Aleksandar Bogdanovic

Visceral artery pseudoaneurysm (VA-PSA) is an uncommon but life-threatening complication of acute-on-chronic pancreatitis, particularly in the presence of walled-off necrosis (WON). Early radiological recognition is essential because of the high risk of rupture. We present the case of a 51-year-old man with chronic pancreatitis who developed a pseudoaneurysm arising from the proper hepatic artery within a pancreatic head necrotic collection. Follow-up contrast-enhanced computed tomography (CT) demonstrated a new arterial-phase enhancing focus within the WON. Digital subtraction angiography (DSA) confirmed the pseudoaneurysm, which was successfully excluded with a covered stent placed via a right transfemoral approach. Post-procedural recovery was uneventful, and short-term follow-up CT showed persistent exclusion of the lesion.

Hepatic echinococcosis, caused by Echinococcus species, remains a significant global health concern, with cystic echinococcosis (CE) being widespread and alveolar echinococcosis (AE) representing a rarer but more aggressive form. CE generally demonstrates characteristic imaging features, allowing straightforward diagnosis, whereas atypical presentations can closely mimic other hepatic lesions, leading to diagnostic uncertainty. AE poses an even greater diagnostic challenge due to its infiltrative, tumor-like growth pattern. Magnetic resonance imaging (MRI), with its superior soft-tissue contrast and multiplanar capabilities, plays a crucial role in the evaluation of AE and atypical CE cases. This pictorial review summarizes MRI features of hepatic echinococcosis, detailing both typical and atypical appearances, and emphasizes key criteria for differentiating hydatid cysts from other cystic or solid hepatic lesions. By consolidating imaging findings and discussing relevant differential diagnoses, this review aims to improve diagnostic accuracy, guide clinical management, and increase radiologists’ awareness of echinococcosis in both endemic and non-endemic regions.

Abdominal wall reconstruction in the presence of midline hernia (MH) and lateral hernia (LH) is a challenging procedure. The purpose of this study was to introduce surgical method combining the retromuscular sublay technique and component separation technique with mesh augmentation for the simultaneous repair of midline and lateral hernias. Between January 2006 and January 2025, 67 consecutive patients who underwent abdominal wall reconstruction for combined MH and LH or parastomal hernia (PH) were retrospectively analysed. The abdominal wall was reconstructed using a combination of the retromuscular sublay technique and the component separation technique, followed by mesh reinforcement. Of 67 patients, 53 underwent reconstruction surgery for simultaneous MH and LH, and 14 patients underwent surgery for MH and PH. LH was incisional (after previous pararectal, oblique, subcostal, or "J" incisions) in 58.5%, at the site of stoma closure in 37.7%, and as a consequence of blunt trauma in 3.8%. The median total defect width was 15 cm (range, 11-18) for the entire cohort. The median operative time was 150 min. Overall morbidity was 17.9%. After a median follow-up period of 24 months (range, 1-58), recurrence developed in 2 (3%) patients and abdominal wall bulging in 1 (1.5%). The combination of the retromuscular sublay technique, the component separation technique and mesh reinforcement is a safe and effective method for the simultaneous repair of MH and LH or PH.

Purpose Management of giant inguinoscrotal hernia (GIH) is still a challenging procedure associated with a higher risk of intraabdominal hypertension and abdominal compartment syndrome as a life-threatening condition. The aim of the study was to present our management strategy for GIH. Methods This is a retrospective review of a case series including 24 consecutive patients with 25 GIH who underwent reconstructive surgery from January 2006 to June 2023, at the University Clinic for Digestive Surgery and Hernia Center Zuvela. A combined surgical strategy was applied: the modified Rives repair for groin hernias alone, Rives combined with organ resection to reduce hernia contents, and Rives combined with procedures for abdominal cavity enlargement. A surgical approach was defined based on the patient’s general health, the volume of the hernia sac, and perioperative parameters. Results All patients were male aged between 43 and 82 years. Rives was the only procedure in 12 patients. In addition to Rives, omentectomy was performed in four patients and intestinal resection in one. Abdominal cavity enlargement was performed following Rives hernioplasty in 9 patients. The median operative time was 215 min (range, 70–720). Surgical complications occurred in seven patients. In-hospital mortality was 12.5%. There was no groin hernia recurrence. Conclusion Our strategy is a single-stage treatment including modified Rives repair with or without additional procedures for abdominal cavity enlargement or hernia volume reduction, tailored to the individual patient characteristics. The procedure is associated with a higher risk of major morbidity requiring a well-trained intensive care unit team.

