RESUMEN
Congenital pancreatic pseudocysts are very rare and have so far been described in only 4 cases. We report on a patient with a congenital pancreatic pseudocyst diagnosed only intraoperatively. We show with this case that diagnosis is difficult. Furthermore, we show the histology and operation method.
Asunto(s)
Seudoquiste Pancreático/congénito , Seudoquiste Pancreático/cirugía , Femenino , Humanos , Recién Nacido , Seudoquiste Pancreático/diagnósticoRESUMEN
Surgeons should be familiar with surgery of the cecum and appendix because the diseases of this region, especially appendicitis, are the most common indications for surgical exploration. Usually, diagnosis of appendicitis and appendectomy are not difficult, but atypical location of the appendix or other anatomic anomalies can make the diagnosis of appendicitis and appendectomy difficult. In cases of atypical anatomy or diffuse clinical picture, especially in young adults or elderly patients, the spectrum of embryologic and anatomic anomalies must be kept in mind to make the correct treatment decision for individual patients. If doubt persists, explorative laparotomy must be performed to avoid overlooking rare, acute, intra-abdominal abnormalities.
Asunto(s)
Neoplasias del Apéndice/cirugía , Apendicitis/cirugía , Enfermedades del Ciego/cirugía , Neoplasias del Ciego/cirugía , Adulto , Apendicectomía , Neoplasias del Apéndice/embriología , Neoplasias del Apéndice/patología , Apendicitis/embriología , Apendicitis/patología , Apéndice/embriología , Apéndice/patología , Enfermedades del Ciego/embriología , Enfermedades del Ciego/patología , Neoplasias del Ciego/embriología , Neoplasias del Ciego/patología , Ciego/embriología , Ciego/patología , Ciego/cirugía , HumanosRESUMEN
Arterial port systems are frequently used in the adjuvant and palliative therapy of colorectal hepatic metastasis. Specific complications are rarely documented in literature. The perforation of an arterial Port-à-cath followed by duodenal fistula is an uncommon complication of regional hepatic chemotherapy. Besides systemic disorders caused by the chemotherapeutic agents, such as vomiting, sickness, or gastritis and duodenitis, gastroduodenal ulcers can occur as a local complication of treatment. Thrombosis of the hepatic artery or occlusion of the port device are the most common reasons for withdrawal of treatment in our series. Based on our experience and the case report of a duodenal fistula we recommend angiography of the port system prior to each cycle of chemotherapy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Catéteres de Permanencia , Enfermedades Duodenales/etiología , Infusiones Intraarteriales/instrumentación , Fístula Intestinal/etiología , Neoplasias Hepáticas/secundario , Neoplasias del Recto/tratamiento farmacológico , Fístula Vascular/etiología , Angiografía , Quimioterapia Adyuvante , Terapia Combinada , Diagnóstico Diferencial , Enfermedades Duodenales/diagnóstico por imagen , Enfermedades Duodenales/cirugía , Duodenoscopía , Femenino , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/cirugía , Neoplasias Hepáticas/tratamiento farmacológico , Persona de Mediana Edad , Reoperación , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugíaRESUMEN
In contrast to childhood intussusception, the clinical signs of intussusception in adults are nonspecific. Generally organic alterations of the small bowel cause intussusception in adults. In this case report on a retrograde jejunojejunal intussusception in a 61-year-old male, following removal of an intraoperatively placed intestinal tube for ileus therapy, the clinical symptoms, diagnostic methods and therapy for intussusception are described. Sonography is not only the diagnostic tool of choice in children, but also led to the correct diagnosis in this case. In contrast to childhood intussusception, operative treatment is preferred in adults.
Asunto(s)
Obstrucción Intestinal/cirugía , Intubación Gastrointestinal , Intususcepción/etiología , Enfermedades del Yeyuno/etiología , Complicaciones Posoperatorias/etiología , Adulto , Humanos , Intususcepción/cirugía , Enfermedades del Yeyuno/cirugía , Masculino , Persona de Mediana Edad , Reoperación , Adherencias TisularesRESUMEN
Thirty-three patients with a radically resected esophageal carcinoma were included in a prospective follow-up study measuring quality of life parameters under the condition of continuous postoperative out-patient care. None of the perioperatively suspected risk factors, like postoperative complications, preoperative risk and weight course or a performed thoracotomy had a predictive value for the long-term quality of life parameters. Yet endoscopic interventions and conservative treatment of dysphagia and eating restrictions improved the quality of life in 12 out of 16 patients with severe symptoms, making the postoperative follow-up an important factor for the quality of life for resected esophageal cancer patients.
