.
Conclusions: AR offers substantial improvements in surgical visualization,
accuracy, and
training. The reviewed research indicates that AR enhances surgical
planning and execution across diverse specialties, resulting in fewer
complications and improved patient results. The continued development of
AR in conjunction with advanced technologies like AI and machine learning

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promises to drive innovation and increase accessibility to high-quality

surgical care globally. Further research is necessary to refine AR
applications and assess their long-term impact on patient care.

Determining the true purpose of the use of abdominal binders after

incisional hernia repair: to reduce the stress forces along the suture
line, to increase compression around the mesh, or to maintain the trunk
circumference

Author: Lidia Mitura1

Supervisor: Małgorzata Pajer, MD2
Affiliiation:
1. Faculty of Medicine, Medical University of Lublin
2.General Surgery Department, Siedlce Hospital

Introduction: One common element of postoperative care for ventral hernia

patients is the use of abdominal binders. The lack of scientific evidence in this
area has led to discrepancies between the available data and common clinical
practice. There are currently no clear guidelines for the use of abdominal binders
after hernia repair. Surgeons are afraid of muscle thinning and weakening of
muscle function due to the use of abdominal binders.

Materials and methods: The Pubmed database have been searched for
publications published between 2004-2024.

Results:: In hernia surgery, highly extensible products are still commonly used,
the structure and behavior of which resemble those of elastic bandages, which
may explain why their effect on generated pressure and maintaining abdominal
circumference may be insufficient. Data show that the use of binders increases
mobility and leads to greater activity. Future studies should analyze whether
commonly used stretchable abdominal binders are able to reduce hernias and
improve the quality of life of patients.

Conclusions: The evidence from current studies on abdominal binders concerns a

variety of different products available on the market. Surgeons commonly use
different protocols when prescribing abdominal binders, leading to heterogeneity
in the analyzed groups. Surgeons assess the effects of abdominal binders on
specific postoperative complications, but the mechanisms of action of these
garments have not been thoroughly analyzed. The binders do not seem to harm
patients and are safe, despite generating high intraabdominal pressure.

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Unveiling the Unusual: Laparoscopic Resolution of a Rare Gallbladder

Hydatid Cyst with Acute Cholangitis

Author: Crețu Elena Cristiana1

Co-author: Abdulrahman Ismaiel, MD, PhD 3 , Covrig Larisa-Raluca4, Ghetler Bianca-
Isabel5, Vizitiu Alin-Stefan6
Supervisor: Mihăileanu Florin Vasile, MD, PhD2
Affiliation:
1,4,5,6
Faculty of medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy,
400006, Cluj-Napoca, Romania
2
Department of General Surgery, “Iuliu Hațieganu” University of Medicine and
Pharmacy, 400006, Cluj-Napoca, Romania
3
Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and
Pharmacy, 400006, Cluj-Napoca, Romania

Background: Hydatid disease, caused by Echinococcus granulosus, primarily

affects the liver and lungs. However, isolated primary hydatid cyst of the
gallbladder is an exceptionally rare occurrence. The cyst may be located within
the gallbladder lumen or on its external surface, leading to diagnostic challenges
due to nonspecific clinical manifestations.

Case report: We present the case of a 57-year-old female with a history of

cholelithiasis and right adnexectomy, who was admitted for right upper quadrant
pain, nausea, vomiting, and jaundice. During her initial hospitalization in
December 2024, laboratory tests showed hepatocellular injury, cholestasis,
hyperbilirubinemia (predominantly direct), and systemic inflammation. Imaging,
including abdominal ultrasound and contrast-enhanced magnetic resonance
cholangiopancreatography (MRCP), identified a hydatid cyst within the
gallbladder, complicated by acute cholangitis (Tokyo I criteria), biliary
pancreatitis, and hepatic steatosis. Serologic testing confirmed Echinococcus spp.
infection. The patient was managed conservatively with intravenous antibiotics,
hepatoprotective agents, and symptomatic treatment, leading to clinical and
biochemical improvement.
Given the confirmed diagnosis, the patient was readmitted in January 2025 for
definitive surgical management. A laparoscopic retrograde cholecystectomy with
pericholecystic adhesiolysis and subhepatic drainage was performed.
Intraoperatively, a 1 cm hydatid cyst was identified at the gallbladder fundus,
without evidence of hepatic or serosal invasion. The retrograde cholecystectomy
technique was chosen to minimize biliary trauma and facilitate safe dissection in
the setting of inflammatory changes. Adhesiolysis was performed to release
pericholecystic fibrotic bands, ensuring complete mobilization of the gallbladder

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while preventing spillage of parasitic contents. Subhepatic drainage was placed

to monitor postoperative bile leakage and prevent secondary infections.

Discussions&conclusions: Primary hydatid cyst of the gallbladder is rare, often

mimicking common biliary diseases. Early diagnosis with MRCP and serology is
crucial, while laparoscopic retrograde cholecystectomy ensures safe cyst
removal. This case underscores the importance of early surgical intervention and
a multidisciplinary approach for optimal outcomes.

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Infectious complications Associated with Central Vascular Access

Devices

Authors: Karolina Pikur1, Katarzyna Zyska2

Supervisor: Małgorzata Pabiś3 RN, MSc, PhD; Małgorzata M. Kozioł 4 MSc, PhD; Witold
Zgodziński 5 MD, PhD , DSc
Affiliation:
1
Master’s Student in Nursing, Faculty of Health Sciences, Medical University of
Lublin, Lublin, Poland
2
Student Scientific Association at the Department and Chair of Medical
Microbiology, Medical University of Lublin, Lublin, Poland
3
Department of Nursing Fundamentals, Chair of Nursing Development, Faculty of
Health Sciences, Medical University of Lublin, Lublin, Poland
4
Department and Chair of Medical Microbiology, Medical University of Lublin,
Lublin, Poland
5
1st Department and Clinic of General, Transplant, and Nutritional Surgery, Medical
University of Lublin, Lublin, Poland

Introduction: Central vascular access devices (CVADs) play a crucial role in

modern medicine, but their use is associated with a high risk of catheter-related
bloodstream infections (CRBSIs), which increases morbidity, mortality, and
healthcare costs. The incidence of CRBSIs is 22.5% for central catheters and only
0.1% for peripheral cannulas. The most serious complication is catheter-related
sepsis which is accounting for about 10% of hospital deaths..The aim of this study
was to present a comprehensive analysis of the epidemiology, pathogenesis,
diagnosis, and prevention strategies of infections associated with CVADs.
Material and methods: This review was based on scientific publications retrieved
from PubMed database. Keywords used to identification relevant articles were
“Central Vasscular Acess Device”, “Catheter- related blood infection”, “catheter-
related complications”.
Results: Skin flora colonising the catheter lumen or external surface are the most
common cause of CRBSIs. Diagnostic approaches involve blood and/or catheter
tip cultures and biomarkers such as for Procalcitonin (PCT), CRP, IL-6. Preventive
strategies include Effective prevention strategies include strict adherence to
aseptic techniques, antimicrobial lock therapy, and the use of impregnated or
coated catheters. Guidelines emphasize the importance of bundled care
approaches to minimize infection risks.
Conclusions: The risk of CRBSIs can be reduced by strict adherence to aseptic
principles. Proper hand hygiene reduces the risk of infections, but adherence to
guidelines among healthcare workers remains suboptimal. Understanding the
epidemiology, spectrum of potential pathogens and mechanisms of CVAD-related
infections is critical for improving patient outcomes. Implementing evidence-
based preventive measures, increasing awareness among healthcare personnel,
educating patients can significantly reduce infection rates, leading to better

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prognosis and lower healthcare costs. Nevertheless, further optimization of care

techniques and the development of novel prevention strategies remain
necessary.

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Not Just Another Liver Mass: A Case Report on Primary Hepatic

Neuroendocrine Tumors
Author: Ruxandra-Ioana Petreuș1,Paul-Florian Radu1
Supervisors: Mihaela Berar2,3 , Florin Graur2,3
Affiliations:
1. “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca,
Romania
2. 3rd Surgical Department, “Iuliu Hatieganu” University of Medicine and
Pharmacy Cluj-Napoca, Romania
3. Department of Surgery, "Octavian Fodor" Regional Institute of
Gastroenterology and Hepatology Cluj-Napoca, Romania

Background: Primary hepatic neuroendocrine tumors (PHNETs) are rare

types of neuroendocrine tumors (NETs), with about 300 cases documented.
Due to the limited number of reported cases, their origin remains
uncertain. Since imaging often offers misleading information, the diagnosis
of PHNETs requires integrating preoperative, intraoperative, and
histological data. While the surgical treatment carries a favorable
prognosis, long-term follow up is needed to exclude a potential recurrence.

Case Report: A 49-year-old woman, who presented with unspecific

digestive symptoms, was diagnosed with a large segment IV PHNET. The
abdominal ultrasound revealed gallbladder lithiasis associated with the
presence of a homogeneous mass, adjacent to the right hepatic lobe,
initially presumed to be a hemangioma. The surgical procedure included:
diagnostic laparoscopy, anterograde cholecystectomy, en bloc tumor
resection with the gallbladder and atypical liver resection. The
histopathological and immunological examination indicated a primary
hepatic neuroendocrine tumor with a high mutation rate (Ki-67 of 90%).
Additional screening was recommended to exclude any potential
malignancy associated.

Discussions and Conclusions: Due to the non-specific symptoms'

presentation, PHNETs can remain unidentified and untreated leading to
their increasing in size and severity. The diagnosis of PHNETs using
radiological imaging is exceptional since it can be mistaken for other types
of liver masses such as hemangioma. Chromogranin A was used for
diagnosis and follow-up, being considered the most important tumoral
marker. The treatment that showed the most significant results is
complete surgical resection or, palliative hepatic resection along with
transcatheter arterial chemoembolization used in patients with
unresectable tumors. Primary hepatic neuroendocrine tumors are
incredibly uncommon. A complete diagnosis and treatment combines
preoperative imaging, surgical resection, and postoperative
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immunohistochemistry. In this case, surgery was the optimal treatment

followed by four cycles of chemotherapy.

Recurrent Bilateral Pneumothorax in Langerhans Cell Histiocytosis: The

Role of Comprehensive Surgical Intervention
Authors: Jakov Kožić1, Mila Kostić1, Martin Bobek1, Marta Krpan1
Supervisor: Ana Hećimović2
Affiliations:
1
School of Medicine, University of Zagreb
2
Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb

Introduction: Langerhans cell histiocytosis (LCH) is a rare disorder characterized

by abnormal proliferation of Langerhans cells, leading to multisystem
involvement. Pulmonary LCH (PLCH) is common type of LCH that frequently
results in cystic lung destruction, leading to spontaneous pneumothorax in
approximately 15% of cases. This case presents a recurrent bilateral
pneumothorax as rare and complex clinical scenario, requiring comprehensive
surgical intervention.
Case Report: A 45-year-old female with a history of systemic LCH, including
diabetes insipidus and osteolytic lesion of mandibula, presented with recurrent
episodes of bilateral pneumothorax. The first course of treatment contained
bilateral chest drainage, however the air leaks persisted and a Heimlich valve
was installed for outpatient care. As the condition worsened, an unsuccessful
pleurodesis attempt was performed. Since there was no improvement in her
clinical condition and respiratory insufficiency, lung transplant was considerd but
due to multisystemic disease she wasn’t a suitable candidate. As a potential
solution another surgical procedure was proposed and it was decided to perform
a right lung lover lobe resection and bullectomy to stabilize her respiratory
function.
After the procedure her clinical condition was improved and she didn’t need
oxygen supplementation any more. In the follow up period of almost 10 years,
she didn’t have recurrence of pneumothorax and she is in a stable condition.
Discussion and Conclusion: This case highlights surgical difficulties in treating
recurrent bilateral pneumothorax in PLCH. Conventional surgical procedures
frequently fail to provide long-term respiratory stability because of the high
recurrence rates and the lung vulnerability. In severe cases like this one, lung
transplantation is considered for suitable candidates early to avoid irreversible
respiratory failure.

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When Two Thyroid Malignancies Coexist: A Case of Differentiated High-

Grade Thyroid Carcinoma and Poorly Differentiated Thyroid Carcinoma

Authors: Oskar Makuch, Joanna Najbar

Supervisor: lek. Łukasz Klepacki
Affilation:
Studenckie Koło Anatomiczne, University of Warmia and Mazury in Olsztyn

Background: New WHO classification introduced Differentiated High-Grade

Thyroid Carcinoma (DHGTC) as a distinct entity, encompassing follicular cell-
derived tumors with well-differentiated histology but exhibiting high-grade
features such as elevated mitotic count and tumor necrosis. It is important to
distinguish DHGTC from Poorly Differentiated Thyroid Carcinoma (PDTC), which
includes features like convoluted nuclei or necrosis. This classification improves
the understanding and categorization of thyroid cancers with intermediate
behavior, impacting prognosis and treatment choices.

Case report: We present the case of a 70-year-old female who reported

experiencing dyspnea, neck pain, and dysphagia. Physical examination revealed
a firm, immobile mass in the cervical region. The patient was admitted to the
thoracic surgery department for further evaluation. A fine-needle aspiration
biopsy of the thyroid gland was performed, revealing tumors in both lobes. In the
right lobe, a cream-colored mass with prominent vitreous areas was identified.
Histopathological analysis diagnosed this as a DHGTC. The tumor infiltrated the
thyroid capsule. The left lobe harbored a larger tumor, predominantly composed
of vitreous tissue. Microscopic examination revealed PDTC, characterized by solid,
trabecular, or insular growth patterns, increased mitotic activity, and tumor
necrosis. The tumor infiltrated approximately 90% of the thyroid lobe, with
numerous vascular tumor emboli present. The patient underwent total
thyroidectomy, confirming DHGTC in the right lobe and PDTC in the left. Adjuvant
radiotherapy followed.

Discussions and Conclusions: This case highlights the importance of

comprehensive histopathological assessment in thyroid tumors, especially when
multiple histological subtypes coexist. Early detection and surgical intervention
are crucial in cases of DHGTC due to its favorable response to treatment.
However, the presence of PDTC necessitates a more aggressive therapeutic

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approach, given its poorer prognosis. In such complex cases, a multidisciplinary

treatment strategy is essential to optimize clinical outcomes.

