Bowel obstruction due to a right paraduodenal hernia with midgut malrotation.

Right paraduodenal internal hernia, which has an embryonic origin, can be a rare cause of bowel obstruction, generally in young adults. We report the case of a young man who sought emergency care for acute abdominal pain with obstruction.

Reduction of carcinomatosis risk using icodextrin as a carrier solution of intraperitoneal oxaliplatin chemotherapy.

There is no standard treatment in patients with high risk metachronous peritoneal carcinomatosis (PC) in colonic cancer, as perforated tumour or synchronous ovarian metastasis. Icodextrin 4% (ICDX), presently used to prevent postoperative abdominal adhesions, could inhibit the coactivation of the tumour cells and the microenvironment cells, associated with the development of PC. The aim of this study was to inhibit the formation of the PC in a murine model mimicking surgical situation using ICDX and intraperitoneal (IP) prophylactic chemotherapy. We created a model of growing PC in mice using cells of murine colonic cancer CT26. Cells and treatments were injected simultaneously. Five groups were created: CT26 (control group), CT26 + ICDX (ICDX group), CT26 + chemotherapy (oxaliplatin and 5FU) (chemo group), CT26 + chemotherapy + ICDX (ICDX chemo group), ICDX (toxicity group). At day 15, PC was evaluated with rodents PCI. In the chemo group, PCI was significantly lower than in the control group (3.2 versus 8.4, p = 0.02). ICDX had a synergetic effect on PC with chemotherapy; indeed PCI in ICDX chemo group was lower than in chemo group (1.4 versus 3.2, p = 0.04). There was no morbidity linked to ICDX in toxicity group. Safety of ICDX needs to be verified, particularly on colonic anastomosis before ICDX associated to IP chemotherapy could be used as a preventive treatment of PC in high risk patients. This prophylactic treatment is easy to use and would be administrated at the end of a curative surgery for a colonic cancer.

Cytoreductive surgery with a hyperthermic intraperitoneal chemotherapy program: Safe after 40 cases, but only controlled after 140 cases.

BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), used to treat peritoneal surface malignancies (PSM), is a complex procedure with significant major morbidity (MM). OBJECTIVE: To investigate the learning curve (LC) of CRS with HIPEC in a new specialized surgical unit with a fully trained senior surgeon and individualize the variables associated with morbidity and oncological results. METHODS: A total of 290 consecutive patients with PSM were included. Complete CRS with HIPEC was performed in 204 patients. A risk-adjusted sequential probability ratio test was used to assess the LC on the basis of rates of incomplete cytoreduction (IC) and MM. RESULTS: Complete CRS, MM, and mortality rates were 70.4%, 30.4%, and 2.5%, respectively. Tumor histotype, a high peritoneal cancer index (PCI) and the invaded region were the major independent risk factors for IC, whereas previous surgery, high PCI, stomia realization and blood transfusion were predictors of MM. RA-SPRT showed that 140 and 40 cases were needed to achieve the lowest risk of IC and MM, respectively. CONCLUSION: CRS with HIPEC to treat PSM has a steep LC. Drastic selection has to be made at the beginning, excluding high PCI, rare peritoneal disease and patients previously operated on.

Pitfalls and mimickers on (18)F-FDG-PET/CT in peritoneal carcinomatosis from colorectal cancer: An analysis from 37 patients.

BACKGROUND: Optimal selection is critical in patients with peritoneal carcinomatosis (PC) in whom curative cytoreductive surgery can be anticipated. (18)F-FDG-PET/CT may result in false-positive findings that may eliminate patients for whom cytoreductive surgery would be beneficial. OBJECTIVES: To determine the rate of false-positive findings on (18)F-FDG-PET/CT and clarify their causes in patients with suspected PC from colorectal cancer. METHODS: A retrospective analysis of 37 patients with suspected PC from colorectal cancer who had (18)F-FDG-PET/CT before cytoreductive surgery was performed to determine the rate and the causes of false-positive findings. (18)F-FDG-PET/CT was considered falsely positive when no tumor was found at surgery, histopathological analysis and follow-up. RESULTS: False-positive findings were observed in four patients, yielding a 11% (95%CI: 3-25%) false-positive rate on a per-patient basis. The causes of false-positives were elucidated in two patients (surgical mesh after umbilical hernia repair and one foreign body granuloma). CONCLUSION: False-positive findings on (18)F-FDG-PET/CT are observed in 11% of patients with suspected PC from colorectal cancer. Familiarity with false-positive findings would result in more accurate selection of patients candidates to cytoreductive surgery.

Intra-abdominal benign multicystic peritoneal mesothelioma.

Benign multicystic peritoneal mesotheliomas are rare: pre-operative diagnosis relies on proper imaging. The differential diagnosis includes pseudomyxoma peritonei and other peritoneal cysts. Absence of previous surgical resection offers the best chance of success when complete resection is performed in a specialized center. We report the case of a 43 year-old man with benign multicystic peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.