Cătălin Nicolae Grasa

Background and Clinical Significance: Iliopsoas abscess has recently become a condition quite frequently present in our practice, arising through hematogenous or lymphatic dissemination (primary), or secondary to trauma or infectious–inflammatory vertebral, renal, or gastrointestinal diseases. It is often diagnosed with difficulty, due to the insidious and rather atypical symptomatology. The simultaneous relevance to neurosurgery, orthopedics, urology, rheumatology, and of course surgery, makes the iliopsoas abscess a real challenge in diagnosis and treatment for any of us, as well as collaboration between specialties. Case Presentation: The aim of this paper is to illustrate all this through a rare clinical case of vertebral tuberculosis, with giant abscesses of bilateral iliopsoas and comparison with data from the literature, through a review. Conclusions: The problems were related to the clinical–paraclinical, etiological diagnosis, surgical strategy, technique and tactics, surgical approach, treatment and immediate, and both long-term postoperative management. The ultimate goal is to reduce morbidity and mortality secondary to this often-disabling condition.

Background: Placenta accreta spectrum (PAS) refers to abnormal placental attachment, categorized into placenta accreta, increta, and percreta, with varying severity. The incidence of PAS has risen alongside the increasing rate of caesarean sections. PAS is a significant cause of maternal complications, including bleeding, hysterectomies of necessity and intestinal or urinary surgical complications, and of foetal complications, preterm birth or foetal anaemia. Early diagnosis is crucial for its management and for improving its outcomes. Materials and Methods: This retrospective study, conducted at the County Emergency Clinical Hospital “Saint Andrew the Apostle”, Constanța, analysed cases of placenta praevia and PAS from 2018 to 2022. Data were collected from observation sheets and operative protocols, involving 13,841 patients. Placenta praevia and PAS were diagnosed using ultrasound and MRI and confirmed by histopathology. Results: Among the 13,841 deliveries, 25 cases of placenta praevia (0.82% incidence) and 17 cases of PAS (0.57% incidence) were identified. Ultrasound demonstrated 88% sensitivity, and MRI 94% sensitivity for PAS detection. Of the 17 PAS cases, 11 were diagnosed as placenta accreta, 3 were diagnosed as placenta increta, and 3 as placenta percreta, with all percreta cases involving bladder invasion. Hysterectomy was the standard surgical treatment. Discussion: The risk factors for PAS included previous caesarean sections (94.1% of PAS cases), smoking, and uterine fibroids. The study confirmed the importance of early imaging and the involvement of a multidisciplinary team in managing PAS, particularly in complex cases with bladder involvement. Caesarean section followed by hysterectomy was the preferred surgical approach. Conclusions: Smoking, uterine scars, and uterine fibroids are significant risk factors for placenta praevia with pathological adhesion. Ultrasound and MRI are highly accurate in diagnosing PAS, with histopathology providing definitive confirmation. Multidisciplinary care is essential in managing complex cases, ensuring optimal maternal and foetal outcomes. The surgical treatment involves caesarean section and hysterectomy, with additional interventions for bladder invasion in percreta cases.

Background: Placenta accreta spectrum (PAS) refers to abnormal placental attachment, categorized into accreta, increta, and percreta, with varying severity. The incidence of PAS has risen alongside the increasing rate of cesarean sections. PAS is a significant cause of maternal and fetal complications, including bleeding, preterm birth, and intrauterine growth restriction. Early diagnosis is crucial for management and improving outcomes. Materials and Methods: This retrospective study, conducted at the County Emergency Clinical Hospital "Saint Andrew the Apostle" Constanța, analyzed cases of placenta praevia and PAS from 2018 to 2022. Data were collected from observation sheets and operative protocols, involving 13,841 patients. Placenta praevia and PAS were diagnosed using ultrasound, MRI, and histopathology. Results: Among the 13,841 deliveries, 25 cases of placenta praevia (0.82% incidence) and 17 cases of PAS (0.57% incidence) were identified. Ultrasound demonstrated 96% sensitivity and MRI 96% sensitivity for PAS detection. Of the 17 PAS cases, 3 were diagnosed as placenta increta, and 3 as percreta, with all percreta cases involving bladder invasion. Hysterectomy was the standard surgical treatment. Discussion: Risk factors for PAS included previous cesarean sections (94.1% of PAS cases), smoking, and advanced maternal age. The study confirmed the importance of early imaging and the involvement of a multidisciplinary team in managing PAS, particularly in complex cases involving bladder or rectal involvement. Cesarean section followed by hysterectomy was the preferred surgical approach, and uterine artery embolization (UAE) was considered for reducing hemorrhage risk. Conclusions: Smoking, uterine scars, and uterine fibroids are significant risk factors for placenta praevia with pathological adhesion. Ultrasound and MRI are highly accurate in diagnosing PAS, with histopathology providing definitive confirmation. Multidisciplinary care is essential in managing complex cases, ensuring optimal maternal and fetal outcomes. Surgical treatment involves cesarean section and hysterectomy, with additional interventions for bladder invasion in percreta cases.