Extra-gastrointestinal stromal tumor presenting as a huge peritoneal mass and mimicking as mesothelioma - A case report.

INTRODUCTION AND IMPORTANCE: Extra-gastrointestinal stromal tumors are group of soft tissue neoplasm, which originates outside the gastrointestinal tract comprising of less than 5% of the total gastrointestinal stromal tumors. CASE PRESENTATION: A 67 years old male came with a history of vague abdominal pain, discomfort and loss of appetite. Per abdominal examination showed a palpable firm mass which was filling both the flanks. Radiological imaging revealed a large abdomino-pelvic mass with central necrotic areas. Exploratory laparotomy was done and the mass was excised intact from the sigmoid mesocolon. Histopathological diagnosis was given as extra-gastrointestinal stromal tumors. CLINICAL DISCUSSION: Extra-gastrointestinal stromal tumor was first described by Miettinen et al. in 1999. The tumor can arise from the pleura, omentum, mesentery, retroperitoneum and prostate. The clinical presentation of the tumor depends on its location and the size of tumor. Patients with these tumors present with abdominal pain, followed by abdominal mass and distention. These tumors show pathological, immunohistochemical and molecular biological characters similar as that of gastrointestinal stromal tumor. CONCLUSION: Extra-gastrointestinal stromal tumor is a rare tumor and can reach to a considerable large size before presenting with clinical symptoms especially if the tumor arises from the mesocolon. IHC study plays an important role to reach to the final diagnosis as the tumor can mimic mesothelioma in routine staining.

Delta-shaped gastroduodenostomy using a robotic stapler in reduced-port totally robotic gastrectomy: its safety and efficiency compared with conventional anastomosis techniques.

To investigate the safety and efficiency of using robotic staplers for intracorporeal gastroduodenostomy in reduced-port robotic gastrectomy for gastric adenocarcinoma. We retrospectively reviewed patients who underwent totally robotic and laparoscopic gastrectomy with intracorporeal gastroduodenostomy. Gastroduodenostomy using the ENDOWRIST robotic stapler (RR) was compared to that using an endolinear stapler during robotic gastrectomy (RE) and to that using an endolinear stapler during laparoscopic gastrectomy (LE). A total of 296 patients underwent gastroduodenostomy: 58, 28, and 210 patients with RR, RE, and LE, respectively. There were no conversions to other methods, and all robotic stapling procedures were performed on the console without receiving additional assistance from a bedside surgeon during RR. Comparing the operative outcomes of RR with those of RE and LE, respectively, we noted similar postoperative short-term outcomes. There were no major complications, including anastomosis-related complications, during the postoperative period after RR. The median reconstruction time during RR was 8 min and 45 s, which was similar to that during RE (8 min, 5 s [P > 0.9999]), but longer than that during LE (6 min, 30 s [P < 0.0001]). Intracorporeal gastroduodenostomy using the robotic stapler during robotic gastrectomy could be safely and feasibly performed on the console without the assistance of assistant, bedside surgeons.

Open Conservative Surgical Management of Cystic Echinococcosis in a Tertiary Care Hospital, Nepal.

BACKGROUND: Cystic echinococcosis (CE) or hydatid disease caused by E. granulosus in Nepal is amenable to surgical treatment. AIM: Aim of the study is to evaluate the efficacy of surgical treatment of CE, by open partial pericystectomy with albendazole as adjuvant. MATERIALS AND METHODS: Material of this prospective study were the consecutive series of 33 patients operated for CE, over a period of 8 years, at a single centre. Clinical examination, ultrasonography (USG) and computed tomography (CT) were used for establishing diagnosis. Patients were prescribed perioperative albendazole. Povidone iodine 10% (betadine)was used as contact scolicidal agent during operation. Cysts were evacuated from livers, lungs, retroperitoneum by partial pericystectomy. CE of mesentery was completely excised. Descriptive statistics was obtained using EPI- info windows version soft ware. RESULTS: A total of 33 patients were operated for CE; 24 were females and 9 males. Age ranged from 4 years to 80 years. Organs/ site involved were: liver - 24, lungs - 4, combined liver and lungs - 2, retroperitoneum - 2 and mesentery - 1. Complication - bile leak for 2 weeks in an operated CE of liver. There was no mortality. Hospital stay (in days) was - mean 14 (range 7to21). Follow up for 3 years (average 2years) showed no recurrence. CONCLUSION: Evacuation of CE by partial pericystectomy is an effective, safe and simple procedure, and gives excellent cure rate with perioperative albendazole therapy.