RESUMEN
The incidence of Barrett's esophagus, complication of gastroesophageal reflux disease, is rising in western countries. It is the same for esophageal adenocarcinoma, of which it is the main contributing factor. This retrospective study seeks to report the incidence of these pathologies observed in a regional hospital center and to describe their management. In 5 years, 354 Barrett's esophagus are detected and 34 of them are complicated by high-grade dysplasia or adenocarcinoma. Endoscopic resection is performed in 24 of these patients. The histological analysis of which leads to the conclusion of adenocarcinoma in 20 patients and high-grade dysplasia in the 14 others. The complications of endoscopic and surgical resections are detailed. Their frequency and severity remain low, comparable to data in the literature.
L'incidence de l'Åsophage de Barrett, complication du reflux gastro-Åsophagien, est en croissance dans les pays occidentaux. Il en est de même de l'adénocarcinome Åsophagien dont il est le principal facteur favorisant. Cette étude rétrospective s'attache à rapporter l'incidence de ces pathologies, observées dans un centre hospitalier régional, et à détailler leur prise en charge. En 5 ans, 354 Åsophages de Barrett sont détectés et 34 d'entre eux sont compliqués de dysplasie de haut grade ou d'adénocarcinome. Une résection endoscopique est réalisée chez 24 de ces malades. Les analyses histologiques permettent de conclure à un adénocarcinome chez 20 malades et une dysplasie de haut grade chez les 14 restants. Les complications des résections endoscopiques et chirurgicales sont détaillées. Leur fréquence et leur gravité restent faibles, comparables aux données de la littérature.
Asunto(s)
Adenocarcinoma , Esófago de Barrett , Neoplasias Esofágicas , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiología , Adenocarcinoma/cirugía , Esófago de Barrett/diagnóstico , Esófago de Barrett/epidemiología , Esófago de Barrett/etiología , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/etiología , Neoplasias Esofágicas/terapia , Hospitales , Humanos , Estudios RetrospectivosRESUMEN
Esophageal cancer is the 19th most common cancer in the European Union. Its prognosis remains poor with a 5-year survival rate estimated between 15 % and 25 %. Accurate diagnosis and pre-therapeutic assessment are essential and should allow a rapid start of therapy. Current treatment is based on multimodal management of which surgery remains the cornerstone. Since 2019, Belgium has started an agreement to centralize esophageal surgery in order to improve surgical outcomes. One year after implementation of centralization, our centre shows a low rate of severe complications (Clavien-Dindo classification IIIb-V) of 20 % and a 0 % mortality rate at 30 and 90 postoperative days. Our patients have benefited from a full minimally invasive or hybrid surgical procedure, contributing to those positive results. In the future, all our efforts must be done to improve collaboration between hospitals in order to provide best medical and surgical treatments.
Le cancer de l'oesophage est le 19ème cancer le plus fréquent dans l'Union Européenne. Son pronostic reste sombre avec un taux de survie à 5 ans estimé entre 15 % et 25 %. La précocité du diagnostic et la qualité du bilan pré-thérapeutique sont essentielles et doivent permettre d'initier un traitement rapide. Le traitement repose sur une prise en charge multidisciplinaire et multimodale dont la chirurgie reste la pierre angulaire. En Belgique, le taux de mortalité à 30 et 90 jours post-opératoires étaient de 4,1 % et 9,5 %, respectivement, pour la période allant de 2008 à 2016. Dans une perspective d'amélioration de cette prise en charge, depuis 2019, la Belgique a concentré la chirurgie de l'oesophage dans 10 centres de référence, incluant le CHU de Liège. Un an après centralisation, notre centre présente un taux de complications sévères selon Clavien-Dindo (IIIb-V) de 20 % et des taux de mortalité à 30 et 90 jours de 0 %. Le bilan d'évaluation initial de chaque patient est discuté en concertation multidisciplinaire. Une prise en charge nutritionnelle est discutée avant l'instauration du traitement. Tous nos patients bénéficient d'une approche systématique totalement mini-invasive ou hybride, participant à l'amélioration des résultats sur la morbidité et la mortalité. Une collaboration croissante avec nos hôpitaux partenaires permet d'harmoniser les mises au point et les plans de traitement oncologiques pour le bénéfice des patients.
Asunto(s)
Neoplasias Esofágicas , Complicaciones Posoperatorias , Bélgica/epidemiología , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/terapia , Humanos , Tasa de SupervivenciaRESUMEN
Mature ovarian teratoma is the most frequent benign tumor in premenopausal women. It is usually asymptomatic but complications are possible such as adnexal torsion, infection, malignant transformation or cystic rupture. The latter can be spontaneous or more often occurs during surgery of excision of dermoid cyst. It can rarely result in chemical peritonitis, which is due to the irritation of the peritoneal serosa by the aseptic content of the tumour. We report the case of a patient who undrewent an emergency laparotomy for a chemical peritonitis following a spontaneous rupture of a dermoid cyst. Afterwards, she developed an acute respiratory distress syndrome that required an admission in the intensive care unit and subsequent surgery.
