[Anatomoclinical contribution to the knowledge of lymphatic cysts of the mesosigmoid].
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Among 126 patients operated upon for acute necrotizing pancreatitis in our department over a 10-year period starting in November 1979, 17 had a colonic resection. Colectomy was made mandatory by a necrotic or ischaemic appearance (12 cases, including 3 bowel perforations), an isolated perforation (2 cases) or extensive fat necrosis of the pericolonic atmosphere (3 cases). The hospital mortality was 5 out of the 17 cases. In 6 patients, the pathological results suggested that colonic resection was unnecessary. Since May 1988, a diverting loop ileostomy has been performed whenever colonic viability was found to be dubious at laparotomy. After this policy was introduced no case of secondary colonic complication was encountered. Nevertheless, there still are "abusive" colectomies unjustified by the pathology. Their number should be reduced by a more cautious indication of colonic resection in acute necrotizing pancreatitis.
Mesocolic hernia is a rare cause of intestinal obstruction in children. The diagnosis involves a high index of suspicion and prompt intervention to prevent strangulation and a high morbidity. The embryological basis of the condition is of paramount importance to assist the eventual surgical correction.
Three cases of chronic gastrointestinal bleeding are described; the Authors emphasize the important role of mesenteric arteriography in establishing site and nature of bleeding. The review of international literature shows a success rate between 41 and 73% of cases studied with this method after negativity of other diagnostic procedures.
Intra-abdominal liposarcomas (IALS) represent a rare localization compared to other liposarcomatous (LS) sites such as the lower extremities and the retroperitoneum. The authors report their experience in a case of giant liposarcoma (weight: Kg 8.2) presenting a massive intra-abdominal extension. Diagnostic and therapeutic problems related to this type of neoplasm as well as a literature review are reported.
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The authors report the first angiofollicular Lymph-Node Hyperplasia (Castleman'tumor) case with a meso-sigmoid location. They carry out a general review of the literature on 315 observations and insist on the anatomic and evolutive aspects allowing a better understanding of the histogenesis of the lesion. The inflammatory theory, actually acknowledge by most of the authors, also seems to them the most plausible.
Sigmoid volvulus is a rare disease of childhood, which requires surgery. The case of a 12-year-old boy is reported. The main aetiopathogenetic causes and the proper surgical approach are also described with particular reference to the so-called mesosigmoidoplasty, which consists of shortening the mesosigmoid by incision along its axis and transverse suture.
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Based on 4 operations, the authors stress the value of intestinal preservation in subjects with poor general suffering from volvulus or with signs of sigmoid torsion by means of mesocolonoplasty. The technical simplicity of this operation allows it to be proposed in the course of laparotomies indicated for any other abdominal pathology.
Internal abdominal hernias are uncommon. A case of sigmoid mesocolic hernia involving cystadenoma of the uterine adnexa is described. Symptoms from internal hernias are vague and uncharacteristic. Most cases are diagnosed at laparotomy for ileus.
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Technical modifications were applied during 47 splanchnicectomies using Dubois' trans-hiatal approach, with major simplification of the method, mainly by the absence of freeing of the abdominal esophagus. The approach to the right and left greater splanchnic nerves involved displacement of the esophagus to the left, avoiding the need to perform a gastro-esophageal antireflux procedure at the end of the operation. Furthermore, the most effective plane for pleural detachment is situated in fact in contact with the aortic adventitia. The simplicity and safety of this modified surgical method makes it an indication of choice for the treatment of intractable supramesocolic pain.
A cow was evaluated for acute onset of abdominal pain and decreased milk production. Physical examination revealed narrowing of the descending colon. Exploratory laparotomy revealed mesocolic defect and torsion of the cecum around the descending colon. After surgical correction of the cecal torsion, the cow recovered rapidly. The mesocolic defect could not be closed, and the history did not indicate a cause for the mesocolic defect.
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A rare case of mesocolic hernia containing the descending colon is described in a 71-year-old man. The literature on lesser sac hernia is briefly reviewed and the pathogenesis symptoms and treatment are discussed.