RESUMEN
BACKGROUND: Surgical resection of advanced primary head and neck cancers especially of the upper aerodigestive tract like hypopharyngeal cancer, usually leave a very big defect, which has to be reconstructed in order to maintain the gastropharyngeal continuity. This oncological surgery is best performed at the same sitting as a one staged procedure. STUDY DESIGN: A clinical case of a 56-year-old female with advanced hypopharyngeal cancer who had a single stage total pharyngolaryngectomy and partial oesophagectomy with reconstruction of the upper aerodigestive tract using pectoralis major pedicled flap and post operative adjunct chemo-radiation therapy. RESULT: Functionally, our patient had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. There was clinical evidence of weight gain. No evidence of flap complications post surgery. CONCLUSION: The rarity of this procedure and its advantages in the management of an advanced hypopharyngeal cancer in this environment are discussed.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Hipofaríngeas/cirugía , Procedimientos de Cirugía Plástica/métodos , Femenino , Humanos , Persona de Mediana Edad , Colgajos QuirúrgicosRESUMEN
Traumatic disruption of the posterior urethra usually occurs in association with pelvic fractures and may result in significant morbidity. The management of this injury remains difficult and controversial. Recently, early restoration of urethral continuity in these patients using either both antegrade and retrograde cystoscopy (with or without fluoroscopy), or flexible retrograde urethroscopy alone under general aneasthesia, has been reported with good results. These procedures have been proposed as an improvement over the traditional teaching of placement of a suprapubic catheter followed by delayed open repair (urethroplasty). We now describe a novel method of restoration of urethral continuity by rigid retrograde endoscopy alone under caudal aneasthesia in the early post-trauma phase. This procedure can be carried out in an outpatient endoscopic suite with standard (endoscopic)optical urethrotomy equipment and is suitable for most patients with prostatomembranous urethral disruptions. A 'high-riding' prostate is however a relative contraindication for this procedure. To date, we have carried out this procedure successfully in 4 of 5 patients with traumatic prostato-membranous disruption (a success rate of 80%). We recommend that early retrograde rigid endoscopic realignment under regional analgesia should be considered as a management option in patients with traumatic disruption of the posterior urethra.
Asunto(s)
Anestesia Caudal/métodos , Cistoscopía/métodos , Endoscopía/métodos , Traumatismo Múltiple/cirugía , Próstata/lesiones , Próstata/cirugía , Uretra/lesiones , Uretra/cirugía , Accidentes de Tránsito , Adulto , Contraindicaciones , Fluoroscopía/métodos , Fracturas Óseas/complicaciones , Humanos , Masculino , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/etiología , Nigeria , Selección de Paciente , Huesos Pélvicos/lesiones , Atención Perioperativa/métodos , Próstata/diagnóstico por imagen , Rotura , Factores de Tiempo , Resultado del Tratamiento , Uretra/diagnóstico por imagen , UrografíaRESUMEN
Caecocolic intussusception was a significant cause of adult intestinal obstruction in Ibadan where it earned itself the appellation "Ibadan Intussusception". Recently, it has been noticed that there is a significant drop in the cases of adult intussusception. A retrospective review of the intra-operative diagnoses of adult patients who presented to the University College Hospital, Ibadan with intestinal obstruction between June 1990 and June 2000 was carried out. The most common cause of adult intestinal obstruction was obstructed groin hernias followed by adhesions. There was a significant paucity of cases of intussusception, hence the paper queries the veracity of the appellation "Ibadan intussusception" in the present day.