ABSTRACT
The Authors describe a case of presacral hemorrhage after a colonoscopy in a patient taking anticoagulation. Surgical treatment was necessary to stop the hemorrhage.
Subject(s)
Colonic Diseases/etiology , Colonoscopy/adverse effects , Gastrointestinal Hemorrhage/etiology , Intestinal Perforation/etiology , Aged , Chronic Disease , Colonic Diseases/diagnostic imaging , Colonoscopy/methods , Constipation/diagnosis , Drainage/methods , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/diagnostic imaging , Humans , Intestinal Perforation/surgery , Laparotomy/methods , Rare Diseases , Risk Assessment , Sacrum , Severity of Illness Index , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND/AIMS: Reestablishment of colonic continuity (RDC) following Hartmann's procedure is associated with high morbidity (anastomotic leak 4-16%) and mortality (0-4%) rates. The aim of this retrospective study is to evaluate the morbidity of RDC following Hartmann's procedure, and to analyze the various factors which may be able to influence the rate of complications. METHODOLOGY: From 1996 to 2002, 74 patients were treated by Hartmann's colectomy. Of these 74 patients, 40 patients underwent a reestablishment of colonic continuity (54% of all the Hartmann's procedures). The common factor of indications is the presence of infection in the abdominal cavity, combined with a distended or prepared intestine, or both. The mean age was 60 years (33-90). RESULTS: The mean delay between Hartmann's operation and the RDC was 139 days (range: 25-450 days) and 15.5 days (8-57 days) was the mean duration of the hospital stay. The mortality rate was 0% and incidence of anastomotic stricture was 2.5%. The morbidity was 45%. The majority of patients presenting complications had an ASA score of III (44.4%), and the patients without complications were for the majority classified as ASA I (45.5%) CONCLUSIONS: The RDC is an intervention performed safely after a 3 to 5-month delay with an acceptable morbidity and a negligible mortality. The ASA score is a determining factor for the risk for complications (p<0.05), unlike the age. However, patients younger than 50 years benefit from a protective factor against complications.
Subject(s)
Colectomy/methods , Colon, Sigmoid/surgery , Colon/surgery , Colostomy , Gastrointestinal Tract/physiopathology , Gastrointestinal Transit , Adult , Aged , Aged, 80 and over , Colectomy/adverse effects , Colectomy/mortality , Colostomy/adverse effects , Colostomy/mortality , Digestive System Surgical Procedures/adverse effects , Female , Humans , Length of Stay , Male , Middle Aged , Reoperation , Retrospective StudiesABSTRACT
Renal cell carcinoma has a variable clinical course. Size is a prognostic factor correlated with venous invasion, lymph node or distant metastases. These are more often encountered when the size exceeds 10 cm. For 20 years, incidental renal tumours have represented the majority of diagnosed cases, as a result of more common use of imaging techniques. We report a case of renal cell carcinoma of an unusually large size, without metastatic or locally advanced disease. Histology revealed a pT2 clear cell renal cell carcinoma of 31 x 31 x 10 cm, which was totally resected. It is the first case reported of localized conventional renal cell carcinoma reaching such a size.
Subject(s)
Carcinoma, Renal Cell/pathology , Kidney Neoplasms/pathology , Aged , Carcinoma, Renal Cell/surgery , Humans , Kidney Neoplasms/surgery , MaleABSTRACT
The leiomyosarcoma are rare tumors, accounting for only 0.1% to 3% of all gastrointestinal malignancies. 150 new cases are diagnosed annually in the United States. The spectacular character of leiomyosarcoma consists in its measurements, its size reaching 35 x 25 x 17 cm, its weight 5.5 kg, and in the asymptomatic character of the tumor. The final diagnosis, although suspect with preoperative diagnostic procedure, is obtained after histologic examination. Complete surgical excision is the best treatment, the role of radiation therapy and chemotherapy are not yet established.
Subject(s)
Leiomyosarcoma/pathology , Peritoneal Neoplasms/pathology , Adult , Humans , Leiomyosarcoma/surgery , Male , Peritoneal Neoplasms/surgeryABSTRACT
Granulocytic sarcoma or Chloroma may develop before, at the time or after presentation of acute myeloid leukemia. We report the case of a 66-year old man presenting with intermittent abdominal pain during one month before developing a peritonitis due to perforation of small bowel followed by irreversible shock and death. Nearly the entire length of small bowel and bone marrow were infiltrated by giant promyelocytic cells. Abnormal circulating cells were never discovered. The literature is briefly reviewed.
