[The first case of cap polyposis in Denmark].

Cap polyposis (CP) is characterized by the presence of inflammatory polyps mainly involving the rectosigmoid. It primarily causes mucous to bloody diarrhoea and is often misdiagnosed initially. We report the first case in Denmark with multiple polyps in the rectosigmoid causing constipation in between periods of mucous and bloody diarrhoea. He was initially misdiagnosed as having ulcerative colitis with pseudopolyps. Due to insufficient effect of medical treatment biopsies from the polyps were obtained. They showed typical histological signs of CP. He was successfully treated by rectosigmoid resection.

Reconstruction of the pelvic floor with a biological mesh after abdominoperineal excision for rectal cancer.

AIM: The aim of the study is to describe the results of reconstruction of the pelvic floor by using an absorbable biological mesh after having performed an abdomino-perineal resection with excision of whole of the pelvic floor for rectal cancer MATERIAL AND METHODS: Eleven consecutive patients had reconstruction of the pelvic floor after abdominoperineal excision (APR) with a biological mesh. The peri- and postoperative courses were registered in a prospective database. Six patients received preoperative radiochemotherapy. RESULTS: One patient had the mesh removed due to infection and later developed local recurrence. The rest had an uneventful postoperative course despite more pain than is usually experienced in the perineal wound after traditional APR. CONCLUSION: The use of a biological mesh for pelvic floor reconstruction is feasible with satisfactory results. A randomised trial is warranted in order to evaluate this technique properly.

[Can endoscopic retrograde cholangiopancreatography be made a low-risk procedure?]. / Kan endoskopisk retrograd kolangiopankreatikografi gøres til en sikker procedure?

Endoscopic retrograde cholangiopancreatography (ERCP) is considered a high-risk procedure. Here we report 30-day morbidity and mortality rates following ERCP in a single referral centre with experienced endoscopists and restrictive selection of patients and indications for the procedure. The specific ERCP-related morbidity rate was 6.9%, and the specific ERCP-related mortality rate was only 0.3%. We conclude that ERCP is a safe procedure in the hands of experts and with the use of selection of patients and restrictive indications for the procedure.

Delayed ischemic cecal perforation despite optimal decompression after placement of a self-expanding metal stent: report of a case.

Endoscopic deployment of self-expanding metal stents offers an alternative to surgical intervention in rectocolonic obstructions. Reported clinical failures in the literature are all related to the site of stent placement. We report a case of serious intra-abdominal disease after technically and clinically successful stent deployment: a potentially dangerous situation of which the surgeon should be aware. A previously healthy 72-year-old female was referred to our department with symptoms of an obstructing colorectal tumor. Successful stent placement resulted in resolution of the obstructive condition. Three days after stent deployment, x-ray examinations revealed a small-bowel obstruction and emergency surgery was performed. Intraoperative findings demonstrated a segment of ileum fixated to the tumor in the small pelvis, resulting in the obstructive condition. Furthermore, a cecal perforation, probably caused by ischemic conditions developed before stent-decompression of the colon was revealed during the operation. The patient died in the postoperative course. We discuss the observation of patients treated with self-expanding metal stents based on the selection-strategy used to allocate patients to this specific treatment. We conclude that although a patient is eligible for treatment with self-expanding metal stents, large-bowel obstruction can be too "old" for stent-decompression, causing ischemic perforation of the colon. Furthermore, we underline the need to focus on the possibility of obstructions other than those being treated.

Thromboembolic prophylaxis as a risk factor for postoperative complications after breast cancer surgery.

Hematoma and bruising (sugillation) are frequent problems after operations for primary breast cancer. In the present study we evaluated the influence of various methods of perioperative thromboembolic prophylaxis on the postoperative incidence of hematoma and suggilation. From June 1994 through August 1996, a series of 425 patients consecutively operated on for primary breast cancer were included. Thromboembolic prophylaxis was low-molecular-weight heparin (LMWH) in 310 patients and thigh-long graded compression (TED) stockings in 102 patients. Postoperative complications including deep vein thrombosis, pulmonary embolism, wound hematoma, and sugillation were recorded, and 17 variables with a potential influence on complications were analyzed by logistic regression analysis. Heparin prophylaxis compared to prophylaxis with TED stockings was significantly and independently associated with postoperative hematoma [odds ratio (OR) 3, 13; 95% confidence interval (CI) 1.38-7.13] or sugillation (OR 3.34; 95% CI 1.93-5.78). No clinically overt thromboembolic complications were diagnosed. After operations for breast cancer we found that LMWH was significantly associated with postoperative hematoma and sugillation compared to TED stockings for perioperative thromboembolic prophylaxis.