Artificial Intelligence in Surgical Decision-Making. Applications,

Challenges, and Implications for Patient Outcomes
Authors: Wiktoria Gołębiowska, Natalia Gryta, Wiktoria Starzyńska, Zuzanna Piech
Supervisior: dr n. med. Justyna Wyroślak-Najs
Affiliation:
Students’ Scientific Association at the II Chair and Department of General and
Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract

Introduction: Artificial intelligence (AI) is a rapidly expanding domain across

various fields in the last years including medicine and surgery since 1950s.
AI broadly refers to the development of computers that are able to carry out
tasks normally associated with human intelligence. More specifically, it describes
machine-based systems that input human-defined objectives to make
predictions, recommendations, decisions influencing their environment which
automatically improve over time.
The aim of this study was to explore the role of AI in surgical decision-making,
focusing on its applications, challenges, and impact on patient outcomes.
Materials and methods: A review of the literature about this topic based on the
PubMed scientific database. Publications from 2024 were selected using keywords
such as: “artificial intelligence”, “AI in surgery”, “AI in medicine”, “AI based
clinical decision making”, “Application and potential of AI”.
Results: Our review shows that AI is transforming surgical decision-making by
providing critical support to surgeons across various stages of care -
preoperative, intraoperative, and postoperative. This includes preoperative risk
prediction, enhancing diagnostic precision, assisting in treatment planning,
offering real-time intraoperative guidance, and optimizing postoperative care.

However, its implementation presents challenges, particularly regarding the

ethical considerations of AI in robotic surgery. Key concerns include data privacy,
model transparency, bias, accountability, financial incentive. It should be also
remembered that the final decision belongs to the surgeon performing the
procedure.

Conclusions: AI in surgical decision-making can provide many benefits in different

phases of patient care. However, it is necessary to remember to take responsible
use of its opportunities.
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Looking Past the Psyche: A Case of Sigmoid Colon Perforation in a

Psychiatric Patient

Authors: Iga Wawrzyniak, Jakub Szytuła, Gabriela Gurtat, Jagoda Grzechnik, Paula Kawka
Supervisor: dr n. med. Justyna Wyroślak-Najs Prof UM
Affiliation:
Scientific Students Association at the II Chair and Department of General and
Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract, Lublin,
Poland

BACKGROUND: The psychiatric population has its own unique challenges that
healthcare providers should be especially vigilant about. The most pronounced is
the communication issue, but research also indicates that individuals with severe
psychiatric conditions experience nearly double the rates of morbidity and
mortality compared to the general population, with 50–90% of these patients
suffering from at least one chronic somatic medical illness. Despite this grand
prevalence, psychiatric patients encounter many barriers in the healthcare
system that often lead to receiving delayed or even inadequate care. The most
notable challenges are limited time available to adequately address both mental
and somatic health concerns, as well as a general discomfort and lack of
specialized training among medical staff in managing this complex patient
population. Other important aspects are diagnostic overshadowing (even 41% of
symptoms initially judged “psychiatric” prove somatic), stigmatization, mistrust,
and implicit biases. We would like to discuss those issues and bring attention to
the importance of resolving them.

CASE REPORT: A 48-year old female patient, notably chronically treated for
schizophrenia, was admitted to the Surgical Department with symptoms of
gastrointestinal inflammation. During physical examination the patient presented
with hypotension, abdominal distension (painful to palpation), tender left lower
abdomen and inaudible peristalsis. Diagnostic examinations confirmed features
of past perforation of the gastrointestinal tract in the area of the sigmoid, with
the formation of purulent infiltration, significant hepatomegaly with signs of
steatosis. The primary diagnosis was a non- traumatic intestinal perforation. The
patient was qualified for surgery and underwent appropriate treatment.
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DISCUSSIONS AND CONCLUSIONS: Psychiatric patients are a particularly sensitive

population, which by its nature may exhibit communication and cooperation
issues. Therefore, it is the duty of the health service to acknowledge and work on
repairing the aspects that are within its control in order to provide the best,
comprehensive care to this often overlooked group.

Bariatric Surgery – is It a Good Choice of Treatment for Young People

With Obesity?

Authors: Hubert Knapik2 , Jakub Szymański2 , Zofia Sorysz2, Anna Mierzejewska MD, PhD1,
Maciej Walędziak MD, PhD3
Supervisor: Anna Różańska-Walędziak MD, PhD
Affiliations:
1. Department of Human Physiology and Pathophysiology, Faculty of Medicine,
Collegium
Medicum, Cardinal Stefan Wyszynski University in Warsaw;
2. Students at Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski
University in Warsaw;
3. Department of General, Oncological, Metabolic and Thoracic Surgery, Military
Institute of Medicine

Introduction: In response to the continuously increasing prevalence of extreme

obesity among youth and due to the inconsistent and short-term effect of lifestyle
interventions, bariatric surgery has been introduced in the group of younger
patients since the early 2000s. Bariatric surgery is associated with a risk of
perioperative complications, however they are negligible when compared to
complications associated with obesity and its comorbidities. Bariatric surgery is a
mainstay of treatment for obesity as the only method leading to long-term effect
of weight loss and remission of comorbidities. Efficient treatment for obesity is of
special importance for young people in the period of psychophysical, mental and
social development. The purpose of the study was to analyze the efficacy and
safety of bariatric surgery in young people in terms of weight loss and remission
of comorbidities, as well as short-term and long-term perioperative complications.

Material and methods: The study was designed as an online survey that included
questions about the operation and its effect measured by the weight loss and
remission of comorbidities. Data was collected from 55 patients from the youth
group [15-24 years old] and from 55 patients from the control group (>24 years
old).

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Results: There were no statistically significant differences between the younger

and the older group in terms of estimated weight loss, remission of comorbidities
and the incidence of perioperative complications.

Conclusions: Bariatric surgery, followed by adequate lifestyle changes, should be

considered a the mainstay of treatment for obesity also in young people. Further
research is needed to establish bariatric surgery as a golden standard in
treatment of adolescent obesity.

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Malnutrition as a factor worsening the prognosis in patients with

pancreatic tumor.

Authors: Hamza Habib, Shahnawaz Imam

Supervisor: Justyna Wyroślak-Najs, MD, PhD Prof UM
Affiliation:
1. Students’ Scientific Association at the II Chair and Department of General and
Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract, Medical
University of Lublin
2. II Chair and Department of General and Gastrointestinal Surgery and Surgical
Oncology of the Alimentary Tract, Lublin

INTRODUCTION: Malnutrition is a common complication in pancreatic cancer,

caused by metabolic changes, tumor burden, and treatment effects. It leads to
weight loss, muscle depletion, and impaired nutrient absorption, significantly
impacting prognosis. Malnutrition predicts poor surgical outcomes, increased
complications, and shorter survival. It worsens recovery, increases the risk of
infections and pancreatic fistulas, and reduces treatment effectiveness.
Understanding the link between malnutrition and prognosis in pancreatic cancer
is crucial for improving patient care. This study explores its impact on surgical
outcomes, long-term survival, and nutritional interventions.

MATERIAL AND METHOD: This review analyzed 10 studies published between

2019 and 2024, focusing on the impact of malnutrition on pancreatic cancer
prognosis. A systematic search was conducted using PubMed and Google Scholar
with keywords such as “malnutrition AND pancreatic cancer.”

RESULTS: Malnutrition significantly impacts pancreatic cancer outcomes.

Unintentional weight loss and low serum albumin levels are linked to increased
postoperative complications, including infections and pancreatic fistulas.
Hypoalbuminemia is particularly predictive of these complications. Low
Nutritional Risk Index (NRI) scores and substantial weight loss are associated with
higher complication rates post-surgery. Preoperative malnutrition negatively
impacts long-term survival, reducing disease-free survival and accelerating
cancer progression. Nutritional interventions, such as immune-enhanced enteral
nutrition, have been shown to improve outcomes by reducing complications and
shortening hospital stays.

CONCLUSION: Early nutritional screening, multidisciplinary interventions, and

PERT are vital for improving survival and quality of life in pancreatic cancer.
Integrating nutritional care into oncology practice is essential for optimizing
patient outcomes

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Non-technical Skills in General surgery

Authors: Umika Deepak Mittal, Sheikh Nabeel Sheikh Mohamed Nazer, Jacob Krynicki
Supervisor: Justyna Wyroślak-Najs, MD, PhD Prof UM
Affiliation:
1. Students’ Scientific Association at the II Chair and Department of General and
Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract, Medical
University of Lublin
2. II Chair and Department of General and Gastrointestinal Surgery and Surgical
Oncology of the Alimentary Tract, Lublin

Introduction: Non-technical skills (NTS) are crucial in surgery, as they support

technical skill and contribute to patient safety and surgical success. These skills—
leadership, communication, teamwork, decision-making, and situational
awareness—allow surgeons to perform well under pressure and remain resilient in
the face of unforeseen challenges in the operating room. Despite their
significance, NTS have been less focused on than technical skills, particularly in
general surgery. This imbalance is indicative of the need to better incorporate
NTS training into surgical training for enhancing teamwork and decision-making,
ultimately patient outcomes.

Material and Methods: Ten published articles examining NTS in general surgery
were reviewed in this study. Research papers were obtained through databases
like PubMed and Google Scholar, paying close attention to the articles available in
the time range from 2019 to 2025. The articles provided information about NTS
functionality during surgical performance, available tools of evaluation, and
effectiveness of training programs. From the analysis of such studies, this article
aimed at finding areas where there are faults in existing training practices and
where NTS training can be done better.

Results: Effective NTS possess evidence that they ward off surgical errors and
complications, and teamwork and communication work best. While formal
training courses are not available despite the availability of formal assessment
instruments like the NOTSS framework, training and feedback have been
demonstrated to improve NTS but with variable impact depending on the
surgeon's experience. The findings point to the need for a more formalized and
stage-dependent NTS training strategy in order to ensure overall skill acquisition
through different levels of surgical experience.

Conclusions: The development of NTS is significant in enhancing operating

performance and patient safety. While some progress has been achieved, there is
a need to do more to standardize the processes of training and assessment to
adequately equip surgeons with the non-technical problems that they will face.

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Surgery & Pediatrics

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”A case of hepatocellular carcinoma metastases”

Author: Karolina Drygała
Supervisor: dr hab. n. med. Ewa Kaznowska, prof. UR
Affiliations:
Univeristy of Rzeszów, Students’ Patomorfology Associaton, Rzeszów,
Poland

Background:Hepatocellular carcinoma is the most common primary liver

cancer, accounting for 90% of all cases. The HCC classification is based on
the Barcelona-Clinic-Liver Cancer Scale which defines five prognostic
subclasses and assigns specific treatments for each stage.
Case report: This paper describes a 71 years old patient with suspicion of
cancer in the spreading stage with an undefined starting point. The patient
was referred for CT scan of the abdomen and chest, which showed
numerous, diffuse small lesions of lung in the 9th segment of the left lung
and irregular lesion adjacent to the bronchovascular bundle in the 9th
segment of the right lung. Chest CT also showed the presence of soft
tissue lytic lesions in bone structures - in the body of sternum and in the V
left rib. Abdominal CT revealed an enlarged liver with a granular structure,
inhomogeneously reduced density, tuberous outlines with features of
cirrhosis and regeneration nodules, but without any clearly distinguishable
focal lesions. Under the control of the CT a biopsy of focal lesion located in
left lung was performed. No diagnostic material was found in the biopsy. It
was decided to try to extract material from the body of sternum. Tissue
fragments were obtained by core-needle biposy. Microscopic image
showed metastasis of liver cancer cells with the following
immunohistochemical profile: TTF1(-), p40(-), CEA(-) CK Cam 5.2(+),
Glipican 3(+), HSA(+/-), Glutamine Synt.( +).
Discussions and conclusions:According to the National Cancer Institute's
SEER database, the average five-year survival rate for HCC patients in the
United States is 19.6% for advanced, metastatic disease. When HCC is
diagnosed early, surgical treatment options include: surgical resection,
ablation, transarterial chemoembolization or liver transplantation.
However, HCC is usually diagnosed at an advanced stage when the tumor
is inoperable. In these cases, systemic therapy with tyrosine kinase
inhibitors becomes the only viable treatment option.

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Under Pressure: Managing Temporary Abdominal Closure in

Postoperative Compartment Syndrome
Authors: Paul-Florian Radu1, Ruxandra-Ioana Petreuș1, Florin-Alexandru
Popa1, Alexandru-Ioan Drăghici1
Supervisor: Oprea Aron Constantin Valentin1,2
Affiliations:
1. “Iuliu Hatieganu” University of Medicine And Pharmacy Cluj-Napoca,
Romania
2. Emergency Military Hospital "Constantin Papilian" Cluj-Napoca,
Romania

Background
Compartment syndrome is a life-threatening condition characterized by
increased pressure within a confined anatomical space, leading to
compromised circulation and potential tissue necrosis. While it is
commonly associated with musculoskeletal trauma, it can also arise
postoperatively.
Case Report
A 58-year-old female presenting diffuse abdominal pain, intestinal transit
disorders and a reducible mid-abdominal pseudo-tumoral mass. Medical
history included total hysterectomy, recurrent ventral hernia repairs
(initially with primary suture, later with prosthetic reinforcement and
IPOM), and comorbidities such as obesity, hypertension, ischemic heart
disease, and dyslipidemia. Preoperative workup was unremarkable.
Surgery addressed an 18 × 15 cm abdominal wall defect with extensive
adhesions and intraperitoneal prosthetic fixation to the sigmoid and small
intestine, involving adhesiolysis, prosthetic explantation, segmental
enterectomy, sigmoid resection with anastomosis, and abdominal wall
reconstruction with supra-aponeurotic mesh.
Postoperatively, the patient developed severe respiratory distress,
hemodynamic instability, mixed acidosis, acute kidney injury and liver
dysfunction. Despite CPAP and vasoactive support, worsening metabolic
status and anuria necessitated emergency surgical decompression,
involving prosthesis and abdominal wall incision, visceral edema
management and laparostomy with a Bogotá bag. The patient showed
improvement. However, on postoperative day 7, a wound culture tested
positive for coagulase-negative Staphylococcus aureus, requiring the
placement of a vacuum-assisted closure therapy system. The colonic
fistula was closed, and a terminal colostomy was taken down. The patient
had a favorable evolution, and one week after the last intervention, the
abdomen was surgically closed definitively.

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Discussions and Conclusions

This case underscores the critical importance of early recognition and
intervention in abdominal compartment syndrome, as outlined by Björck’s
scale. It emphasizes the advantages of various temporary abdominal
closure techniques, selecting the most appropriate method based on
individual clinical circumstances.
Compartment syndrome remains a severe postoperative complication that
requires prompt management. Surgical decompression remains the
cornerstone of treatment, and its timely execution can significantly
improve patient outcomes.