Asunto(s)
Adenocarcinoma/cirugía , Cuidados Posteriores , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Calidad de Vida , Endoscopía , Esofagectomía , Femenino , Estudios de Seguimiento , Humanos , Escisión del Ganglio Linfático , Masculino , Recurrencia Local de Neoplasia/cirugía , Cuidados Paliativos , Estudios ProspectivosRESUMEN
OBJECTIVE: To investigate the surgical results of adenocarcinoma of the esophagus and esophagogastric junction and its relationship with gastroesophageal reflux disease (GERD) and Barrett's esophagus. BACKGROUND: The incidence of adenocarcinoma of the cardia is continuously rising. Specialized intestinal metaplasia in Barrett's esophagus seems to be the source of these tumors. Barrett's esophagus is end stage GERD. In experimental studies alkaline reflux give rise of Barrett's esophagus and adenocarcinoma. PATIENTS: 122 patients with adenocarcinoma of the cardia and 121 patients with squamous cell tumor of the esophagus. METHODS: All esophageal resections between 11/85 and 2/95 were retrospectively analyzed. The relationship of gastroesophageal reflux disease, Barrett's esophagus and malignancy was compared between both groups using parameters of case history and histological sections. Survival was analyzed for tumorstage, T-and N-stage and R-classification. RESULTS: 5.9% of the adenocarcinomas were stage I, 44.1% stage II, 41. 5% stage III and 8.5% stage IV. Heartburn, regurgitation, consumption of H2 blockers or Barrett's mucosa were significantly more frequent for adenocarcinomas. A 5 year survival of 100% was seen for stage I tumors. Invasion of t he muscular layer reduced survival to 50%, lymph node invasion to 20%. R0-resection had a survival of 40%. CONCLUSIONS: A relationship of GERD and adenocarcinoma of the cardia seems to be likely in our cases. Most patients had advanced malignancy. Survival is good only for early cases. Prevention of tumor genesis with effective antireflux surgery in case of alkaline reflux seem to be the best therapeutic decision.
Asunto(s)
Adenocarcinoma/cirugía , Esófago de Barrett/cirugía , Unión Esofagogástrica/cirugía , Reflujo Gastroesofágico/cirugía , Neoplasias Gástricas/cirugía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Esófago de Barrett/mortalidad , Esófago de Barrett/patología , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Cardias/patología , Cardias/cirugía , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Unión Esofagogástrica/patología , Femenino , Reflujo Gastroesofágico/mortalidad , Reflujo Gastroesofágico/patología , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Tasa de SupervivenciaRESUMEN
A modified Ivor Lewis operation was introduced to the surgical treatment of adenocarcinoma of the oesophagogastric junction in an investigative study of 122 consecutive patients. The procedure consisted of a transmediastinal subtotal oesophagectomy with mediastinal lymphadenectomy to the level of the tracheal bifurcation, a proximal 4/5th-gastrectomy with D2-lymphadenectomy and splenic hilar dissection and was completed by a collar oesophagogastrostomy using a gastric tube from the greater curvature. The new concept was followed by good oncologic results without anastomotic recurrencies and a reduction in potential lethal complications like mediastinal anastomotic leakage.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Unión Esofagogástrica/cirugía , Estómago/cirugía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Unión Esofagogástrica/patología , Humanos , Escisión del Ganglio Linfático , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Reoperación , Tasa de SupervivenciaRESUMEN
Between November 1985 and January 1994 a total of 239 patients were operated for replacement of the esophagus and primary reconstruction. Of these 3 had benign disease and 236 had malignancy. Continuity of the alimentary tract was restored in 202 cases by stomach transposition, in 16 cases by colon interposition and in 21 cases by free jejunal autograft. Complication rate of surgical resection was 36.8%, lethality 5.1%. Lethality of coloninterposition was as low as for gastric transposition (6.3 vs 5.5%). None of the patients with free jejunal autograft died during hospital course (p < 0.001). Survival rates by life-table analysis for the whole group were 65%, 42%, 36%, 32%, and 22% after 1, 2, 3, 4 and 5 years, respectively. The malignant tumors consists of 111 esophageal carcinomas, 104 carcinomas of the esophagogastric junction and 21 carcinomas of the hypopharynx. 15.1% of the tumors were staged I, 42.7% II, 35.7% III and 6.5% IV. The collectives for esophageal carcinoma and cardia carcinoma were equal for age, sex, and distribution of tumor stages. The survival rates for both groups were similar. Differences occurred in a three times higher rate for concomittant hiatal hernia and history of reflux esophagitis in the cardia carcinoma group.