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease marked by inflammation, fibrosis, and narrowing of the bile ducts, leading to cholestasis. Magnetic resonance cholangiopancrea-tography (MRCP) is the gold standard for the diagnosis of PSC allowing insight into biliary duct changes. The typical presentation of PSC includes multifocal anular and short-segmental strictures alternating with normal or slightly dilatated biliary ducts. Besides cholangio-graphic findings, magnetic resonance (MR) allows the assessment of liver parenchymal changes which might indicate the severity of the disease. The scoring systems based on MR findings, such as the ANA-LI score, and new computer-based software analysis termed MRCP+, provide a prediction of the course of disease and identify high-risk patients. Thus, Mr with MRCP is a promising diagnostic tool for the integrative evaluation of PSC patients allowing not only initial diagnosis and detection of complications but also has prognostic significance.

Introduction: The prognostic value of the age-adjusted Charlson comorbidity index (ACCI) for patients with colorectal liver metastases (CRLM) undergoing liver resection is still unclear. The aim of this study is to analyze the impact of ACCI in the prediction of shortand longterm outcomes after liver resection in patients with CRLM. Material and methods: Data related to 101 patients who underwent liver resection for CRLM at the University Clinic for Digestive Surgery between October 2019 and October 2022 were analyzed in this cohort retrospective study. ACCI was determined according to an established point scale. Patients were further divided into two groups: group 1, ACCI <7, and group 2, ACCI ≥7. Results: There was no statistically significant difference in the length of postoperative ICU stay (p=0.9670), semi-ICU stay (p=0.627), and hospital stay (p=0.243). Overall morbidity was higher in group 1 (60%) than in group 2 (39.3), p=0.042, while major morbidity (grade ≥3) was similar between groups, p=0.127. Biliary fistula was more common in group 1 compared to group 2 (12.5% vs 1.6%), p=0.035. In-hospital mortality, 30-day, and 90-day mortality were similar between the study groups (p=1; p=0.517 and p=0.517). During the follow-up period, recurrence was registered in 48.5% of patients. There was no difference in recurrence-free survival between groups, p=0.430. The overall survival was similar between the groups, p=0.141. Conclusion: ACCI can be used to predict postoperative morbidity after liver resection for CRLM. The postoperative mortality and recurrence-free survival are similar regardless of age and comorbidity.

Background: Transarterial chemoembolisation (TACE) is the primary treatment for intermediate-stage hepatocellular carcinoma (HCC), according to the updated Barcelona Clinic Liver Cancer (BCLC) staging system. Although growing evidence favours liver resection (LR) over TACE for intermediate-stage HCC, the best treatment option remains controversial. This meta-analysis aimed to compare the overall survival (OS) after LR versus TACE for intermediate-stage HCC. Methods: A comprehensive literature review of PubMed, Embase, Cochrane Library, and Web of Science was performed. Studies that compared the efficacy of LR and TACE in patients with intermediate (BCLC stage B) HCC were selected. According to the recent updated BCLC classification, intermediate stage of HCC was defined as follows: (a) four or more HCC nodules of any size, or (b) two or three nodules, but if at least one tumour is larger than 3 cm. The main outcome was OS, expressed as the hazard ratio. Results: Nine eligible studies of 3355 patients were included in the review. The OS of patients who underwent LR was significantly longer than that of patients who underwent TACE (hazard ratio=0.52; 95% CI: 0.39–0.69; I²=79%). Prolonged survival following LR was confirmed after sensitivity analysis of five studies using propensity score matching (HR=0.45; 95% CI: 0.34–0.59; I ²=55%). Conclusion: Patients with intermediate-stage HCC who underwent LR had a longer OS that those who underwent TACE. The role of LR in patients with BCLC stage B should be clarified in future randomised controlled trials.

Solid pseudopapillary neoplasm (SPN) is rare pancreatic tumor occurring most commonly in young females. The typical imaging appearance of SPN is of well-defined, encapsulated, and large heterogeneous tumors, consisting of solid and cystic components due to various degrees of intralesional hemorrhage and necrosis. However, atypical imaging presentation in the form of small solid tumors or uniformly cystic lesions might also be seen, which can be explained by specific pathological characteristics. Other imaging features such as a round shape, the absence of main pancreatic duct dilatation, and slow growth, in combination with vague symptoms, favor the diagnosis of SPNs. Nevertheless, the radiological findings of SPN might overlap with other solid and cystic pancreatic neoplasms, such as neuroendocrine tumors, serous and mucinous neoplasms, and even small pancreatic adenocarcinomas. In addition, a few benign non-tumorous conditions including walled-of-necrosis, and intrapancreatic accessory spleen may also pose diagnostic dilemmas simulating SPNs on imaging studies. The aim of this manuscript is to provide a comprehensive overview of the typical and atypical imaging features of SPNs and to describe useful tips for differential diagnosis with its potential mimickers.