1,720,991 research outputs found
Leiomyosarcoma arising from the inferior mesenteric vein
No full textLeyomiosarcomas arising from the portal/mesenteric venous system are very rare tumours, and only a few cases have been reported in the global literature. As the other leyomiosarcomas of vascular origin, they are associated with a poor prognosis. The present report describes the case of a 66-year-old woman with a leyomiosarcoma of the inferior mesenteric vein, unexpectedly found during a CT scan performed for another indication. A brief review of the literature is also given. The patient underwent radical surgical excision and enjoys a good health, without radiological signs of recurrence, 24 months after surgery. In this case, an early incidental diagnosis determined an early treatment and, probably, a favourable prognosis. This is the second case of leyomiosarcoma of the inferior mesenteric vein reported in the literature
Primary hepatic leiomyosarcoma in a young male after Hodgkin s disease: diagnostic pitfalls and therapeutic challenge
No full textBackground. Primary leiomyosarcoma of the liver is a rare tumor whose development patterns are unsatisfactorily known.
Patient case. A 26-year-old male patient with a previous history of radiochemotherapy treatment for Hodgkin's lymphoma was referred to our unit with a histological and radiological diagnosis of primary hepatic leiomyosarcoma. Six months before referral, in a workup for hypertension, a CT scan of the abdomen had shown a 2.5-cm lesion in liver segment VII, which was interpreted as an angioma. Shortly before referral the lesion had grown to 7.8 cm associated with two smaller lesions in segments VIII and 111, and a diagnosis of hepatic leiomyosarcoma was made at biopsy. After referral he underwent a right hepatectomy with wedge resection of segment III. This was followed by rapid progression of the disease, in spite of transient stabilization under gemcitabine treatment. Octreotide was also administered after the detection of elevated chromogranin A in serum. The patient died 25 months after liver resection.
Conclusions. The challenges and peculiarities of this case are related to the rarity of the tumor, its accidental discovery without immediate suspicion of its nature, its very aggressive behavior that was only partly controlled by chemotherapy, and the unusual expression of a neuroendocrine phenotypic feature with high serum chromogranin A levels
What are risk factors for COVID-19 vaccine breakthrough infections in patients with previous history of bariatric surgery?
No full textElectronic clinical challenges and images in GI. Giant gastric polyp prolapsing into the duodenum
No full textNo Abstrac
Analysis of the components of hypertransaminasemia after liver resection
No full textBackground: The increase in plasma aspartate (AST) and alanine (ALT) aminotransferase after liver resection is multifactorial, and a major problem is the difficult quantification of the impact of each factor involved.
Methods: Regression analysis of a large series of measurements for 92 hepatectomy patients was carried out to assess in detail the postoperative evolution of AST and ALT, together with related components.
Results: The best correlate of increased AST and ALT on postoperative day 1 was the duration of surgery (T-surg) (r(2) = 0.311 and 0.29), with a lower correlation for intraoperative liver ischernia (T-isch) (r(2) = 0.22 and 0.17, respectively; p < 0.001 for all). Subsequently AST decreased more quickly than ALT and both followed an inverse exponential pattern. T-surg, T-isch, time after surgery and plasma bilirubin explained 77% and 51% of the variability of AST and ALT, respectively, for all postoperative measurements (p < 0.001 for both). The best correlate of T-isch was a delayed increase in bilirubin, detected on postoperative day 7, attenuated by the use of intermittent liver ischernia.
Conclusions: These data show that T-isch may not be the main determinant of increased transaminases after hepatectomy, and provide a quantitative analysis of the main impact of the trauma of liver resection, liver ischernia, and other factors on the postoperative evolution of transaminases
Complicanze biliari della colecistectomia: la gestione della fase acuta delle lesioni iatrogene della via biliare principale
No full textPremessa
Le lesioni iatrogene della via biliare principale (VBP) costituiscono
una grave complicanza della colecistectomia.
Scopo dello studio
Presentare l’esperienza di un centro di chirurgia epato-biliare
nella gestione della fase acuta delle lesioni iatrogene della VBP.
