AbstractAscariasis is a helminthic infection of global distribution, and intestinal obstruction is its most common gastrointestinal complication. This is a case of a 7-year-old boy admitted to Pediatric Surgery because of intestinal obstruction caused by ascariasis. On admission, the patient presented with colicky abdominal pain, bile-stained vomiting and meteorism. On physical examination, the patient was thin, pale, and dehydrated. An abdominal examination showed distention and diffuse tenderness. After admission, the patient had fecal vomiting and expulsion of worms through the mouth. Laboratory-test results showed leucocytosis, eosinophilia, hypoalbuminaemia, and hypochloremia. Abdominal radiographs and ultrasound studies were indicative of small-bowel obstruction due to roundworms, which led to the performance of an exploratory laparotomy. On bowel exploration, an intraluminal mass, 10 by 6 cm in diameter, consisting of roundworms in the middle third of the ileum was found. A longitudinal enterotomy was performed, and the worms were meticulously extracted manually. Postoperatively, broad-spectrum antibiotics and antihelminthic drugs were administered. Our case of intestinal obstruction caused by ascariasis is the first to be reported in Serbia, according to the Serbian literature.

Precision TACE represents effective and controlled method for application of chemotherapeutic agencies with reduced systemic toxicity. Our preliminary results show increased therapeutic efficacy, diminished mortality and subsequently prolonged survival rate and improved quality of life in patients with HCC.

AbstractBezoars are collections of indigestible materials found in the gastrointestinal tract. Rapunzel syndrome is a rare complication of a gastric trichobezoar in which the mass of hair extends through the pylorus into the small bowel and can even reach the colon. A 12-year-old girl with severe pain and a feeling of “fullness” in the upper abdomen was admitted to Pediatric Surgery. Two days before admission, the patient presented with vague abdominal pain, vomiting with a little blood, and black stool. On physical examination she was pale and listless with patchy alopecia. Abdominal examination showed a mobile, palpable mass in the epigastrium. The initial hematocrit was 7,1%, and the erythrocyte count was 1,12×1012 cells per liter. Abdominal ultrasound and computed tomographic (CT) examinations confirmed the presence of a tumor-like formation in stomach. A giant bezoar with ulceration on the back wall of the stomach was verified by upper gastrointestinal endoscopy. Endoscopic extraction was not possible because of the size of the bezoar. Gastrotomy was performed to remove the bezoar that occupied most of the stomach, with a long tail that extended deeply into the duodenum (Rapunzel syndrome). The bezoar, 35 by 10 cm in diameter, was black and consisted of hair and synthetic fibers. Prompt diagnosis and treatment of trichobezoars are important to avoid a possible fatal outcome.