Bowel Obstruction Due to Stenotic Sigmoid Colon Cancer in a 32-Year-Old Patient Presenting in the Third Trimester of Pregnancy: A Case Report of an Interval Surgical Approach.

BACKGROUND Colorectal cancer among pregnant women is a rare entity. If colon cancer is suspected during pregnancy, the diagnosis is a therapeutic challenge that should be managed by a multidisciplinary team of specialists. Standardized therapeutic models do not exist. In this article we present a case of a pregnant patient with stenotic sigmoid colon adenocarcinoma. We describe the interdisciplinary treatment and the 2-step surgical approach used during pregnancy. CASE REPORT A 32-year-old women in week 28.8 of pregnancy was admitted to the Department of Gynecology and Obstetrics, meeting the standard pregnancy criteria of constipation. After a week of unsuccessful conservative treatment, the patient underwent magnetic resonance imaging (MRI), which disclosed a stenosed segment in the sigmoid colon. After an emergency colonoscopy with biopsy sampling, histological analysis confirmed sigmoid adenocarcinoma. In a multidisciplinary consultation of specialists, in which neonatological and oncological aspects were considered, a 2-step surgical plan was established. In the first step (gestational week 29.8), a loop transverse colostomy with intestinal decompression was performed. In the second step (gestational week 32.8), an elective primary caesarean section followed by open oncological sigmoid resection was performed. No postoperative complications occurred in either step. The neonate was healthy and had a birth weight appropriate for the gestational age. CONCLUSIONS In cases of colorectal cancer during pregnancy, staged surgical approaches should be considered to reduce maternal and fetal morbidity.

Hypothermic Oxygenated Machine Perfusion of Extended Criteria Kidney Allografts from Brain Dead Donors: Protocol for a Prospective Pilot Study.

BACKGROUND: Kidney transplantation is the only curative treatment option for end-stage renal disease. The unavailability of adequate organs for transplantation has resulted in a substantial organ shortage. As such, kidney donor allografts that would have previously been deemed unsuitable for transplantation have become an essential organ pool of extended criteria donor allografts that are now routinely being transplanted on a global scale. However, these extended criteria donor allografts are associated with significant graft-related complications. As a result, hypothermic oxygenated machine perfusion (HOPE) has emerged as a powerful, novel technique in organ preservation, and it has recently been tested in preclinical trials in kidney transplantation. In addition, HOPE has already provided promising results in a few clinical series of liver transplantations where the liver was donated after cardiac death. OBJECTIVE: The present trial is an investigator-initiated prospective pilot study on the effects of HOPE on extended criteria donor allografts donated after brain death and used in kidney transplantation. METHODS: A total of 15 kidney allografts with defined inclusion/exclusion criteria will be submitted to two hours of HOPE via the renal artery before implantation, and are going to be compared to a case-matched group of 30 patients (1:2 matching) who had kidneys transplanted after conventional cold storage. Primary (posttransplant dialysis within 7 days) and secondary (postoperative complications, early graft function, duration of hospital and intensive care unit stay, and six-month graft survival) endpoints will be analyzed within a six-month follow-up period. The extent of ischemia-reperfusion injury will be assessed using kidney tissue, perfusate, and serum samples taken during the perioperative phase of kidney transplantation. RESULTS: The results of this trial are expected in the first quarter of 2020 and will be presented at national and international scientific meetings and published in international peer-reviewed medical journals. The trial was funded in the third quarter of 2017 and patient enrollment is currently ongoing. CONCLUSIONS: This prospective study is designed to explore the effects of HOPE on extended criteria donor kidney allografts donated after brain death. The present report represents the preresults phase. TRIAL REGISTRATION: Clinicaltrials.gov NCT03378817; https://clinicaltrials.gov/ct2/show/NCT03378817.

Median Arcuate Ligament Compression in Orthotopic Liver Transplantation: Results from a Single-Center Analysis and a European Survey Study.

Median arcuate ligament compression (MALC) potentially causes arterial complications in orthotopic liver transplantation (OLT). Here we aimed to investigate the incidence of MALC and its impact on clinical outcome after OLT. In addition, we performed an international survey among 52 European liver transplant centers to explore local protocols on the management of these patients. Data of 286 consecutive OLT recipients from a prospective database were analyzed retrospectively (05/2010-07/2017). Preoperative computed-tomography images were evaluated. Celiac axis stenosis due to MALC was found in 34 patients (12%). Intrinsic stenosis was present in 16 (6%) patients. Twenty-six patients (77%) with MALC underwent standard arterial revascularization with median arcuate ligament (MAL)-division. Patients treated for MALC had comparable baseline data and no difference was found in early- and long-term outcome compared to the rest of our cohort. Our survey found heterogeneous strategies regarding diagnosis and treatment of MALC. Only 29% of the centers reported the division of MAL in these patients as routine procedure. Even though there is no consensus on diagnosis and management of MALC among European centers, a surgical division of MAL is feasible and safe and should be considered in OLT recipients with MALC.