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Advancing the Management of Pediatric Appendicitis- A Scarless

Approach

Author: Agnieszka Kowalczyk2

Supervisors: Michał Puliński MD, PhD1, Michał Szostawicki MD, PhD1,
Tomasz Janowicz MD, PhD1, Wojciech Choiński MD, PhD1
Affiliations:
1
Pediatric Surgery and Urology Clinical Ward, The Regional
Specialized Children’s Hospital in Olsztyn
2
Pediatric Surgery Students’ Association, Collegium Medicum,
University of Warmia and Mazury in Olsztyn

INTRODUCTION: The standard operating procedure for acute appendicitis

(AA) depends on the technical and professional capabilities. In Pediatric
Surgery and Urology Clinical Ward at The Regional Specialized Children’s
Hospital in Olsztyn, Transumbilical Laparoscopic Assisted Appendectomy
(TULAA) was first performed in 2012. As experience was gained, their own
treatment algorithm was implemented. The standard approach assumes
that TULAA is the first-choice method. Whenever removal of the appendix
is not possible using this technique, conversion to standard laparoscopic
appendectomy (SLA) or open appendectomy (OA) follows. The decision to
convert to SLA depends on the position of the appendix and the possibility
of exteriorizing it through the umbilicus.

MATERIAL AND METHODS: The data of all patients with AA who were
hospitalized in the Pediatric Surgery and Urology Clinical Ward at The
Regional Specialized Children’s Hospital in Olsztyn between 2012, and July
2014 were retrospectively analyzed. 1,568 appendectomies were
performed, including 504 OA, 694 SLA and 369 TULAA. In all methods, the
surgery time, length of the hospital stay, and cosmetic outcome were
compared.

RESULTS: The surgery time for TULAA is significantly shorter than with
other methods. The hospital stay after TULAA is comparable to SLA and
shorter than after OA, depending more on the severity of the disease than
on the surgical method. The greatest advantage of TULAA is its excellent
cosmetic outcome. Patients (and their parents) highly appreciate the
absence of visible scars. Currently, approximately 40% of all
appendectomies performed in the center are using the TULAA.

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CONCLUSIONS: TULAA has the potential to become the standard

approach in the surgical treatment algorithm for acute appendicitis due to
its numerous advantages. A short hospital stay, reduced surgery time and
excellent cosmetic outcomes may justify the selection of TULAA as the
preferred surgical treatment.

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Massive true thymic hyperplasia in a 4-month-old infant - case

report
Authors: Mikołaj Sawicki2, Julia Szelmanowska2
Supervisor: dr n. med. Marek Wolski1
Affiliations:
1
Department of Pediatric Surgery and Urology, Medical University of
Warsaw, Warsaw, Poland
2
Student’s Society for Pediatric Surgery and Urology, Medical
University of Warsaw, Warsaw, Poland

ABSTRACT
Background
True thymic hyperplasia (TTH) involves a diffuse enlargement of the
thymus, exhibiting normal immunohistochemical characteristics, and a
weight surpassing the age-adjusted upper limit of normal. Massive true
thymic hyperplasia (MTTH) is a particularly rare and clinically important
subtype of TTH in children, due to its potential for serious complications.
Case Report
A 4-month-old female infant was admitted to our Pediatric Surgery
Department with a 7-day history of cough, wheezing, feeding fatigue, and
dyspnea. Physical examination revealed respiratory effort, tachypnea and
intercostal retraction. Radiological imaging demonstrated a large
intrathoracic homogeneous, well-circumscribed soft tissue with thymus
morphology. Given the suspicion of lymphoma and the elevated anesthetic
risk, a biopsy was deferred, and high-dose systemic corticosteroids were
initiated as a life-saving measure, which successfully alleviated her
dyspnea and led to a reduction in tumor mass. Ultrasound-guided biopsy
showed typical thymic tissue. The patient was discharged home with
a gradual reduction in glucocorticoid doses. However, this led to
an aggravation of symptoms and a recurrence of tumor enlargement. The
re-initiation of high-dose glucocorticoid therapy enabled the successful
performance of a total thoracoscopic thymectomy, a less invasive
procedure than traditional methods. The mediastinal mass was excised
and pathologically identified as TTH via morphological and
immunohistochemical analysis. Postoperative imaging showed elevation of
the right hemidiaphragm, which regressed over two months, returning to
near-normal parameters.
Discussions and Conclusions
Diagnosing MTTH is challenging due to its rarity and nonspecific
symptoms, requiring oncological vigilance. In this case, the tumor
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demonstrated a significant positive response to glucocorticoid therapy,

highlighting the potential effectiveness of corticosteroids in managing
MTTH - a finding that warrants consideration in clinical practice. Also,
glucocorticoid therapy effectively reduced the risk of potential
postoperative complications, facilitating the successful performance of a
total thoracoscopic thymectomy. This approach allowed for increased
maneuverability within the thoracic cavity and minimized the risk of
permanent phrenic nerve injury.

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Permanent complication of a critical condition - two pediatric

cases of amputation due to sepsis

Authors: Agata Wróblewska, Iga Stefańska, Oliwia Pyżyńska

Supervisor: lek. Katarzyna Rasiewicz
Affiliation:
Wroclaw Medical University

Background:

Amputations in pediatric surgery are rare procedures, typically

unscheduled, resulting from trauma, malignant tumors, irreversible
ischemia, or infections. While life-saving, these procedures are
permanently disabling. Consequently, their primary goal is to preserve as
much growth and function in the residual limb as possible. Therefore,
sparing growth cartilage is crucial. Infections, followed by sepsis, may
result in irreversible necrosis due to coagulopathy and peripheral
ischemia, the ultimate and effective treatment of which is limb
amputation. Even in critically ill patients, the level of amputation is
significant as it impacts quality of life after recovery.

Case reports:

We present two cases of an amputations after sepsis in children.

A 3-year-old girl developed septic shock following streptococcal
pharyngitis, leading to ischemic-necrotic lesions, affecting primarily her
legs and fingers. During treatment for cardiorespiratory failure, ischemia
progressed, eventually resulting in compartment syndrome in both legs,
requiring four-compartment fasciotomy. The patient subsequently
underwent multiple necrotectomies, hyperbaric therapy, and, ultimately,
bilateral below-knee amputations.
A 3-month-old boy with meningococcal sepsis was admitted to the surgical
unit after stabilization to manage necrotic tissue in the lower extremities
and genital area. During hospitalization, necrotectomy of ischemic limb
tissues was performed. The patient also received hyperbaric therapy, and
ultimately, amputation of right forefoot and left lower leg were necessary.
All surgeries had to be multistaged due to poor tolerance and concomitant
renal failure.

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Discussion and Conclusions:

Amputations, although infrequent, may be required during treatment for
septic shock in children. Early diagnosis, close monitoring of kidney
function and appropriate medical intervention are crucial in managing
progression of peripheral necrosis. It should further be noted that pediatric
patients who experience amputation as treatment for complicated sepsis
require long-term, multispecialty care, including physiotherapy and early
prosthetics, to facilitate optimal future growth and development.

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Persistent thymus in a young person – case report

Authors: Natalia Bębenek
Supervisor: dr hab. n. med. Ewa Kaznowska, prof. Uniwersytetu
Rzeszowskiego
Affiliations:
Studenckie Koło Naukowe Patomorfologii,
Uniwersytet Rzeszowski, Rzeszów, Polska

Background: Physiologically, involution of the thymus begins at the first

year of life. In rare cases, this process can be disrupted, leading to the
presence of a persistent thymus in adults. The persistent organ is impaired
in its functions, which can result in an increased risk of opportunistic
infections, autoimmune diseases and cancer. In addition, autoantibodies
can be produced, causing clinical symptoms similar to those of myasthenia
gravis.
Case Report: The paper describes a 24-year-old patient who was admitted
to the hospital for videothoracoscopy due to a mass on the left side in the
upper anterior mediastinum described in the computed tomography scan
with suspicion of thymoma. The man was last hospitalized in January 2025
in the neurology department to further diagnose myasthenic symptoms. In
the interview, the patient reported symptoms of muscle weakness that
had been present for many years, appearing especially after physical
exertion. Recently, the symptoms have worsened - dysphagia, speech
problems and episodes of muscle weakness causing the inability to keep
the head upright. Symptoms were most severe in the evening and after
physical exertion. Computed tomography with contrast revealed a
spherical, soft tissue lesion measuring 12 mm without contrast
enhancement to the left of the ascending aorta, which raised the suspicion
of thymoma. The thymus was not enlarged and measured 17x12 mm.
Pathomorphological examination of the material collected during
videothoracoscopy revealed thymus tissue with features of involution.
Discussions and Conclusions: Available literature has shown a relationship
between the occurrence of myasthenic symptoms and the occurrence of
persistent thymus in adults. In about 65% of patients, the thymus is
described as hyperplastic. One of the available methods of treating
persistent thymus is its surgical removal, called thymectomy. In some
patients, the use of such treatment allows for a significant reduction in the
occurring muscular and neurological disorders.

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PRIMARY HYDATID CYST OF THE PANCREAS – LAPARASCOPIC

APPROACH
Author: Larisa-Ionela Tizu 1
Supervisor: PhD Vasilescu Alin 1, 2
Affiliations:
1
Faculty of Medicine, University of Medicine and Pharmacy
Gr.T.Popa, Iasi
2
First Surgical Clinic , St. Spiridon University Hospital

Background
The liver and lungs are the most common locations of Echinococcosis , the
pancreatic hydatid cyst being considered a very rare occurrence even in
countries where hydatid disease is endemic.
Case report
We present the case of a 63-year-old female patient, with no medical
history, hospitalized for epigastric pain, nausea and vomiting with
insidious onset over the past 2 months.
We performed a laparoscopic exploration of abdominal cavity which
revealed a retrogastric cystic mass, macroscopically resembling a hydatid
cyst developed from pancreatic body.
The surgical treatment consisted in puncture, evacuation of proligera,
lavage with hypertonic serum, pericyst was partially excised and drainage
of the cavity.
Postoperatively, the patient underwent anti echinoccocus treatment, i.e.
albendazole for 2 months.
The follow-up at 6, 12 and 24 month did not show relapse.
Discussion & Conclusion
Primary pancreatic hydatid cyst is extremely rare with an incidence of
0.14% to 0.2%.
Laboratory tests for detecting specific serum antibodies and echinococcal
antigens such as ELISA test has good sensitivity, specificity and diagnostic
accuracy over 90%.
Surgical excision or evacuation of cyst contents with partial cystectomy
and the cavity should be washed with hypertonic saline solutions. Drug

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treatment with Albendazole for a period of 8–12 weeks before and after
the procedure is the most effective.
Hydatid cyst is a rare cause of a cystic mass of the pancreas, but should
be included in the differential diagnosis of cystic mass of the pancreas,
especially in endemic areas.
Laparoscopic approach is feasible and secure and when combined with
drug treatment greatly reduces the risk of recurrence.
Silent Threat: Internal Hernia with Necrosis as a Late Complication
of Roux-en-Y Gastric Bypass
Authors: Julia Modzelewska
Supervisor: dr n. med. Natalia Dowgiałło-Gornowicz
Affiliations:
Student Scientific Association of General, Minimally Invasive, and
Geriatric Surgery

Background:
One of the most commonly performed surgical procedures for obesity
treatment is the Roux-en-Y Gastric Bypass bariatric surgery. This procedure
reduces the size of the stomach and alters the intestinal pathway, leading
to a limitation in food intake and reduced absorption of nutrients. It is
often used as a revision surgery to treat early and late complications of
sleeve gastrectomy.
Case report
A 37-year-old woman was transferred from the ER due to symptoms of an
acute abdomen, which persisted despite analgesic treatment and had
been ongoing for 24 hours. Laboratory tests showed decreased red blood
cell parameters and elevated CRP levels. CT of the abdomen showed signs
of high intestinal obstruction. Two years earlier, the patient had undergone
a Roux-en-Y Gastric Bypass surgery as a revision following a sleeve
gastrectomy. An emergency operation was decided upon.
Laparotomy revealed strangulated intestinal loops with established
necrosis. The necrotic bowel was resected with a margin of unaffected
loops, and an entero-enteric anastomosis was performed. Due to the
patient’s critical condition, she was admitted to the ICU. Within two days,
her general condition improved—she was extubated and no longer
required circulatory support. After transitioning from parenteral to oral
nutrition, recurrent gastrointestinal bleeding occurred. The bleeding was
managed with transfusions of blood products and plasma, leading to
improvement. She developed a central line infection, which was treated
with empirical antibiotic therapy, later adjusted based on blood and
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catheter culture results, with positive outcomes. The patient was

discharged home in good general condition.
Discussions and Conclusions
Internal hernia with necrosis is a rare complication of Roux-en-Y Gastric
Bypass surgery that can occur even long after the procedure and is
potentially life-threatening. Its development can be sudden. Therefore,
post-surgical patients should remain highly vigilant for persistent cramping
pain in the mid-abdomen and should not ignore such symptoms.

From Scar to Function: Surgical Management of Pediatric Post-

Burn Hand Contracture – Case Report with Follow Up

Author: Maria Kamila Klimeczek- Chrapusta

Supervisor: Anna Chrapusta, MD, PhD, DSc.
Affiliation:
Student Scientific Group of Pediatric Surgery

Background: Children are more prone to developing post-burn contractures than

adults, even after successful and appropriate initial burn care. Severe
contractures can result in deformities and functional disabilities.

Case Report: We present a case of a pediatric patient referred to a surgeon at

the age of 2 by his parents a few months after sustaining third-degree burns to
both hands. Although the burns had healed, extensive scarring resulted in severe
contractures, leaving the child’s hands tightly clenched and preventing him from
extending and flexing or moving his fingers, thereby severely impairing hand
function. A multi-stage surgical plan was devised to release the contractures and
restore hand function. A total of five surgeries—two on the left hand and three on
the right—were performed, resulting in successful restoration of mobility and
improved aesthetic outcomes. The surgical approach included full-thickness skin
grafts and the use of Kirschner wires to maintain finger extension following
passive joint release and contracture correction. The wires also provided
stabilization and facilitated proper healing of the skin grafts. Following the
patient’s complete healing after the final surgery, six years after the accident,
their quality of life was evaluated through Pediatric Quality of Life Inventory both
parent and patient report for toddlers.

Discussions and Conclusions: Through a multi-stage surgical approach over

six years, we successfully restored the patient’s hand functionality and achieved
a pleasing aesthetic outcome. The recovery process was smooth, with minimal
pain and no complications. Beyond the physical improvements, the restoration of

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hand function played a crucial role in supporting the child’s development,

fostering independence and enhancing social integration—contributing
significantly to their overall quality of life.

