[Squamous cell carcinoma of caecum--case report]. / Rak plaskonablonkowy katnicy--opis przypadku.

Squamous cell cancer is a very rare malignancy in colon and rectum. It accounts for 0.05-0.1% of all types of cancers in this localization. It predominantly occurs in caecum. In the article we present a case of 77 year old women who was operated due to tumor of caecum which infiltrated the proximal transverse colon. During the operation a right hemicolectomy was performed. There were no macroscopic signs of metastases in liver and lymph nodes. Histopathological examination of removed tumor revealed squamous cell carcinoma of caecum in pT4 stage. In the Clinic retrospective material squamous cell cancer of colon accounts for 0.07% of the total colon cancer cases. The patient was disqualified from post-operative chemotherapy because of the age and general condition. Four months after the operation liver metastases and ascites occurred. The patient died five months after the surgery. Despite the radical surgical treatment the course of the disease was rapid.

[Inflammatory fibroid polyp of the stomach--a case report]. / Wlóknisty polip zapalny zokldka--opis przypadku.

Inflammatory fibroid polyp of the stomach is a rare benign mass of unknown etiology, mostly located within the pyloric area. Histopathological findings mainly reveal the presence of mononuclear fusiforme cells forming loose extensive bundles or rotary structures of rotated spirals with abundant amount of eosinophilic cytoplasm. These cells are negatively stained for S-100 protein and desmine and positively stained for CD-34. Symptoms of the disease depend on the localization and the size of the polyp. We report a case of 50-year-old woman with a large inflammatory fibroid polyp with a diameter of 60 x 50 x 40 mm imitating benign gastric tumour. She mainly suffered from abdominal pain and lab tests revealed symptoms of severe anaemia. We performed partial gastrectomy with Hofmeister-Finsterer modification. Postoperative pathological findings certified sings of inflammatory fibroid polyp. During the two year followup period we did not report any signs of recurrence or dissemination. Clinical manifestation of large inflammatory fibroid polyp of the stomach can imitate symptoms of gastric cancer. Partial gastrectomy with an unaltered, healthy wall margin of 2 to 3 cm is sufficient, curative treatment modality in such cases.

[Gastric complaints or postcholecystectomy syndrome?]. / Dolegliwosci gastryczne czy zespól po cholecystektomii?

UNLABELLED: Postcholecystectomy syndrome (PCS) is a complex of symptoms from gastrointestinal tract that could develop and maintain after cholecystectomy. PCS usually consists of: abdominal pain or colic, dyspepsia, constipation or diarrhoea, nausea, bloating, fatty food intolerance. Regarding PSC as disease entity is still a point of many controversies. THE AIM OF THE STUDY: To estimate the prevalence of PCS in patients after cholecystectomy performed in Department of General and Colorectal Surgery of Medical University in Lodz. Material and methods. From the cohort of 243 patients (pts) operated on due to symptomatic cholecystitis the group of 150 pts was surveyed. We included 86 pts who answered the questionnaire. The prevalence of PCS and intensity of symptoms were measured with the use of modified Gastrointestinal Symptoms Rating Scale (GSRS)--only 6 complaints commonly connected with pathology of biliary system were chosen (abdominal pain, rebounding, constipation, urgent diarrhea, nausea, bloating). RESULTS: After cholecystectomy gastric complains were revealed in 32 pts (37.2%). In a group of 12 pts (13.9%) symptoms were noted at the same level of intense. However in 20 pts (23.25%) either more intense or appeared as brand new manifestation. Excessive amount of intestinal gases (93.75%) and bloating (87.5%) were the most common symptoms unlike abdominal pain, heartburn and diarrhea. CONCLUSIONS: Gastric symptoms of PCS occur in one third of pts after elective cholecystectomies. Complete PCS develops after 3 months postoperatively what is likely connected with the change of diet. Excessive amount of intestinal gases, bloating, abdominal pain and diarrhea were the most common symptoms. The most intense complaint is persistent abdominal pain likely indicating comorbidities.

[Clinical assessment of the closure of a temporary diverting ileostomy]. / Ocena wyników wlasnych odtworzenia ciaglosci przewodu pokarmowego przez zamkniecie czasowej ileostomii petlowej.

