Colonoscopy is routinely used for the diagnosis and treatment of colorectal diseases. Bowel perforation is a rare but severe complication that significantly increases the morbidity and mortality. Tension pneumothorax is an uncommon complication of colonic perforation. We present a case of the successful treatment of a patient with tension pneumothorax, following colonoscopy, by using tube thoracostomy and Hartman-type resection of the rectosigmoid junction and proximal sigmoid. Surgeons, anesthesiologists, and endoscopists should consider the possibility of pneumothorax as a rare complication of colonoscopy. Early detection and urgent treatment is the key to successful management.

Altered expression of the ectonucleotidase CD39 in T lymphocytes has been described in various immunopathologies including solid tumors. However, the information on the cells expressing this immune checkpoint molecule in patients with hematological malignancies is limited. The aim of the present study was to see the frequency of CD39+ cells in circulating and splenic CD4+ T lymphocyte populations of patients with hematological malignancies and to determine their correlation with blood biomarkers of systemic inflammation.The study was conducted on seven patients diagnosed with hematologic malignancies, who underwent splenectomy for therapeutic reasons. Two groups of splenectomized patients were used as controls. The first control group consisted of six patients without a diagnosis of cancer or autoimmune diseases, and the second control group consisted of nine patients diagnosed with immune thrombocytopenia (ITP).Our results revealed that the frequencies of CD4+CD39+ cells in the blood and spleen of patients with hematologic malignancies do not differ from similar values in splenectomized patients having no history of cancer or autoimmune disease. The frequency of CD4+CD39+ cells in the spleen of patients with hematologic malignancies is significantly higher than the similar rate of ITP patients. In addition, a strong negative correlation is confirmed between the frequency of CD4+CD39+ cells in the spleen of the patients of the study group and the platelets to monocytes ratio in the blood.

Pancreatic parenchyma-preserving procedures performed for benign and low-grade malignant tumors of the neck or body of this organ significantly reduce the incidence of postoperative exocrine and endocrine insufficiency compared to distal pancreatectomy. Tumor enucleation spares pancreatic parenchyma, but it can have positive surgical margins, and postoperative leakage after it is significant. We present our initial successful experience of laparoscopic central pancreatectomy. A patient was operated on for cystadenoma of the pancreatic neck. The organ was transected proximally with a linear stapler but distally with ultrasonic shares, and a caudal stump was used for the creation of the pancreaticogastrostomy. The postoperative period was uneventful. The four-month follow-up did not reveal any exocrine or endocrine insufficiency.

We present a case of the multiple venous intestinal infarction in patient with two inherited thrombophilias: Leiden factor V (LFV) and factor VIII elevation. The patient had a critical hypocoagulation caused by vitamin K antagonist (VKA) overdose. At laparotomy, several intestinal segments were necrotic and ischemic. Coagulopathy was corrected by the transfusion of the fresh frozen plasma. Because of the 4th duodenal segment infarction distal segmental duodenectomy with side-to-side duodenojejunostomy was done, which is a rarely performed procedure. On postoperative day 6 deep vein thrombosis developed, despite nadroparin profillaxes, early mobilisation and compressive stockings. Our case demonstrated that in patients with congenital thrombophilia, development of the mesenteric venous thrombosis is possible even with VKA induced severe hypocoagulation. Venous infarction of the small bowel can be associated with the hemoperitoneum and gastrointestinal bleeding. After resection of the fourth duodenal segment, side-to-side duodenojejunostomy is a feasible method of reconstruction.

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