Neo-adjuvant chemoradiotherapy; an opportunity in sphincter preserving procedure for rectal cancer

Aim: The present study was designed to assess the impact of neo-adjuvant chemoradiotherapy on the possibility of utilizing sphincter preserving techniques in rectal cancer surgery

Background: For both patients and surgeons anal sphincter preserving surgery serves as the ideal procedure to treat rectal cancer

Patients and Methods: Patients with rectal cancer who were admitted to Shohadaye Tajrish hospital between 2001 and 2011 and underwent sphincter preserving or non-preserving surgery were identified. They were divided into those who had received neo-adjuvant chemo-radiotherapy prior to surgery and those who didn't, and the type of surgical procedure they underwent was compared between the two arms. Data regarding tumor pathology, tumor size and distance from anal verge before and after neo-adjuvant therapy, together with the duration of chemo-radiotherapy were also assessed

Results: 103 patients with documented rectal cancer were included in our analysis. Among 47 patients who had not received neo-adjuvant therapy, 26 [55%] underwent APR while 15[32%] and 6[13%] patients were treated with LAR and VLAR respectively. Of the 56 patients who had gone through chemo-radiotherapy prior to surgery, 30 [53%] underwent APR while 14 [25%] and 10 [18%] patients were treated with LAR and VLAR respectively. 2 patients had unresectable tumor. Tumor staging before and after neo-adjuvant therapy showed a statistically significant difference [p=0.0001]

Conclusion: Neo-adjuvant chemo-radiotherpy can decrease tumor size, increase the distance between the tumor and anal verge, and downgrade the staging. However, it does not necessarily increase the possibility of performing sphincter preserving surgery on patients suffering from low-lying tumors

left paraduodenal hernia causing bowel obstruction: a case report

A 41-year old mentally retarded patient presented acutely with a 3 day history of vomiting and absolute constipation. Intestinal obstruction was diagnosed following an abdominal x ray. At laparotomy, a left paraduodenal hernia was present, without incarceration of small bowel. The herniated loops were reduced and the hernia orifice closed. The anatomy, treatment and importance of considering this uncommon diagnosis when examining a patient with acute small bowel obstruction are discussed

Perforated jejunal diverticula- a rare cause of acute abdominal pain: a case report

Jejunal diverticula have a prevalence of approximately 1% in the general population. Perforation of jejunal diverticulum is a rare. Clinically this diagnosis may be easily confused with other causes of an acute abdomen. In the article, we discuss a 74-year-old man with a 2-day history of constipation and left-sided abdominal pain. The day before admission he developed an abrupt exacerbation his symptoms with pain localized to periumbilical and left lower quadrant. An abdominal computed tomography scan revealed soft tissue stranding within the left upper quadrant, bilateral plural effusions, larger on the left, an opacity with the right and left pulmonary lobes and polypoid lesion with in stomach. Physical examination revealed left upper quadrant fullness. An emergency laparotomy was carried out. This revealed multiple jejunal diverticula, one of which had perforated 40 centimeters distal to the ligament of Treitz

patient with cystic lymphangioma in pancreas

Cystic lymphangioma of the pancreas is extremely rare, accounting for less than 1% of pancreatic tumors. Though congenital, it can affect all age groups. Cystic lympangioma occurs more frequently in females. Patients usually present with epigastric pain and an associated palpable epigastric mass. Complete excision is curative, even though, depending on the tumor location, surgery may be simple or involve extensive pancreatic resection and anastomoses. In this case report, we discuss a 63 -year old patient who presented with epigastric pain and on investigation was found to have pancreatic head cystic lymphangioma. At surgery the tumor was completely excised, with preservation of pancreatic duct. Histology and immunohistochemistry confirmed cystic lymphangioma of the pancreas. This case highlights that a diagnosis of cystic lymphangioma of the pancreas should be taken into consideration as a differential diagnosis of pancreatic cystic lesions

study of contractility of proximal surgical margin in esophageal cancer

The marginal length from main tumor in esophageal cancer is a considerable issue regarding surgical management and adjuvant treatment, so we decided to study the contractility effect on the proximal surgical margin after immersing it in 10% buffered formalin as a fixative. The proximal marginal length of ten sequential patients with esophageal cancer who underwent transhiatal esophagectomy were studied, on the operating table as fresh specimens, immediately after resection, and next 24, 48 and 72 hours after immersing in 10% buffered formalin. The contraction continued through the day 3, the mean contractility after one day was about 27%, after two days was 33% and after three days was 38%. This study shows how the proximal esophageal margin can vary by the time, after immersing in 10% buffered formalin and should be considered in every settings and reporting documents by pathologists