NEUROSURGERY

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Obstructive hydrocephalus due to hemorrhage into a pineal cyst – a

surprising cause of worsening headache.

Authors: Paulina Świętoń, Jakub Słoń

Supervisor: Magdalena Rybaczek, MD
Affiliation:
Students Scientific Association at the Department of Neurosurgery with
Department of Interventional Neurology, Medical University of Bialystok

Background: Pineal apoplexy is a rare condition characterized by sudden

hemorrhage or necrosis within the pineal gland. It is the most severe
consequence of a pineal cyst and may also be associated with neoplastic
changes or vascular abnormalities. The implications of apoplexy include
hydrocephalus and neurological deficits resulting from mass effect. Pineal
apoplexy can be a life-threatening condition requiring urgent neurosurgical
intervention.

Case Report: A 38-year-old female was admitted to the Neurosurgery Clinic on an

emergency basis with developing obstructive hydrocephalus due to hemorrhage
into a pineal cyst, as diagnosed by MRI performed in an outpatient setting. Her
medical history included persistent headaches and visual field disturbances.
Imaging studies revealed a cyst with fluid levels (MRI: 28x20x21 mm) and
peripheral calcifications (CT). Due to the presence of obstructive hydrocephalus,
she was qualified for ventriculostomy of third ventricle. However,
intraoperatively, due to the inability to visualize intraventricular structures using
endoscopy, a decision was made to place an external drainage system.
Laboratory and imaging diagnostics ruled out neoplastic features, leading to the
decision to perform cyst fenestration and hematoma evacuation via a
supracerebellar infratentorial approach. Postoperative imaging showed regression
of the cyst size (MRI: 23x13x17 mm), decompression of the cerebral aqueduct,
relief of the mass effect, and no compression of the quadrigeminal plate. The
patient, in good general, local, and neurological condition, was discharged home
with recommendations for wound monitoring and neuroimaging follow-up.

Discussion and Conclusions: The presented case highlights the importance of

considering pineal apoplexy in the differential diagnosis of headaches. Despite its
rarity, it should be taken into account due to potential risks such as rapidly
progressing hydrocephalus, which untreated can be fatal. Determining the cause
of apoplexy is essential, as confirming a neoplasm would require a tailored
treatment strategy.

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Dysregulation of the kynurenine pathway in patients with orbital

proliferative lesions- preliminary study
Authors: Mikołaj Krupa1, Andrzej Sieśkiewicz2, Anna Tankiewicz-Kwedlo3
Supervisor: Tomasz Łysoń1,4
Affiliation:
1
Department of Neurosurgery, Medical University of Bialystok, 15-276 Bialystok,
Poland.
2
Department of Otolaryngology, Medical University of Bialystok, 15-276 Bialystok,
Poland.
3
Department of Pharmacodynamics, Medical University of Bialystok, 15-222
Bialystok, Poland
4
Department of Interventional Neurology, Medical University of Bialystok, 15-276
Bialystok, Poland

Introduction: Orbital tumors pose an interdisciplinary challenge requiring

collaboration among ophthalmologists, neurosurgeons, maxillofacial surgeons,
and otorhinolaryngologists. Intraorbital lesions constitute a highly heterogeneous
group, yet their pathogenesis remains poorly understood. Dysregulation in the
metabolism of specific amino acids may contribute to the development of these
tumors. Tryptophan is primarily metabolized via the kynurenine pathway, whose
intermediates exhibit diverse biological activities. Notably, kynurenine, an
endogenous ligand of the aryl hydrocarbon receptor, inhibits T-cell activity and
promotes regulatory T-cell differentiation, thereby suppressing the anti-tumor
immune response.
Materials and methods: A total of 44 patients (15 in the control group and 29 in
the study group) were included in the study. The control group consist of 15
healthy subjects. The study group comprised patients with different intraorbital
lesions treated surgically. Preoperative serum concentrations of kynurenine
pathway metabolites (tryptophan, kynurenine, kynurenic acid, anthranilic acid, 3-
hydroxyanthranilic acid, and 3-hydroxykynurenine) were measured using high-
performance liquid chromatography. Difference between study and control group
was analyzed.
Results: Serum concentrations of tryptophan, kynurenine, and 3-
hydroxykynurenine was lower in study group (p < 0.0001) and serum kynurenic
acid concentrations was lower in control group (p < 0.0001). No significant
difference was observed in anthranilic acid and 3-hydroxyanthranilic acid serum
concentrations between groups. Furthermore, no differences were found between
the two study subgroups: patients with benign tumors versus those with
malignant tumors.
Conclusions: Our contribution highlights alterations in the kynurenine pathway
among patients with orbital proliferative lesions, suggesting its potential
involvement in tumor pathophysiology.

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The Point of No Return: A Case of Self-inflicted Intracranial Injury by

Arrow

Authors: Aleksandra Kozłowska1, Miłosz Szczotka1, Serhii Homzar1

Supervisor: Krzysztof Kura, MD2
Affiliation:
1
Student Scientific Association, Department of Neurosurgery and Pediatric
Neurosurgery, Medical University of Lublin, Poland
2
Department of Neurosurgery and Pediatric Neurosurgery, Medical University of
Lublin, Poland

Background. Penetrating brain injuries (PBI) are among the most severe and fatal
injuries in the field of neurosurgery with the mortality rate of around 90%. The
most frequently observed complications after such injuries include hemorrhages,
cerebral contussion, vascular injury, infections or cerebral edema. Most PBI cases
occur as a result of firearm gunshot wounds, and less frequently as a
consequence of stab injuries inflicted by a sharp instrument. Nowadays
transcranial arrow injuries are exceedingly rare, however sporadic cases have
been reported.

Case report. A 20 year-old patient has been admitted to the ER after suffering a
self-inflicted head injury by an arrow. A CT scan showed an arrow passing through
the floor of the oral cavity, left side of the ethmoid bone, left frontal lobe and
ending in the frontal bone. Upon physical examination – the patient was
conscious without evident neurological deficits. A decision of undertaking
immediate surgery was made. The following were performed: bifrontal
craniectomy, removal of a foreign body, removal of an intracerebral hematoma,
plastic surgery of the anterior cranial fossa and osteomeningeal decompression.
In addition, a tracheostomy was performed and wounds on the neck, floor of the
mouth, tongue and palate were treated. In the next stages of treatment, plastic
surgery of the anterior cranial fossa with implantation of a titanium plate was
performed. The patient has fully recovered and currently does not present any
symptoms indicating complications related to the accident.

Discussion and Conclusion: Despite their rarity, self inflicted PBIs pose a major
challenge to modern neurosurgery, which is related to their high mortality rate
and the degree of complexity in therapy. The presented case demonstrates the
complex operative methods and describes the complications associated with
trauma after a transcranial arrow shot.

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Chronic Venous Ulcer with Underlying Follicular Lymphoma: A Case of

Complex Wound Healing

Author: Tea Škrobo, MD1

Supervisor: Davor Mlikotić, MD2
Affiliations:
1 – Family medicine practice Davor Mlikotić MD, Zagreb, Croatia
2 – Family medicine practice Davor Mlikotić MD, Zagreb, Croatia

Background: Chronic wounds are a significant clinical challenge, particularly in

patients with vascular, metabolic, or immunological disorders. Unlike acute
wounds, they fail to heal in a normal timeframe and are often complicated by
infections, tissue necrosis, and impaired circulation. Common causes include
venous insufficiency, arterial disease, diabetes, and malignancies. This case
highlights the complexity of chronic wounds, demonstrating the interaction
between chronic venous insufficiency, persistent ulceration, and an underlying
hematologic condition — follicular lymphoma.

Case report: A 72-year-old female presented to the emergency department with

pain and swelling in the left lower leg. Examination revealed hypertrophic leg and
superficial ulcerations. Laboratory tests showed elevated inflammatory markers,
and duplex ultrasonography excluded deep vein thrombosis. An enlarged lymph
node in the left inguinal region was noted. Empirical antibiotic therapy was
started. Follow-up revealed cellulitis, with a 10 cm increase in leg circumference.
Despite wound care, erythema and pain recurred, and cultures identified
Pseudomonas aeruginosa infection. A surgical necrosectomy was performed but
complicated by significant bleeding, required rehospitalization. The ulcer failed to
heal over 18 months, involving one-third of the lateral lower leg. Further
evaluation of lymphadenopathy led to a diagnosis of grade two follicular
lymphoma. Chronic wound management included regular debridement, infection
control, and dressing changes. Persistent care eventually led to granulation tissue
formation and improved mobility. The patient was treated with R-CVP
chemotherapy, resulting in disease control.

Discussions and Conclusions: This case emphasizes the critical role of persistence
in chronic wound management. Chronic ulcers require ongoing care, highlighting
the importance of maintaining local wound management while also addressing
underlying systemic factors to achieve healing and improve outcomes.

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A Novel Approach to Treating Chiari Malformation Type I in Adults: The

Interlayer Dural Split Technique

Author: Vizitiu Alin-Stefan1

Co-authors: Ghetler Bianca-Isabel1, Dorobantu Miriana-Gabriela1, Cretu Elena Cristiana1
Supervisor: Florian Ioan-Alexandru2 MD, PhD
Affiliations:
1
Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
2
Clinic of Neurosurgery, County Emergency Hospital Cluj-Napoca, Romania

Background: Chiari malformations (CMs) are defined as herniation of brain tissue

via the foramen magnum, being divided into four categories. Chiari malformation
type I (CMI) is characterised by the cerebellar tonsils descent through the
foramen magnum, for at least 3-5 mm, with changes in cerebrospinal fluid (CSF)
flow. CMI treatment consists of decompressing the foramen magnum using
craniectomy, duraplasty, and excision of the cerebellar tonsils. These procedures
have different success rates, and there is considerable debate over whether more
or less invasive methods are required. We propose a treatment that combines
invasive and less-invasive methods by incising the exterior layer of the dura
mater and not entering the subdural regions, as well as performing autologous
duraplasty.

Case Report: We discuss the case of a 46-year-old female who presented with
severe headache, nausea, vertigo, and ataxia. She did not respond to
conservative treatment. An MRI revealed an unilateral descent of the right
cerebellar tonsil and moderate syringomyelia. We chose a method with a low risk
of CSF fistula and recurrence rate, utilising the Interlayer Dural Split technique.
There were no CSF leakage and no pneumocephalus on postoperative imaging
examinations. As of 8 months after surgery, she is still completely symptom-free.

Discussions and Conclusions: This case shows that CMI in adults can be efficiently
treated using the novel technique of incising the outer dural layer and carefully
separating it from the inner one. Our approach has the advantage of a lower risk
of postoperative sequelae, such as CSF leakage, pseudomeningocele, or aseptic
meningitis, while also being suitable for patients with syringomyelia. However, a
longer operative time is required in order to perform the closure of the outer dura
layer.

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Central hypoventilation syndrome as a complication after surgical

treatment of choroid plexus papilloma.
Author: Julia Jabłońska1
Co-authors: Julia Kucharzewska2, Jan Krzowski3
Supervisor: M.D, Ph.D Maciej Szmygin 4
Affiliations:
1 2 3
, , Student’s Scientific Society at the Department of Interventional Radiology and
Neuroradiology, Medical University of Lublin.
4
Department of Interventional Radiology and Neuroradiology, Medical University of
Lublin.

Background: Congenital central hypoventilation syndrome (CCHS) is a very rare,

life-threatening neurological disorder. The most common cause is a genetic
mutation that leads to impaired autonomic control of breathing during sleep,
resulting in loss of automatic respiratory function. There are also cases of
acquiring the disorder, most often as a result of complications from treatment of
vascular malformations, pathological brainstem lesions or trauma.
Case report: A 22-year-old female patient was admitted to the neurology
department with severe headaches and dizziness, nausea, and episodes of
unconsciousness. Neurological examination revealed limb ataxia, diplopia, and
symptoms indicative of meningeal irritation. An elevated white blood cell count
was noted. A cranial CT scan revealed a cerebellar lesion, cerebrospinal fluid
analysis showed no pathology. A complete resection of the cerebellar lesion,
which turned out to be a choroid plexus papilloma, was performed. After the
operation, the patient's disorders did not resolve, and in addition, she developed
symptoms characteristic of CCHS, such as loss of consciousness during sleep,
which threatened her life. Further dysfunctions such as cardiovascular and
respiratory failure and probable ischemic changes in the spinal cord and
cerebellum also developed. Respiratory stimulation drugs and oxygen
administration did not bring significant improvement, as episodes of
hypoventilation continued to occur during sleep. During one of these episodes,
the patient suffered extensive damage to the cerebral cortex, resulting in a
vegetative state.
Discussions and Conclusions: Although, central hypoventilation syndrome usually
has a genetic basis, cases of the disease resulting from complications after
neurosurgical treatment of other brainstem pathologies should not be excluded.
The case presented here aims to raise awareness of the risks associated with
these complications, which may enable earlier diagnosis of CHS and
implementation of appropriate treatment, thereby increasing the chances of
recovery.

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Comprehensive Management of Severe Traumatic Brain Injury: A Case

Report

Author: Tea Škrobo, MD1

Supervisor: Davor Mlikotić, MD2
Affiliations:
1 – Family medicine practice Davor Mlikotić MD, Zagreb, Croatia
2 – Family medicine practice Davor Mlikotić MD, Zagreb, Croatia

Background: Severe traumatic brain injury (TBI) is a leading cause of mortality

and disability in adults, often resulting from severe trauma such as traffic
accidents, falls, or sports-related injuries. These injuries typically involve complex
intracranial damage that complicates management. Early neurosurgical
intervention, intensive care, and multidisciplinary management are essential to
improve outcomes. This case highlights the challenges of acute care, the need for
continuous neurological monitoring, and the importance of early rehabilitation.

Case report: A 37-year-old male patient was admitted to the intensive care unit
after sustaining a severe TBI in a bicycle accident. Upon arrival, his Glasgow
Coma Scale score was 6, requiring urgent intubation and radiological assessment.
Imaging revealed a subdural hematoma, subarachnoid hemorrhage, diffuse
axonal injury, skull base fracture and scapular fracture. History of chronic
respiratory insufficiency and pulmonary embolism was also noted. Due to these
findings, urgent neurosurgical intervention was indicated. A right frontal burr hole
was performed for intracranial pressure (ICP) monitoring, followed by a left
frontotemporoparietal craniotomy for evacuation of the subdural hematoma.
Postoperatively, the patient remained intubated, sedated, mechanically
ventilated, and hemodynamically stable, with intensive ICP and brain tissue
oxygenation monitoring. Empirical antibiotics were started due to elevated
inflammatory markers, along with gastroprophylaxis, antiepileptic prophylaxis,
and thromboprophylaxis. The patient developed recurrent pulmonary embolism,
requiring increased doses of low-molecular-weight heparin. As sedation was
reduced, EEG and neurological assessments confirmed gradual neurological
improvement, allowing for successful extubation. Early physical therapy,
including assisted mobilization, was initiated. The patient demonstrated
progressive recovery, with stabilization of both neurological and respiratory
status.

