From March 1979 to January 1980, the EEA stapler was used in the construction of 46 anastomoses after left colonic and anterior rectal resections. The mortality was 0 and the morbidity minimal. The safety of the sutures was excellent. The operative procedure was greatly facilitated, mainly in the cases of low rectal anastomoses. The functional results were good. In the surgical treatment of the rectal carcinomas, the use of the EEA allowed larger margins of resection, and increased the rate of conservative operations [Acta chir. belg., 1981, 80, 11-15].

Adult↗

PubMedDate not supplied

[Superselective vagotomy: operative testing of the gastric secretion and postoperative evolution. Report on 42 cases (author's transl)].

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Adolescent↗

PubMedDate not supplied

The clinical [corrected] background of familial adenomatous polyposis. History, epidemiology, diagnosis and treatment.

Familial adenomatous polyposis (FAP) is a dominantly inherited genetic disorder predisposing to colon cancer through the early development of multiple adenomatous polyps in the large bowel. FAP is not restricted to the colon and rectum, but is a more complex disease which can potentially affect almost any organ not only with benign tumours but also with life threatening carcinomas. Desmoid tumours and gastroduodenal polyps and cancer are the two more worrying extracolonic manifestations of FAP. Recent advances in FAP knowledge, such as the report of congenital hypertrophy of the retinal pigment epithelium (CHRPE) or the APC gene identification, are very useful for screening and long-term follow-up of the patients through regional or national registries. Nutritional and pharmacological intervention trials are under way to assess potential new medical treatments of FAP. Surgery is still the only effective treatment for colorectal cancer prevention in FAP. The choice of a surgical procedure is controversial, but the introduction of total proctocolectomy with ileal pouch-anal anastomosis can be considered as a major advance in surgical treatment of FAP during the last decade.

Abnormalities, Multiple↗

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Acute colonic complications after kidney transplantation.

Over a 30-year period (1963-1993), 12 patients out of 2091 renal allograft recipients (0.5%) were identified for an acute colonic complication. They were 7 males and 5 females with a mean age of 43 years. The mean elapsed time from transplantation to symptoms was 55 months. Peritonitis was diagnosed in all cases, requiring an emergency laparotomy in 6 patients (50%); delayed surgery was possible in 4 patients (33%) after failure of conservative treatment. One patient (9%) was operated electively later on while the last patient died before any surgery from sepsis after diffuse bowel ischaemia. Aetiology included complicated diverticulitis in 9 instances (75%), one colon perforation caused by faecal impaction, one cytomegalovirus colitis and one bowel ischaemia. Another patient died postoperatively after colon resection for perforated diverticulitis. The use of cyclosporine since 1985 did not reduce the incidence of colonic complication. In conclusion aggressive medical support and early surgical exploration are mandatory for renal recipients presenting with an acute colonic complication.

Abdomen, Acute↗

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Primary melanosarcoma of the rectum.

We report two cases of anorectal malignant melanoma observed these last four years in the department. The first case was a 62-year-old female patient, and the second case was a 68-year-old male patient. Both suffered from a primary rectal tumour, arising from the rectum, with an intact anal canal. There were pulmonary metastases in the latter patient. At rectal biopsies, tumours were poorly differentiated and diagnosis of malignant melanoma could only be established by the complementary immuno-histochemical methods. The first patient had an AP excision of the rectum and died from generalized disease seven months later. In the second case, only palliative irradiation was carried out and the patient died six weeks later. Literature review confirms that rectal melanoma is a very rare tumour. Diagnosis is difficult, especially in the amelanotic forms. Prognosis remains very poor and the best therapeutic approach is still controversial.

Aged↗

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Primary squamous-cell carcinoma of the colon: a case report.

We report a new case of S.C.C. of the large bowel with multiple liver metastases. A resection of the primary tumour and liver biopsies were performed with administration of a postoperative chemotherapy (5-Fluorouracil). After a stabilization of 3 months, the metastases were rapidly progressive and the patient died a year after the diagnosis. About 70 cases of S.C.C. of the colon and rectum have been described in the literature. It is most common in the fifth decade and occurs equally in male and female. The most frequent locations are the rectum and the sigmoid. Clinical and physical features and common diagnostic methods do not differentiate the S.C.C. from adenocarcinoma. Treatment is the same but the prognosis of S.C.C. appears to be worse than that of adenocarcinoma.

Carcinoma, Squamous Cell↗

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[Place of endorectal echography in the diagnosis and treatment of sessile villous tumors of the rectum].

Appropriate treatment of villous adenomas of the rectum remains a challenge, since accurate diagnosis can only be established after total removal of the lesion. The aim of the study was to assess the contribution of endorectal ultrasound (EUS) to diagnosis and treatment of these tumours. From 1989 to 1992, 22 patients with 24 villous adenomas of the rectum had preoperative EUS. Sixteen tumours were C1 (< 1/3 of the rectal circumference), 6 were C2 (between 1/3 and 2/3), and 2 were C3 (> 2/3). Multiple biopsies showed slight or moderate dysplasia in 12 cases, severe dysplasia or islets of invasive cancer in 12 cases. Depth of tumoural invasion could not be established. Tumours were staged by EUS as uT1 (no malignant infiltration) in 17 cases, uT2 and uT3 (invasive cancers) in 5 and 2 cases respectively. Patients had local excision of the tumours in 21 cases, and a radical rectal resection in 3. Accuracy of pathological sampling and EUS for diagnosis were evaluated, as well as the contribution of EUS to the treatment. Multiple biopsies achieved a 62% accuracy rate of diagnosis. Sensitivity in detecting invasive cancer was 71.5%. EUS reached a 92% accuracy rate; sensitivity and specificity in detecting invasive cancers were 85% and 94% respectively. The initial therapeutic option was modified in 6 patients as result of EUS stadification: undelayed surgery instead of iterative coagulations (n = 1), radical instead of local resection (n = 2) and local instead of rectal resection (n = 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma, Villous↗