Management of presacral tumors: Our experience with posterior approach.

INTRODUCTION: Presacral tumors are a rare variety of space occupying lesions arising in the presacral space. Most of the tumors are congenital in origin. Due to obscure anatomic location, difficult surgical approach and etiological heterogeneity, tumors arising here pose a diagnostic and therapeutic challenge. We report our experience of 10 cases of presacral tumors with posterior approach being used in 6. MATERIALS AND METHODS: A retrospective analysis was conducted on 10 cases of presacral tumors managed at our hospital during a period of 14 months (May 2013-July 2014). 9 cases were operated while one had advanced disease and was referred for palliative care. Complete en bloc excision of the mass was possible in 8 cases. Finally, presenting complaints, clinical diagnosis, surgical procedure and histopahological findings of the cases were studied. RESULTS: All of our patients were females in the age group of 18-50 (mean 28.4) years. The pathological findings included schwannoma, leiomyosarcoma, hemangiopericytoma, neurofibroma, paraganglioma and rest were developmental cysts. 6 cases were managed using the posterior approach and rest by anterior approach. There was no major complication or mortality in the follow up. CONCLUSION: Complete surgical excision remains the mainstay of therapy. Surgical approach depends upon the location, size, local invasion and surgical expertise of the surgeon. Benign tumors have a good prognosis while the prognosis in malignant tumors remains guarded due to difficulty in obtaining safe resection margins. Posterior approach is an attractive option for low lying, benign tumors that is more direct, with better exposure and quicker recovery.

Malroatation of gut with superior mesenteric artery syndrome and multiple jejunal diverticula presenting as acute intestinal obstruction in 6th decade: A rare case report.

INTRODUCTION: Intestinal malrotation is a disease of neonates and young children presenting as acute intestinal obstruction. Presentation of malrotation in elderly patients with intestinal obstruction is quite rare with only a few cases reported in literature. We report a case of intestinal malrotation presenting as acute obstruction in sixth decade. PRESENTATION OF CASE: A 55 years old male presented to the emergency with features of acute intestinal obstruction. Imaging studies revealed intestinal malrotation. Exploratory laparotomy revealed malrotation with compression of 3rd part of duodenum and terminal ileum by superior mesenteric artery with multiple jejunal diverticula. Bypass procedures (duodenojejunostomy and ileo-colic anastomosis) with appendicectomy were done. DISCUSSION: Malrotation of gut is an anomaly usually presenting in neonatal period with complications such as midgut volvulus. Presentation in adult age is rare with most cases being asymptomatic. Ladd's procedure is the operation of choice with division of the Ladd's bands and appendicectomy being performed. CONCLUSION: Surgeons should keep a flexible approach in management of malrotation of gut presenting in late stages of life as more and more clinical variants to the presentations described in literature are being encountered.