[Primary necrosis of the ligamentum teres hepatis]

Report a new case of primary necrosis of the ligamentum teres hepatis and discuss preoperative diagnosis strategy and therapeutic options. This is a patient of 76 years, hypertensive, who was admitted for an acute abdomen. The diagnosis of acute pancreatitis was referred to the poor clinical examination and amylase to six times normal. Abdominal CT scan showed a normal pancreas appearance and hypodense infiltration extended along the round ligament of the liver to the anterior abdominal wall that did not take the contrast. The patient was operated 24 hours after admission to the signs of clinical and biological severity. There was gangrene of the round ligament and the suspensory ligament of the liver. We performed a resection of all necrotic tissue and cholecystectomy. The postoperative course was uneventful. Primary necrosis of the round ligament of the liver is an extremely rare cause acute abdomen. Its diagnosis is difficult despite the contribution of the abdominal CT scan. Treatment is surgical

Primary anorectal melanoma: a case report

Anorectal melanoma is a rare but highly lethal malignancy. Clinical symptoms are non-specific and treatment is still debated. The aim of this study was to report a case concerning diagnostic and management of Anorectal melanoma. A 66-year-old man was admitted in our surgical unit with a 3-month history of pain and rectal bleeding. Rectal examination revealed a tender mass arising from the 5 o'clock position of the anal canal that bled on touch. A provisional diagnosis of rectal polyp was made and it was removed by local excision under general anaesthesia. Histopathologic examination reported it as an anorectal malignant melanoma. The postoperative course was uneventful. Extension staging showed a 15 mm nodule on the left lung. The patient underwent a metastasectomy of the left lung. No adjuvant therapy was given. He died one year later. With this case we want to illustrate that malignant melanoma can be difficult to diagnose, as patients have non-specific symptoms and histology may be misleading. Surgery remains the mainstay of treatment. Wide local excision combined with adjuvant loco-regional radiotherapy should be preferred when technically feasible. Abdominoperineal resection has to be done only in the case of large tumors or when the anal sphincter is involved. Overall 5-year survival is less than 20%. It's correlated to extension of disease regardless of initial surgical therapy

Stromal tumor of the ampulla of vater: report of a case and systematic review of reported cases

Gastrointestinal stromal tumours are a large category of primary no epithelial neoplasms of the digestive tract. The localization of stromal tumours in the ampulla of Vater [STAV] is very rare. The aim of this study was to describe clinical, endoscopic and therapeutic particularities of STAV. We reported a new case and we carried out an extensive electronic search for the relevant literature using Medline. Key words used were "ampulla of Vater" and "Gastrointestinal stromal tumor" and "CD 117". With our case, we collected seven other cases in the literature. The analysis of the sample of these eight cases leads us to propose the following conclusions. STAV is a tumor of adult after the age of fifty. There is no specific symptomatology. Gastroduodenal endoscopy with biopsies and immunoassaying allows positive preoperative diagnosis in the 5 cases. Treatment should be duodenopancreatectomy since the tumor is often malignant [5 cases]