Le tératome mature de l'ovaire est la tumeur ovarienne bénigne la plus fréquente chez la femme en pré-ménopause. Le plus souvent, il est asymptomatique, mais il peut se compliquer par une torsion annexielle, une infection, une dégénérescence maligne ou une rupture kystique. Celle-ci peut être spontanée ou, plus souvent, survenir lors d'une chirurgie d'exérèse du kyste. Rarement, elle peut entraîner une péritonite chimique. Celle-ci est consécutive à l'irritation de la séreuse péritonéale par le contenu aseptique da la tumeur. Nous rapportons ici le cas d'une patiente opérée en urgence pour une péritonite chimique suite à une rupture spontanée d'un kyste dermoïde. Dans les suites opératoires, la patiente a développé un syndrome de détresse respiratoire aigu qui a nécessité une prise en charge aux soins intensifs et une nouvelle intervention chirurgicale.
Asunto(s)
Quiste Dermoide/complicaciones , Neoplasias Ováricas/complicaciones , Peritonitis/etiología , Rotura Espontánea/complicaciones , Teratoma/complicaciones , Adulto , Quiste Dermoide/patología , Femenino , Humanos , Neoplasias Ováricas/patología , Peritonitis/patología , Teratoma/patologíaRESUMEN
Pyoderma gangrenosum (PG) is an uncommon, ulcerative skin disease that is often associated with systemic illness. In rare cases, PG occurs after surgery, which can lead to delayed diagnosis as other causes such as wound breakdown or bacterial/fungal infection are considered. We report a rare case of PG following the repair of an inguinal hernia, and review the presentation of this disease after surgery.
Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/efectos adversos , Piodermia Gangrenosa/etiología , Anciano de 80 o más Años , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/cirugía , Piodermia Gangrenosa/patología , Piodermia Gangrenosa/cirugíaRESUMEN
Bochdalek hernias on the right side of the diaphragm are very rarely diagnosed in adults. We report a case of a 52-year-old female patient, who presented to the emergency department with acute intestinal obstruction. Plain and cross-sectional imaging identified a large right-sided Bochdalek hernia containing small bowel loops and the right colon. A laparoscopic approach was performed. The herniated intestinal loops and the right colon were reduced into the abdominal cavity. The diaphragmatic defect was closed using clips with reinforcement by a prosthetic polypropylene mesh. A mini median laparotomy was performed to ensure the viability of the bowel and a few stitches were inserted on superficial lesions of the serosa. The recovery was uneventful and the patient was discharged from the hospital 6 days after admission. Nine months later the patient is doing well.
Asunto(s)
Obstrucción Intestinal/etiología , Laparoscopía/métodos , Enfermedad Aguda , Colon Ascendente/cirugía , Diagnóstico Diferencial , Femenino , Hernia Diafragmática/complicaciones , Hernia Diafragmática/diagnóstico por imagen , Hernia Diafragmática/cirugía , Hernias Diafragmáticas Congénitas , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The severity and most appropriate treatment of diverticulitis in young patients are still controversial. The aim of this study is to compare young patients (
Asunto(s)
Diverticulitis del Colon/terapia , Enfermedad Aguda , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Diverticulitis del Colon/patología , Tratamiento de Urgencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
OBJECTIVE: To review our personal experience of the last 10 years with adrenal surgery in order to define the indications of laparoscopic adrenalectomy (LA) and open adrenalectomy (OA), respectively. PATIENTS AND METHODS: From November 1993 to June 2003, we performed 105 adrenalectomies on 97 patients (29 males and 68 females). The lesions resected were preoperatively considered non-secreting in 47 cases (45%) and hormonally active in 58 cases (55%). In 78 patients (80%), LA was performed and 84 adrenal glands were resected. In 19 patients (20%), OA was considered the best modality of resection and 21 adrenal glands were resected. The average tumour size was 37.2 mm (range 25-90) in LA group and 82.6 mm (30-260) in the OA group. All the LA were performed using a trans-peritoneal approach. Depending on the particularities of the lesions and of the patients, the OA were performed by anterior or lumbar incisions. RESULTS: There was no mortality. Conversion from LA to open surgery was necessary in two patients. Mean operating time was 110 minutes for LA and 135 minutes for OA. Two (2.6%) patients suffered complications after LA and 4 (19%) after OA. CONCLUSIONS: In our experience, trans-peritoneal LA proved to be a safe and reliable procedure for benign adrenal disease. In our institution, it has become the gold standard technique for the resection of adrenal tumours, except for those suspected or proven malignant.