Tomasz Kościński’s research while affiliated with Poznan University of Medical Sciences and other places

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Publications (45)


Chirurgia. Tom 2
  • Book

November 2021

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84 Reads

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Magnetic resonance. Coronal and axial T2 single shot fast spin echo sequences revealed retroperitoneal peripancreatic fluid collections (a) extending to mediastinum (b) and free fluid in both pleural cavities (c). P: pancreas; F: fluid collection. ∗Free fluid in pleural cavity.
Magnetic resonance. Coronal and axial T2 single shot fast spin echo sequences revealed retroperitoneal peripancreatic fluid collections (a) extending to mediastinum (b) and free fluid in both pleural cavities (c). P: pancreas; F: fluid collection. ∗Free fluid in pleural cavity.
Magnetic resonance. Coronal and axial T2 single shot fast spin echo sequences revealed retroperitoneal peripancreatic fluid collections (a) extending to mediastinum (b) and free fluid in both pleural cavities (c). P: pancreas; F: fluid collection. ∗Free fluid in pleural cavity.
Magnetic resonance cholangiopancreatography. Coronal reconstruction. Normal caliber of bile and pancreatic ducts, no connection with fluid collections. Massive amount of free fluid in the right pleural cavity. White arrow: cholangiopancreatic ducts. ∗Free fluid in pleural cavity.
Computed tomography of chest cavity after intravenous contrast injection in axial plane. Free fluid in the right pleurum with atelectasis of the right lung and mediastinal shift. ∗Free fluid in pleural cavity. L: lung; M: mediastinum.

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Pancreaticopleural Fistula as a Rare Cause of Both-Sided Pleural Effusion
  • Article
  • Full-text available

March 2021

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136 Reads

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6 Citations

A pancreaticopleural fistula is a rare cause of pleural effusion. It is a complication of chronic or acute pancreatitis. It is rarely formed to the right or both pleural cavities. Diagnosis and proper treatment often turn out to be difficult and require the cooperation of a multidisciplinary team. The authors present the case of a 59-year-old patient treated for recurrent pleural effusion of unknown origin, first to the left and then to the right pleural cavity. After many months of treatment, the diagnosis of a pancreaticopleural fistula was made. The patient underwent surgery, which finally led to a successful complete recovery. Pancreaticopleural fistula should always be considered in patients with pleural effusion of unknown origin.

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Ileal pouch anal anastomosis leak after restorative proctocolectomy without protective stoma successfully treated with endoscopic vacuum therapy

October 2019

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23 Reads

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1 Citation

Polish Journal of Surgery

Aim An ileal pouch anal anastomosis (IPAA) leak is one of the most severe complication after restorative proctocoletomy (RPC). We present a rare case of a successful management of IPAA leak after RPC without defunctionig stoma with the utility of endoscopic vacuum therapy. Methods A 57-year-old male with a ileal pouch anal anastomosis leak after RPC due to ulcerative colitis with presacral abscess was qualified for endoscopic vacuum therapy (EVT). The abscess of the left buttock was drained and secured with suction drain (redon drain). Due to the lack of defunctioning stoma, a system for contain and divert fecal matter was placed within afferent limb of the J-pouch and EVT was placed directly within IPAA dehiscence. EVT was changed every third day. Results The patient underwent a total of five EVT sessions. Improvement of patient’s general condition characterized with lack of pelvic pain, fever and reduction of inflammatory markers was achieved. Locally, anastomosis dehiscence was healed with prominent reduction in the defect’s dimension, contraction and revascularization. Based on imaging studies no chronic presacral sinus or any other perianal disturbances were revealed at the time of five months follow up. Conclusions EVT is a promising method for management of IPAA leak. Although, it remains extremely difficult, EVT may serve as a method of choice in early pouch-related septic complications after RPC performed without defunctioning stoma



Prosthetic materials for treating posterior vaginal wall prolapse and rectocele — own experience

