RESUMO
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
RESUMO
Leiomyoma of the colon are rare benign smooth muscle tumours. Report a new case of colic leiomyoma revealed by gastrointestinal bleeding. A 71-year-old man, diabetic, consulted the emergencies for acute per-rectal bleeding. The physical examination was essentially normal. Haemoglobin level was 3.7g/dl.. The upper digestif endoscopy was normal. The colonoscopy showed an active bleeding from the right colon but it was enable to specify the nature and the exact seat of the bleeding lesion. An emergent operation showed a tumor of the right colic angle of 8 cm. A right hemicolectomy was performed with immediate ileocolic anastomosis. Pathology showed a leiomyoma. Postoperative course mentioned a nosocomial pneumopathy. Colic leiomyomas are rare benign tumours. The determination of the mitotic index is of primary importance to differentiate them from the leiomyosarcomas of low rank of malignancy whose prognosis is unfavourable