Discussions and Conclusions: This case emphasizes the critical role of timely
neurosurgical intervention and comprehensive multidisciplinary care in managing
severe TBI. Early intervention, continuous monitoring, and rehabilitation are
essential for improving outcomes and reducing complications in complex
neurotrauma cases.

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Hyperacute Klebsiella Infection Following Brain Surgery: A Fatal Case

Report and Neurosurgical Lessons

Author: Vizitiu Alin-Stefan1

Supervisor: Florian Ioan-Alexandru2 MD, PhD
Affiliations:
1
Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
2
Clinic of Neurosurgery, County Emergency Hospital Cluj-Napoca, Romania

Background: Infections following brain surgery are uncommon and usually

preventable consequences. Hyperacute infections are even less common,
occurring primarily in immunocompromised patients with a high mortality rate.
Klebsiella infections pose considerable concerns due to their rapid propagation
and resistance to antibiotics.

Case Report: A 70-year-old male patient presented to the Neurosurgery

Department with headaches, visual field deficits, nausea, and fatigue. A brain MRI
detected a cystic tumor in the left occipital lobe, thought to be a metastasis from
lung cancer. Later, the histological examination revealed that it was a
glioblastoma. The patient underwent successful surgery, which resulted in the
total removal of the tumor. His progress in the first 24 hours after surgery was
favorable, with total symptom remission. After 24 hours, the patient complained
of increased headache, nausea, and incoherence. The CT scan revealed an
increasing volume of air within the residual cavity, most likely coming from the
subdural region. As a result, the amount of depletive drug was increased.
On the second postoperative day, the patient became unresponsive and was
admitted to the ICU. The collection was quickly evacuated, revealing a significant
infectious mass that covered the whole postoperative cavity and spread beyond
the dura mater and cranial cavity. An external ventricular drainage was inserted
for antibiotic irrigation. The microbial analysis revealed a Klebsiella infection,
which was also identified in the patient's urine. He died of sepsis-related
complications.

Discussions and Conclusions: This case demonstrates the possibility of a deadly

and rapidly progressing brain infection, even with intense and targeted therapy.
Even if this case is regarded as tragic, it offers every neurosurgeon a vital lesson:
extra precautions must be taken in the treatment of oncologic patients to avoid
hyperacute infections.

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Optimizing Surgical Outcomes in Olfactory Groove Meningioma: A Case

of Minimally Invasive Resection
Authors: Dorobanțu Miriana-Gabriela1, Ghetler Bianca-Isabel2, Vizitiu Alin-Ștefan3
Supervisor: Prof. Dr. Ioan Ștefan Florian4, Dr. Pădurean Vlad Adrian5
Affiliations:
”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca,
Romania1,2,3,4,5
Cluj County Emergency Hospital, Neurosurgery Clinic4,5

Background: Olfactory groove meningiomas (OGMs) are rare, benign tumors

originating from the arachnoid cap cells of the dura overlying the cribriform plate
in the anterior cranial fossa. They constitute approximately 2% of all primary
brain tumors and 34% of anterior cranial fossa meningiomas. Due to their slow
growth, symptoms often remain absent until the tumor reaches a significant size
(≥4 cm). When symptomatic, patients typically present with anosmia, headaches,
and personality changes, posing unique diagnostic and management challenges.

Case Report: We report the case of a 60-year-old female with a history of

hypertension, diabetes, and hepatic steatosis, who presented after an episode of
loss of consciousness, accompanied by olfactory dysfunction, visual disturbances,
memory deficits, and irritability. Neurological examination revealed intact
consciousness (Glasgow Coma Scale 15), signs of frontal lobe dysfunction,
cephalalgia, irritability, and hyposmia, but no motor deficits or meningeal signs.
Imaging confirmed a large extraneuraxial tumor in the anterior cranial fossa,
bilaterally involving the olfactory grooves.

A minimally invasive approach was chosen for surgical intervention in this case.
The surgery was performed with the patient positioned supine, via a left fronto-
lateral craniotomy followed by a subfrontal approach leading to the tumour.
Despite the tumor's extensive proliferation along the median line, the surgeon
successfully achieved total resection without resorting to the large bifrontal
craniotomy technique commonly used for such meningiomas. Postoperatively,
the patient developed transient hypertension and aphasia, both of which
improved. However, persistent hyposmia/anosmia remained, a common
irreversible outcome in advanced OGMs.

Discussion & Conclusion: While bifrontal craniotomy is a standard technique for

OGMs, it carries risks such as frontal sinus injury and vascular damage. This case
illustrates that a targeted, less invasive approach can achieve complete tumor
resection while minimizing complications. Surgical strategies should be tailored to
each case, optimizing patient outcomes with reduced morbidity.

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ORGANIZATION OF THE DORSAL ROOT OF THE SPINAL NERVE –

SYSTEMATIC LITERATURE REVIEW AND OWN OBSERVATIONS

Author: Marek Misiak

Supervisor: prof. Bogdan Ciszek
Affiliation:
WMCM UKSW; Center for Biostructure Research, WUM

Introduction: Spinal nerves connect to the spinal cord bilaterally via ventral and
dorsal roots. The current understanding is that each root is made up of 5-10
bundles of nerve fibers. The dorsal root emerges directly from the spinal cord,
containing afferent (sensory) fibers. A rhizotomy involves damaging certain nerve
fibers as a treatment for chronic pain or spasticity. The objective of the study was
to establish the anatomical pattern of spinal root bundles in relation to clinical
significance.
Materials and methods: Microanatomical dissection of the posterior roots of the
lumbar nerves L1-L5 was performed (eight cadavers fixed in 10% formalin). A
total of 80 nerve roots from L1 to L5 were examined using a Zeiss surgical
microscope. Sketches and photographs were used to document observations.
Results: The number of root's bundles and the presence of interradicular fibers
were investigated. The posterior root of the spinal nerve can be divided into 3
sections: paraspinal section, middle section, and paraganglionic one. The
patterns presented by the bundles forming the dorsal root of the lumbar spinal
nerves are characteristic for a specific section and are summarized, taking into
account the exchange of fibers between individual bundles. Anastomoses both
within the same segment and adjacent segments are taken into account in
reference to existing literature.
Conclusions: The morphology of the posterior roots of the lumbar spinal nerves is
not consistent with previous reports. It is proved that diverse morphology
depending on the root section can be found which is crucial carrying out
rhizotomy procedures. The overlap of segmental innervation ranges could be
influenced by the presence of interradicular fibers. Proper knowledge of the
organization of the posterior roots of lumbar nerves and the possible patterns
presented by the fascicles may help us to gain a deeper understanding of the
pathologies of this region.

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Severe Spinal Cavernous Hemangioma: Surgical Risks, Complications,

and the Reality of Long-Term Management

Author(s): Agnieszka Kowalczyk2

Supervisor(s): Krzysztof Nosek MD, PhD1
Affiliation(s):
1
Department of Pharmacology and Toxicology, University of Warmia and Mazury,
Olsztyn, Poland
2
Collegium Medicum, School of Medicine, University of Warmia and Mazury in
Olsztyn

BACKGROUND: Cavernous malformations are commonly found in intracranial

structures but are rare in the spine, accounting for approximately 6-11% of all
spinal vascular malformations. These lesions are characterized as benign,
enlarged vascular structures within neural tissues. Complete resection is crucial
for achieving optimal treatment outcomes. This case study presents a 50-year-old
patient with an exceptionally severe course of spinal cavernous hemangioma.

CASE REPORT: A 50-year-old patient was admitted to the Neurological

Department with severe paraparesis in both lower extremities. In June 2022 he
was diagnosed with cavernous hemangioma in the spine at thoracic level. The
first symptoms were paraparesis of the lower limbs and trunk. Bladder and
intestinal disorders appeared. Magnetic resonance imaging showed hemorrhage
of malformation. Therefore, an operation was performed, but proved
unsuccessful. The surgery was complicated with massive bleeding. Pulmonary
embolism with sudden cardiac arrest appeared one day postoperatively, following
an attempt at verticalization. The patient received antiedema drugs and steroids.
Currently, the patient presents progressive spastic paraparesis in the lower
extremities, an inability to stand without support, disturbances of deep sensation,
hypoesthesia, and pain in the lower limbs. Moreover, he self-catheterizes and
performs manual bowel evacuation. The patient does not qualify for surgery and
is treated with pregabalin, vitamin B, baclofen, and duloxetine due to pain.

DISCUSSIONS AND CONCLUSIONS: Cavernous hemangioma can lead to extremely

serious symptoms. This case report highlights the importance of rapid surgery as
the most effective way of treatment and the possible outcomes of
pharmacotherapy as the only way of treatment.

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Title: Temporal lobe abscess as the complication of cholesteatoma and

otitis media: A case report

Authors: Jakub Kurasz1 , Michał Sitkiewicz1

Supervisor: Marcin Masalski MD, PhD2.
Affiliations:
Student Research Group of Otolaryngology, University of Opole, Poland 1,
Department of Otolaryngology, University Clinical Hospital of Opole, Poland
2

Background: Chronic otitis media is an advanced stage of ear disease

characterized by a persistent infection of the middle ear without an intact
tympanic membrane. This disease can lead to the development of
cholesteatoma. As the process of cholesteatoma formation progresses, the
inflammatory and resorptive processes that erode the structures of the middle
and inner ear become increasingly active. As these processes spread
intratemporal and intracranial complications can occur. Intracranial complications
such as brain abscess may be life-threatening and require immediate surgical
intervention.

Case report: A 38-year-old patient was admitted to the Neurology Department of

WSS Hospital in Bytom following her first epileptic seizure. In the preceding week,
the patient exhibited symptoms including right ear pain, fever, and a minor
purulent effusion, reporting a long-standing history of right ear leakage. After a
week of hospitalization in the neurology department, the patient was urgently
transferred to the ENT department of the USK in Opole. Right attico-anthro
mastoidectomy with removal of inflammatory lesions was performed.
Continuation of antibiotic therapy Biotraxone, Vancomycin, Metronidazole
followed the operation. After the week of hospitalization, the patient was
transferred to the Neurology Department of WSS Hospital in Bytom due to poor
mental state caused by separation from her family.

Discussion and Conclusion: Ear infections followed by pathological neurological

symptoms and history of purulent discharge from the ear should always raise
vigilance among medical specialists. It is crucial to implement rapid surgical
intervention and appropriate antibiotic treatment as soon as possible in order to
manage the patient's deteriorating condition.

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ORTHOPEDICS AND TRAUMA

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Genicular Artery Embolization – A Breakthrough Solution for Chronic

Knee Pain

Authors: Pola Bakalczuk, Natalia Dziuba, Jakub Florek

Presenting Author: Pola Bakalczuk
Supervisor: Krzysztof Pyra, MD, PhD, Marcin Czeczelewski MD
Affiliations:
Students’ Scientific Society at the Department of Interventional Radiology and
Neuroradiology, Medical University of Lublin

Background: Osteoarthritis (OA) - degenerative disease of the synovial joints

characterized by the progressive chondral wear and bony remodeling, which
manifests clinically as joint pain and dysfunction, affecting quality of life. When
standard treatments fail to provide lasting relief, alternative approaches such as
Genicular Artery Embolization (GAE) may offer a promising solution for managing
knee OA with minimal invasiveness.

Case Report: A female patient with chronic right knee pain and recurrent joint
effusions was initially evaluated in November 2022. MRI revealed marked
synovial hypertrophy, significant joint effusion, fluid in gastrocnemius-
semimembranosus bursa, 4 mm lateral displacement of the patella in full
extension, Dejour type B, and chondropathy grade III/IV. Despite an initial
improvement following Diprohos injections, her symptoms persisted. In
September 2024, due to ongoing functional limitations, she underwent GAE under
local anesthesia. Vascular access was obtained via the left femoral artery. Vert
catheter was introduced into the distal segment of the right superficial femoral
artery, followed by angiography of the popliteal artery. Congestion of the lateral
knee was observed, primarily supplied by the lateral superior and lateral inferior
genicular arteries. ProGreat 2.0 catheter and a Traxcess guidewire were advanced
into these vessels, and embolization was performed using 250 µm particles.
Control angiography confirmed effective reduction of congestion. The procedure
was uneventful, and the patient was discharged with recommendations for
limited weight-bearing, knee bracing, and pharmacologic support.

Discussions and Conclusions: GAE presents a promising and effective alternative

for managing chronic knee pain which is unresponsive to conventional
treatments. In this case, the procedure resulted in significant reductions in
synovial inflammation and joint effusion, alongside notable improvements in pain
relief and functional capacity, though a minor extension deficit remained. These
outcomes highlight the potential of GAE as a minimally invasive treatment for
degenerative knee conditions, emphasizing the need for further clinical research.

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Reconstruction of a Proximal Humerus Anatomical Neck Fracture with a

Femoral Head Osteochondral Allograft: A Case Report
Author: Martin Bobek1, Jakov Kožić1, David Glavaš Weinberger2, DinkoVidović1,2
Supervisor: Tomislav Ćuti2
Affiliations:
1
School of Medicine, University of Zagreb, Zagreb, Croatia
2
Department of Sports Traumatology, Traumatology Clinic, University Hospital
Center Sisters of Charity

Background: Posterior shoulder dislocation is rare and accounts for approximately

4% of shoulder dislocations. It typically occurs during convulsions or
electrocution. Anatomical neck fracture of the humerus is rarely a complication of
posterior shoulder dislocation. Femoral head osteochondral allografts are
infrequently used to manage proximal humerus fractures. We report the case of a
patient with posterior shoulder dislocation complicated by the fracture of the
humeral anatomical neck requiring reconstruction and osteosynthesis using a
femoral head allograft.
Case Report: A 43-year-old male patient presented to the emergency department
in February 2024 with a posterior shoulder dislocation following a seizure due to a
cocaine overdose. Closed reduction was attempted unsuccessfully, and therefore,
open reduction was performed. Postoperative CT scan showed a large Hill Sachs
defect with posterior Bankart fracture. During the hospital stay, the patient had
another posterior shoulder dislocation following a fall. CT scans revealed a
displaced multifragmentary anatomical neck fracture of the humerus with
dislocation. The patient underwent open reduction with internal fixation and
reconstruction of the humeral head with a tissue-banked osteochondral femoral
head allograft. Control radiographs showed good implant position and joint
congruence. Six months postoperatively, he underwent further supraspinatus
tendon reconstruction. At his last follow-up, 1 year postoperatively, the patient
reported subjective improvement with adequate range of motion and the ability
to conduct all activities of daily living.
Discussions and Conclusions: This case report showcases the successful outcome
of reconstructive surgery using a femoral head allograft for displaced anatomical
neck fractures. Osteochondral humeral head allografts have been used to treat
large Hill Sachs defects but rarely for displaced fractures with low healing
potential. The report emphasizes the potential role of allografts in complex
shoulder reconstructions and highlights the importance of considering alternative
treatment techniques for complex fractures.

