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Introduction: Desmoid-type fibromatosis, also known as desmoid tumors, are rare fibroblastic neoplasms that account for less than 3% of all soft tissue tumors. Although they are benign neoplasms without metastatic potential, they are known to be locally aggressive and may invade adjacent structures leading to fatal complications. Case presentation: We describe the case of a 26-year-old woman who presenting with the clinical picture of acute peritonitis. Emergency surgery was performed and a large poorly-circumscribed heterogeneous tumor was found, occupying the jejunum mesentery and infiltrating the jejunal wall causing its perforation into the abdominal cavity. En bloc resection of the tumor and the involved jejunum was performed. Histology and immunohistochemistry confirmed it to be mesenteric desmoid-type fibromatosis. The postoperative course was uneventful and the patient had no evidence of recurrence 18 months after tumor resection. Conclusions: Mesenteric desmoid-type fibromatosis is a rare condition with insidious growth and locally aggressive behavior. Serious complications such as bowel perforation are rare but possible, as shown in our presentation. Complete surgical resection is the first-line treatment bur high recurrence rates remain problematic.
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The biliary system is an uncommon location for neuroendocrine tumours (NETs), and within this system, the common hepatic duct is an even more rare site for NETs. Clinical and radiological presentations are challenging because these tumours may be preoperatively confused with Klatskin-like lesions. Here we report a well-differentiated grade 2 NET arising from the common hepatic duct in a 64-year-old female. Curative surgery was performed, and no evidence of recurrent disease was observed at the 2-months follow-up.
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Neoplasias de los Conductos Biliares , Procedimientos Quirúrgicos del Sistema Biliar/métodos , Antígeno Ki-67/análisis , Tumor de Klatskin/diagnóstico , Tumores Neuroendocrinos , Neoplasias de los Conductos Biliares/metabolismo , Neoplasias de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/cirugía , Diagnóstico Diferencial , Femenino , Conducto Hepático Común/diagnóstico por imagen , Conducto Hepático Común/patología , Conducto Hepático Común/cirugía , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Tumores Neuroendocrinos/metabolismo , Tumores Neuroendocrinos/patología , Tumores Neuroendocrinos/cirugía , Resultado del TratamientoRESUMEN
Gastric diverticula are the most uncommon form of gastrointestinal diverticula. They can either be of true or false type with different pathogenesis. They may be very challenging to diagnose as symptoms are nonspecific and imaging can simulate a malignant lesion. We report an unusual case of pre-pyloric diverticulum in a 69-year-old man, leading to severe gastric obstruction with a poor general condition. As subsequent endoscopy and imaging were alarming and couldn't exclude malignancy, the patient underwent an antrectomy. The final diagnosis was made on pathological examination. We discuss, through this case, the clinical and pathological features of gastric diverticula with an emphasis on the pathogenesis of this rare entity and the risk of a malignant transformation.
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Divertículo Gástrico/diagnóstico , Gastrectomía/métodos , Neoplasias Gástricas/diagnóstico , Anciano , Divertículo Gástrico/patología , Divertículo Gástrico/cirugía , Humanos , MasculinoRESUMEN
INTRODUCTION: The complete histological response represents the goal of neo-adjuvant treatment of locally advanced rectal cancer. This objective is a real challenge requiring the research of predictive factors for this response, from the perspective of targeted therapeutic strategies. The results of the various studies focused on these predictive factors are discordant. AIM: To seek a correlation between 7 prognostic factors tested in pre-therapy and the histological response to neo-adjuvant treatment. METHODS: A retrospective study involving 44 patients with locally advanced rectal adenocarcinoma who received neo-adjuvant radiotherapy or radiochemotherapy. The 7 prognostic factors studied were clinical (age and sex), radiological (tumor size and parietal invasion) and histological (histological grade, vascular and nerve invasion) features. The complete histological response was defined by Bateman's tumor grade m-RCRG 1 and the absence of lymph node metastases. RESULTS: A complete histological response was observed in 25% of cases (n = 11). In multivariate analysis, age> 60 years (OR: 1.14 and p = 0.028), male sex (OR: 21 and p = 0.045) and radiological wall invasion exceeding the subserosa (OR: 11 , 5 and p = 0.008) were significantly associated with the histological response. In contrast, none of the 3 histological factors tested were correlated with this response's intensity. CONCLUSION: Age, gender, and pre-therapeutic parietal invasion could be used to select "good" and "poor" responders to neo-adjuvant treatment in locally advanced rectal cancers.