UNLABELLED: Closure of the temporary diverting ileostomy is technically easy procedure but may have its own side effects, such as obstruction and anastomotic leak. The aim of this study was designed to assess the results of the closure of the protective ileostomy in the group of patients' operated on for inflammatory bowel disease and other inflammatory conditions with inflammatory exudate and to compare them with those who underwent surgery for uncomplicated colorectal cancer and precancerous conditions. Radiological examination of the efferent ileostomy loop was performed preoperatively to assess its influence on surgical strategy and postoperative complications resulting from the disturbances of passage of the intestinal contents. MATERIAL AND METHODS: This is a retrospective review of 48 patients divided into 2 groups: patients who suffered from inflammatory bowel disease or peritonitis (group I, n = 16) and patients with uncomplicated malignant disease or precancerous conditions of the gastrointestinal tract (group II, n = 32). Moreover, 18 patients (group A) without preoperative radiological assessment were compared with 30 patients (group B) in whom such examination was carried out. Statistical analysis was performed by using of the U-Mann-Whitney, the Fisher's exact and Student's t-tests. The differences were considered significant for levels of less than 0.05. RESULTS: Postoperative complications (obstruction and anastomotic dehiscence) occurred in 9 patients (18.7%). Seven patients (14.6%) were reoperated on: 6 patients in group 1 (37.5%) and 1 patient in group II (3.1%), (p = 0.013). Out of all postoperative complications that required secondary surgery, 22.2% of them occurred in patients who did not have preoperative radiological examination performed and 10% of them had patients in whom radiological assessment was done. Radiological findings revealed efferent ileostomy loop stenosis in 4 patients (13.3%) what influenced the operative strategy. CONCLUSIONS: Postoperative complications rate was high (18.7%). Closure of the temporary diverting ileostomy in patients with inflammatory bowel disease or any other inflammatory conditions within the peritoneal cavity are at the increased risk of complications than in those with malignant diseases or precancerous conditions. Preoperative radiological examination of the efferent ileostomy loop is useful in planning of surgical approach and influences improved treatment results.

[Gastrointestinal stromal tumors (GIST)]. / Nowotwory podscieliskowe przewodu pokarmowego (GIST).

Gastrointestinal stromal tumors (GIST) are the example of very rare sarcoma of alimentary tract. In the presented material, 5 cases of GIST were diagnosed and treated in our Department. One tumor was localized in stomach, two in rectum and one in jejunum. Primal localization of the last tumor was not discovered. It was visualized between rectum and bladder, covered by the omentum. In each case confirmation of the diagnosis was done on the basis of the immunohistochemical staining--CD117(+). In four cases surgery was the primary treatment. Only in one case radical resection was performed. In other three cases radical resection was not possible due to the presence of liver metastases (in two cases) and the size of the tumor (20 x 10 cm). One patient was disqualified from the surgical treatment. Four patients were qualified for the chemotherapy with imatinib. In one case, patient did not undergo the treatment. In the group treated with imatinib the early reply was satisfactory. On the ground of our material we conclude that patients usually begin the treatment in the advanced stage of the disease. When the GIST diagnosis is probable, one has to broaden the histopathological examination with immunohistochemical staining for CD117 antigen. Making the right diagnosis is crucial for patients, since imatinib is effective even in the advanced stages of the disease. Nevertheless radical surgical treatment is still the primary choice for the patients with GIST.

[Intestinal tract endometriosis]. / Endometrioza przewodu pokarmowego.

Pelvic endometriosis in 3-37% of cases involves the intestinal tract, mainly sigmoid colon and rectum. In clinical practice endometriosis of the intestinal tract is rarely diagnosed and usually after long-lasting symptoms. During 3 years we treated only 2 women with this disease and therefore we want to report this seldom disorder. One woman had been diagnosed as having had rectal endometriosis before she was admitted to the hospital and the other one was admitted because of complications after laparoscopic treatment of pelvic endometriosis. In spite of typical signs of intestinal tract endometriosis, the proper diagnosis was made after several years of symptoms in one woman and in the second female histopathology of removed sigmoid colon because of its lesion finally revealed endometriosis. Laparoscopy seems to be the best diagnostic method of intestinal endometriosis and its treatment is to remove the involved part of the bowel together with endometriotic foci and surrounding tissues. Cyclical intestinal endometriosis symptoms correlating with menstrual cycle should always draw our attention to this rare disorder.