ABSTRACT
Successful eradication of a complicated, recurrent fistula-in-ano with maintenance of anal continence, requires a specialized surgical approach. Mucosal advancement anoplasty is associated with acceptably low rates of recurrence and continence and is reported in this small series of 11 patients where it followed preliminary deployment of a loose guiding and drainage seton. The technique was also supplemented by internal anal sphincter repair at the time of the advancement anoplasty. Success was achieved in nine cases without any effect on reported continence.
La erradicación exitosa de la fístula anal complicada, recurrente, con mantenimiento de la continencia anal, requiere un abordaje quirúrgico especializado. La anoplastia por avance de colgajo de mucosa esta asociada con tasas aceptablemente bajas de recurrencia y continencia, y se reporta en esta pequeña serie de 11 pacientes, en la que a continuación se produjo el uso preliminar de un sedal (setón) de drenaje y laxo de guía. La técnica fue también complementada por la reparación del esfínter anal interior en el momento de la anoplastia de avance. Se logró éxito en nueve casos sin efectos sobre la continencia reportada.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Anal Canal/surgery , Fissure in Ano/surgery , Rectal Fistula/surgery , Fecal Incontinence , Mucous Membrane/surgery , Digestive System Surgical Procedures , Treatment Outcome , Anal Canal/physiology , Retrospective Studies , Suture TechniquesABSTRACT
Preoperative staging of rectal cancer assists in surgical decision making regarding the suitability of curative local excision as well as in the selective use of preoperative adjuvant radiation and chemoradiation, both of which have been shown to reduce the incidence of loco-regional cancer recurrence substantially. Most colorectal units employ endorectal ultrasound (ERUS) in the assessment to define tumour depth (T) and nodal (N) status. The preliminary Barbadian experience of 40 such cases showing an accuracy for T stage of 85% and for N stage of 50% in keeping with international reports is presented The interpretation and limitations of this technology are presented
La estadificación preoperatoria del cáncer rectal ayuda en la toma de decisiones en relación con la conveniencia de la excisión local curativa, así como en el uso selectivo de la radiación adyuvante preoperatoria y la quimoradiación, las cuales han probado su eficacia en cuanto a reducir sustancialmente la incidencia de la recurrencia del cáncer loco-regional. La mayor parte de las unidades colorectales emplean el ultrasonido endorectal (UER) en la evaluación para definir la profundidad del tumor (T) y el estatus nodal (N). Se presenta la experiencia preliminar barbadense en 40 de estos casos, que muestran una precisión del 85% para el estado T y del 50% para el estado N en correspondencia con los reportes internacionales. Se presentan la interpretación y las limitaciones de esta tecnología.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Endosonography/methods , Rectal Neoplasms , Barbados/epidemiology , Neoplasm Staging , Rectal Neoplasms/epidemiology , Rectal Neoplasms/pathology , Sensitivity and Specificity , Predictive Value of TestsABSTRACT
Jejunal adenocarcinoma is rare, often presenting late with widespread intraperitoneal disease. Intraperitoneal chemotherapy (IPC) has been shown in non-randomized studies to improve the survival of patients presenting with intraperitoneal metastases from carcinoma of the colon, appendix and stomach and in primary peritoneal malignancies including mesothelioma and pseudomyxoma peritonei, providing that adequate operative cytoreduction can be performed. A case is presented of obstructive jejunal adenocarcinoma in which 19 intraperitoneal deposits were excised. The patient was treated successfully with immediate postoperative IPC followed by systemic chemotherapy. This condition is reviewed along with the rationale for IPC.
El adenocarcinoma del yeyuno es raro, presentándose a menudo de forma tardía con enfermedad intraperitoneal extensa. Estudios no randomizados han demostrado que la quimioterapia intraperitoneal (QIP) mejora la supervivencia de pacientes que presentan metástasis intraperitoneal del carcinoma de colon, apéndice y estómago, así como en malignidades peritoneales primarias, incluyendo el mesotelioma y el pseudomixoma peritoneal, siempre que se realice una adecuada citoreducción quirúrgica. Se presenta un caso de adenocarcinoma yeyunal obstructivo en el que se extirparon 19 depósitos del intraperitoneal, tratándose inmediatamente al paciente exitosamente con quimioterapia intraperitoneal postoperatoria, seguida de quimioterapia sistémica. Se examina esta condición junto con las razones para practicar la QIP.
Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma/drug therapy , Adenocarcinoma/surgery , Peritoneal Neoplasms/drug therapy , Peritoneal Neoplasms/surgery , Jejunal Neoplasms/drug therapy , Jejunal Neoplasms/surgery , Antineoplastic Combined Chemotherapy Protocols , Adenocarcinoma/pathology , Fluorouracil/administration & dosage , Infusions, Parenteral , Leucovorin/administration & dosage , Neoplasm Metastasis , Peritoneal Neoplasms/secondary , Jejunal Neoplasms/pathology , Intestinal Obstruction/etiology , Intestinal Obstruction/surgeryABSTRACT
Rectal leiomyosarcoma is rare. It is frequently treated by abdominoperineal resection. The role of adjuvant therapy is unclear. Two cases of rectal leiomyosarcoma are presented. Pre-operative endorectal ultrasound predicted submucosal invasion in one case treated by low restorative resection and muscularis propria infiltration in the other managed with abdominoperineal resection. In both cases, ultrasound suggested malignant characteristics as evident by heterogeneous cystic spaces, irregular outline, large size and echogenic foci. Histology was CD34 negative and desmin, alpha-smooth muscle actin and HHF-35 positive, distinguishing these tumours from gastrointestinal stromal tumours. Rectal leiomyosarcoma may be successfully treated by restorative resection and pre-operative ultrasound is useful in assisting this surgical decision by defining malignant features of the tumour. Histopathological characteristics predictive of poor prognosis include high mitotic activity, intratumoural necrosis and tumour size