Simultaneous gastric adenocarcinoma and gastrointestinal stromal tumor of the stomach: a case report

Simultaneous a collision tumor of stomach consisting of adenocarcinoma and Gastrointestinal Stromal Tumor [GIST] is very rare based on our knowledge. This coexistence has rarely been reported in literatures. We report a case of 64-year-old woman who has diagnosed with prepyloric poorly-differentiated diffuse signet-ring cell type adenocarcinoma and has undergone an elective D2 total gastrectomy. During operation another mass in fundic body region has found. The pathologic examination of the mass has shown GIST. Immunohistochemical staining for CD117 and Desmin was positive whilst that for S100 was negative. This case reports the simultaneous two tumors development of different histotypes and natures in the same organ

Peutz-Jeghers syndrome without mucocutaneous pigmentation: a case report

Peutz-Jeghers syndrome is a rare condition characterized by mucocutaneous pigmentation, polyposis and an increased cancer risk at a number of gastrointestinal and extra intestinal organs. We present a patient with a history of gastrointestinal bleeding with no mucocutaneous pigmentation. Upper and lower gastrointestinal endoscopy revealed multiple polyps located in the deuodenum and colon. Histopathological evaluation of the polyps revealed hamartomatous polyps of Peutz-Jeghers syndrome

[ effects of hemovac on short- term outcome of Lichtenstein herniorrhaphy]

Many patients with inguinal hernia are operated and hemovac is used to drain extra fluids from the surgery site. In this study, we compared the results of surgery in patients operated with hemovac vs. who had not hemovac. In a randomized clinical trial, 86 patients with inguinal hernia were assigned into two groups. Patients were operated by Lichtenstein method and hemovac was used in one group. The short- term outcome was compared between two groups. Severity of pain in hemovac group was mild in 20 cases, moderate in 16 and severe in 5, and in non hemovac group was mild in 19 cases, moderate in 20 and severe in 2. Severity of scar in hemovac group was mild in 21 cases, moderate in 20 and severe in 2, and in non hemovac group was mild in 25 cases, moderate in 16 and severe in 2. Inflammation in hemovac group was mild in 23, moderate in 20 and nobody had severe inflammation, while in non hemovac group was mild in 31 cases, moderate in 11 and severe in 1. There were no significant differences in pain, scar and inflammation among groups with and without hemovac. Using hemovac in inguinal hernia repair does not have effect on the healing of surgery site

Infections after laparoscopic and open cholecystectomy: ceftriaxone versus placebo; a double blind randomized clinical trial

Gallstone disease is one of the most common gastrointestinal diseases requiring surgery with probable postoperative infection. The role of prophylactic antibiotics [AB] in prevention of infection is controversial. This study aimed to compare the manifestations, complications and outcomes of two groups of patients, those receiving prophylactic AB versus placebo, in order to determine whether antibiotic therapy is required. In this double blind randomized clinical trial, we studied 130 patients with symptomatic cholelithiasis or polyps of gallbladder admitted in Shohada-e-Tajrish Hospital, Tehran, Iran for cholecystectomy between 2006 and 2008. Patients were randomly assigned in two subgroups: the first group received Igr ceftriaxone during induction of anesthesia and the second group received l0mL of isotonic sodium chlorides solution as placebo. All patients were followed for 4 weeks after surgery. The study population included 61 males and 69 females with the mean age of 49.3 +/- 9.6 and 51.8 +/- 9.9 years in treatment and placebo group, respectively. Of 130 bile culture results, 83 were negative. Escherichia coli, Klebsiella and Staphylococcus aureus were the most common cultured bacteria. There was no statistically significant difference in culture results between the patients received AB and placebo [MS]. The surgical technique [open versus laparoscopic] did not influence the culture results. It can be concluded that prophylactic antibiotics do not have any preventive effect on wound infection in a double blind setting. According to our findings, routine antibiotic prophylaxis as recommended for biliary surgery [open or laparoscopic cholecystectomy] is now questionable

[Pruritus after abdominal blunt trauma: early presentation of rupture of hydatid cyst]

Hydatid cyst mostly presents solitary cyst in right lobe of liver. It is asymptomatic and patient presents with pressure effects or rupture of cyst. We introduce a patient who was referred to the emergency room with history of blunt trauma and symptoms of abdominal pain and generalized severe pruritus without anaphylaxis and urticaria. Explorative laparotomy showed a ruptured hydatid cyst. Albendazole 400 milligram was prescribed twice a day for 4 weeks after operation. The patient discharged with healthy appearance. There was no abnormal findings in further followup visits