[Incapacitating dysphagia and paracardiac gastric diverticulum].
We report a new case of gastric diverticulum, unusual by the severity of the dysphagia and weight loss. Relief of symptoms was obtained only after surgical resection.
Adult↗
Biomedical subjects
I Leblanc
Publications and source records attributed to I Leblanc.
[Digestive hemorrhage caused by rupture of esophageal varices. Analysis of 47 emergency surgeries].
Between 1 January 1984 and 31 December 1986, 47 patients out of a total of 228 patients admitted to hospital with endoscopy-proven bleeding esophageal varices, underwent an emergency operation. The indications were massive hemorrhage in 29 patients, and rebleeding early after a first serious episode in 18 patients. Four patients underwent early reoperation for recurrent variceal bleeding. Thirty-seven porto-caval shunts, 10 esophageal transections, 3 proximal gastric resections and 1 exploratory laparotomy were performed. The early results were satisfactory in 53.2% of the patients; operative morbidity and mortality were 19.1% and 27.7% respectively. Four patients died from gastric variceal bleeding soon after esophageal transection. Operative mortality was greater when the patient was Child C or operated for massive hemorrhage. Survivors were followed for at least 12 months. Two patients died from shunt occlusion and recurrent variceal bleeding. No severe encephalopathy was reported. Analysis of the results suggest that porto-caval shunt is indicated in Child A or B patients, particularly with recurrent variceal bleeding soon after a first episode controlled medically.
Adult↗
[Infrahepatic hematoma secondary to gangrenous cholelithiasic hemocholecyst treated with antivitamins K].
Acute haemocholecyst is a rare disorder but often reported in patients with gallstones. Rupture of the gallbladder causing hypovolaemic shock secondary to massive intraperitoneal bleeding has been reported in about fifty patients to date. We report a new case of haemocholecyst with rupture of the gallbladder in a patient with gallstones treated by anticoagulant therapy. This case is unusual in terms of the nature of the gallbladder disease: massive gangrene with complicating hemorrhage and destruction of deficient regions of the wall of the gallbladder induced an infrahepatic haematoma without hypovolemic shock, in contrast with the massive intraperitoneal hemorrhage reported in other cases.
Aged↗
[Safe colectomy for volvulus of the cecum: apropos of 4 cases].
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Adult↗
[Acute intestinal ischemia from arterial thrombosis. Value of emergency arteriography and revascularization].
A 77 year old woman undergoing surgery for acute digestive arterial thrombosis, was successfully revascularized without intestinal resection. Early diagnosis is difficult and is based upon evaluation of past history and an arteriography when there is the slightest doubt. Apart from when necrosis is already developed, revascularization by aorto-superior mesentric by-pass using an autologus saphenous vein and a routine "second look" to assess intestinal viability is the best therapeutic approach.
Aged↗
[Long-term results of surgical treatment for achalasia of the esophagus].
25 patients were operated with Heller's procedure for achalasia of the esophagus. A study of their clinical, radiological, manopetric and pH-metric evolution was carried out over an average period of 75 months. While the long-term results were satisfactory in 80% of these patients, the poor results were essentially caused by the occurrence of gastroesophageal reflux. An objective study performed by manometry and pH-metry allowed evidencing true asymptomatic acid reflux. It is necessary to devise an anti-reflux valve if the myotomy reaches as far as the cardia.
Adolescent↗
[Superficial gastric cancer. A review of 30 cases].
Thirty cases of superficial cancer of the stomach were treated over a ten-year period from 1984 to 1993. Actuarial survival rate at 5 years was 73%. The depth of cancer invasion has a predominant effect on two prognosis factors: mucosal and submucosal involvement. Invasion of the lymph nodes is more frequent in cases with submucosal invasion. Treatment is based on gastric surgery. Nevertheless, if the diagnosis of superficial cancer is certain before operation and deep extension is clearly identified by histology and especially by echoendoscopy, more selective surgery could be justified: R1 type exeresis for cancers involving the mucosa only and R2 type exeresis for submucosal involvement.
Aged↗
[Appendiceal mucoceles. Pathophysiology and therapeutic indications].
Appendiceal mucoceles (AM) are rare lesions of the appendix, characterized by an accumulation of mucus. Two main pathogenic mechanisms may be invoked to explain their development. Firstly, AM are secondary to an obstruction of the appendiceal lumen for a wide variety of reasons. Secondly, they may be due to tumours of the appendix, whether malignant (cystadenocarcinomas) or benign (cystadenomas), responsible for a hypersecretion of mucus. Intraperitoneal mucinous effusion (IME) develops when appendiceal perforation occurs, especially with malignant AM. We found 13 retention AM and in most a definite obstructive lesion was present. There were 3 malignant AM, all associated with a neoplastic IME. While they are frequently described in the literature, no cystadenoma was observed in these series. Clinical symptoms are often confusing, but paraclinical investigations may lead to preoperative diagnosis. Appendectomy is the treatment of retention AM and cystadenoma. Their prognosis is related to other associated diseases, namely ovarian and colorectal tumours, but is otherwise good. Cystadenocarcinomas require a right hemicolectomy with evacuation of IME but their prognosis is poor.
Adenocarcinoma, Mucinous↗
[Practical approach to tumoral perforations of cancers of the colon. Apropos of 7 cases].
In 4 to 5% of cases, the cancer of large bowel is presented with a perforation in situ. The mortality rate in these conditions is high, and it is evaluated in the literature between 40 to 50% of cases. The authors present their experience with 7 consecutive patients, operated for this complication. In all cases, the tumour is excised: in 6 patients, terminal colostomy is realised while one patient only had a direct resection anastomosis. No per-operative mortality, was noted, and in four patients retauration of intestinal tract is realised, within 3 to 6 months latter. In our experience, the perforated tumour does not appear as a factor of immediate gravity.
Adenocarcinoma↗
Ileoanal anastomosis for ulcerative colitis: results of an evolutionary surgical procedure.
BACKGROUND/AIMS: Proctocolectomy with ileoanal anastomosis (IAA) has proved to be the most suitable surgical treatment for ulcerative colitis. The aim of this study was to compare the results of IAA according to the evolution of surgical procedures and particularly to compare the results of stapled versus hand-sewn anastomosis. METHODOLOGY: From 1984 to 1996, 37 men and 31 women were operated on in our centre for ulcerative colitis. The anastomosis between the J pouch and the dentate line was handsewn in 35 patients (group 1) and stapled in 33 patients (group 2). RESULTS: The mean operative time was significantly shorter in group 2 as compared with group 1 (265+/-59 vs. 323+/-53, p<0.01, respectively), whereas morbidity and functional results were comparable in both groups. In 10 patients with stapled IAA, a diverting ileostomy was not performed and the morbidity in this group did not increase. CONCLUSIONS: These results suggest that stapled IAA anastomosis is a safe procedure. The stapling technique of IAA simplifies total excision of the rectum and could mean that a diverting ileostomy is not necessary.
Adult↗