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At least 433 records · Page 24Linked to original sources
PubMedDate not supplied

Postoperative results of left upper abdominal evisceration for advanced gastric cancer.

BACKGROUND/AIMS: In spite of the improvement of surgical techniques, the prognosis of patients with advanced gastric cancer still remains poor. With the aim of achieving en bloc resection of primary tumor, peritoneal dissemination on the greater omentum and lymph node metastasis, left upper abdominal evisceration (LUAE) was performed for 75 patients. In this report, we investigated the prognostic difference between the LUAE group and standard gastrectomy (total gastrectomy + pancreatosplenectomy). METHODOLOGY: In the LUAE group, total gastrectomy was performed with the en bloc resection of the transverse colon, pancreas body and tail, spleen and left adrenal gland. In addition, omental bursa, covering retroperitoneum and pancreas body and tail was resected in combination with greater omentum, transverse mesocolon, and lesser omentum. RESULTS: There were 3 (4.1%) postoperative death in the LUAE group, and 2 (1.7%) in the control group. However, there was no statistical difference in the incidence of postoperative complications between these 2 groups. The overall 5-year survival rates of the LUAE and control groups were 33% and 39%, respectively. There was no statistical survival difference between these 2 groups. Survival difference between the LUAE and control group was not found in terms of tumor location, wall invasion, lymph node status, peritoneal dissemination, and macroscopic type. CONCLUSIONS: From these results, LUAE cannot improve the survival of patients with advanced gastric cancer. Consequently, LUAE should be indicated for T4 tumors, which directly invade into the transverse colon.

Adrenalectomy↗
PubMed1998

[A left paraduodenal hernia--a case report].

The left paraduodenal hernia obtains when the small intestine goes through the left paraduodenal fosset. It (the hernia) develops on the left, at the back of the descending mesocolon. The present authors study one case looking at its pathogeny and the clinical and therapeutic problems posed by such a variety of congenital internal hernia. The authors emphasize, in particular, its morbid associations with the volvulus of the pelvic colon. Finally they highlight the importance of a through and careful exploration of the abdominal cavity during any laparatomy following an occlusive syndrome.

Abdominal Pain↗
PubMedDate not supplied

Rectal carcinoma with stercoral ulcer perforation.

We report a case of ruptured stercoral ulceration due to chronic constipation which is caused by rectal carcinoma. This case suffered from difficulty of stool passage for 5 months. Periumbilical pain and current-jelly stool were experienced before his admission. Physical examination revealed diffuse abdominal rebounding pain and laboratory data showed leukocytosis. Computed tomography demonstrated marked dilatation of the sigmoid colon with stool impaction due to neoplastic growth in the rectosigmoid junction. Thickening and edematous change of the colonic wall were noted. There was amorphous material with gas in the mesocolon, which indicated fecal peritonitis. Emergent operation with Hartman's procedure and left colostomy was performed. Diffuse pressure gangrene of the sigmoid colon wall with a perforating hole was identified. Pathologically, the resected colon specimen showed non-specific-acute and chronic inflammatory change. The perforating hole was surrounded by a necrotic border of ulcerative mucosa. After the operation, pelvic drainage was undertaken for 1 month and then the patient was discharged uneventfully.

Aged↗
PubMed2000

[Adenocarcinoma of the appendix--case report].

The authors describe a case with a rare diagnosis of adenocarcinoma of the appendix in an adult female patient. The patient was indicated for surgical revision on account of acute appendicitis with a peroperative finding suspect of malignity of the vermiform appendix. A radical resection of the ileocoecal area was performed along with part of the ascendant colon and appropriate mesocolon as a primary operation. According to the postoperative histological evaluation of the resected portion the diagnosis of adenocarcinoma of the appendix was confirmed.

Adenocarcinoma↗
PubMedDate not supplied

Left paraduodenal hernia presenting as intestinal obstruction: report of one case.

