1,720,998 research outputs found
Colonic stent placement as a bridge to surgery in patients with left-sided malignant large bowel obstruction. An observational study
No full textBackground. Acute left-sided malignant colonic obstruction is common in elderly patients, in which emergency surgery is related with high morbidity and mortality rates, and often necessitates a two-step resection. Although the use of self-expanding metallic stents (SEMS) in elderly patients has not been adequately described yet, there are almost two international important trials which are still in progress, the stenting technique is established to be, by the international literature, an useful treatment with low morbidity and mortality. It’s also a bridge to surgery, since the insertion of a SEMS can decompress the obstruction, making bowel and patient preparation possible and facilitating singlestage surgical resection. Palliative stenting can improve quality of life when compared to surgery in patients with metastasis or high co-morbidity.
The aim of this study is to analyze mortality, avoidance of stoma, short- and long-term survival in patient with malignant left-sided large bowel obstruction who underwent to stent placement in our Emergency Surgery Unit, which is operative since November 2010 in our city Hospital in Ferrara.
Patients and methods. Between November 2010 and December 2012 a total of 15 patients with acute left-sided malignant large bowel obstruction suitable for colonic stent application were admitted to Emergency Surgery Unit. Among these patients, 9 underwent to self-expanding metallic stent placement (group A), the other (group B) 6 patient underwent to emergency surgery.
In this observational not-randomized study we analyzed the efficacy and safety of SEMS placement for patients either as a bridge to surgery or as a palliation, beside the short term and long term outcomes, versus those patients operated straight.
Results. Self-expanding metallic stents were successfully implanted in 9 of the 15 patients with acute left-sided malignant large bowel obstruction. No acute procedure-related complication was observed. All the patients in group A kept the stent in place for an average of 7,7 days, then everyone underwent to surgery. A large bowel resection with one-time recanalization was performed in 8 of the 9 patients. None Hartmann resection was necessary. Only one underwent again to surgery because of a dehiscence, a stoma was necessary.
Between the other 6 patients in group B who underwent directly to surgery, In one case was necessary an Hartmann resection, another one incurred in dehiscence of the anastomosis that required reoperation with stoma creation.
Conclusions. Placement of SEMS seems to be an useful alternative to emergent surgery in the management of acute left-sided bowel obstruction, both as a bridge to surgery and as a palliative procedure. SEMS can provide an effective and safe therapeutic option compared to emergency surgery, most of all in elderly patients, with a lower mortality rate, a significantly higher rate of primary anastomosis and the avoidance of stoma.
However, to fully determine their role for these indications, more data and more high level evidence is required
The surgical approach to near-total small bowel infarction in a patient with massive portomesenteric thrombosis. Case report.
No full textAIM:
To describe an acute portomesenteric venous thrombosis, with massive small bowel infarction, which is managed with small bowel resection, primary anastomosis, and open abdomen management (OAM).
CASE REPORT:
A 76-year-old male patient was admitted to the surgical ward, complaining spread abdominal pain. Contrast Enhanced Computed Tomography (CECT) diagnosed massive bowel ischemia, caused by portomesenteric thrombosis. He had negative coagulation tests for thrombophilia, while he presented concomitant risk factors (cancer, previous venous thrombosis, obesity). Surgery was performed, including open abdomen management, and the patient was discharged one month after surgery. No recurrences of portal thrombosis were found in one-year follow-up.
DISCUSSION:
Mesenteric venous thrombosis (MVT) diagnosis could be difficult to establish and it often presented itself late with peritonitis. Currently, CECT scanning is considered the gold standard for MVT, because it identifies not only filling defects in the portomesenteric system, but also possible complications, such as bowel ischemia. Standard initial treatment of MVT included heparin anticoagulation alone or in combination with surgery. When peritoneal signs initially are present, immediate surgery is indicated. During laparotomy, assessment of bowel viability and of the border between ischemia and vivid bowel could be more difficult to define. A planned "second-look" operation remains the gold standard for final bowel viability assessment.
CONCLUSIONS:
OAM strategy could possibly play an important role, also in case of resection for bowel ischemia, in improving survival in critically patients with increased risks of complications of re- anaesthesia and re-laparotomy.
KEY WORDS:
Acute Mesenteric Ischemia, Open Abdomen, Portal vein, Venous Thrombosis
Fish bone ingestion: Complications and legal implications
No full textForeign body (FB) ingestion, which can be accidental or intentional, is quite common, especially in children, elderly and some categories of profession. On the other hand, perforation and abscess formation as complications of FB ingestion are rare. Their presentation is not clinically different from other causes of peritonitis and differential diagnosis is sometimes difficult. The most common cause of FB perforation is due to fish bone ingestion. We present two consecutive cases of complications associated to fish bone ingestion. In the first case, patient had diffused abdominal pain, without laboratory considerable signs of inflammation. Computer tomography (CT) scan evidenced ileal perforation due to a probable FB; in the second case patient presented abdominal pain, leukocytosis and elevated CRP. The CT scan revealed presence of abscess and omental inflammation near ileum. Both patients submitted surgery. In the first case, an enterotomy was done, in the second case omentectomy and abdominal cleaning were performed. Surprisingly, In the second case, the patient claimed for damages in the high suspicion for a medical error occurred in a previous operation. Fortunately, the specimen exam revealed the truth. Complications due to FBs ingestion must be adequately recognized and rapidly treated. Radiological tools, especially ultrasonography and CT scan, can be useful to make diagnosis but sometimes this is reached only at the time of intervention
Solitary fibrous tumour of gluteus: a case report about an uncommon localization of a rare neoplasm.
