RESUMEN
Although lots of modern surgical and imaging techniques have been developed and last generation antibiotics are in use, the difficulties in the diagnosis and treatment of hepatic abscesses are still a rather sombre reality. Our research concerning 14 patients submitted to surgery within the last ten years can be thought of as a record, considering the poor number of cases in the last decades. So, our study also includes the possible clinical or imaging errors, the technical details of the surgery, the attitude towards the abscess cavity and the still obscure etiology in most of the cases. The correlation between the surgical risk and the rest of the hepatic volume, evaluated by computed scanning technique, represents another objective of this paper. In the large or in the multiple disseminated abscesses, the small area of the remaining functional hepatic tissue, was correlated to the postoperative slow or even bad evolution in two cases. The radiological, ultrasound and scanner control showing the reducing or disappearing of the abscess cavity after drainage in all the cases, represent an argument of the correct therapeutic approach.
Asunto(s)
Absceso Hepático/cirugía , Adulto , Anciano , Drenaje/métodos , Femenino , Hepatectomía , Humanos , Laparoscopía/métodos , Absceso Hepático/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , UltrasonografíaRESUMEN
The transomphalic and then the transligamentary extraperitoneal drainage imagined by D. Burlui and its multiple use in the liver and the biliary tract surgery, is well known. Concerning the hepatic hydatid cysts, the drainage of the remaining cavity by the round ligament way is possible for most of the locations of the parasite, but it is less performed in the right liver lateral segments locations, too far situated, and also in the left liver locations. On the other hand, this specific method implies to place the drainage tube using the round ligament "in situ ", normally placed and inserted. We encountered an extremely large hydatid cyst of the left hepatic lobe, adherent to the anterior and posterior abdominal wall, spleen, stomach, pancreas and large bowel, which required to extend the incision to the left and make the necessary segmentation of the round ligament at its hepatic insertion. After pericystotomy and the evacuation of the cyst, the remaining cavity drainage was performed through the same round ligament whose free end was tightly fixed to the partial pericystotomy border. This transposition allowed the exteriorisation of the drainage tube in the same way as for the transligamentary and total extraperitoneal original method.
Asunto(s)
Drenaje/métodos , Equinococosis Hepática/terapia , Ligamentos , Ombligo , Animales , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Our paper studies the quite rare occurrence of the digestive superior occlusive pathology, namely some causes which might induce partial or even total obstruction of the digestive tract, at the distal anatomical limits of the duodenum, also known as the Treitz angle. The first two described cases were carcinoid tumors, obstructive and ulcerated in the lumen of the same angle. The last two cases were an obstructive leiomyosarcoma and an invasive mesenteric metastasis from a right colon cancer, which cause a total external compression of the Treitz angle, clinically manifested as a complete food intolerance, as a first symptom. Concerning the clinical evolution, these are totally different lesions, malign, metastasis and neuroendocrine tumors, which occurred at the same level, had a totally different clinical evolution and surgical approach, only three of them developing at good postoperative course. The imaging, clinical and pathological diagnosis problems, the different specific surgical solutions, the postoperative care and finally the rarity of this level of obstruction of the small bowel, are the aim of this paper.
Asunto(s)
Adenocarcinoma/cirugía , Tumor Carcinoide/cirugía , Neoplasias Duodenales/cirugía , Neoplasias del Íleon/cirugía , Leiomiosarcoma/cirugía , Neoplasias Primarias Múltiples/cirugía , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundario , Anciano , Tumor Carcinoide/diagnóstico , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/secundario , Neoplasias del Colon/cirugía , Neoplasias Duodenales/diagnóstico , Resultado Fatal , Femenino , Humanos , Neoplasias del Íleon/diagnóstico , Leiomiosarcoma/diagnóstico , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Primarias Múltiples/diagnósticoRESUMEN
The authors discuss the case of a 40 year-old woman, which was performed surgery for a stenosant duodenal ulcer by bilateral troncular vagotomy and hemigastrectomy, using the Pean-Billroyh 1 anastomosis. Immediately after surgery untractable hicongh gradually set in which lasted over a 14 year, till the moment when a compressive pleuropericardic lymphocele, of the right phrenic nerve was revealed, a very long time growing cyst. After the surgical removal of the lymphocele was performed, which had compressed the right phrenic nerve, singultation totally disappeared, the patient has been monitorized through periodical medical checkings for more than 4 years. The period of 14 years when the patient constantly complained of steady untractable singultation has comprised 30 admission or more, to various surgical, gastroenterology and psychiatry wards. The patient was finally considered an incurable psychotic and was medically pensioned. The authors discuss a number of possible sequels of the initial gastric surgery which could have triggered untractable singultation, without being able to control them or totally ruling out the psychotic causes. There is natural suspicion cast of either existence or beginning of this cyst simultaneous with surgery since clinical tests and explorations were able to reveal it only after 14 years.