We report a case of internal hernia of the small intestine in a 13-year-old boy with presentation of partial intestinal obstruction. The patient suffered from recurrent abdominal pain and chronic constipation over the past few years. An abdominal mass was suspected from clinical manifestations and images derived from abdominal echography. Upper gastrointestinal contrast study revealed poor motility at the distal jejunum with barium stasis. Follow-up film on the next day delineated medially and downwardly displaced splenic flexure and proximal descending colon. At operation, total herniation of small intestine into a retroperitoneal space through a defect on left mesocolon was noted. A left paraduodenal (mesocolic) hernia was diagnosed. The patient made an uneventful recovery after the hernia was repaired. This report provides unusual image clues of internal hernias of the small intestine presenting as ileus. Though rare, paraduodenal hernia should be taken into account in a differential diagnosis of intestinal obstruction. Early surgical intervention allows uneventful recovery to occur and also prevents the possible complication of gangrenous bowels.

Adolescent↗
PubMedDate not supplied

[Retroperitoneal rupture of the duodenum caused by closed abdominal injury].

Preoperative diagnosis of retroperitoneal rupture of the duodenum is very difficult. Radiographical observation of air surrounding the right kidney or psoas muscle is of great assistance in this respect, but may only be expected in 30% of cases. Examination of the first segment of the digestive tract with the aid of "gastropgrafin" is advised. With the abdomen open, the presence of air, haematoma or bile in the transverse mesocolon or mesentery of the small intestine may be noted. In most cases, the breach can be closed with a double layer, leaving a drainage tube in the retroperitoneum. Measures than can be taken when suturing is unfeasable are also described.

Abdominal Injuries↗
PubMedDate not supplied

Internal herniation of wandering spleen--a rare cause of recurrent abdominal pain.

A rare case of wandering spleen herniating through a defect in transverse mesocolon, which was managed electively by splenopexy using polyglycolic acid mesh is reported. An enlarged wandering spleen is at constant risk of trauma, torsion and infarction. Internal herniation seems to increase the above risks. Early recognition and elective splenopexy should be the treatment of choice.

Abdominal Pain↗
PubMed2002

Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience.

PURPOSE: We prospectively evaluated the morbidity, and minor and major complications of laparoscopic radical prostatectomy performed by a single surgical team. MATERIALS AND METHODS: Between January 28, 1998 and February 28, 2001, 567 patients 42 to 77 years old (mean age plus or minus standard deviation 63.5 +/- 6) with clinically localized prostate cancer underwent laparoscopic radical prostatectomy, including 458 (80.6%), without lymphadenectomy. Mean body mass index was 25.3 +/- 2.9 (range 17.3 to 37.5). American Society of Anesthesiologists score was 1 to 3 in 65%, 27% and 8% of cases, respectively. A total of 12 patients (2.1%) had undergone intra-abdominal surgery below the mesocolon and 40 had undergone urological surgery. Intraoperative and postoperative data were recorded as well as all complications and their severity score within the initial 30 days postoperatively. RESULTS: A total of 105 complications were observed in 97 patients (17.1%), including 21 major (3.7%) and 83 minor (14.6%) complications. Of the patients 21 (3.7%) underwent reoperation for a postoperative complication, including 10 (1.76%) who required an intensive care unit stay. Seven cases (1.2%) were converted to conventional retropubic radical prostatectomy. Mean blood loss was 380 +/- 195 ml. and the overall transfusion rate was 4.9%. In 2 patients (0.3%) deep vein thrombosis was associated with another surgical complication but not with pulmonary embolism. Urological, bowel and hemorrhagic complications represented 66.6%, 16.2% and 7.6% (total 89.4%) of all complications, and 20%, 33.3% and 33.3% of all repeat interventions, respectively. CONCLUSIONS: Laparoscopic radical prostatectomy was performed according to the defined protocol with no complications in 82.9% of patients. The morbidity of this approach compares favorably with that of retropubic surgery. Growing experience and knowledge sharing concerning the prevention and early management of these complications would make possible a further decrease in the morbidity of laparoscopic radical prostatectomy.

Adult↗
PubMed2001

[Technique of right laparoscopic hemicolectomy].

