ABSTRACT
Study Design Case report. Objective The usual procedure for partial sacrectomies in locally advanced rectal cancer combines a transabdominal and a posterior sacral route. The posterior approach is flawed with a high rate of complications, especially infections and wound-healing problems. Anterior-only approaches have indirectly been mentioned within long series of rectal cancer surgery. We describe a case of partial sacrectomy for en bloc resection of a locally advanced rectal cancer with invasion of the low sacrum through a combined transabdominal and perineal approach without any posterior incision. Methods Through a midline laparotomy, the tumor was dissected and the sacral osteotomy was performed. Once the sacrum was mobile, the muscular attachments to its posterior wall were cut through the perineal approach. This latter route was also used to remove the whole specimen. Results The postoperative period was uneventful in terms of infection and wound healing, but the patient developed right foot dorsiflexion paresis that completely disappeared in 1 month. Resection margins were negative. After a follow-up of 18 months, the patient has no local recurrence but presented lung and liver metastases. Conclusion In cases of rectal cancer involving the low sacrum, the combination of a transabdominal and a perineal route to carry out the partial sacrectomy is a feasible approach that avoids changes of surgical positioning and the morbidity related to posterior incisions. This strategy should be considered when deciding on undertaking partial sacrectomy in locally advanced rectal cancer.
ABSTRACT
Localization of digestive hemorrhage is essential for the management of this entity. However, management is difficult in the small bowel, where emergency situations are rare but may require surgery without precise location of the lesion. We present a case of hemorrhage caused by jejunal diverticulum diagnosed by angiography. A highly selective microcatheter was placed in the bleeding site to achieve staining of the lesion with intraoperative methylene blue.
Subject(s)
Diverticulum/diagnosis , Gastrointestinal Hemorrhage/etiology , Jejunal Diseases/diagnosis , Aged , Diagnosis, Differential , Diverticulum/complications , Fatal Outcome , Female , Humans , Indicators and Reagents , Jejunal Diseases/complications , Methylene BlueABSTRACT
La localización de la hemorragia digestiva es fundamental para controlarla, algo que se complica en el caso del intestino delgado, donde las situaciones de emergencia son infrecuentes pero pueden requerir una laparotomía sin una clara localización de la lesión. Presentamos un caso de una hemorragia secundaria a divertículos yeyunales que se diagnosticó por angiorradiología y canulación selectiva del vaso sangrante, para conseguir el tatuaje de la lesión mediante inyección intraoperatoria de azul de metileno (AU)
Localization of digestive hemorrhage is essential for the management of this entity. However, management is difficult in the small bowel, where emergency situations are rare but may require surgery without precise location of the lesion. We present a case of hemorrhage caused by jejunal diverticulum diagnosed by angiography. A highly selective microcatheter was placed in the bleeding site to achieve staining of the lesion with intraoperative methylene blue (AU)