November 2016

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24 Reads

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1 Citation

Ginekologia Polska

Objectives: This report describes results of posterior vaginal wall prolapse and rectocele treatment performing tension free reconstruction method with polypropylene mesh implantation. Material and methods: In years 2001 to 20015, 71 female patients in age of 42–82 years were surgically treated. Besides difficult emptying they complained of feeling of heaviness in the pelvis (38%) and dyspareunia (16.9%). Defecography and magnetic resonance proved the presence of rectocele in 84.5%, enterocele in 38%, descending perineum in 28.2%, genital organ prolapse in 23.9%, and rectal prolapse in 22.5% cases. 37 patients with defects of low location have undergone implantation of prosthetic material from vaginal approach. In cases of high location and genital organ prolapse abdominal approach was done. Results: Permanent reconstruction of the rectovaginal septum has been achieved in 70 patients (98%). Symptoms of dyschesia, pelvic plain, heavy straining were persisted in 4 patients (10.3%). 3 cases of mash erosions were diagnosed. One patient was reoperated. Among 6 other patients who needed futher surgical treatment only one was reoperated because of vaginal prolapse. 81.7% of patients was satisfied with their treatment. Conclusion: Using prosthetic materials in pelvic floor defects treatment is characterized by high efficacy and low complication percentage. The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.


Figure 1. Surgical technique. A) Surgical approach: incision in vaginal antrum and opening of its posterior wall; B) porcine-derived acellular collagen mesh (Pelvicol ® ) is sutured to lateral rims of levator ani muscles using interrupted absorbable sutures; C) excision of redundant vaginal mucosa; D) technique of repair of posterior vaginal wall.
Advantages of implantation of acellular porcine-derived mesh in the treatment of human rectocele – Case report

September 2016

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8 Reads

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2 Citations

Annals of agricultural and environmental medicine: AAEM

Introduction. A rectocele is a hernation of the rectum into the vaginal lumen developing as a consequence of weakness of the rectovaginal septum. It affects about 18% of women after childbearing age. Symptoms associated with a rectocele include constipation, vaginal fullness or heaviness, feeling of a bulging mass within vagina, incomplete stool evacuation and dyspareunia. Current methods of surgical treatment of a rectocele often require implantation of a mesh graft. In most of cases, synthetic and non-absorbable meshes are used. Although implantation of a synthetic and non-absorbable mesh is effective in the treatment of rectocele, a high rate of mesh erosion has been reported. Case report. This study presents a surgical technique and case report for the treatment of a rectocele in a 46-year-old women by implantation of a porcine-derived absorbable collagen mesh (Pelvicol®) by transvaginal approach, with six year follow-up. A review of the literature concerning implantation of Pelvicol® for the treatment of rectocele was also undertaken. Conclusions. The clinical experience and review of the literature by the authors suggest that a porcine-derived acellular mesh is non-cytotoxic, pyrogenic or allergenic, and the application of a biomesh in the management of rectocele is effective and safe, and the risk of mesh erosion is very low.


Use of Negative Pressure Wound Therapy after Endovascular Revascularization in a Patient with Diabetic Foot Syndrome Complicated by Sepsis

October 2015

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523 Reads

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2 Citations

Negative Pressure Wound Therapy Journal

Pacjent lat 60, przyjęty do szpitala z powodu ostrego niedokrwienia kończyny dolnej prawej z martwiczymi zmianami po stronie grzbietowej i zewnętrznej stopy. Zmiany martwicze o szybko postępującym charakterze - owrzodzenia III/IV stopień według klasyfikacji Wagnera. Pacjent choruje na cukrzycę typu drugiego oraz na nadciśnienie tętnicze. Chory pali papierosy w ilości 1,5 paczki dziennie od 40 lat, prowadzi siedzący tryb życia. Leczenie zachowawcze polegało na miejscowym zastosowaniu maści z antybiotykiem o szerokim spektrum działania. Chorego poddano operacji rewaskularyzacyjnej i leczeniu opatrunkiem podciśnieniowym. Niewłaściwa pielęgnacja opatrunku V.A.C. i niekorzystne warunki zewnętrzne w oddziale chirurgicznym przyczyniły się prawdopodobnie do rozwoju zakażenia miejscowego i posocznicy co w konsekwencji było przyczyną amputacji kończyny.


