[Stapled vs. hand-sewn colorectal anastomosis in complicated colorectal cancer--a retrospective study]. / Anastomozele manuale versus anastomozele mecanice in cancerul colorectal complicat--studiu retrospectiv.

UNLABELLED: Emergens in colorectal pathology are in most cases by complications of cancer. The prognosis for colorectal cancer is poor when this pathology is addressed in emergency situations because, on one hand, of the organ specific structure, blood supply, septic content and, on the other hand, because of the special group of patients with this pathology: aged, immunosuppressed and with various comorbidities. The high rate of postoperative complications of these patients requires a specific management. The development and improvement of medical devices has brought to the surgeons new products among which mechanice devices for anastomoses. In this study we compared two groups of operated patients (with hand sutured and stapled anastomoses) who presented as emergences with complications of colorectal cancer. MATERIAL AND METHOD: Retrospective clinical study with a total of 72 patients who underwent a colorectal resection procedure in emergency in our clinic (Emergency Hospital Bucharest) over a period of 2 years (2007-2008). RESULTS: The 72 patients who required emergency surgery were randomly assigned to 2 categories according to the type of anastomosis: hand sutured (group 1, n = 34) and stapled (group 2, n = 38). Age, sex, comorbidities, and tumor staging were comparable in both groups. The emergency was represented by obstruction (56.94%), hemorrhage (8.33%) and perforation (34.72%). The mortality (10.5% vs. 8.8%) and orbidity rate (20.83% vs. 15.27%) was higher in the stapled anastomosis group. The average duration of the surgical procedure performed in emergency was also quantified and was 118 min. (group 2) vs. 236 min. (group 1) respectively. CONCLUSION: Comparison did not disclose any significant difference in the number of complications in these two groups. Anastomosis is safe in emergency colorectal surgery and the reduction of the operative time may also improve the outcome of these patients.

[Laparoscopic approach in gallbladder agenesis--an intraoperative surprise]. / Abordul laparoscopic în agenezia veziculei biliare--o surpriza intraoperatorie.

INTRODUCTION: The congenital absence of the gallbladder in the absence of biliary atresia is extremely rare, world literature recognizing only 413 cases. The aim of this study is to clarify the diagnostic and therapeutic approach of this rare condition. METHOD: There were retrospectively analyzed the first 2 cases of gallbladder agenesis admitted and surgically approached in the Emergency Hospital, Bucharest. RESULTS: The first case (woman, 23 years old) had typically biliary complaints at admission, shrinked gallbladder and lithiasis on ultrasound. There was a laparoscopic approach but we didn't find any gallbladder. After a non-therapeutic laparoscopy the biliary symptoms disappeared. In the second case (woman, 52 years old) the admission was for upper abdominal quadrant colicative pain and the transparietal abdominal ultrasound showed chronic cholecystitis. Common bile duct dilatation was revealed during laparoscopy. After conversion to laparotomy there was performed intraoperative colangiography, but no other biliary pathology was revealed. The initial complaints also disappeared after surgery. CONCLUSIONS: We find the laparoscopic approach an effective method for the diagnosis of gallbladder agenesis. Postoperative Magnetic Resonance Cholangiopancreatography represents a very useful imagistic tool to rule out an intrahepatic gallbladder.

[Splenic angioembolization--a safe, efficient and rational approach]. / Angioembolizarea terapeutica în trauma splenica--eficienta, sigura si rationala.

The authors present a case of postraumatic splenic rupture grade III (AAST-OIS), with injury severity score 10, revised trauma score 7841 managed nonoperatively, by angioembolization, with successful outcome. The indications and different types of splenic angioembolization in trauma are discussed, together with the role of this procedure in increasing the success rate of nonoperative management. Up to our knowledge, this is the first reported case of therapeutic splenic angioembolization in the Romanian medical literature.

[Köhlmeier-Degos disease (Malignant Atrophic Papulosis): a cause of recurrent multiple intestinal perforations]. / Boala köhlmeier-Degos (Papuloza Atrofianta Maligna): cauza de perforatii intestinale multiple iterative--prezentare de caz.

Malignant Atrophic Papulosis (MAP) or Degos disease is a very rare vasculopathy affecting multiple systems. When associated with gastrointestinal tract or central nervous system involvment, patients with Degos disease have a poor prognosis and a high mortality. We report a case of Degos disease with systemic involvement, which ultimately caused peritonitis, sepsis, and death, despite all treatment. A 29-year-old man was admitted in June 2007 on the surgical ward of our hospital with acute generalized abdominal pain and multiple skin lesions. The patient had an appendectomy at another hospital 6 weeks before the current presentation. The exploratory laparotomy showed 2 perforations of the ileum. After the initial procedure, the patient developed spontaneous recurrent perforations of the small bowel and suffered another 3 reoperations. Neuroradiologic reports described central and peripheral nervous system involvement with progressive clinical deterioration and a meningovascular pattern at cerebral MRI. Despite aggressive treatment the patient died 3 months after the first surgical intervention.