Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer.

INTRODUCTION: An infiltration of urological organs is found in 5-10% of patients with colorectal carcinoma. Total pelvic exenteration is the standard procedure for locally advanced rectal cancer. In selected patients with rectal cancer involving the prostate or seminal vesicles, the bladder can be preserved and en bloc radical prostatectomy with abdominoperineal rectal resection can be performed. We report two patients who treated with this combined approach. PRESENTATION OF CASE: Two patients with symptoms of rectal bleeding and pelvic pain were investigated. Colonoscopy demonstrated a tumor in the lower rectum. Biopsies revealed adenocarcinoma. Both pelvic MRI and endorectal ultrasound showed tumors that invaded the prostate and the seminal vesicles directly but without invasion of the bladder. After neoadjuvant chemoradiation, combined radical prostatectomy and abdominoperineal amputation was performed. None has developed local recurrence, but one of them was operated on for a single lung metastasis. After a follow-up of 28 and 20 months, respectively, the patients are alive without evidence of local recurrence or distant disease. DISCUSSION: This procedure obviates the need for urinary diversion without compromising the local tumor control. Intraoperative and postoperative diagnostic difficulties, and clinical aspects in relation to postoperative anastomotic leak and survival of patients are discussed. CONCLUSION: En bloc radical prostatectomy and proctosigmoidectomy is feasible in selected patients with rectal cancer and invasion limited to the prostate or seminal vesicles because it provides good local tumor control and significantly improves the patient's quality of life in comparison to total pelvic exenteration.

Glucagonoma syndrome: a case report.

INTRODUCTION: Glucagonoma syndrome is a rare paraneoplastic phenomenon, with an estimated incidence of one in 20 million, characterized by necrolytic migratory erythema, hyperglucagonemia, diabetes mellitus, anemia, weight loss, glossitis, cheilitis, steatorrhea, diarrhea, venous thrombosis and neuropsychiatric disturbances in the setting of a glucagon-producing alpha-cell tumor of the pancreas. Necrolytic migratory erythema is the presenting manifestation in the majority of cases, so its early suspicion and correct diagnosis is a key factor in the management of the patient. CASE PRESENTATION: We present the case of a 70-year-old Caucasian woman with glucagonoma syndrome due to an alpha-cell tumor located in the tail of the pancreas, successfully treated with surgical resection. CONCLUSION: Clinicians should be aware of the unusual initial manifestations of glucagonoma. Early diagnosis allows complete surgical resection of the neoplasm and provides the only chance of a cure.

Abdomen agudo secundario a pica / Acute abdomen due to pica

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Emergency hernia repairs in elderly patients.

The aim of this study was to determine the clinical presentation, morbidity, and mortality and to identify the factors that might affect the outcome of emergency repair in elderly patients. A study of 143 patients (> 65 years old) who underwent emergency surgical repair for incarcerated external hernias during the period 1992-2001 was done. Fifty patients (35%) presented after 48 hours of symptoms onset. Coexisting diseases were found in 104 cases (77.7%). Bowel resection was required in 25 patients (17.5%). Overall morbidity was 46.2%, and major complications were seen in 17 cases (11.9%). Mortality was observed in seven patients (4.9%). Longer duration of symptoms, delayed hospitalization, concomitant illness, and high American Society of Anesthesiologists scores were significant factors linked with unfavorable outcome. To avoid the increased risks of emergency hernia repairs in the elderly, priority admission and early elective surgery should be used.