Anatomical and functional results of a modified sacral perineocolporectopexy for extreme forms of complex pelvic organs prolapse - Own experience

June 2015

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12 Reads

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3 Citations

Ginekologia Polska

Anatomical and functional results of a modified sacral perineocolporectopexy for extreme forms of complex pelvic organs prolapse. Between 2005 and 2010, 10 women aged 47-75 years were treated by abdomino-perineal implantation of polypropylene mesh for modified sacral perineocolporectopexy and subsequently followed-up. They were suffering from enterocele (9 pts), genital prolapse (8 pts), descending perineum (5 pts), rectal prolapse (4 pts), rectocele (3 pts). Five women were incontinent (mean Wexner: 9) and six had incomplete rectal evacuation. Defecography revealed enterocele III°(5 pts) and II°(4 pts). MR designed descending perineum in 5 pts (mean: 3.8 cm). Permanent reconstruction of the pelvic floor and remission of organs prolapse was achieved at 12-months follow-up in all except 1 patient. There were 2 small vaginal erosions of the mesh and 1 haematoma within the pelvic floor Improvement at rectal emptying was found in 4 patients, feeling of pelvic heaviness in 6 patients, dyspareunia in 3 patients. Mean incontinence score decreased from 9 to 4. 1. Modified sacral perineocolporectopexy is effective in the treatment of complex pelvic floor anatomical defects and organ prolapse. 2. Improvements in rectal emptying, pelvic feeling of heaviness and dyspareunia have been achieved. 3. The implant tolerance was good and the complications rate was law.


Figure 1: Extensive Buschke-Loewenstein tumor of the perianal region.
Figure 2: The healing process in the grafted skin and subcutaneous tissue flaps.
Figure 3: The full wound healing process at 6 months follow-up.
Figure 4: The scar stenosis at the skin border of the anal canal which was treated with anal dilatator.
Buschke - Loewenstein tumor resection with simultaneous reconstruction of extensive tissue losses: Case report

April 2015

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7,836 Reads

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12 Citations

BMC Surgery

Background Giant condyloma acuminatum or Buschke - Loewenstein tumor is a very rare disease usually located in the genital, anorectal, and perianal regions. It is locally invasive but in mostly cases displays a benign cytology on preoperative tissue sampling. Because of its low incidence little is known about treatment outcomes. Complete surgical excision is the treatment of choice. Different surgical methods have been applied to reach curability. To our knowledge such an advanced sized tumors in this localization has only been reported few times before with different surgical techniques being applied. Case presentation We describe a case of 56 years old female with 20 years persisting condyloma acuminatum progressing to a very huge dimensions perianal Buschke-Lowenstein tumor with one of the widest excision in the literature without the need for diverting stoma. The tumor size and its location determined the choice of treatment option and suspected prognosis for the patient outcome. Treatment was impeded by patient’s malnutrition. The giant Buschke - Loewenstein tumor was resected from the anus, perineum and gluteal areas. The large tissue losses were simultaneously covered with rotational skin and fatty subcutaneous tissue flaps, mobilized from neighboring gluteal and femoral areas. The circumferential part of the anal canal was covered with skin grafted from the mentioned flaps and it was attached to the anal mucosa. No protective stoma was formed. Despite temporary problems with healing of the covering skin flaps, full permanent coverage of the resection site has been achieved. Anal canal function has also improved within the time. Conclusion The patient with BLT must be very carefully clinical and imagistic investigated in order to detect the tumor visceral invasion and to establish the extension of the surgical procedure. There exists an extensive and time-consuming surgical procedure which allows to remove the giant anorectal Buschke - Loewenstein tumors with good function of the anorectum and without the necessity of diverting stoma creation.