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Application of 3D printing in orthopedics – literature review

Authors: Szymon Kania¹, Aleksandra Ciżyńska¹, Aleksandra Białek¹, Wiktor Babiuch¹,
Wiktoria Szymczak¹
Supervisor: PhD Paulina Gil – Kulik¹
Affiliation:
¹Students Scientific Association at the Department of Clinical Genetics, Medical
University of Lublin, Lublin, Poland

Introduction: 3D printing is revolutionizing medicine, particularly in surgical fields

such as orthopedics. This technology enables the precise customization of
medical devices, offering tailored solutions for individual patients. Its applications
range from implants to orthoses, significantly enhancing bone integration and the
restoration of mechanical function.
Materials and Methods: This review was developed through a comprehensive
literature search on the PubMed database. The search utilized the keywords “3D
printing,” “implants,” and “orthopedics” to identify relevant studies discussing
the impact and technological advancements of 3D printing in medicine. The
selection covered publications from 2020 to 2025 to ensure the inclusion of the
most recent developments in the field.
Results: The findings reveal that 3D printing facilitates the production of highly
personalized implants with optimal biocompatibility and surface characteristics.
The creation of microporous structures promotes improved osteointegration, a
breakthrough in implant technology. Additionally, the entire process—from design
to manufacturing—can be completed within 24 hours, although a rapid approach
may sometimes compromise design precision. Technological progress is driving
down costs, yet the initial investment, ongoing maintenance, and stringent
material sterilization requirements continue to pose challenges.
Conclusions: The integration of 3D printing in orthopedics offers transformative
potential, particularly through its ability to tailor implants to the unique anatomy
of each patient. Despite the clear advantages, significant hurdles remain,
including high costs and the need for specialized training among orthopedic
surgeons. Future advancements in both technology and professional education
are essential to fully harness the benefits of 3D printing in improving patient
outcomes.

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Unequal battle with the unknown – Case report: Recurrent infection with an
unknown pathogen after anterior cruciate ligament (ACL) reconstruction

Author: Zofia Głuchowska

Co-author: Dominika Miazga
Supervisor: dr n. med. Andrzej Ciszewski
Affiliation:
Student Scientific association at the Department of Paediatric Ortopedics and
Rehabilitation, Medical University of Lublin

Background: Joint infection after ACL reconstruction occurs in less than 2% of

patients and is considered a rare but severe complication. Diagnosis of septic
infection is based on laboratory markers of inflammation, imaging, and synovial
fluid analysis, including volume, appearance, cytology, and smear. Treatment
involves prolonged antibiotic therapy, punctures, rinsing, and surgical cleaning of
the joint. Despite this, infection can lead to permanent cartilage damage, graft
failure, and the need for graft removal.

Case Report: A 17-year-old patient, following ACL reconstruction with a hamstring

tendon graft and intraoperative antibiotic therapy, presented to the clinic with
pain and swelling in the operated knee. Due to inconclusive synovial fluid
analysis, empiric oral antibiotics were started. Magnetic resonance imaging
revealed graft loosening. The patient was admitted for arthroscopic inspection,
during which a revision ACL reconstruction was performed. One month later, the
patient returned to the emergency department with recurrent pain and significant
swelling. Punctures were performed. Synovial fluid analysis and low inflammatory
markers prompted intravenous antibiotic therapy. Multiple cultures and Multiplex
PCR tests failed to identify the pathogen. A second arthroscopy was performed
due to persistent swelling. Removal of the infected graft, joint cleaning, and
prolonged antibiotic therapy were necessary. Despite this, five months later
infection recurred, causing grade 4 chondromalacia, another joint cleaning and
three-month antibiotic therapy were initiated. Patient now awaits knee prosthesis
surgery.

Discussions & Conclusions: Infection after ACL reconstruction may present with
negative microbiological cultures and Multiplex PCR results. Prolonged antibiotic
therapy combined with punctures and surgical cleaning may prove ineffective.
Diagnosing and managing such infections is challenging and can have tragic
consequences. Repeatedly preoperative patient washing, surgical site cleaning,
soaking the graft in antibiotics, and careful postoperative care reduce the risk of
infection but never eliminate it entirely.

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Exploring Approaches: Surgical Incisions in Hip Replacement

Author: Giurgiu Alexandru-Radu1

Co-author: Gavra Marta-Adriana²

Supervisor: Dan Fruja³

Affiliation:
1,2
Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca
³ ”Vasile Goldis” West University Arad, Romania; Orthopedic Department,
Emergency Clinical County

Introduction: The hip replacement surgery consists of replacing the diseased

bone tissue and the cartilage with artificial parts. There are lots of surgical
approaches proposed for this procedure, every one of them having their negative
effects on multiple groups of muscles. This review aims to analise the advantages
and disadvantages each approach has and to see which will result in less
complications in post surgical rehabilitation.

Materials and Methods: A search was done on PubMed using the key words "hip
replacement", "hip replacement approach", "Smith-Petersen", "Modified
Hardinge". Clinical trials and randomized controlled trials were selected based on
the following criteria: full text available, published after the year 2005, the study
to be written in english, done on humans aged over 19 years old.

Results: Out of the 261 results found, 10 were selected and analised 1256
pacients, 21% were operated using the direct anterior approach, 19% posterior,
40% lateral and 17% minimally invasive and 3% other techniques. The anterior
approach has a 6% higher risk of nerve injury, but it requires less recovery time.
Reduced pain is associated with the approaches damaging smaller and less
muscles, like the anterior one and the bikini incision.

Conclusions: Robotic-assisted surgery with digital preoperative planning provides

the best outcomes overall in terms of precision and post-operative recovery.
However, the anterior approach can be advantageous for those prioritizing quick
recovery, while the posterior approach remains a robust option for broader
patient demographics.

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The fracture that hid the disease - the case of a 14-year-old patient with
osteosarcoma.

Authors: Magdalena Kijowska 1, Karolina Klusek 1, Maria Kiełbus 1

, Justyna Turczak
Supervisor: Andrzej Ciszewski, MD, Ph.D. 1,2
Affiliation:
1. Students' Scientific Association at the Department of Paediatric
Orthopaedics and Rehabilitation, University Children's Hospital in
Lublin, UM Lublin, Poland
2. Department of Paediatric Orthopaedics and Rehabilitation, University
Children's Hospital in Lublin, Poland

Background: Low-energy fractures in children are often underestimated, although

they may be the first sign of tumours. Bone sarcomas, like osteosarcoma,
account for approximately 5% of malignant tumours in children. These neoplasms
commonly occur in the long bones, especially around the knee. For
osteosarcoma, survival is 64% with localised disease and 28% with metastases.

Case report: We present the case of a 14-year-old female patient who fractured
her left femur due to a minor trauma. The fracture was repositioned and
stabilised with a plate. Several days later, the girl presented to the ED with pain
and a haematoma of the operated limb. The patient was qualified for surgery
with a suspected purulent infection of area. After opening the wound, a massive
haematoma with severe bleeding was visualised. The gelatinous masses were
removed and fragments were taken for histopathological examination. After
surgery, she was transferred to the ICU, where broad-spectrum antibiotic therapy
was given. After a few days, she was transferred to the Department of
Orthopaedics and Rehabilitation, where examinations continued. X-ray of the
lungs showed possible metastatic changes, similarly around the bones. The MRI
and CT showed extensive destruction of the left femur and a heterogeneous mass
in the immediate area of the popliteal vessels. Following the test results, the
patient was transferred to a high-reference oncology unit for treatment.

Discussions and conclusions: A pathological fracture can be an 'alarm signal' of a

serious underlying disease. In the case of fractures that don’t correspond to the
mechanism of injury, it may be necessary to examine the patient more closely,
especially as the skeletal system in children is usually stronger than in adults.
Symptoms such as pain, swelling or deformity in the area of fracture should be
carefully monitored, and should prompt physicians to perform additional tests
and biopsy.

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Rupture of an accessory spleen caused by blunt trauma

Authors: Agata Grochowska

Supervisor: Piotr Arkuszewski, MD, PhD
Affiliation:
Students’ Scientific Club of Biomedicine and Experimental Surgery, Medical
University of Lodz, Lodz, Poland

Introduction: The accessory spleen is quite a common abdominal anomaly.

However, the traumatic accessory spleen rupture is a highly infrequent condition
requiring surgical intervention. A few instances of traumatic accessory spleen
were described in the professional literature. The study aims to evaluate
traumatic accessory spleen rupture cases regarding their causes, clinical course,
and possible diagnosis without surgery and treatment.

Materials and methods: Desk research method was implemented using available
online databases. Descriptive methods were employed to analyze the collected
data. The results are summarized in the table concerning gender, age, injury
details, accessory spleen injury characteristics, treatment, and others such as
previous splenectomy or primary spleen involvement in injury or accompanying
abdominal injuries.

Results: In total, there were 9 cases of traumatic accessory spleen, of which 2

were managed conservatively, and the remaining 7 were treated operatively. All
the patients survived. One-third of all included patients already had their primary
spleen removed, which facilitated the diagnosis of traumatic rupture of an
accessory spleen. The proper diagnosis of an accessory spleen rupture was
concluded in 2 cases and confirmed in surgery.

Conclusion: The recognition of the traumatic rupture of an accessory spleen

before surgery is challenging but can be made easier if the patient has
undergone a splenectomy. The traumatic accessory spleen rupture does not
coexist with an injury of the primary spleen.

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Plastic Surgery & Breast Surgery

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Clinical Management of Luminal B Breast Cancer: A Case Report

Authors: Vana Stojić 1 , Ilona Sušac 2, Ana Šoštarić Zadro 3 Boris Zdilar 1
Supervisor : Zvonko Zadro 1
Affiliations:
1 Department of Plastic and Reconstructive Surgery, Clinical Hospital “Sveti Duh”,
Zagreb, Croatia
2 Department of Oncology and Interventional Pulmonology, Clinical Hospital “Sveti
Duh”, Zagreb, Croatia
3 Department of Ultrasound Diagnostics and Radiology , Special Hospital for
Pulmonary Diseases, Zagreb, Croatia.

Background: Breast cancer remains the most common invasive cancer in women
worldwide, with invasive ductal carcinoma being the most common histological
subtype. The St. Gallen classification is a consensus-based guideline in which
subtypes are classified by immunohistochemical staining: luminal A, luminal B
HER2-negative, luminal B HER2-positive, HER2-negative non-luminal, or basal-
like. It is used to determine treatment options and prognostic outcomes. Luminal
B type is defined by aggressive clinical behaviour and has a prognosis similar to
that of non-luminal cancers. The recurrence pattern and clinical prognosis of the
luminal B subtype should raise concern.

Case report: A 57-year-old patient presented with a lump in the upper outer
quadrant of the right breast. Cytological puncture of the lesion showed epithelial
hyperplasia with atypia. Core needle biopsy was inconclusive. After breast
segmentectomy, a tumour 2.5 cm in diameter, as well as another tumour 1.5 cm
away from the primary, were described. The final pathohistological diagnosis was
invasive multicentric ductal cancer, Grade III. Tumour was classified as Luminal B
according to the St. Gallen 2013 classification, indicating a hormone receptor-
positive status with a higher proliferation rate compared to Luminal A tumours. It
was estrogen receptor positive (Er+), progesterone receptor negative (Pr-), HER2-
negative (Her2-), with high Ki-67 expression of 30%, and androgen receptor
positive. The patient underwent surgery, chemotherapy, and endocrine therapy
with abemaciclib, letrozole, and ibandronate sodium. Two years later, follow-up
assessments showed no recurrence, metastases, or secondary cancer.

Discussions and Conclusions: Personalized treatment for each breast cancer type
is crucial. The combination of surgery, chemotherapy, and endocrine therapy in
our patient showed effective disease management.

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Fasciocutaneous flap reconstruction in the treatment of radiation

necrosis: a case report

Authors: Ivan Ruxandra, Peptu Petronela

Supervisor: Lecturer Tamaș Camelia
Affiliation:
Emergency County Hospital "St. Spiridon", University of Medicine and Pharmacy
"Grigore T. Popa", Iași, Romania

Background: Radiation necrosis is an uncommon but severe consequence of

radiation therapy given to destroy cancer cells.The surgical therapy for
radionecrosis is complex and the first step - excision of necrotic tissue- is
crucial.The surgical reconstruction of the resulting soft-tissue defect may use a
regional fasciocutaneous flap, after a correct local preparation.

Case report: A 70-year-old woman was initially operated for cervical neoplasm 20
years ago. The surgical treatment has consisted of total hysterectomy with
bilateral salpingo-oophorectomy which was accompanied by radiotherapy.
Currently, the patient addresses the Plastic Surgery Clinic consultation and
treatment, accusing pain while walking, itching and burning sensation located on
a sacral lesion. The symptoms debuted 5 years ago and the local examination
revealed hyperpigmentation in the affected area, indurated borders, ulceration,
purulent discharge and firm edema. The medical team has concluded to a
supposition of trophic disorder after radiotherapy. The patient was subjected to
two different surgical procedures for treatment. The first operation aimed the
excision of the ulceration surrounded by the modified skin, followed by
pathological examination. In this procedure, a negative pressure wound therapy
system was also installed to stimulate the local vessels to develop. Secondly, the
surgical team reconstructed the affected area by doing two gluteal
fasciocutaneous flaps. The gluteal flaps were mobilized to cover the wound and
fixed with deep suturing. The long-term succes of this proceeding is confirmed by
the use of negative pressure wound therapy to drain the exsudate from the
defect and to accelerate the local granular tissue development, before
reconstruction.

Discussions and Conclusions: The fasciocutaneous flap is a vital and versatile

surgical technique, particularly in treating complex tissue defects like
radionecrosis. Beyond this case, it is essential in reconstructive surgery for
trauma, infections, and chronic conditions, the correct preparation of the defect
using negative pressure wound therapy when indicated.

