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At least 523 records · Page 29Linked to original sources
PubMed1997

The extent of lymph node dissection for colon carcinoma: the potential impact on laparoscopic surgery.

BACKGROUND: The surgeon is no longer able to palpate the mesocolon for lymph node metastases during laparoscopic colectomy. The extent of lymph node dissection should be determined beforehand for cancer control. METHODS: The distribution of lymph node metastases was obtained by the clearing method on colon carcinomas for 164 patients. RESULTS: For pericolic spread: for pT1 tumors, the distance from the primary tumor to a metastatic lymph node was 2.5 cm; for pT2, the distance was within 5 cm; for 97.0 % of pT3 tumors with lymph node metastases, the distance was within 7 cm; for 93.3 % of pT4 tumors with lymph node metastases, the distance was within 7 cm. For central spread: for pT1 tumors, the rate of metastasis to central lymph nodes was 0 %; for pT2, the rate of metastasis was 20.0 % to intermediate lymph nodes; for pT3, the rate of metastasis was 30.6 % to intermediate lymph nodes and 15.3 % to main lymph nodes; for pT4, the rate of metastasis was 44.4 % to intermediate lymph nodes and 22.2 % to main lymph nodes. CONCLUSIONS: Central lymph node dissection is not required for patients with T1 carcinomas, but proximal and distal 3-cm margins of resection are required. For T2, central lymph node dissection that includes the intermediate lymph node should be performed, as well as 5-cm proximal and distal margins of resection. For T3 and T4, central lymph node dissection including the main lymph node should be performed, as well as 7-cm proximal and distal margins of resection. [See editorial on pages 177-8, this issue.]

Colectomy↗
PubMed1997

[Unusual vascular lesions in the course of a colonic leishmaniasis in an HIV positive patient].

Patients with acquired immunodeficiency syndrome are often susceptible to atypical dissemination of visceral leishmaniasis. Digestive localizations seem to be relatively frequent. Colonic localizations reported in the literature are endoscopically normal or show superficial mucosal lesions. We describe an original case of leishmaniasis associated with a colonic pseudotumoral stenosis with perforated ulcer penetrating in the mesocolon. Striking inflammation of mesenteric blood vessels, even far from the ulcer, suggested an ischemic mechanism for the colonic stenosis. These findings raise the hypothesis that vasculitis is secondary to mucosal parasitic infection.

Adult↗
PubMedDate not supplied

[Carcinoma of the splenic flexure. Nosological and therapeutic contribution].

Twenty-one patients undergoing colectomy for carcinoma of the splenic flexure from November 1996 throughout October 1993 were studied retrospectively. Clinical and prognostic features were compared with those of other colon cancers treated in the same period at the same Institution. No differences in symptoms at onset and stage distribution were found in the two groups. The complex removal of the cancer tissue was achieved with the resection of the major part of the transverse colon, splenic flexure, descending colon and its mesocolon. The splenic flexure cancer did not show a worse prognosis than other colon cancers.

Adenocarcinoma↗
PubMed1998

Pericolonic mass containing chyle as a presumed sequela to chronic pancreatitis in a dog.

A 9-year-old dog was admitted because of recurrent episodes of chronic pancreatitis. Ultrasonography revealed a multiloculated, fluid-filled cystic mass at the caudal portion of the stomach. Guided fine-needle aspirates yielded a fluid consistent with chyle. The dog underwent surgery during which a 6- to 8-cm mass was found adhered to the mesocolon and serosa of the transverse colon. Intraoperative lymphangiography revealed lymphangiectasia, but contrast medium did not accumulate within the mass. The mass and a portion of transverse colon were removed en bloc. Results of histologic examination were consistent with an abscess. Pancreatic enzymatic digestion may allow abscesses to extend beyond pancreatic parenchyma, cause severe local inflammation, and encapsulate and incorporate adjacent abdominal lymphatics. Subsequent lymphatic leakage can result in chyle within the abscess. Inflammatory masses of the pancreas are a rare, but serious, complication of pancreatitis in dogs. Familiarity with these types of lesions can aid in selection of appropriate treatments.

Abscess↗
PubMed1997

[Laparoscopic surgery of rectal carcinoma].

Laparoscopic colorectal procedures for treatment of benign disorders are increasingly appreciated. However, laparoscopic resections for rectal cancer are controversial. In the Department of Surgery at the Medical University of Lübeck 25 patients with rectal cancer were treated by laparoscopic procedures within four years. Using four trocars the intraabdominal dissection of the sigmoid colon and rectum including mobilisation of the left flexure were performed. A complete lymphadenectomy with high ligation of the inferior mesenteric artery and dissection of the mesocolon and colon were accomplished by laparoscopic techniques. There was no case requiring conversion to open surgery attributable to intraoperative complications. Apart from stoma complications one venous bleeding occurred postoperatively requiring laparotomy. The median lymph node harvest were 12 nodes. Laparoscopic colorectal surgery for rectal cancer is oncologically feasible. Concerning long-term outcome and due to the problem of port site recurrences laparoscopy for rectal cancer should be offered only to patients enrolled in a prospective randomized trial.