Metodi
Nel periodo 1994-2007 sono stati trattati 103 pazienti per lesione
iatrogena della VBP in corso di colecistectomia. Questo studio
riguarda 62 pazienti trasferiti post-operatoriamente nella fase acuta
della complicanza. Il riconoscimento della lesione è stato intraoperatorio
in 21 pazienti (con conversione laparotomica in 19 e colangiografia
in 2; tentata riparazione in 20 e semplice drenaggio
sotto-epatico in 1), con 6 reinterventi per coleperitoneo. Il riconoscimento
è stato post-operatorio in 41 pazienti (per ittero semplice
in 7 e fistola biliare/coleperitoneo in 34), seguito da tentata riparazione
in 27. Dopo il trasferimento nella nostra U.O. 7 pazienti con
ittero hanno eseguito precocemente un’epatico-digiunostomia
(Hepp-Couinaud). Per quanto riguarda i 55 pazienti con perdita biliare
(di cui 12 rioperati subito per coleperitoneo), 13 con lesione
minore/deiscenza del cistico hanno eseguito un trattamento endoscopico/
conservativo; dei 42 con lesione maggiore, 3 sono deceduti
per sepsi prima di qualunque riparazione, 15 pazienti, con sezione
parziale della VBP, sono stati sottoposti ad un trattamento endoscopico
con stent e 24, con sezione completa/lesioni complesse
della VBP, a ricostruzione chirurgica a 90 giorni in media dalla colecistectomia,
dopo la risoluzione dei problemi acuti.
Risultati
Tre pazienti (4,8%) con storie complesse sono deceduti per sepsi
prima di qualunque riparazione. Le 7 ricostruzioni chirurgicheper ittero semplice ed i trattamenti endoscopici/conservativi per lesioni
minori/sezioni parziali della VBP hanno avuto risultati eccellenti/
buoni. Le 24 ricostruzioni chirurgiche per sezioni
complete/lesioni complesse della VBP hanno avuto risultati eccellenti/
buoni, completando in 4 casi il trattamento con calibraggio
percutaneo.
Conclusioni
Questa revisione critica indica che la gestione della fase acuta
di una lesione biliare e il trasferimento precoce in un centro specialistico
multidisciplinare sono decisivi per la prognosi di questi pazienti
e assicurano i migliori risultati.Background
Iatrogenic bile duct injury is a severe complication of cholecystectomy.
Purpose
To describe the experience of a hepatobiliary surgery unit in the
management of iatrogenic bile duct injuries in the acute stage.
Methods
A total of 103 patients with iatrogenic bile duct injuries occurred
during cholecystectomy were treated between 1994 and 2007. This
study includes 62 patients who were referred to our Unit in the
acute stage of the complication. The injury was intraoperatively
identified in 21 patients (conversion to open surgery in 19, cholangiography
in 2; attempted repair in 20 and simple abdominal
drainage in 1), with 6 re-operations for choleperitoneum; it was
postoperatively identified in 41 patients (obstructive jaundice in 7
and biliary fistula/choleperitoneum in 34), with attempted repair in
27. After referral to our Unit, 7 patients with jaundice underwent
hepaticojejunostomy (Hepp-Couinaud). With regard to the 55 patients
with bile leak (of whom 12 reoperated on immediately due to
choleperitoneum), 13 with minor injury/cystic stump leak underwent
endoscopic/conservative treatment. As regards the 42 patients
with major injury, 3 died from sepsis prior to repair, 15 with partial
common bile duct (CBD) transection underwent endoscopy with
stenting, and 24 with complete CBD transection/complex injury underwent
surgical reconstruction at a mean distance of 90 days from
cholecystectomy, after fully recovering from acute problems.
Results
Three patients (4.8%) died from sepsis before any repair. The 7
surgical reconstructions for simple jaundice and the
endoscopic/conservative treatments for minor injury/partial CBD
transection yielded excellent/good results. The 24 surgical reconstructions
for complete CBD transection/complex injury yielded
excellent/good results; in 4 cases treatment was completed with
percutaneous dilatation.
