Mixed Adenoneuroendocrine Carcinoma Causing Colonic Intussusception.

Colonic intussusception is a rare cause of intestinal obstruction in adults and is caused by a malignant lesion in about 70% of cases. Early diagnosis and treatment are essential. We present a 64-year-old male patient with right colonic intussusception caused by a mixed adenoneuroendocrine carcinoma (MANEC), presenting as a giant pedunculated polyp (54 mm of largest diameter). The patient underwent right colectomy with primary anastomosis and adjuvant chemotherapy. The diagnosis of intussusception of the colon in adults is difficult because of its rarity and nonspecific clinical presentation. In this case, the cause was a rare histological type malignant tumor (MANEC).

Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery.

BACKGROUND: C-reactive protein (CRP) has been used as an indicator of postoperative complications in abdominal surgery. Its short half-life makes it a reliable marker of the systemic inflammatory response secondary to a surgical procedure or to the appearance of complications, rapidly returning to normal values with the recovery of the patient. AIM: To demonstrate the value of sequential serum determinations of postoperative C-reactive protein (CRP) and white blood cell counts (WBC) in the identification of increased risk of anastomotic leakage after colorectal surgery. METHODS: We reviewed the daily postoperative serum CRP and white blood cell counts in 173 patients who underwent surgery for colorectal disease with anastomosis, between January 2008 and October 2009. Patients with anastomotic leakage (Group A, n = 24) were compared to patients without leakage (Group B, n = 149). Patients with ongoing infections before surgery or with acquired postoperative infections other than leakage were excluded. Mean pre- and postoperative values of CRP and WBC were compared. RESULTS: The diagnosis of anastomotic leakage was made between the 4th and 11th postoperative day (POD; mean 7th POD). The daily average values of serum CRP were significantly higher in group A starting at the 2nd POD and remained significantly elevated until the diagnosis of leakage (p = 0.003). The cut-off value of 140 mg/L on the 3rd POD maximized the sensitivity (78%) and specificity (86%) of serum CRP in assessing the risk of leakage. Comparison of postoperative serum WBC values did not show any significant differences between the two groups until the 6th POD. CONCLUSION: According to these results, an early and persistent elevation of CRP after colorectal surgery with anastomosis, is a marker of anastomotic leakage. A cut-off value > 140 mg/L on POD3 maximizes sensitivity and specificity.

Surgical management of acute cholecystitis (experience of 249 cases).

BACKGROUND/AIMS: Although laparoscopic cholecystectomy is the most widely used technique in the surgical treatment of acute cholecystitis, some schools continue to perform the open approach in the treatment of that disease. Our objective is to make a comparative analysis of results obtained with laparoscopic cholecystectomy (LC) and gall bladder removal by open cholecystectomy (OC). METHODOLOGY: The study includes 249 acute cholecystitis cases operated on between January 2007 to December 2008. Mean age was 60.9 years (+/- 16.6) (21-94 years); 51.8% men and 48.2% women. The diagnosis was made considering clinical, laboratory and echographic findings. There were 217 acute calculous cholecystititis and 32 noncalculous. Surgery was performed as follows: 167 LCs, 64 by OC and 18 percutaneous cholecystostomies (PC). RESULTS: The comparative analysis of mortality and morbidity of LC with gall bladder removal by OC showed the following results: mortality (1.19% vs 4.6% p=n.s.), major morbidity (5.3% vs 31.25% p<0.001), lesions of the main bile duct (0.5% vs 3.1% p=n.s.) reoperation (3.6% vs 12.5% p<0.05) and hospital discharge up to 48 hours (69.5% vs 10.9% p<0.001). CONCLUSIONS: Laparoscopic cholecystectomy provides superior results to open cholecystectomy, and is therefore the first choice treatment in acute cholecystitis.