Patho-anatomic feature such as easy mobilisation of the colon segment on mesocolon, technically easy approach to the central lymphovascular pedicle, and the possibility of relative uncomplicated salvage and anastomosis warrant including this method in the procedures of modern colorectal surgery. Mobilisation from the vascularisized mesenterial bridges in a window technique, transection of the ileocolic lymphovascular pedicle, lateral and proximal mobilisation of ileocoecum, colon ascendance, right flexure and proximal transversum. After enlargement of one trocar incision the exteriorized colon is resected and an extracorporeal anastomosis is performed in the standard manner. With this standardized method, right hemicolectomy is easy, practicable, and repeatable and can be done with all the advantages of minimally invasive surgery.

Colectomy↗
PubMed2002

Bizarre impalement fatalities--where is the implement?

Two fatalities due to unusual impalement injuries are reported. (1) A large branch broken off during a storm had entered a passing car and perforated the chest of the driver and the back of the seat. The chest organs were grossly lacerated. The car was subsequently stopped by another tree and this second impact removed the wood from the body. (2) A man suffered anorectal impalement by the leg of a stool turned upside down. He had introduced one stool leg into his anus for sexual stimulation and fell onto it. This resulted in a wound channel 36 cm long including perforation of the rectum, urinary bladder, mesentery, transverse mesocolon and liver. Before autopsy, the mode of death was unclear because the man had removed the stool leg himself, his wife had hidden the stool from the scene, and there were no relevant external injuries. In both cases, a reliable reconstruction required investigation of the scene and consideration of extremely unlikely circumstances or of bizarre human activities.

Abdominal Injuries↗
PubMedDate not supplied

Obstructive jaundice due to internal herniation: a case report and review of the literature.

A 45-year-old man was suffering from abdominal pain and vomiting. He was admitted to our hospital with a diagnosis of ileus and obstructive jaundice. He had undergone Roux-en-Y anastomosis for choledocholithiasis 14 years earlier. A computed tomography scan revealed a dilated afferent loop and dilated intrahepatic bile duct. Upper gastrointestinal examination with contrast medium and percutaneous transhepatic cholangiography showed a high intestinal obstruction around the jejunojejunal anastomosis. The patient underwent laparotomy based on a diagnosis of obstructive jaundice due to ileus. During the operation, he was found to have internal herniation of the small bowel through a rent in the mesentery around the Roux-en-Y anastomosis for choledochojejunostomy. The hernia was reduced, and bowel resection was performed due to stenosis of the afferent loop. Jejunojejunal anastomosis was re-performed and the defect in the mesocolon was closed. Internal herniation after Roux-en-Y anastomosis is a rare sequela, but it should be recognized that this complication can occur after Roux-en-Y anastomosis. For prevention of internal herniation around the Roux-en-Y limb, secure closing of the mesenteric defects is important.

Anastomosis, Roux-en-Y↗
PubMed2000

[Topographic features of the embryogenesis of human adrenal glands].

The investigation of embryotopography of adrenals was performed on 95 embryo and 5-12 weeks old prefetus preparations, by microscopy, graphic and plastic reconstruction. It was abolished that adrenals develop in close morphologic correlation with temporary (primary kidneys, sex glands) and persistent (secondary kidneys) organs of embryonic retroperitoneal space. Developing in close correlation with derivatives of visceral layer of mesoderm (dorsal mesogastrium, mesocolon), adrenals, especially the left one are covered by an additional peritoneal layer during prefetal period.

Adrenal Glands↗
PubMedDate not supplied

[Surgical treatment of locally advanced esophago-gastric cancer; preliminary results].