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Juvenile gynecomastia – surgical treatment

Authors: Dora Biškup1, Ana Katić2, Antonija Jurišić1

Supervisor: Rok Kralj1
Affiliation:
1
Department of Pediatric Surgery, Children's Hospital Zagreb, Croatia
2
Institute for Emergency Medicine, Karlovac County, Croatia

Background: Gynecomastia is a benign enlargement of the breasts in the male

population, involving glandular and/or fatty tissue. Pediatric gynecomastia results
from a multifactorial imbalance of estrogen and androgens. In more than 95% of
cases, the development of gynecomastia is idiopathic.
Case Report: A 17-year-old male patient presented to an endocrinologist for
evaluation of enlarged breasts. Two years prior, due to significant breast
enlargement, he decided to lose weight and lost 22 kg over a one-year period.
Despite the weight reduction, breast enlargement persisted at Tanner stage 2,
with larger and darker pigmented areolas that were not protruding. Laboratory
results, including AST, ALT, GGT, albumin, alpha-fetoprotein (AFP), beta-hCG,
prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH),
testosterone, DHEAS, and estradiol (E2), were all within normal limits. A
karyotype analysis confirmed a normal male result (46, XY). Breast ultrasound
showed fibroglandular parenchymal proliferation without suspicious lesions.
Based on the clinical presentation and pubertal development stage, surgical
treatment was indicated, and a reduction of fibroglandular tissue and excess skin
was performed using the Webster technique. A subareolar incision was made,
and the fibroglandular mass was removed using a combination of sharp and blunt
dissection, separating it from the pectoral muscle fascia. Due to a persistent
postoperative hematoma in the left thoracic wall area, a revision surgery was
performed three days later. Through an infraareolar incision, clotted and fresh
blood was evacuated, hemostasis was achieved using bipolar cautery, and a
drain was placed along with a compressive dressing.
Discussions and Conclusions: Gynecomastia in teenagers is self-limiting within 1
to 3 years in 84% of mild cases, 47% of moderate cases, and 20% of severe
cases. If it does not regress within two years, surgical treatment is indicated.

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Surgical approach to large and neglected melanoma

Authors: Mirta Košćak1, Marta Krpan1, Jakov Kožić1, Mila Kostić1
Supervisor: Sanda Smuđ Orehovec2
Affiliations:
¹School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
2
Department of surgery, Division for plastic surgery, University Hospital
Centre Zagreb, Zagreb, Croatia

Background: Melanoma is a malignant tumor of melanocytes, the cells that

produce the pigment melanin. Because of its extremely aggressive nature, early
detection and surgical treatment are key to a favorable prognosis. This case
presents the treatment of a patient with a large and neglected melanoma.
Case Report: In 2019, an elderly female patient was admitted to the emergency
department due to a lump on her back noticed a year earlier. A biopsy under
ultrasound guidance confirmed melanoma. Furthermore, a CT scan revealed the
following: multiple, partly necrotic tumor nodules on the left side of the body,
including a subpectoral nodule measuring 8cm, a laterally located nodule in the
breast measuring 8.3cm, an axillary nodule measuring up to 3cm and a
retroscapular nodule measuring 7cm. In the left posterior part of the subclavian
artery, nodules measuring up to 1.2cm were detected. Two nodules were
identified in the right lung–one in the base of the upper lobe and the other in the
middle lobe, measuring 1.2cm and 2cm. Further treatment included systemic
immunotherapy (nivolumab) and surgery. In 2020, surgery was performed to
excise metastases in the chest and back, including affected muscles (m.
pectoralis major and minor, part of m. latissimus dorsi, m. serratus anterior, m.
teres minor and major and m. infraspinatus), and to expose and ligate axillary
and subclavian vessels, as well as the brachial plexus. Additionally, a
subcutaneous mastectomy of the left breast and excision of cutaneous
metastases on the back were performed. Defects were repaired with locally
rotated flaps. Postoperative care proceeded without complications. In 2021, the
patient died due to COVID-19.
Discussions and Conclusions: This case report higlights the importance of
multidisciplinary approach to melanoma treatment, combining immunotherapy
and surgery. The specific clinical characteristics of the presented patient
demonstrate strategical planning, as well as succesfull performance of this
procedure.

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Adjusted treatment of invasive breast cancer in a young patient with a

history of Non-Hodgkin lymphoma
Authors: Fran Popović1; Lea Paradinović1; Ivan Dulić2; Dora Petričević3; Eleonora Suvaljko4;
Marko Babić5
Supervisor: Marko Babić5
Affiliations:
1 – Osijek – Baranja County Health Centre, Osijek, Croatia
2 – Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek,
Croatia
3 – Emergency Department of Clinical Hospital Centre Osijek, Osijek, Croatia
4 – Institute for Emergency Medicine of Zadar County, Zadar, Croatia
5 – Department of Plastic, reconstructive and aesthetic surgery, University
Hospital Centre Osijek, Croatia

Background: Non-Hodgkin lymphoma (NHL) is a malignant tumor of lymphocytes,

while invasive breast cancer (IBC) originates from the epithelium of the terminal
ducts in the breast. This case report aims to explore the treatment adjustments
and potential correlation between these two diseases.

Case report: We present the case of a 36-year-old woman who was diagnosed
with NHL at the age of 23. The lymphoma was localized in the mediastinum and
the upper left lung lobe. After eight cycles of chemotherapy combined with
radiotherapy, complete remission was achieved. Since then, she has been
regularly monitored, with no signs of B symptoms, and has given birth to three
children. In August 2022, a breast ultrasound revealed a fibroadenoma, classified
as BI-RADS 2. However, in March 2023, a follow-up CT scan showed a spherical
enlargement of the left pulmonary hilum, although other tests excluded a
recurrence of NHL. In May 2024, a follow-up breast ultrasound revealed the same-
sized fibroadenoma, but a hypoechogenic area above, classified as BI-RADS 4C. A
core biopsy was performed, revealing an infiltrative process at the 3 o’clock and a
fibroadenoma at 12 o’clock in the left breast. Histopathology confirmed IBC. Due
to the previously radiated mediastinum, the multidisciplinary team indicated
mastectomy and adjuvant chemotherapy. In July 2024, subcutaneous
mastectomy and sentinel lymph node excision in the left axilla were done, along
with the placement of a prepectoral breast implant. Two months postoperatively,
she began chemotherapy. A follow-up PET CT showed a reactive lymph node,
which required only observation.

Discussions and Conclusions: In patients with a history of NHL treated with

radiotherapy, the management of subsequent IBC requires careful consideration.
Due to the previous radiotherapy, mastectomy is preferred over quadrantectomy.
Furthermore, this case suggests a possible link between NHL and IBC, requiring
further research into the potential correlation between these two malignancies.

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The Journey of Delayed Multistage Breast Reconstruction Following

Invasive Ductal Carcinoma: a Case Report
Author: Bianca-Isabel Ghetler1
Co-author: Alin-Stefan Vizitiu1, Elena-Cristiana Cretu1, Miriana Dorobantu1;
Supervisors: Lecturer Maximilian Muntean1,2, MD, PhD, Adrian Pascu1,2, MD;
Affiliations:
1
“Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
2
“Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca, Romania

Background: Breast cancer (BC) is a leading malignancy in women, with invasive ductal carcinoma
being the most common subtype. Mastectomy’s physical and psychological impact necessitates
reconstruction to restore form and function. Multistage reconstruction with tissue expansion, implants,
and fat grafting optimizes outcomes.

Case Report: We report the case of a 48-year-old female patient, who presented with a palpable mass
in the upper-external quadrant of the left breast, with no suggestive family history. The patient was
diagnosed with invasive ductal carcinoma based on biopsy findings following imaging investigations.
She received neoadjuvant chemotherapy, followed by a skin-sparing mastectomy to preserve the
natural contour of the breast. Postoperative radiotherapy was administered to reduce recurrence risk.
After achieving remission, a staged breast reconstruction was initiated. A submuscular tissue expander
was placed beneath the pectoralis major muscle in the mastectomy pocket and gradually inflated with
50 mL of saline weekly, ensuring adequate soft tissue adaptation while minimizing skin tension. In a
second-stage procedure, the expander was replaced with a silicone breast implant, achieving improved
projection and contour. To further refine the aesthetic outcome, autologous lipofilling was performed
using fat harvested from the anterior abdominal wall through liposuction, in order to enhance the
natural appearance of the reconstructed breast. Given the patient’s desire, a prophylactic mastectomy
of the contralateral breast was performed concurrently with implant placement, ensuring symmetry
and reducing future oncologic risks.

Discussions and Conclusions: The combination of implant-based reconstruction and lipofilling

provided a natural, symmetrical outcome while addressing oncologic safety. The preventive
mastectomy of thecontralateral breast contributed to risk reduction and aesthetic harmony. The
psychological impact of breast mastectomy was significant, reinforcing the importance of a patient-
centered approach. This case underscores the benefits of a multistage reconstructive strategy
integrating oncologic safety, advanced surgical techniques, and aesthetic refinements, emphasizing the
need for personalized treatment approaches in BC survivors.

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Posterior Thigh Flap as Decubitus Ulcer Treatment for a Patient with

Arnold-Chiary type II Malformation

Authors: Dora Petričević1; Ivan Dulić2; Fran Popović3; Želimir Orkić4

Supervisor: Marko Babić4
Affiliations:
1 –Emergency Department, Clinical Hospital Centre Osijek, Osijek, Croatia
2 – Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
3 – Osijek-Baranja County Health Centre, Osijek, Croatia
4 – Department of Plastic, Reconstructive and Aesthetic Surgery, Clinical Hospital
Centre Osijek, Osijek, Croatia

Background: Arnold-Chiary malformation type II is a congenital anomaly

characterized by the descent of the cerebellum through the foramen magnum
and meningomyelocele. Patients with this diagnosis are often wheelchair-bound
and therefore susceptible to developing pressure ulcers. By presenting this case,
we want to show how a posterior thigh flap procedure improved the quality of life
of a young patient by eliminating a difficulty that developed as a complication of
his underlying disease.
Case Report: We present a case of a 17-year-old male born with Arnold-Chiary
malformation type II. In his childhood patient underwent lumbar
meningomyelocele surgery and third ventriculostomy for hydrocephalus. The
patient has paraparesis and is in a wheelchair which is why he developed a
decubitus ulcer grade III of left gluteal region. He was initially admitted to the
Department of Pediatric Surgery where Vacuum Assisted Closure (VAC) was
placed following the surgery where ulcus excision and gluteus maximus
fasciocutaneous V-Y advancement flap was performed. However, the patient was
readmitted due to Proteus Mirabilis infection which compromised the effect of the
previous surgery. After antibiotic treatment, the patient was admitted to the
Department of Plastic Surgery and a posterior thigh flap was performed. In this
operation the ulcer was excised and a myocutaneous flap was placed in its place
with the interposition of part of the m. biceps femoris on the vascular pedicle of
the deep femoris artery and the donor site was primarily closed. After a routine
postoperative recovery, the patient was discharged and is being monitored in the
outpatient clinic with local improvement.
Discussion & Conclusion: This case report highlights how various flaps play a
crucial role in addressing decubitus ulcers as a complication of the primary
illness, effectively promoting wound healing and significantly improving the
patient's quality of life.

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Cardiac Surgery & Interventional

Cardiology

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First use of the True Flow balloon as a bridge to TAVI via central access
in Poland in a patient with an LVEF of 13% and an AVA of 0.2 cm².

Authors: Aleksandra Ciżyńska¹, Szymon Kania¹, Aleksandra Białek¹

Supervisor: Prof. UM Kamil Baczewski, MD, PhD²
Affiliation:
¹Students Scientific Association at the Department of Cardiac Surgery, Medical
University of Lublin, Lublin, Poland
²Department of Cardiac Surgery SPSK4, Medical University of Lublin, Lublin, Poland

Background: Severe aortic stenosis is a leading cause of heart failure, with TAVI
being the treatment of choice for high-risk patients. When peripheral access is
not feasible, central access via the ascending aorta serves as an alternative. The
use of continuous-flow balloons, such as the True Flow balloon, can be crucial for
maintaining hemodynamic stability during the procedure in some cases.

Case Report: A 68-year-old patient was admitted to the cardiology department

due to exacerbation of heart failure symptoms. Echocardiographic examination
revealed extremely severe impairment of left ventricular systolic function (LVEF –
13%) and AVA – 0.2 cm². Outcomes also showed single-vessel coronary disease,
atherosclerotic wall changes in the aortic, 50% stenosis of the left internal carotid
artery and 70% stenosis of the right one, which determined that TAVI could not
be performed via peripheral access (femoral and carotid arteries). Central access
was chosen as it additionally allows preparation for extracorporeal circulation
support during the procedure. As a bridge for valve implantation a True Flow 22
balloon was used providing no need for cardiac stimulation and no risk of patient
decompensation during balloon inflation when blood flow was temporarily halted.
Subsequently, an Evolut PRO+ 34 valve was implanted through the ascending
aorta access. The procedure was uneventful.

Discussion and Conclusions: The absence of peripheral access for TAVI

implantation does not preclude the successful completion of the procedure.
Moreover, the use of a continuous flow balloon reduced the risk of patient
decompensation at the critical moment prior to aortic valve implantation. Careful
planning of the surgical procedure and consideration of various complication
scenarios enabled a successful surgical intervention, ultimately saving the
patient's life.

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Intraoperative vasoplegic shock as a complication of cardiopulmonary

bypass

Authors: Michał Janusz, Krzysztof Sankowski, Olivia Ogorzałek

Supervisor: Prof. Marek Cisowski MD, PhD, Witold Gwóźdź MD
Affiliation:
Students’ Scientific Association of Cardiac Surgery, University of Opole

BACKGROUND: The cardiopulmonary bypass (CPB) machine is commonly used in

various cardiac surgeries. The most frequent complications associated with CPB
include lung injury, embolization, neurological damage, and kidney dysfunction.
These complications are often recognized postoperatively rather than during the
procedure.

CASE REPORT: A 63-year-old male patient was admitted to the cardiac surgery
ward for a planned coronary artery bypass grafting procedure. The surgery began
with a median sternotomy, followed by harvesting of the left saphenous vein and
left internal thoracic artery. After atrial and aortic cannulation, the
cardiopulmonary bypass was initiated. Within three minutes, the patient’s blood
pressure suddenly dropped to 50/20 mmHg. Patient cooling to 30 degrees celsius
was initiated and ice was applied to the patient’s head to prevent potential brain
injury. Norepinephrine and vasopressin were administered to raise the blood
pressure, but without the desired effect. The surgeon proceeded with LIMA-LAD
and SV-IM anastomoses. By the end of the procedure, the blood pressure was
80/45 mmHg. Postoperative interleukin-6 levels were measured at 2500 pg/ml,
which decreased to 1000 pg/ml the following day. The low blood pressure was
managed with norepinephrine and stabilized after three days.