No full textSolitary fibrous tumour (SFT) is a rare benign tumour that occurs most frequently in the pleura. It is considered rare in soft tissues. We report a case of a middle-aged woman that presented a solitary fibrous tumor of gluteus. The tumour was composed of mesenchymal spindle-shaped cells positive for CD34 and bcl-2. Although rare, SFT should be included in the differential diagnosis of mesenchymal soft tissue tumours. The clinical presentation and imaging can be helpful for a better pre-operative diagnosis
IMPLANTED DELIVERY SYSTEMS IN ADVANCED CANCER PATIENTS: OUR EXPERIENCE WITH THE CEPHALIC VEIN AND THE INTERNAL JUGULAR VEIN ACCESS
No full textAcute necrotizing pancreatitis: Can tigecycline be included in a therapeutic strategy?
No full textIntroduction. Acute necrotizing pancreatitis is a severe and lifethreatening disease. Infection, which occurs in about 30% of cases, is the most feared complication. Antibiotic therapy is still discussed and there are no clear recommendation in literature. These clinical series underline the importance of having a clear antibiotic protocol, including tigecycline, in the management of acute necrotizing pancreatitis. Clinical series. Six patients with clinical and radiological diagnosis of necrotizing acute pancreatitis are treated in Emergency Surgery Department, following a conservative management, which includes fluid resuscitation, intensive care unit and radiological monitoring, ultrasound-guided percutaneous drainage and an antibiotic treatment protocol, that includes tigecycline. No one of the six patient undergo surgery (mean hospital stay: 44 days). In a six months follow-up all patients are alive and in good clinical conditions. Discussion. Infection is the most important factor which determinate prognosis and outcome of acute necrotizing pancreatitis. Antibiotic prophylaxis is still discussed and there are no clear antibiotic treatment guidelines in literature. Despite its side effects on pancreatic gland, tigecycline is successful in resolution of sepsis, caused by infected pancreatic necrosis. Conclusions. Collaboration with infectivologist and a clear antibiotic protocol is fundamental to solve infected necrosis. Antibiotic treatment, set up as soon as possible, is successful in our six patients, as they recover without undergoing surgical procedures. Tigecycline offers broad coverage and efficacy against resistant pathogens for the treatment of documented pancreatic necrosis infection. However, further studies are necessary to fully understand the safety profile and efficacy of tigecycline
A fissured aortic aneurysm accidentally detected thanks to a symptomatic retroperitoneal leiomyosarcoma: Case report
No full textWe present the case of a concomitant retroperitoneal leiomyosarcoma and a fissured abdominal aortic aneurysm. Coexistence of these two pathologies is itself rare, but in our case we observed a singular presentation, that avoided the surgical emergence which represents the inspected rupture of an aortic aneurysm for an unaware patient. In fact, our subject presented to emergency with a symptomatology related to a complication of the neoplasm, but imaging exams let us discover an unknown fissured aortic aneurysm in a pre-rupture phase. The abdominal pain to the left flank referred by our patient was due, in fact, to an intraparenchimal hemmorage. The CT scan demonstrated an aortic aneurysmatic dilation with signs of recent bleeding, compatible with a tamponed fissured aneurysm. In these cases, the treatment strategy must consider if a combined surgery can be performed, or if the most urgent pathology must be addressed first. In our case, the patient was submitted to a combined operation of abdominal and vascular surgery few days after the accidental diagnosis of his life-Threatening condition, with macroscopical complete excision of the neoplasm and aneurysm repair with aorto-Aortic graft. No short or middle-Time complications occurred, but six-months follow-up revealed a neoplasm relapse, confirming the local aggressiveness of leiomyosarcomas
Delayed diagnosis of blunt carotid trauma in a seat belt syndrome with associated abdominal wall injury A case report
No full textThe aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal trauma because, carotid artery injury consequent to blunt trauma is rare, affecting less than 1% of patients as reported in literature. A 45-years-old female, involved in a traffic accident, arrived to Emergency Room hemodynamically stable, with a Glasgow Coma Scale of 15, complaining abdominal pain, without any neurological signs. She underwent Computed Tomography (CT) scan that showed a complete disruption of left abdominal wall muscles, associated with massive bowel loops herniation. No free air nor other visceral injuries were found. The radiological brain evaluation was negative for neurological injuries. Considering the nature of the trauma, an explorative laparotomy was performed. During the fifth postoperative day, the patient presented neurological side signs with right facial-brachial-crural hemiparesis and expressive aphasia. Head and neck CT scan revealed a lesion of the left common carotid artery with distal embolization of the internal carotid. A left-carotid-axis revascularization procedure and a surgical endarterectomy were immediately performed. Patient was discharged after 20 days without neurological consequences. Physicians should be aware of neck vascular injuries when evaluating patients with multiple trauma, even in neurological asymptomatic patients without seatbelt abrasions of the neck skin
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