RESUMEN
INTRODUCTION: Sclerosing peritonitis or abdominal cocoon syndrome is characterized by small bowel loops completely encapsulated by a fibrocollagenous membrane in the center of the abdomen. Although cocooning of the abdomen is mostly seen in patients on peritoneal dialysis, it can occur de novo; it very rarely manifests as complete mechanical bowel obstruction. CASE PRESENTATION: A 46-year-old Asian man presented with complete mechanical bowel obstruction. He had previous attacks of partial bowel obstruction during the past 6 to 8 months, which was misdiagnosed as abdominal tuberculosis because tuberculosis is very prevalent in the region in which he lives. He took anti-tuberculosis therapy for 3 months but this did not result in resolution of his symptoms. This time he had diagnostic laparoscopy followed by laparotomy in which a fibrocollagenous membrane, resulting in entrapment of his bowel, was excised and his entire small bowel was freed. Postoperatively he again had a mild episode of partial bowel obstruction but this was relieved with a short course of steroids. DISCUSSION: Sclerosing peritonitis is a rare benign etiology of complete mechanical bowel obstruction. Patients might have suffered recurrent attacks of partial bowel obstruction in the past that were falsely managed on lines of other conditions such as tuberculosis, especially in endemic areas like Pakistan or India. CONCLUSION: Sclerosing peritonitis is a rare benign diagnosis which can manifest as complete bowel obstruction and a high index of suspicion is required to diagnose it. Contrast-enhanced computed tomography of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Diagnostic laparoscopy is usually confirmatory. Peritoneal sac excision and adhesiolysis is the treatment and a short course of steroids in relapsing symptoms.
Asunto(s)
Obstrucción Intestinal/etiología , Peritonitis/diagnóstico , Esclerosis/diagnóstico , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/cirugía , Masculino , Persona de Mediana Edad , Peritonitis/patología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To look for trends in surgical management of acute cholecystitis and compare the outcomes of patients with severe condition. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, from January to December 2016, and comprised data of adult patients who underwent cholecystectomy for acute cholecystitis from January 1, 2001, to December 31, 2014. Record of patients from 2001 to 2007 was designated in Group-1 while Group-II covered period between 2008 and 2014. Severe cases of acute cholecystitis were divided into similar period-based Group-A and Group-B. Data was analysed using SPSS 20. RESULTS: Of the 1153 patients, 521(45.2%) were males. The overall mean age was 49.3+14 years. There were 309(36.2%) patents in Group-I and 844(73.2%) in Group-II. Early laparoscopic-cholecystectomy was performed in 907(78%) patients. Postoperative morbidity was observed in 73(6.3%) patients. In Group-II, there was significant increase in early cholecystectomy, decrease in conversion rates and use of percutaneous cholecystostomy tube placement (p<0.05 each). In patients with severe acute cholecystitis, higher rate of early cholecystectomy was found in Group-A but it was not significant, and the same was the case in terms of conversion rate, postoperative morbidity and hospital stay (p>0.05 each). CONCLUSIONS: Over the years, the institutional experience of managing acute cholecystitis has changed dramatically which has helped improve the level of care for the patients.
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Colecistectomía Laparoscópica/tendencias , Colecistitis Aguda/cirugía , Intervención Médica Temprana/tendencias , Complicaciones Posoperatorias/epidemiología , Adulto , Colecistostomía/tendencias , Conversión a Cirugía Abierta/tendencias , Manejo de la Enfermedad , Femenino , Humanos , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios RetrospectivosRESUMEN
Carcinosarcoma of the esophagus is a rare neoplasm characterized histologically by presence of carcinomatous and sarcomatous elements. Case report of carcinosarcoma of the esophagogastric junction whose morphological and immunohistochemical features makes it quite distinctive from other tumours is presented. It was an ulcerated lesion diagnosed in an elderly Afghan lady located 34 cms from the incisor teeth. The patient was a smoker.
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Carcinosarcoma/patología , Neoplasias Esofágicas/patología , Unión Esofagogástrica/patología , Esófago/patología , Carcinosarcoma/diagnóstico , Carcinosarcoma/inmunología , Carcinosarcoma/cirugía , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/inmunología , Neoplasias Esofágicas/cirugía , Unión Esofagogástrica/cirugía , Esófago/cirugía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Invasive papillary carcinomas of the Extrahepatic Bile Ducts (EBD) are uncommon (4-5%). The course is less aggressive than conventional adenocarcinomas of the extrahepatic bile ducts. Non-invasive and minimally invasive papillary carcinomas are even rarer, behave as in-situ carcinomas and are associated with excellent long-term prognosis. A variety of lesions of the EBD that show papillary architecture should be distinguished from papillary carcinoma. Here, we report a case of papillary carcinoma of the common bile duct showing minimal invasion. Separation of invasive from non-invasive or minimally invasive papillary carcinoma is critical in estimating the patient outcome.
Asunto(s)
Neoplasias de los Conductos Biliares/patología , Conductos Biliares Extrahepáticos , Carcinoma Papilar/patología , Neoplasias de los Conductos Biliares/cirugía , Carcinoma Papilar/cirugía , Humanos , Masculino , Persona de Mediana Edad , Invasividad NeoplásicaRESUMEN
Ovarian squamous cell carcinoma is a rare malignancy and the occurrence is attributable to malignant transformation of an existing ovarian dermoid cyst. The de novo occurrence of squamous cell carcinoma of the ovary, in the absence of an antecedent ovarian dermoid, is extremely rare. The case of a 31 year old Asian woman, evaluated for abdominal distension and discomfort is presented. Abdominal CT was suggestive of a malignant neoplastic process. Laparotomy confirmed a malignant tumour with involvement of the right adnexa and extension into the omentum and bowel. Surgical debulking, hysterectomy, bilateral salpingo-ophorectomy and total omentectomy and bowel resection was performed. Histopathology demonstrated squamous cell carcinoma arising from the right ovary with no co-existing ovarian dermoid. The postoperative period was significant for disease progression despite adjuvant chemotherapy.