DISCUSSIONS AND CONCLUSIONS: Vasoplegic shock associated with CPB is an

immunological reaction triggered by the activation of the complement system.
Although rare, this potentially fatal reaction could be avoided by, for example,
performing off-pump cardiac surgeries. A question remains: Is there any
preoperative factor that could be identified to help prevent such complications?

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Neurological disorders after successful surgery of post-myocardial

infraction ventricular septal defect

Authors: Krzysztof Sankowski, Michał Janusz, Olivia Ogorzałek

Supervisors: Prof. UO Marek Cisowski MD, PhD, Witold Gwóźdź MD
Affiliation:
Students’ Scientific Association of Cardiac Surgery, University of Opole

BACKGROUND: Cardiac surgery, despite medical progress, carries the risk of

postoperative complications incuding heart rhythm disorders, thromboembolic
complications, heart failure, but also neurological disorders like ischemic stroke
and postoperative encephalopathy
CASE REPORT: A 76-year-old woman was admitted to the hospital due to an
episode of depression and chest pain three days earlier. An ECG revealed ST
elevation in leads V2 to V4, however the echocardiogram showed a ventricular
septal defect with a diameter of 10 mm. A head CT scan was performed, ruling
out central nervous system pathologies. The heart team decided to postpone the
surgery and in case of hemodynamic deterioration, to implement intra-aortic
balloon counterpulsation. The patient spent three weeks in the cardiology
department, during which no neurological abnormalities were observed. After this
period the procedure was performed. Thrombi and necrotic endocardial tissue
fragments were removed. The VSD was successfully closed as confirmed by
intraoperative transesophageal echocardiography. Postoperatively, the patient
was admitted to the intensive care unit. In the following days, she periodically
opened her eyes and made spontaneous head movements but showed weak
responses to external stimuli, including painful stimuli. A neurological
consultation revealed decreased muscle tone in all four limbs, absence of deep
tendon reflexes and a positive Babinski sign on the left side. A CT scan of the
head was performed, revealing a fresh infarction in the left frontal region. After
37 days, she was discharged to the cardiac surgery unit, the patient exhibited
dysphoric symptoms, was agitated, and experienced a reversal of the sleep-wake
cycle. After a few days, her condition improved. She was oriented to time, place,
and person and was discharged.
DISCUSSIONS AND CONCLUSIONS: Neurological complications are relatively rare
after cardiac surgery. The most common neurological complication is
postoperative encephalopathy, which manifests as confusion, delirium, cognitive
dysfunction, and agitation.

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Mitral valve surgery without aortic cross-clamping – a new gold

standard?

Authors: Adrian Kasprzyk 1, Karolina Klusek 1, Magda Kijowska 1, Aleksandra Głogowska 1,

prof. UM Kamil Baczewski, MD, Ph.D. 1,2
Supervisor: Prof. UM Kamil Baczewski, MD, Ph.D. 1,2
Affiliation:

1. Students Scientific Association at the Department of Cardiac Surgery, Medical

University of Lublin, Lublin, Poland
2. Department of Cardiac Surgery SPSK4, Medical University of Lublin, Lublin,
Poland

Background: Mitral valve repair surgeries under beating-heart conditions present

a clinical challenge, particularly in patients with advanced ascending aortic
atherosclerosis. The need to limit manipulation of the aorta to reduce the risk of
embolism and damage to calcified structures has become the foundation for the
development of alternative surgical strategies. One such technique is beating-
heart cardiac surgery, which allows for minimizing the risk of complications
compared to traditional methods that require aortic cross-clamping.

Case Report: The aim of this study is to analyze three cases of patients who
underwent mitral valve repair with ring implantation under beating-heart
conditions. The study evaluates the risks of using this method in patients with
comorbidities and its effectiveness compared to traditional techniques that use
cardioplegia.

In the analyzed cases, an advanced surgical technique was used with access
through a right-sided thoracotomy, allowing for surgery on a beating heart. The
decision to use this procedure was based on the presence of advanced aortic
atherosclerosis, which was associated with a high risk of complications such as
embolism or damage to the calcified aorta. Peripheral cannulation was performed
through the right femoral vein and left femoral artery, ensuring adequate
perfusion. The mitral ring implantation technique was performed using single
sutures and the Cornot instrument. The procedure was completed without
complications, including bleeding or air embolism.

Discussions and Conclusions: Beating-heart surgery with extracorporeal

circulation and without aortic cross-clamping is a safe and effective alternative to
traditional methods in the treatment of mitral valve disease, particularly in
patients with aortic atherosclerosis. This technique reduces aortic manipulation,
minimizing the risk of complications such as embolism or aortic injury, and lowers
perioperative mortality. Additionally, this method helps reduce the length of
hospitalization for patients undergoing the procedure. In the analyzed cases, the
procedure demonstrated high effectiveness, with no complications related to
bleeding or air embolism.
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Penumbra system usage in acute PE: a review paper

Authors: Valentyna Levadna1, Veronika Kobylianska1

Supervisor: Bartosz Kondracki, MD, PhD 2
Affiliations:
1. Students Scientific Association at the Department and Clinic of Cardiology, Medical
University of Lublin
2. Department of Cardiology, Medical University of Lublin

Introduction: Pulmonary embolism (PE) is an acute manifestation of venous

thromboembolism (VTE) of high mortality mainly caused by right ventricle failure
causing cardiogenic shock. Reperfusion is the treatment choice in high-risk
patients. Percutaneous catheter-based methods are used in case of clinical
deterioration, contraindications for thrombolysis or after thrombolysis failure.
The concept of penumbra in cardiology, particularly in PE, refers to use of
advanced catheter-based therapies to manage acute PE cases. This device
aspirates blood clots from blood vessels, allowing rapid arterial recanalization and
hemodynamic improvement in patients. In this study we evaluated efficacy of the
Penumbra in treatment of acute PE.

Material and methods: A literature search was conducted using 2019 ESC
Guidelines and 24 publications from PubMed databases (2014-2025), based on
the following keywords: "Pulmonary embolism and Penumbra system,"
"Computer Assisted Vacuum Thrombectomy".

Results: In analysed studies, there were 584 patients qualified to mechanical

thrombectomy using the Penumbra system (94 had high-risk acute PE, and 415 -
intermediate-high-risk), a median of 27,83% drop in RV/LV ratio and 17,19%
decrease in systolic pulmonary arterial pressure (sPAP) was observed after
Penumbra use. There were 28 post-Penumbra major adverse events (MAE)
(4,79%): 5 intraprocedural, 23 during 48hrs, and 9 deaths (1,54%): 4
intraprocedural deaths, 5 deaths within 48hrs.

Conclusions: The Penumbra System can be considered in acute PE, particularly in

hemodynamically unstable, high-risk patients when systemic thrombolysis is
contraindicated or ineffective. Its use in hemodynamically stable intermediate-
high-risk patients should be individualized, considering the patient's clinical
status and potential for deterioration. The main advantages of the Penumbra
system allows for the removal of clots from the pulmonary arteries, improving
hemodynamics and reducing the risk of long-term complications. The integration
of penumbra into PE management represents a modern approach in personalized
and multi-modal therapeutic strategies, increasing survival rates and patient
outcomes.

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Aortomitral Curtain Reconstruction Technique with Aortic and Mitral

Valve Replacement in Native Bi-valvular Endocarditis – Case Report
Authors: Abigail Kimber, Kamil Tracz, Ghany Nasrullah
Supervisor: Dr Wojciech Karolak
Affiliations:
Medical University of Gdańsk, Scientific Circle of Cardiac Surgery

Background: Treatment of extensive bi-valvular endocarditis involving the

aortomitral curtain (AMC) poses a significant challenge, often necessitating highly
complex surgical intervention. The gold-standard approach, ‘The Commando
Procedure’, was first described and popularised by David et al. in 1997. We
present a case in which a novel surgical technique was employed, demonstrating
a successful and innovative strategy for managing this severe condition.
Case Report: A 64-year-old man with a history of poorly controlled type 2
diabetes and arterial hypertension presented with anuria, increasing fatigue,
dyspnoea, and an unintentional 25kg weight loss, without fever. He was admitted
due to severe anaemia and acute kidney failure, with suspicion of rapidly
progressive glomerulonephritis secondary to vasculitis. Shortly after, he was
diagnosed with Streptococcus mutans septicaemia. Echocardiography revealed
extensive aortic and mitral valve destruction, an abscess in the AMC, and a
13mm vegetation on the aortic valve, resulting in valvular insufficiency and a
LVEF of 45%. Aggressive antibiotic treatment was initiated, and the patient was
qualified for surgery.
Surgical excision included the aortic valve cusps, the superficial surface of the
AMC, and the adjacent aortic annulus, along with the anterior mitral valve cusp
and its associated annulus. However, intraoperative assessment determined that
complete excision of the AMC was unnecessary, allowing for a more conservative
approach and therefore, less extensive reconstruction, compared to the
traditional Commando Procedure.
Discussion and Conclusion: This surgical technique provides an alternative
reconstruction method for patients in whom complete excision of the AMC is
unnecessary, although in who debridement of infected tissue remains essential to
successful treatment. By offering a less complex and extensive reconstruction,
this technique results in shorter cross-clamp and bypass times, fewer
postoperative complications, and improved postoperative cardiac function. When
feasible in patients with similar disease presentation and severity, it could be
considered a viable alternative to the traditional Commando Procedure.

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A Rare Case of Unrecognized Thymic Squamous Cell Carcinoma

Discovered During Coronary Artery Bypass Grafting

Authors: Ivan Dulić1; Dora Petričević2; Fran Popović3; Karla Lauš4; Franjo Kovčalija2; Grgur
Dulić1,5
Supervisor: Grgur Dulić1,5
Affiliations:
1 – Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
2 – Emergency Department, Clinical Hospital Centre Osijek, Osijek, Croatia
3 – Osijek-Baranja County Health Centre, Osijek, Croatia
4 – Specialist Family Medicine Office Lidija Zubac-Karavidović,
dr.med.spec.obit.med, Osijek, Croatia
5 – Department of Cardiothoracic Surgery, Clinical Hospital Centre Osijek, Osijek,
Croatia

Background: Thymic Squamous Cell Carcinoma (TSCC) is the most common

subtype of thymic carcinoma, a rare and aggressive malignant tumor originating
from the epithelial cells of the thymus gland, located in the anterior mediastinum.
Unlike thymomas, thymic squamous cell carcinoma (TSCC) is more likely to
invade nearby tissues and metastasize to distant organs.
Case Report: In this case report, we present a 71-year-old male patient who
required coronary artery bypass grafting (CABG) due to ST-elevation myocardial
infarction (STEMI), a life-threatening condition caused by acute and complete
occlusion of a coronary artery. In coronary angiography, it is important to
highlight the presence of significant stenosis in the left anterior descending (LAD)
artery and the circumflex artery (Cx), as well as total occlusion of the right
coronary artery (RCA). During CABG, after a median sternotomy, a substantial
number of adhesions were observed in the mediastinum, extending toward the
left and right pleura and infiltrating them. Additionally, a tumor mass was found
above the aorta, completely covering it and adhering tightly to its surface. The
sample was sent for intraoperative analysis, and the pathologist confirmed that it
was indeed a tumor mass. After the reduction of the tumor mass, a coronary
bypass grafting was performed using the great saphenous vein. Later, a CT scan
was performed on the patient, which revealed a tumor mass in the upper anterior
mediastinum, measuring 33 x 50 x 61 mm. The mass was found to infiltrate both
brachiocephalic veins and the inferior vena cava. The histopathological findings
confirmed the diagnosis of thymic squamous cell carcinoma and since the tumor
is inoperable, chemotherapy has been indicated.
Discussion & Conclusion: This case highlights the rarity of TSCC, incidentally
discovered during urgent CABG for STEMI. Such unexpected intraoperative
findings underscore the importance of vigilance and adaptability in medical
practice, as they can significantly influence patient outcomes.

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Cardiac tamponade disguised by pulmonary embolism in an oncology

patient - a case report

Authors: Ivan Đuran1, Anja Đurđević1, Marko Đurišević1, Mirko Vilibić1

Supervisor: Jasenka Markeljević, MD, PhD1,2
Affiliation:
1. School of Medicine, University of Zagreb, Zagreb, Croatia
2. Department of immunology and rheumatology, University Hospital Center
Sestre Milosrdnice, Zagreb, Croatia

BACKGROUND: Cardiac tamponade is a life-threatening condition caused by

impaired ventricular filling during diastole, leading to fatal outcome if left
untreated. It is commonly associated with malignancies, percutaneous cardiac
interventions, aortic dissection and other causes, with urgent pericardiocentesis
being the primary treatment. We will present a case in which tamponade may
have been masked by a coexisting pulmonary embolism.

CASE REPORT: A 61-year-old patient was admitted to the emergency department

with dyspnea on minimal exertion, coughing, diarrhea, and reduced apettite. A
few days before admission, he recorded an elevated pulse rate and took
benzodiazepines and bisoprolol, which caused a short episode of syncope without
falling or sustaining injury. The patient was undergoing treatment with
pembrolizumab for advanced lung adenocarcinoma with brain metastases and
was also being monitored for chronic pericardial effusion with preserved systolic
function of the left ventricle and an ejection fraction of 60%. Blood work was
consistent with his pembrolizumab immunotherapy, while D-dimers were
significantly elevated at 4.15 mg/L. A computed tomography (CT) scan was
ordered due to a high suspicion of pulmonary embolism, which was later
confirmed, along with findings of impending tamponade and pleural effusions.
Emergent pericardiocentesis via subcostal approach was performed, though
technical difficulties arose due to restricted access caused by adhesions from the
chronic pericardial effusion. A Billau drain was inserted, collecting 2,750 mL of
pericardial effusion over 96 hours. Cytological analysis of the effusion was
suspicious for adenocarcinoma metastases. The patient was stabilized, and the
team initiated anticoagulation theapy with low-molecular-weight heparin for the
pulmonary embolism.

DISCUSSIONS & CONCLUSIONS: Oncology patients often present challenges in

emergency department settings due to the presence of multiple coexisting
conditions and the potential interactions of various therapies. However, it is

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crucial to remain systematic and focused, prioritizing the treatment of life-

threatening complications.

Conferences we
cooperate with:

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