ABSTRACT
We report two rare cases of female patients presenting with oesophageal leiomyoma associated with oesophageal diverticulum, both of whom were surgically managed. Oesophageal leiomyoma and oesophageal diverticulum are uncommon as separate entities and rare as combined disease presentation. Clinicians need to be aware of the rare combination of the two entities and need to be able to exclude the presence of a tumour (benign or malignant) within a diverticulum and so plan the optimum treatment. Herein, we present two cases of oesophageal leiomyoma within oesophageal diverticulum and we try to elucidate the association between the two. To date, there is no consensus whether a diverticulum is secondary to a leiomyoma or, on the contrary, a leiomyoma arises within a diverticulum.
ABSTRACT
Desmoid tumors, characterized by aggressive local infiltration of surrounding tissues, are uncommon benign neoplasms with no metastatic potential, that occasionally may attain large size. We report a case of a 37-year-old woman with an abdominal wall desmoid tumor that appeared and grew rapidly during her pregnancy, diagnosed by trucut core biopsy. Complete surgical excision of a 20 x 16 cm in size tumor and immediate reconstruction with mesh was performed in the postpartum period. She had no postoperative complications and no recurrence at 2-year follow-up. Optimal management of large abdominal wall desmoids during pregnancy has to be individualized, with wide surgical excision remaining the treatment of choice.
Subject(s)
Abdominal Wall , Fibromatosis, Aggressive/surgery , Pregnancy Complications, Neoplastic/surgery , Adult , Female , Fibromatosis, Aggressive/pathology , Humans , Pregnancy , Pregnancy Complications, Neoplastic/pathologyABSTRACT
BACKGROUND: The aim of this study was to assess early morphological changes of the residual small intestine 30 days after application of Benzalkonium Chloride (BAC) in a rat model of short bowel syndrome (SBS). MATERIALS AND METHODS: Twenty nine Wistar rats (260 +/- 20 g) underwent 80% midsmall bowel resection with end to end anastomosis. In group 1 (n=14) BAC solution 0.1% was applied to a 2 cm segment of jejunum, and in group 2 (n=15) normal saline was applied in a similar manner and the rats were sacrificed 30 days after operation. Specimens for histological examination were obtained initially and at sacrifice. RESULTS: In the BAC treated jejunal segment (group 1), a statistically significant increase (p< 0.05) was noted in villous height by 33.2%, in crypt depth by 26.4%, in muscle thickness by 26%, 109.6% in intestinal diameter, and 20% in total intestinal length, compared to group 2. CONCLUSIONS: BAC application to the serosal surface of rat's jejunum in SBS is a simple method that within only 4 weeks can topically augment the natural adaptation process noticed following intestinal resection. Further research with a tapering technique performed in sequence is suggested, to prevent possible problems associated with pseudoobstruction in the long term.
Subject(s)
Anti-Infective Agents, Local/pharmacology , Benzalkonium Compounds/pharmacology , Jejunum/drug effects , Short Bowel Syndrome/drug therapy , Animals , Anti-Infective Agents, Local/therapeutic use , Benzalkonium Compounds/therapeutic use , Body Weight/drug effects , Denervation , Disease Models, Animal , Enteric Nervous System/drug effects , Hyperplasia/chemically induced , Hyperplasia/pathology , Intestinal Mucosa/drug effects , Jejunum/growth & development , Jejunum/pathology , Malabsorption Syndromes/prevention & control , Male , Rats , Rats, Wistar , Short Bowel Syndrome/pathology , Short Bowel Syndrome/surgeryABSTRACT
BACKGROUND: Bile duct injuries (BDI) have been reported to occur more frequently during laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC). Several studies have demonstrated various potential predisposing factors for BDI. However, there is a controversy as to whether gallbladder inflammation is a significant predictor for BDI. Therefore, out primary aim was to investigate the relationship between inflammation and BDI at LC, and secondarily to present the management and clinical outcome of BDI. METHODS: We recorded all consecutive LC performed between 1993 and 2005 in our institution by nine staff surgeons. BDI were classified according to Strasberg's classification. Simple and multivariate logistic regression analysis was performed to evaluate the association between inflammation and BDI occurrence during LC. RESULTS: There were 2,184 patients. Among those, 344 had inflammation (16%). The conversion rate was 5% and was higher among male, elder patients, and those with inflammation. The BDI incidence was 0.69% (0.14% for major and 0.55% for minor injuries) and it was significantly higher in those with inflammation compared to those without inflammation (p = 0.01). In particular, the risk for BDI was almost 3.5 times higher in those with inflammation (OR = 3.61, 95% CI 1.27-10.21). Inflammation remained an independent risk factor for BDI even after adjustment for potential confounders. Among patients sustaining injury, one died and two have recurrent cholangitis. No association was observed between clinical outcome and management of BDI, time of diagnosis, sex, and inflammation. CONCLUSION: We revealed that inflammation is an independent predictor of BDI occurrence during LC. Therefore, it would be advisable for surgeons to not hesitate to convert a LC to an OC in the presence of inflammation.