UNLABELLED: The aim of this paper is to sustain the palliative resection in neoplasm of the esophago-gastric junction, as a surgical approach that allows a better post-operative life comfort in comparison with simple gastrostomy. 62 observations with proximal neoplasm of the stomach (12.5%) were identified between January 1996-August 2001, representing 12.5% of the 496 patients with gastric neoplasm admitted in our unit in the same period. Out of these 62 cases, 55 (88.71%) underwent surgical procedures. Our attitude was aggressive in 25 cases. 40.32%, including the locally advanced lesions with palliative surgical indications (18 obs.). The other 30 patients underwent: 10 laparotomies, 5 gastrostomies and 15 jejunostomies. Local invasion to the neighboring organs imposed partial resection of the transverse colon--1 obs., of the transverse mesocolon--2 obs., and corporeo-caudal pancreatectomies--3 obs. The surgical approach was a left abdomino-thoracic incision, with total gastrectomy and distal esophagectomy, with N1 and N2 lymphadenectomy, splenectomy, and esojejunal intrathoracic anastomosis, with a Roux-en-Y loop, with or without jejunostomy (13 obs.). The immediate post-operative complications were 8 anastomotic leakage, one duodenal stump fistula, one occlusion due to a jejunostoma, and 13 extradigestive complications. There were 5 post-operative deaths. CONCLUSION: Neoplasm of the esophago-gastric junction is lately diagnosed, but whenever is possible, total gastrectomy with distal esophagectomy should be carried out.

Adenocarcinoma↗
PubMed1992

[Vertebral fractures and abdominal trauma. A retrospective study based on 415 documented vertebral fractures].

415 spinal fractures were analysed retrospectively. A simultaneous occurrence of vertebral fracture and abdominal trauma was found in 14 patients (3.4%). The mechanism of injury was a fall from a considerable height in 9 cases, a car accident in 3 and a motorcycle accident in 2. Isolated fractures of the transverse processes and rotational injuries of the spine were found to be associated particularly frequently with an abdominal trauma (3 of 14 isolated fractures of the transverse processes = 22%, 5 of 61 rotational injuries = 8.2%), while compression injuries only showed such a simultaneous abdominal injury in 2% of the 300 fractures of this type. We never encountered the combination of distraction injury/abdominal trauma. This is probably because two-point lap-type seat belts are only rarely used in our country. In 2 patients with rotational injuries neurological deficits were observed. The abdominal injuries encountered in our patients were: massive concussion of the kidney (6 cases), rupture of the spleen (3 cases), rupture of the liver (2 cases), rupture of the mesocolon (2 cases), rupture of the caecum (1 case), rupture of a pre-existent aneurysm of the aorta (1 case), rupture of a renal artery (1 case), massive retroperitoneal haematoma (1 case). Other injuries were present in 12 of the 14 patients: 3 craniocerebral injuries, 7 fractures of the long bones, 6 injuries to the thorax and 3 to the pelvis. In conclusion, a simultaneous finding of vertebral fracture and abdominal trauma is rare in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed2003

[Management of anastomotic fistula following excision of rectal cancer].

The risk of anastomotic leak after resection of cancers of the mid or low rectum with mesorectal excision is about 10%--the lower the colo-rectal or colo-anal anastomosis, the higher the risk of leak. If the fistula is asymtomatic and the leak is walled off, it is best to defer the closure of the diverting ileostomy for 2-3 months and to proceed only when a radiologic contrast study shows the fistula to have disappeared. More commonly, the anastomotic fistula presents as a pelvic abscess. It is simple and logical to drain the abscess into the digestive tube by enlarging the orifice of the fistula; this can usually be done with a brief general anesthetic. Less commonly, the abscess may present at some distance from the anastomotic leak; this calls for percutaneous drainage. If abscess drainage fails, if pelvic sepsis persists, or if the leak presents from the start as generalized peritonitis, laparotomy is called for in order to lavage the abscess cavity, place effective drains, and perform, if necessary, a diverting stoma upstream. Two strategies are possible: 1) drain placement at the leak site with upstream loop diverting stoma, or 2) takedown of the anastomosis, closure of the distal stump as a Hartmann pouch, and proximal end colostomy in the left lower quadrant. In the first instance, one must be sure the fistula has healed before stoma closure. In the second, the problem is to obtain (at a second stage) sufficient length of well-vascularized proximal colon to make an anastomosis to a short Hartmann pouch or to the anus in a pelvis scarred and inflamed by infection and radiation. A Soave procedure may allow an anastomosis with less risk to peri-rectal innervation and with less blood loss. Two maneuvers which may help to gain length are the Toupet technique for freeing the transverse mesocolon or the Deloyer technique of mobilizing the hepatic flexure. In the face of post-operative pelvic sepsis, an early intervention adapted to the circumstances will increase the chances of healing and reestablishment of intestinal continuity, and may avoid multiple complex interventions with poor functional results including incontinence, urgency, and difficult evacuation.

