Extrauterine leiomyomata presenting with sepsis requiring hemicolectomy / Leiomiomas extrauterinos com sepse que exigem hemicolectomia

Extrauterine leiomyomas are rare, benign, and may arise in any anatomic sites. Their unusual growth pattern may even mimic malignancy and can result in a clinical dilemma. Occasionally, uterine leiomyomas become adherent to surrounding structures. They also develop an auxiliary blood supply, and lose their original attachment to the uterus, thus becoming 'parasitic'. Parasitic myomas may also be iatrogenically created after uterine fibroid surgery, particularly if morcellation is used. This report presented two cases of parasitic myomas with sepsis, both requiring right hemicolectomy. It reviewed the pertinent literature.

Leiomiomas extrauterinos são raros e benignos e podem surgir em qualquer local anatômico. O padrão de crescimento não-usual destas lesões pode até mesmo imitar malignidade e resultar em dilema clínico. Ocasionalmente, os leiomiomas uterinos aderem-se às estruturas circunvizinhas, desenvolvem suprimento sanguíneo auxiliar e perdem sua ligação original ao útero, tornando-se assim "parasíticos". Os miomas parasíticos podem também ser criados iatrogenicamente após cirurgia fibroide uterina, especialmente se for utilizada morcelação. Este relato apresentou dois casos de miomas parasíticos com sepse, ambos exigindo hemicolectomia à direita, bem como revisão da literatura pertinente.

Minilaparotomy cholecystectomy – An appropriate alternative to laparoscopic cholecystectomy in developing nations.

Background: This study reports the experience of performing minilaparotomy cholecystectomy (MC) and assesses the peri-operative outcome of this surgery in the setting of a developing country. Methods: Data of all patients who underwent minilaparotomy cholecystectomy by a single surgical unit were collected and reviewed. These included demographics, surgical technique used, peri-operative complications and length of hospital stay. Descriptive analyses were done. Results: 476 patients who underwent elective minilaparotomy cholecystectomy in a single surgical unit over a 15 year period were studied. Of these, 84.8% were female. The mean age was 47 years. The most common indication for surgery was symptomatic cholelithiasis with chronic cholecystitis (66%). Mean length of the surgical incision was 4.8 cm and mean operating time was 31 min. Rate of conversion to conventional open cholecystectomy was 4%. Median hospital length of stay was 22 hours. Minor wound infection was the only surgical post-operative complication recorded in 7 patients. Nine patients in the converted group and 3 in the minilaparotomy cholecystectomy group had significant vomiting. There was no mortality. Conclusion: The study reinforces the view that minilaparotomy cholecystectomy can be safely and effectively performed with minimal peri-operative complications, and is ideal for developing country settings.

Caroli's Disease Associated with a Gastric Diverticulum

Caroli's disease or communicating ectasia of the intrahepatic biliary tree is a rare disease with unknown aetiology. The coexistence of this along with the uncommon condition of a gastric diverticulum has never been reported before. A deficiency in the fibromuscular matrix of both the bile ducts and the gastric wall may explain why these two pathologies may coexist in a single patient.

Compartment syndrome due to reperfusion injury

Theorectically, tisue oedema due to reperfusion injury may be severe enough to cause compartment syndrome. One such rare case is presented.