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Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/terapia , Adenocarcinoma/epidemiología , Adenocarcinoma/patología , Anciano , Anciano de 80 o más Años , Quimioradioterapia , Citodiagnóstico , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Clasificación del Tumor , Pronóstico , Radioterapia , Neoplasias del Recto/epidemiología , Neoplasias del Recto/patología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Hepatocellular carcinoma (HCC) is a public health problem in african countries. The chemoembolization (CE) could represent the only therapeutic strategy. Two methods can be proposed: charged microparticles and lipiodol chemoembolization. The purpose of this study was to compare results, morbidity and survival between charged microparticles and lipiodol chemoembolization. METHODS: A 5 years retrospective, study was conducted including 62 patients with HCC treated by chemioembolization. The efficacy of the treatment was evaluated for patients by performing a computed tomography four to six weeks after the act. We used « European Association for Study of the Liver ¼ criteria to evaluate the therapeutic outcome. RESULTS: A total of 102 sessions of chemoembolization were performed. This was a with charged microparticles in 70 cases (68.6%) and lipiodol chemoembolization in 32 cases (31.3 %). The difference was not significant between the two CE techniques (lipiodol and charged microparticles) in terms of complete and objective response and complications. The mean survival rate was 30 months ± 4 for all techniques combined, with no statistically significant difference in terms of survival time without recurrence between the two chemoembolization techniques. CONCLUSION: The efficacy, morbidity and survival of the two CE techniques to lipiodol or microfilled particles are comparable. The selectivity of the technique is to be taken into consideration. For economic health purposes, the CE lipiodolée appears to be more adapted to the context of the developing African countries.
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Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , África del Norte/epidemiología , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiología , Quimioembolización Terapéutica/efectos adversos , Quimioembolización Terapéutica/estadística & datos numéricos , Aceite Etiodizado/uso terapéutico , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiología , Masculino , Microesferas , Persona de Mediana Edad , Oncología por Radiación/métodos , Oncología por Radiación/estadística & datos numéricos , Estudios Retrospectivos , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The Laparoscopic treatment of perforated ulcer is accompanied by a lesser morbidity and mortality compared with treatment by laparotomy. However, the morbidity of the laparoscopic approach is not nil (4%). It is influenced by pre and intraoperative factors. The aim of our work is to establish a morbidity score in patients undergoing laparoscopic surgery for acute peritonitis with perforated duodenal ulcer. METHODS: This is a retrospective study conducted in a General Surgery Department. We included 384 cases of perforated duodenal ulcer operated laparoscopically over a fourteen-year period ranging from January 2000 to December 2014. We conducted a multivariate logistical regression analysis by step-by-step-descending method. From these independent factors we established a score using the ROC curves. The threshold with the best sensitivity and specificity for predicting morbidity was investigated. In all statistical tests, the significance level was set at 0.05. RESULTS: The overall morbidity rate of our patients was 3.38% (13 patients). Multivariate analysis has identified five independent morbidity risk factors: temperature higher than 37.6° C, renal failure, age> 45 years, a number of stitches of two or higher and operating time to 75 minutes or longer. Our morbidity score took into account these 5 factors by integrating the intrinsic value of each factor. The threshold of the score having the best torque sensitivity specificity to predict morbidity was 10. CONCLUSION: A morbidity score for perforated duodenal ulcer surgery performed by laparoscopy may be useful to organize the post-operativecare of these patients usually young and active. A lower score than the threshold predictive of morbidity could allow a rapid rehabilitation of these patients and a one day hospitalization management.
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Úlcera Duodenal/cirugía , Laparoscopía/efectos adversos , Úlcera Péptica Perforada/cirugía , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Úlcera Duodenal/complicaciones , Femenino , Fiebre/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias , Insuficiencia Renal/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
The detection of primary tumors synchronous with colorectal cancer has been the subject of multiple publications. This association can occur sporadically or fall under the framework of well defined clinical syndromes such as Lynch syndrome. Synchronous association of colorectal cancer (CRC) and renal cell carcinoma is rare. It is even more rare when renal cell carcinoma is of papillary origin, with only 2 cases reported in the literature. The association between CRC and renal cell carcinoma does not seem to be related to mismatch repair proteins (MMR) abnormality and does not include, up to now, any clinical syndrome. We report the case of a 69-year old woman with colorectal cancer associated with synchronous type 1 papillary renal cell carcinoma unexpectedly detected during screening for CRC. We here discuss the pathogenesis as well as the prognosis of this rarely described entity.