Citations (23)


... По данным литературы панкреато-плевральный свищ встречается менее чем в 1 % случаев [4][5][6]. Отсутствие специфических симптомов данного осложнения является основной проблемой его своевременной диагностики [7]. Диагностические ошибки связаны с тем, что панкреато-плевральные свищи проявляются рецидивирующим гидротораксом, что обычно интерпретируется как осложнение соматической патологии и приводит к длительному лечению пациентов в непрофильном терапевтическом или пульмонологическом отделении [5,[8][9][10][11]. ...

Reference:

Rare complications of acute pancreatitis: Clinical cases
Pancreaticopleural Fistula as a Rare Cause of Both-Sided Pleural Effusion

... But the implantation of the collagen mesh is never enough and relapses occur in 41% of patients within 3 years. Pelvicol is used as an additional strengthening of the rectovaginal septum in plastic surgery operation -colporrhaphy [40]. ...

Advantages of implantation of acellular porcine-derived mesh in the treatment of human rectocele – Case report

Annals of agricultural and environmental medicine: AAEM

... Insufficient tissue mobilization and excessive tension where the suture line and direct sutures meet in the vaginal and rectal walls, are the disadvantages of this procedure. A recurrence rate ranges from 30% to 84% (19,20). In our study most of the cases were low localized fiistulas and these were excised with rectal,vaginal and perineal approach. ...

Surgical Treatment of Rectovaginal Fistulas
  • Citing Article
  • August 2007

Polish Journal of Surgery

... The Altemeier procedure is used to perform a full-thickness resection of the rectum and a part of the sigmoid colon (perineal rectosigmoidectomy). Additionally, it seems to be the procedure of choice for patients with an incarcerated, gangrenous rectal prolapse and a very good option for patients with a recurrence after the earlier perineal procedure [10,24]. In our series, all cases were electively operated on, and we used the Altemeier procedure in the majority of our recurrences with good results. ...

Surgical treatment of recurrent rectal prolapse - Own experience
  • Citing Article
  • January 2006

... Rectal prolapse is a difficult and rare clinical condition. The frequency of the abovementioned is estimated at 0.04-1% (1), which consists between 2 to 5.6% of adult patients subject to treatment due to proctologic disorders (2). Rectal prolapse consists in the retroanal canal dislocation of one or all layers of the large bowel wall. ...

Etiopathogenesis of the rectal prolapse
  • Citing Article
  • January 2005

Gastroenterologia Polska

... 16,17 Koscinski and Sekowska offered their patients with low RVF and anal sphincter injury a combined approach of anal sphincter reconstruction plus advancement flap for repairing the RVF. 18 In this series, combining RVF surgery with anterior anal sphincter repair didn't add to the failure rate (0%). Instead, there was marked improvement of postoperative psychological status of patients as a consequence of enhanced continence. ...

Surgical treatment of rectovaginal fistulas
  • Citing Article
  • January 2007

... A reduction in FL levels was confirmed in 2 small cohorts of patients effectively treated with anti-TNFα [56], steroids, mesalamine, or thiopurines [57]. A significant decrease from baseline FL levels was reported after 3 and 12 months of therapy in patients treated with anti-TNFα (p < 0.05), in parallel to CDAI and SES-CD (p < 0.05) [58]. S100A12 performed poorly at 14 weeks (AUC 0.70) as compared to FC (AUC 0.87), in discriminating between patients who remained in remission from those who experience a loss of response within a year during anti-TNFα [59]. ...

Diagnostic importance of faecal markers in long-term monitoring of anti-TNF- therapy in primary responders with Crohn’s disease

Gastroenterology Review

... With its ability to improve peripheral perfusion, rheocarna may be associated with an increased risk of infection exacerbation. The use of a rheocarna in a highly inflammatory state is likely to result in severe sepsis 14 . Therefore, we used the rheocarna after a moderate inflammatory response. ...

Use of Negative Pressure Wound Therapy after Endovascular Revascularization in a Patient with Diabetic Foot Syndrome Complicated by Sepsis

Negative Pressure Wound Therapy Journal