Aged↗
PubMed1997

Abdominal fluid collection secondary to acute pancreatitis: treated with percutaneous catheter drainage.

BACKGROUND: Complicated pancreatic inflammatory diseases are often life-threatening, multifocal, and multibacterial disorders. Untreated, these lesions often prove fatal. The purpose of the study is to describe interventional radiologic techniques for diagnosis and treatment of complicated peripancreatic fluid collections. METHODS: Between January 1994 and December 1995, 17 patients with abdominal fluid collection from complicated acute pancreatitis underwent percutaneous drainage following initial diagnosis with computed tomography (CT). These patients required multiple CT examinations, multiple catheter insertions, multiple catheter manipulations, and long-term catheter drainage. RESULTS: Twenty-five infected fluid collections among these 17 patients were percutaneously drained. Sixteen (94%) patients were successfully treated with catheter drainage alone. Surgical treatment was necessary in one patient because of segmental stricture of transverse colon caused by inflammation and adhesion of transverse mesocolon. Catheter drainage duration averaged 31 days. Patients required an average of three catheter manipulations and four abdominal CT scans. Mean hospital stay was 42 days (range, 11-95 days), and mean ICU stay was 25 days (range, 1-70 days). CONCLUSIONS: The study confirms that complicated peripancreatic fluid collections can be safely and effectively treated in most patients with percutaneous catheter technique.

Abscess↗
PubMed1976

Multiple mesenteric cysts diagnosed by ultrasound. A case report.

The diagnostic value of ultrasound in mesenteric cysts in infancy and childhood is demonstrated by a case report of a 4 year old girl with multiple cysts in the transverse mesocolon and with no other symptoms or signs than an enlargement of the abdomen. Neither clinical nor radiological examination could give the diagnosis, whereas ultrasound examination promptly revealed large, thin-walled, partly locular, cystic masses.

Child, Preschool↗
PubMed1998

[A new reconstruction procedure as antireflux surgery after proximal gastrectomy. Interposition of the jejunal pouch with valvuloplasty].

In order to reduce the incidence of reflux esophagitis following proximal gastrectomy, we have developed a new reconstruction procedure with an interposed jejunal pouch with antireflux valvuloplasty between the esophagus and the gastric remnant. After a standard proximal gastrectomy and lymph node dissection, the jejunum is divided at a point 25 cm from the Treitz ligament. The distal jejunum is pulled up through the transverse mesocolon with a mesenterium and anastomosed to the esophagus with a PCEEA stapling device. The pulled through jejunum is doubled up at a point 30 cm from the esophagojejunostomy, and the 5 cm tip of the jejunum is resected. A 5.5 cm autosuture GIA is inserted into the jejunum from both cut ends of the jejunum for side-to-side anastomosis on the antimesenteric side to make a 5 cm long jejunal pouch, and the jejunum is further divided 5 cm distal from the jejunal pouch. As a result, the interposed jejunal segment is omponed of a single-lumen 15 cm jejunum, a parallel lumen 5 cm jejunum, and a double-lumen jejunum. In the double-lumen jejunum, the jejunal pouch plays the role of a pressure absorber in the residual stomach, and the septum of the parallel lumen jejunum that of an anti-reflux valve. Peristalsis of the single lumen 15 cm jejunum prevents reflux to the esophagus. Postoperative examinations showed that this reconstruction method has satisfactory to excellent results.

Adult↗
PubMed1998

Paraduodenal hernia.

An internal hernia is the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. Internal hernias account for 0.2 to 0.9 per cent of all cases of intestinal obstruction. Paraduodenal hernias are relatively rare congenital malformations and account for 30 to 53 per cent of all internal hernias. They result from incomplete rotation of the midgut, with part of the small intestine trapped posterior to the mesocolon. Right and left paraduodenal hernias are distinct and separate entities, varying not only in anatomic structure but also in embryological origin. Symptoms are often vague, and a high index of suspicion is required to make the diagnosis. This entity should be considered whenever atypical abdominal symptoms are present. A CT scan or barium upper gastrointestinal radiography provides the best preoperative evidence of this condition, although ultrasonography and plain films are also useful. Elective repair of such a hernia should always be performed to avoid bowel incarceration or strangulation. An understanding of the anatomy of these hernias facilitates the surgery and is necessary in decreasing the likelihood of complications. Careful reduction of the hernia and surgical repair will avoid injury to the major mesenteric vessels juxtaposed to the hernial orifice. The surgical management of three patients, who were diagnosed preoperatively with this condition, is described with a review of its pathogenesis and present surgical treatment.

Adult↗