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Adenocarcinoma/diagnóstico , Carcinoma de Células Renales/diagnóstico , Neoplasias Colorrectales/diagnóstico , Neoplasias Renales/diagnóstico , Adenocarcinoma/patología , Anciano , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patología , Carcinoma de Células Renales/patología , Neoplasias Colorrectales/patología , Femenino , Humanos , Neoplasias Renales/patología , Tamizaje Masivo/métodos , Neoplasias Primarias Múltiples/patología , PronósticoRESUMEN
INTRODUCTION: The prognosis of hepatic metastases in colorectal cancers is constantly being improved at the cost of multidisciplinary care, allowing each patient to have an adapted strategy. The prognostic factors make it possible to recognize patients needing further treatment after resection and closer monitoring. OBJECTIVE: The aim of our study was to conduct a prognostic study to identify factors influencing survival at 5 years for patients operated of colorectal liver metastases. METHODS: This is a retrospective study conducted over a period of 10 years (2005-2015). All patients operated for liver metastasis of colorectal cancers were included. The primary endpoint was overall survival. Secondary endpoints were recurrence-free survival and operative morbidity and mortality. The proportions were compared by the Chi 2 test. The survival curves were established according to the Kaplan-Meier method and the comparison of the curves according to the Logrank test. A univariate and then multivariate Cox model was used to determine prognostic factors. The significance level was set at 0.05. RESULTS: Overall survival of our patients at 3 and 5 years was 49% and 32% respectively. Recurrence-free survival was 21% at 3 years and 15% at 5 years. In multivariate analysis, the hepatic resection margin <1 mm and the number of hepatic metastases ≥3 were independent factors correlated with survival. CONCLUSIONS: colorectal liver metastases surgery improves patient survival. Some factors need to be sought to adapt care strategies.
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Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Estudios de Cohortes , Neoplasias Colorrectales/mortalidad , Femenino , Hepatectomía , Humanos , Hígado/patología , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
INTRODUCTION: POSSUM (Physiologic and Operative Severity Score for the enumeration of Mortality and morbidity) is a scoring system for predicting mortality which is largely used in elective aortic and abdominal surgery. The aim of our study was to validate POSSUM with regards to elderly patients (> 70 years) undergoing digestive emergency surgery. We wanted to determine the optimal threshold for POSSUM, consisting of a physiological score and of an operative score for predicting mortality in this population. METHODS: This is a case-control analytic retrospective study of 291 patients aged ≥70 years undergoing digestive emergency surgery. These patients were divided into two groups each comprising 50 patients. Group "DC": patients died in the immediate postoperative period and Control group "SURV" chosen by lot. We analyzed the reliability of POSSUM in predicting mortality and morbidity. Subsequently, we created ROC curve to find the thresholds with the best sensitivity/specificity couple. RESULTS: The physiological score, operative score and mortality and morbidity rates predicted by POSSUM and mortality predicted by P-POSSUM are predictors of mortality (P < 0.0001). The threshold values for the physiological and operative score with the best sensitivity/specificity couple were 23 and 15 respectively. CONCLUSION: Predicting mortality in patients allows to target care management programs and to inform the patient and his family of the risks.
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Procedimientos Quirúrgicos del Sistema Digestivo/mortalidad , Urgencias Médicas , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/mortalidad , Curva ROC , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: during this century, therapeutic management of rectal cancer has known a lot of advances. Survival is still depending on factors related to the patient, the tumor or the surgeon. AIM: The aim of our study is to report survival and prognosis factors of our patients managed for a rectal cancer. METHODS: We report an descreptive retrospective study about 154 patients. SPSS 19.0 version was used for the statistical analysis. Desriptive study was done using means, and pourcentage. Survival was analysed using Kaplan meier curve. In univariate analysis, we calculated the odd ratio in order to evaluate risk factors. Multivariate analysis used Cox model. Significancy was 0.05. RESULTS: Global survival was 52.4% at 3 years and 42.4% at 5 years. Free reccurence survival was 76% at 3 years and 69.15% at 5 years. In univariate analysis, factors significantly influencing survival were age>70 years, CAE level, tumor perforation, TNM, tumor differentiation, peroperative blood transfusion, and reccurency. In multivriate analysis, only age > 70 years, T and local reccurency were independants factors influencing survival. CONCLUSION: A better knowledge of prognosis factors ead to a better management of this cancer with more adjuvant treatment indications and closer monitoring.