Conclusions
This analysis demonstrates that early referral and management
of iatrogenic bile duct injuries in a specialised multidisciplinary
centre are of fundamental importance for patient prognosis and
yield good results
Case Report: Recurrent colonic metastasis from lung cancer—diagnostic pitfalls and therapeutic challenge of a peculiar case
No full textLung cancer (LC) mortality exceeds 20%, and detecting metastases from LC is becoming a challenging step in understanding the real prognostic role of specific localization. We report a case of a patient with lung metastasis to the colon with local recurrence at the anastomosis after radical resection for metastasis. In both cases, the diagnosis was on oncological follow-up, and surgery was offered in consideration of reasonable life expectancy, good control of LC, and high risk of intestinal occlusion. A 67-year-old male, with a history of LC 18 months ago, was referred to our surgical unit after a positron emission tomography CT total body, where an area of intense glucose metabolism (SUV max: 35.6) at the hepatic colic flexure was reported. A colonoscopy revealed an ulcerated, bleeding large neoplasm distally to hepatic flexure, almost causing resulting total occlusion. Histologic examination revealed a tumor with complete wall thickness infiltration, which appears extensively ulcerated, from poorly differentiated squamous carcinoma (G3), not keratinizing, with growth in large solid nests, often centered by central necrosis. Two of the 30 isolated lymph nodes were metastatic. The omental flap and resection margins were free from infiltration. The malignant cells exhibited strong positive immunoreactivity only for p40. The features supported metastatic squamous carcinoma of lung origin rather than primary colorectal adenocarcinoma. After 8 months from surgery, intense Fluorodeoxyglucose (FDG) uptake of tissue was confirmed in the transverse colon. Colonoscopy evidenced an ulcerated substenotic area that involved ileocolic anastomosis on both sides. Reoperation consisted of radical resection of ileocolic anastomosis with local lymphadenectomy and ileotransverse anastomosis. The second histologic examination also revealed poorly differentiated squamous carcinoma (G3), not keratinizing, with positive immunoreactivity only for p40, suggesting the origin of LC. This case report confirmed that the possibility of colonic secondary disease should be part of the differential diagnosis in asymptomatic patients and those with a history of LC diagnosis. In addition, relapse of colonic metastasis is infrequent but should be considered during follow-up of LC. More studies on colonic metastasis of LC are required to better understand the clinical features and outcomes
Left hepatectomy for metastatic thrombosis of umbilical vein and left portal vein from renal cell carcinoma
No full textRenal cell carcinoma is an aggressive tumor which is often advanced at the time of diagnosis; its distant spread can take a lymphatic route or, more often, a vascular route (renal vein and inferior vena cava), but tumor thrombosis of left portal vein extending into the round ligament (the umbilical vein) coming from this tumor, to our knowledge, has never been described. We report the case of a metastatic thrombosis of left portal vein and of the umbilical vein from renal cell carcinoma, developed 13 years after nephrectomy, which was successfully treated with left hepatectomy. The experience with hepatectomy for metastatic renal cell carcinoma has been rarely reported. Nevertheless radical hepatectomy is considered to be the only opportunity for curative treatment for selected patients with metastatic renal cell carcinoma
External lymphatic fistula after intra-abdominal lymphadenectomy for cancer. Treatment with total parenteral nutrition and somatostatin
No full textObjective: External lymphatic fistula or chyloperitoneum after intra-abdominal lymphadenectomy may present challenging problems. In the absence of definite guidelines the choice of treatment is often empirical, with unpredictable effectiveness, and the reporting of new cases may broaden the available experience.
Methods: We describe two cases. One patient had high-output external fistula (1300 mL/d) after para-aortic lymphadenectomy for metastatic lymph nodes. The fistula became fully evident at postoperative day 4, with resumption of an oral diet, oil the basis of a 1300-mL/d output of white milky fluid from an abdominal drainage. Oral feeding was interrupted and total parenteral nutrition was started: this was transiently associated with octreotide administration, subsequently replaced by somatostatin. The second patient had a low-output fistula (350 mL/d) after liver resection and lymphadenectomy for cholangiocarcinoma and underwent treatment with total parenteral nutrition and somatostatin.
Results: In the first case the lymphatic fistula healed ill just less than 3 wk, with the patient constantly remaining in very good condition, without secondary complications. In the second case the low-output fistula healed more rapidly.
Conclusion: Interruption of oral feeding with total parenteral nutrition and continuous somatostatin infusion was an effective treatment in both patients with all intra-abdominal lymphatic leak
Unexpected diagnosis of Crohn's disease after the ingestion of a dental bridge
No full textNo Abstract - Letter with 2 figures
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