Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI) incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient. the aim of the study was analysis of iatrogenic bile duct injuries and methods of their repair,taking into consideration the circumstances, under which the injuries occur. Material and methods. The study group consisted of 16 patients who had suffered IBDI during surgery. The analysed parameters included sex, age, indications for surgery, the setting of the surgical procedure and the type of bile duct injury. Additionally, the time of injury diagnosis, type of repair and treatment outcome were assessed. The IBDI analysis used the EAES classification of injuries. The time of IBDI repair was defined as immediate, early or late,depending on the time that had passed from the injury. The analysis included complications seen after bile duct repair. Results. The study group consisted of 10 women and 6 men, aged 29-84. Patients underwent 6 classic cholecystectomies, 8 laparoscopic cholecystectomies, one gastrotomy to remove oesophageal prosthesis and one laparotomy due to peptic ulcer. IBDI was diagnosed intraoperatively in 4 patients. In 12 patients IBDI was diagnosed within 1-7 days. The diagnosis was based on endoscopic retrograde cholangiopancreatography and the results of biochemistry tests. According to the EAES classification, the injuries were of type 1 (4 patients), type 2 (8 patients), type 5 (3 patients) and type 6 (1 patients). Reconstruction procedures were performed during the same anaesthesia session in 3 patients, and in the early period in 13 patients. The main procedure was Roux-en-Y anastomosis (12 patients), with the remaining including bile-duct suturing over a T-tube (3 patients) and underpinning of an accessory bile duct in the pocket left after gallbladder removal (1 patient). The most common reconstruction complications included bile leak (3 patients), recurrent cholangitis (3 patients) and bile duct stricture (2 patients). Mortality in the study group was 12.5%. Conclusions. The procedures of laparoscopic and classic cholecystectomy are associated with a risk of IBDI, especially in the presence of inflammatory state of the gall-bladder. IBDI is a complex complication: its treatment poses a challenge for the operating surgeon, and even the most careful treatment adversely affects the patient's lifedue to complications.

Haemorrhages into the inflammatory cisterns or adjacent organs (stomach, transverse colon mesentery) secondary to AP are the most severe complications, which are difficult to manage. The successful use of interventional radiology methods to inhibit and prevent the recurrence of bleeding in some of the patients is a significant milestone.

Introduction. Fournier gangrene (FG) is life - threatening condition, defined as the necrotizing fascitis of perineum and can spread to the adjacent areas. It is rare disease and infection is caused by mixed bacterial flora, seldom by fungal infection. Risk factors are: male sex, diabetes, hypertension, malignant neoplasms, alcoholism, immunospression. Material and methods. The analysis of four group patients treateted for Fournier gangrene was made about diagnostic and therapeutic process, assessment of prognosis based on Fournier’s Gangrene Severity Index). Results. All patients were males. Average age at the moment of diagnosis was 60 years. All of them had comorbidities resulting with the higher risk of susceptibility to FG. Morbitity was 50%, despite of all of patients had less than 9 points in FGSI. Discussion. The FG, despite of better diagnostic tools and technological progres remaines the significant clinical issue because of the mortality - 80%. „The golden standard” is surgical excision of necrotic tissues, antibiotics support, equation of fluid, electrolytes and base – acid balance, level of glycemia is very important. The treating results were assessed on the base of FGSI. The significance has the moment of performing the surgical intervention – it is proven, that should be carried out during 24 hours. The hyperbaric oxygen therapy is controversial. Seem to be appropriate if the infection is caused by anaerobic bacteria. Conclusions. Fournier syndrome is significant clinical issue. Its treatment requires early surgical approach with exicision of necrotic tissues, antibiotics support and treatment of hyperbaric oxygen in some cases.

Splenectomy performed concomitantly with gastrectomy for gastric cancer increases the risk of minor general complications. However, it does not increase the risk of severe surgical complications, such as oesophago-intestinal anastomotic leakage and does not increase the risk of death.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a working diagnosis in about 10% of cases presenting with symptoms suggestive of acute myocardial ischaemia and no significant atherosclerotic plaques in coronary angiography. It is a heterogenous clinical entity with a complex aetiology and always requires a challenging work-up. The final diagnosis may confirm any coronary pathology (dissection, spasm, thrombus) or significantly differ from the previous one (myocarditis, takotsubo cardiomyopathy). This paper focuses on the current knowledge on MINOCA, guidelines on the management of patients, and indicates new research areas to further elucidate this issue. The most important message is that MINOCA is a serious condition with outcomes at least as serious as in myocardial infarction resulting from coronary atherosclerosis. Streszczenie Zawał serca bez istotnych zmian w nasierdziowych tętnicach wieńcowych (MINOCA) to robocze rozpoznanie ustalane w ok. 10% przypadków, w których w koronarografii nie stwierdza się istotnych zwężeń miażdżycowych, a objawy kliniczne silnie sugerują podłoże niedokrwienne. Choroba stanowi istotne wyzwanie diagnostyczne ze względu na heterogenną etiologię i zawsze wymaga uważnego podejścia. Ostateczna diagnoza może potwierdzić przyczynę wieńcową (dysekcja, skurcz, zakrzep) lub znacznie różnić się od wstępnego rozpoznania (zapalenie mięśnia serca, kardiomiopatia takotsubo). W artykule przedstawiono zarys współczesnej wiedzy na temat MINOCA, obowiązujące zalecenia dotyczące diagnostyki i terapii oraz wskazano nowe kierunki badań niezbędnych do pełnego wyjaśnienia tego zagadnienia. Najważniejszym przesłaniem pracy jest wniosek, że mimo braku zwężeń w tętnicach wieńcowych MINOCA jest zespołem chorobowym o rokowaniu co najmniej tak poważnym jak w zawale serca o podłożu miażdżycowym.