Anterior resection for rectal cancer with mesorectal excision: institutional review.

This study aims to compare the operative results and oncological outcomes of patients with total mesorectal excision (TME) for mid and distal cancer and partial mesorectal excision (PME) for proximal cancer. Anterior resection has become the preferred treatment option for rectal cancer. TME with sharp dissection has been shown to be associated with a low local recurrence rate. Controversies still exist as to the need for TME in more proximal tumor. Resection of primary rectal and rectosigmoid cancer was performed in 298 patients from January 2003 to November 2010. These 298 patients (163 men and 135 women; median age, 67 years) underwent anterior resection. The curative resection was performed in 269 patients (90.3 %). TME was performed in 202 patients (67.8 %). Significantly longer median operating time, more blood loss, and a longer hospital stay were found in patients with TME. The overall operative mortality and morbidity rates were 1.8 % and 32.6 %, respectively, and there were no significant differences between those of TME and PME. Anastomotic leak occurred in 8.1 % and 1.3 % of patients with TME and PME, respectively (P < 0.001). Independent factors for a higher anastomotic leakage rate were TME, the malegender, the absence of stoma, and increased blood loss. The advanced stage of the disease and the performance of coloanal anastomosis were independent factors for increased local recurrence. By performing TME in patients with mid and distal rectal cancer, the local control and survival of these patients are similar to those of patients with proximal cancers where adequate clearance can be achieved by PME.

Intussusception in adults: institutional review.

OBJECTIVE: The objectives were to review adult intussusception (AI), its diagnosis and treatment. BACKGROUND DATA: Intussusception is a different entity in adults than it is in children. AI represents 1% of all bowel obstructions, 5% of all intussusceptions. METHODS: The records of all patients, 18 years and older, with the postoperative diagnosis of intussusception at the B.P.K.I.H.S during the years 2003-2009 were reviewed retrospectively. RESULTS: In six years, there were thirty-eight patients of surgically proven AI. The patients' mean age was 49.6 years, M:F ratio was 1.3:1. Intestinal obstructions of various extents were the commonest presentation in twenty-seven patients (71%). There were 42% enteric, 32% ileocolic and 26% colonic AI. The diagnostic accuracy of the ultrasonography was 78.5%, CT scan was 90% and colonoscopy was 100%. The pathological lesions were found in 94% of AI. Among the pathological lesion, enteric have 62% benign, 38% malignant, ileocolic have 50% benign, 50% malignant, and in colocolic 70% malignant, 30% benign. In enteric AI, 68% were reduced successfully, 25% reduction was not attempted. Of ileocolic AI, 58.3% were reduced successfully, 41.6% had resection without reduction. Of colocolic AI, 30% of them were reduced successfully before resection, 70% had resection without reduction. CONCLUSIONS: AI is a rare entity and requires a high index of suspicion. CT scanning proved to be the most useful diagnostic radiologic method. Colonoscopy is most accurate in ileocolic and colonic AI. The treatment of adult intussusception is surgical. Our review supports that small-bowel intussusception should be reduced before resection if the underlying etiology is suspected to be benign or if the resection required without reduction is deemed to be massive. Large bowel should generally be resected without reduction because pathology is mostly malignant.

Idiopathic sclerosing encapsulating peritonitis in an adult male with intermittent subacute bowel obstruction, preoperative multidetector-row CT (MDCT) diagnosis.

Idiopathic sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterised by a thick greyish-white fibrotic membrane encasing the small bowel. It is difficult to make a definite preoperative diagnosis. We report a successfully treated case of a 42-year-man, presented with sub acute small bowel obstruction caused by SEP. CT showed characteristic findings of small bowel loops congregated to the center of the abdomen encased by a soft-tissue density mantle. He had undergone adhesiolysis and uneventful postoperative period. A high index of clinical suspicion may be generated by the recurrent character of small bowel obstruction combined with relevant imaging findings and lack of other plausible aetiologies. Clinicians must rigorously pursue a preoperative diagnosis, as it may prevent a surprise upon laparotomy and result in proper management.

Giant sacrococcygeal teratoma in an adult: case report.

Congenital sacrococcygeal teratoma (SCT) is the most common germ cell tumour of infancy and childhood. Authors report a case of 18-year-old female with progressively enlarging sacral mass since birth. MRI showed a solid-cystic mass with no involvement of surrounding structures and it was excised completely by the post-anal route.

Intrauterine omphalic ileal entrapment as an unusual cause of ileal atresia: report of a case.

We report a case of ileal atresia (IA) caused by an omphalic ring closure anomaly. A 2-day-old male neonate started vomiting bile, accompanied by abdominal distention. Laparotomy revealed that the distal part of the ileum was entrapped within the omphalic ring and that this entrapped segment of ileum was atretic. To our knowledge, this potential mechanism of IA has not been described before.

Tracheal agenesis type B: further evidence to a lethal congenital tracheal malformation.

Tracheal agenesis is an extremely rare, typically fatal congenital tracheal malformation. Lack of prenatal symptoms and emergent presentation usually lead to a failure to arrive at the correct diagnosis and manage the airway properly before the onset of irreversible cerebral anoxia. We report the case history of an infant born with immediate respiratory failure who was diagnosed with tracheal agenesis. The clinical presentation, embryology, classification, and surgical management are discussed.