Enterovesical Fistula Secondary to Transitional Cell Carcinoma of the Bladder.

Although fistulae between the urinary bladder and the gastrointestinal tract are not uncommon, those caused by carcinoma of the urinary bladder are rare. This report describes the case of an 85 years old male who was diagnosed with a mass involving the small bowel and the urinary bladder during the course of investigation for recurrent urinary tract infections. At laparotomy, the presence of an enterovesical fistula involving the ileum and bladder was confirmed. Histopathological examination of the resected mass showed poorly differentiated urothelial carcinoma. No early postoperative complications were encountered and postoperative cystography showed healing of the bladder without evidence of leakage. Due to the patient's age and comorbidities, no further oncological treatment was offered. Three months later the patient was readmitted to hospital with a severe pneumonia to which he succumbed.

Solitary Fibrous Tumour A rare cause of acute abdomen.

Solitary Fibrous Tumours(SFT), previously known as haemangiopericytoma, are rarely encountered in surgery. They arise from mesenchyme tissue and can occur at several sites in the body - head and neck, extremities, thorax, abdomen and retroperitoneal space. In the thorax, where they arise from the pleura, and abdomen they may attain a large size before giving rise to symptoms. Most SFT behave in a benign manner. However a number of them recur locally or metastasize. Recurrences can occur several years after excision of the primary tumour. Complete surgical excision remains the primary modality of treatment. But, in sites where complete excision is not possible, other modalities have been tried with varying success. Here, we describe a SFT of the mesentery of the small intestine, an uncommon manifestation of the tumour, recurring after a period of 19 years in a 55 year old female, and presenting to the Emergency Department as an acute abdomen caused by acute intestinal obstruction. Surgical excision of the tumour was performed together with primary anastomosis of the small intestine. KEY WORDS: Acute abdomen, Late recurrence, Mesentery, Solitary Fibrous tumour.

Meckel's diverticulum in a strangulated femoral hernia. Case report and review of literature.

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. In the vast majority of cases it remains asymptomatic throughout life but in about 5% of cases it gives rise to complications, namely, haemorrhage, intestinal obstruction and inflammation. A rare complication is being presented--a femoral hernia containing a strangulated Meckel's diverticulum. This is known as Littre's hernia, which often exhibits subtle variations from the norm in its presentation. Preoperative diagnosis of Littre's hernia containing Meckel's diverticulum is rather difficult; almost always, the strangulated diverticulum is first discovered during operation. The diverticulum was resected and the femoral canal closed by a polypropylene mesh plug. The patient underwent an uneventful recovery and was discharged home on the fourth postoperative day. Complications arising from Meckel's diverticulum usually occur at a young age, with the ectopic tissue present in the diverticulum frequently being the cause of the symptoms. Criteria for the resection of Meckel's diverticulum found incidentally at laparotomy have been suggested.

Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy.

PURPOSE: Postoperative pain is the main adverse effect of formal hemorrhoidectomy. A new technique based on Doppler-guided ligation of the terminal branches of the superior hemorrhoidal artery was introduced in 1995 as an alternative to hemorrhoidectomy. The authors report a preliminary experience with this procedure. METHODS: The Doppler-guided hemorrhoidal artery ligation technique uses a special proctoscope bearing a Doppler transducer that allows identification and suture ligation of the hemorrhoidal arteries. Sixty-eight consecutive patients (mean age, 48 years; range, 21-74 years) with Grade 3 hemorrhoids were treated. RESULTS: Intraoperative discomfort was measured by a visual analog scale (1-10) and resulted in a mean score of 2.3 (range, 1.3-2.8). Only 38 percent of patients required postoperative analgesia. Patients were examined at 1 week, 1 month, and 3 months and every 6 months thereafter. The mean follow-up was 11 (range, 3-18) months. Bleeding resolved in 91 percent of patients, pain in 73 percent, and prolapse in 94 percent. Complications were recorded in five patients and included persistent pain for more than two days in two patients (3 percent), swelling and thrombosis of one of the hemorrhoids in two patients (3 percent), and a secondary hemorrhage in one patient (1.5 percent). CONCLUSION: Doppler-guided ligation of the hemorrhoidal artery is a safe and effective alternative to hemorrhoidectomy and is associated with minimal discomfort and low risk of complications.