Anastomosis, Surgical↗
PubMed1992

[New uretero-cystoneostomy in cystocecoplasties. Technique and results].

Ureteric reimplantations into an intestinal segment are frequently followed by early, secondary or late stenoses. In UCN, it is essential to perform atraumatic ureteric dissection followed by reimplantation of a short ureter well vascularized by a single superior pedicle, i.e. the simplest UCN, putting the least strain on the ureter both during creation of the diversion and during subsequent healing. The ileal segment of an ileocaecocystoplasty must extend above the right iliac vessels. It is open on the antimesenteric border and its distal border is stripped of a 3 mm band of mucosa. To reach its homologue, the left ureter passes underneath the common root of the sigmoid mesocolon. Each optimally shortened ureter is placed in and fixed to the start and the end of a longitudinal mucosal tunnel, about 3 cm long. The ileum is sutured as a cuff around the orifice of each ureter. A ureteric stent is left in place for a fortnight. The ileum is sutured to the right laterocaval retroperitoneal tissue. This UCN is simple and rapid to perform.

Cecum↗
PubMed1992

[Hartmann's procedure. A retrospective study of 86 cases].

The purpose of this retrospective study is to define current indications and results of Hartmann's procedure (H). From 1978 to 1989, 86 H were performed, 52 (60%) as emergency surgery. Indications were: colo-rectal cancer (37): 15 complicated and 22 as an elective procedure, diverticular disease acute or complicated (24), ischemic colitis (10), volvulus of the pelvic colon (5), inflammatory bowel disease (4), colonic perforation (3), traumatic hematoma of the sigmoid mesocolon (1). Fourteen patients died after operation (mean age: 79). There was no death after elective H for cancer. Post-operative complications were numerous: pulmonary (25%), abdominal would sepsis or disruption (21%), rectal strump leakage (14%), the later being harmless due to the associated Mickulicz drainage. Seven patients were reoperated on for necrosis of the colonic stoma. Mean initial hospital stay was 31 days. Restoration of the gastrointestinal continuity was done in 27 cases (37% of the surviving patients, 76% of the diverticular diseases). The authors conclude that for complicated diverticular disease H procedure improves survival without preferable continuity. For cancer, H procedure is permanently compromising gastrointestinal in the elderly to hazardous low anastomosis, and to palliative abdomino-perineal resection.

Adult↗
PubMed2003

[A case of advanced type 4 gastric cancer with peritonitis dissemination, navel metastasis effectively treated with combined chemotherapy of biweekly paclitaxel (TXL) and TS-1].

The patient was a 44-year-old woman who had unresectable advanced gastric cancer with peritoneal dissemination and navel metastasis (Sister Mary Joseph metastasis). The lesion was considered surgically incurable, so she was placed on neoadjuvant chemotherapy consisting of biweekly TXL (100 mg/m2/day 1, 15) and TS-1 (80 mg/m2/day 1-14) and 2 weeks rest. Before chemotherapy, she could not eat anything because of poor expansion of the stomach and ascites. After the 1st course she could eat half the volume of a normal meal. The only side effect of this treatment was pigmentation of the skin and alopecia. After the 2nd course, she returned home and chemotherapy was continued on an outpatient basis. After the 5th course, the stenosis of colon and ascites had disappeared in a barium enema and CT scan, respectively. The poor expansion of the stomach was slightly improved. She was considered to have responded and underwent total gastrectomy with D2 and transverse colectomy and splenectomy. There were no clear nodules indicating peritoneal dissemination in the intra-operative findings. Intra-operative cytological examination was negative. The depth of the cancer invasion was limited to the subserosal layer and there was no invasion to the colon histologically. There was no lymph node metastasis, but there were a small number of cancer cells obtained diffusely in the omentum and mesocolon. There was no findings of recurrence 5 months later. Biweekly TXL and TS-1 therapy was thought to be an effective chemotherapy against advanced gastric cancer.

Adult↗