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Adenocarcinoma/mortalidad , Neoplasias del Recto/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Anciano , Análisis de Varianza , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Rectal prolapse is a rectal static disorder which involves rectal wall intussusception inducing its externalization through the anus. It usually affects children and the elderly. Its occurrence in young adults is rare. Strangulated rectal prolapse is also a rare complication. We report the case of a 30-year old patient who underwent emergency surgery for strangulated rectal prolapse. Emergency perineal rectosigmoidectomy (Altemeier repair) was performed with simple outcome.
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Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Urgencias Médicas , Prolapso Rectal/cirugía , Adulto , Factores de Edad , Humanos , Masculino , Prolapso Rectal/patología , Resultado del TratamientoRESUMEN
BACKGROUND: during this century, therapeutic management of rectal cancer has known a lot of advances. Survival is still depending on factors related to the patient, the tumor or the surgeon. AIM: The aim of our study is to report survival and prognosis factors of our patients managed for a rectal cancer. METHODS: We report an descreptive retrospective study about 154 patients. SPSS 19.0 version was used for the statistical analysis. Desriptive study was done using means, and pourcentage. Survival was analysed using Kaplan meier curve. In univariate analysis, we calculated the odd ratio in order to evaluate risk factors. Multivariate analysis used Cox model. Significancy was 0.05. RESULTS: Global survival was 52.4% at 3 years and 42.4% at 5 years. Free reccurence survival was 76% at 3 years and 69.15% at 5 years. In univariate analysis, factors significantly influencing survival were age>70 years, CAE level, tumor perforation, TNM, tumor differentiation, peroperative blood transfusion, and reccurency. In multivriate analysis, only age > 70 years, T and local reccurency were independants factors influencing survival. CONCLUSION: A better knowledge of prognosis factors ead to a better management of this cancer with more adjuvant treatment indications and closer monitoring.
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Adenocarcinoma/mortalidad , Neoplasias del Recto/mortalidad , Factores de Edad , Análisis de Varianza , Supervivencia sin Enfermedad , Humanos , Estimación de Kaplan-Meier , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaAsunto(s)
Infarto/diagnóstico por imagen , Epiplón/irrigación sanguínea , Adulto , Humanos , Infarto/cirugía , Laparoscopía , Masculino , Persona de Mediana Edad , Necrosis/diagnóstico por imagen , Necrosis/cirugía , Epiplón/diagnóstico por imagen , Epiplón/cirugía , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/cirugía , RadiografíaRESUMEN
BACKGROUND: feasibility and advantages of laparoscopic approach in performed duodenal ulcer have no longer to be demonstrated. Laparoscopic suture and peritoneal cleaning expose to a conversion rate between 10 and 23%. However less than laparotomy, morbidity of this approach is not absent. AIM: This study aim to analyze factors exposing to conversion after laparoscopic approach of perforred duodenal ulcer. We also aim to define the morbidity of this approach and predictive factors of this morbidity Methods: Retrospective descriptive study was conducted referring all cases of perforated duodenal ulcer treated laparoscopically over a period of ten years, running from January 2000 to December 2010. All patients were operated by laparoscopy with or without conversion. We have noted conversion factors. A statistical analysis with logistic regression was performed whenever we have sought to identify independent risk factors for conversion verified as statistically significant in univariante. The significance level was set at 5%. Analytic univariant and multivariant study was performed to analyze morbidity factors. RESULTS: 290 patients were included. The median age was 34ans.T he intervention was conducted completely laparoscopically in 91.4% of cases. The conversion rate was 8.6%. It was selected as a risk factor for conversion: age> 32 years, a known ulcer, progressive pain, renal function failure, a difficult peritoneal lavage and having a chronic ulcer. Postoperative morbidity was 5.1%. Three independent risk factors of surgical complications were selected: renal failure, age> 45 years, and a chronic ulcer appearance. CONCLUSION: Laparoscopic treatment of perforred duodenal ulcer expose to a conversion risk. Morbidity is certainly less than laparotomy and a better Knowledge of predictif's morbidity factors become necessary for a better management of this disease.