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1.
Chirurgia (Bucur) ; 117(2): 211-217, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35535783

ABSTRACT

The ischemic complications during the isolation of the substituting oesophageal graft placement and after its placement may lead to graft necrosis and to the need to find a different reconstructive procedure. The most frequent reports of graft necroses occur in the days following the reconstruction. We are presenting the case of a 27-y.o. with full dysphagia as a result of caustic stenosis, in whose case the oesophageal reconstruction was abandoned following the irreversible ischemia of the right colic graft during the vascular isolation, followed by right-side hemicolectomy and ileo-transverse anastomosis. 4 years post the ingestion of a caustic substance and 2 years post the right colic graft ischemic necrosis, we performed an oesophageal reconstruction using a pediculated, cervically revascularized, ileo-colic graft on the left colic vessels. The graft's particularity is that is formed from left and transverse colon and ileum portions, including the ileo-transverse anastomosis performed 2 years prior to the oesophageal reconstruction.


Subject(s)
Caustics , Colic , Esophagoplasty , Anastomosis, Surgical/methods , Colic/surgery , Colon/transplantation , Esophagoplasty/methods , Humans , Ileum/surgery , Necrosis , Treatment Outcome
2.
Chirurgia (Bucur) ; 115(5): 665-669, 2020.
Article in English | MEDLINE | ID: mdl-33138904

ABSTRACT

Duplication of inferior vena cava (DIVC) is a rare congenital malformation of extreme importance for vascular and urology surgeons, interventional radiologists. Oftentimes it goes unnoticed and is diagnosed incidentally at a routine or emergency CT-scan when complications occur due to associated congenital malformations. We present a case of a 70-year-old male patient who was admitted into the emergency room (ER) accusing abdominal pain. He was diagnosed with an intestinal obstruction due to a left paraduodenal hernia (LPDH), associated with a DIVC. The reviewing the literature led to concluding that DIVC is not the cause of LPDH.


Subject(s)
Internal Hernia/etiology , Intestinal Obstruction , Vascular Malformations/complications , Vena Cava, Inferior/abnormalities , Abdominal Pain/etiology , Aged , Humans , Intestinal Obstruction/etiology , Male , Treatment Outcome
3.
Orv Hetil ; 160(38): 1510-1513, 2019 Sep.
Article in Hungarian | MEDLINE | ID: mdl-31537097

ABSTRACT

Gallbladder agenesis is a rare congenital malformation due to an embryological defect of the biliary system. In most cases it is asymptomatic, but it can also mimic biliary colic. We report the case of a 72-year-old Caucasian woman with a medical history of cardiovascular disease and hypercholesterolemia, under cholesterol-lowering and hypotensive treatment, who presented symptoms suggesting biliary colic. She underwent laparoscopic surgery that confirmed the final diagnosis. We present our approach in this rare case as well as a brief review of medical literature. The surgeon should decide intraoperatively whether to continue and search for a possible ectopic gallbladder or investigate further with imaging studies. Gallbladder agenesis is a rare condition that the surgeon must be aware of. In the cases of inconclusive or indirect signs of cholelithiasis, the best approach is complementary imaging investigations such as magnetic resonance cholangiopancreatography in order to avoid surgery. Orv Hetil. 2019; 160(38): 1510-1513.


Subject(s)
Congenital Abnormalities/surgery , Gallbladder/abnormalities , Laparoscopy , Adult , Aged , Cholecystectomy, Laparoscopic , Cholelithiasis/diagnosis , Diagnosis, Differential , Female , Gallbladder/surgery , Humans
4.
World J Clin Cases ; 7(14): 1837-1843, 2019 Jul 26.
Article in English | MEDLINE | ID: mdl-31417929

ABSTRACT

BACKGROUND: Primary choriocarcinoma of the stomach (PCCS) is a rare tumor, with fewer than 60 cases published in the English-language literature up to December 2018. In this paper, we present the complex immunoprofile of one PCCS and a hypothesis regarding its histogenesis. CASE SUMMARY: A 66-year-old previously healthy male underwent an emergency palliative gastrectomy for a gastric obstructive tumor. The histologic examination and immunoprofile of tumor cells showed a mixed tumor that consisted of choriocarcinoma (90%) and moderate differentiated adenocarcinoma (10%), with hepatic metastases (Stage pT2NxM1L1V1R0) and microsatelite stable status. The patient died one month after surgery. The tumor cells showed focal positivity for CDX2 (adenocarcinoma component), HCG (choriocarcinoma) and CD138 (plasmacytoid carcinoma component) and were negative for HER-2, α-fetoprotein, VEGF, maspin and markers of epithelial-mesenchymal transition. The gastric mucosa cells displayed positivity for CDX2, Hepar A and CD138. The complex immunoprofile and literature data synthesis prove that the gastric mucosa cells can present a multilineage differentiation. CONCLUSION: PCCS should be considered as an aggressive variant of microsatellite stable gastric adenocarcinoma of an epithelial type, and not a germ cell tumor.

5.
Chirurgia (Bucur) ; 114(3): 409-413, 2019.
Article in English | MEDLINE | ID: mdl-31264580

ABSTRACT

Pica is a serious condition that is characterized by ingesting inedible things which can prove to be fatal (glass, pebbles, etc.) We present the case of a 64-year-old male patient who is admitted to the emergency room with the following complaints: upper GI tract bleeding manifested through hematemesis and melena, epigastric pain, lack of bowel movements. A contrast computed tomograohy is performed showing the presence of a hyper-dense stomach content, gastric wall thickening, abdominal fluid but with no signs of intestinal occlusion. A laparotomy is performed and ollowing an anterior gastrotomy a large quantity of pebbles is found along with a hemorrhagic and stenotic tumor of the lesser curvature. Taking into account the intraoperative aspect the decision was made to perform an end-to-side stapled esophago-jejunal anastomosis on an omega loop with a Braun entero-entero anastomosis following total gastric resection and D1 lymphadenectomy. Postoperative course is uneventful. A barium swallow carried out on the 10th day following surgery shows a functional anastomosis without leakage. On day 11, the patient is discharged. Pica is usually discovered by accident, most frequently on the operating table which is why thorough preoperative examination and investigations are required.


Subject(s)
Esophagus/surgery , Gastrointestinal Hemorrhage/etiology , Jejunum/surgery , Pica/complications , Anastomosis, Surgical , Gastrectomy , Gastrointestinal Hemorrhage/surgery , Hematemesis/etiology , Hematemesis/surgery , Humans , Male , Melena/etiology , Melena/surgery , Middle Aged , Pica/diagnostic imaging , Pica/surgery , Stomach/diagnostic imaging , Stomach/surgery
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