Extensive colonic necrosis following cardiac arrest and successful cardiopulmonary resuscitation: report of a case and literature review.

Non-occlusive colonic ischaemia is a recognized albeit rare entity related to low blood flow within the visceral circulation and in most reported cases the right colon was affected. This is the second case report in the literature of extensive colonic necrosis following cardiac arrest and cardiopulmonary resuscitation (CPR). A 83-year-old Caucasian woman was admitted to our hospital due to a low energy hip fracture. On her way to the radiology department she sustained a cardiac arrest. CPR started immediately and was successful. A few hours later, the patient developed increasing abdominal distension and severe metabolic acidocis. An abdominal multidetector computed tomography (MDCT) scan was suggestive of intestinal ischaemia. At laparotomy, the terminal ileum was ischaemic and extensive colonic necrosis was found, sparing only the proximal third of the transverse colon. The rectum was also spared. The terminal ileum and the entire colon were resected and an end ileostomy was fashioned. Although the patient exhibited a transient improvement during the immediate postoperative period, she eventually died 24h later from multiple organ failure. Histology showed transmural colonic necrosis with no evidence of a thromboembolic process or vasculitis. Therefore, this entity was attributed to a low flow state within the intestinal circulation secondary to the cardiac arrest.

Hepatic abscess in a pre-existed simple hepatic cyst as a late complication of sigmoid colon ruptured diverticula: a case report.

INTRODUCTION: Hepatic abscesses have been reported as a rare complication of diverticulitis of the bowel. This complication is recognized more commonly at the time of the diagnosis of diverticulitis, or ruptured diverticula, but also can be diagnosed prior to surgery, or postoperatively. CASE PRESENTATION: This report describes a man who developed an hepatic abscess within a simple hepatic cyst, two months after operation for ruptured diverticula of the sigmoid colon. The abscess was drained surgically and the patient made a complete recovery. CONCLUSION: The development of an hepatic abscess in a pre-existing hepatic cyst, secondary to diverticulitis, is a rare complication. A high degree of clinical suspicion is required for immediate diagnosis and treatment.

Gastrointestinal stromal tumor of the gastric serosa protruding to the greater omentum. Report of a giant tumor with a rare histological pattern.

We report an unusual case of a 76 year old woman admitted to our hospital for investigation of anemia and palpable epigastric mass. Intraoperatively a huge (19 cm), well defined tumor was found adhering to the stomach wall, protruding into the greater omentum and compressing the transverse colon. A tumorectomy was performed and the greater omentum was removed due to its close relation. Pathology revealed a high risk Gastrointestinal Stromal tumor of the gastric serosa. Histologically the tumor was of mixed type (spindle and epithelioid cells) with hem-angio-peri-cytomatoid pattern peripherally, variably myxoid stroma, central necrosis and cytologic pleomorphism. On immunohistochemical examination there was a consistent positivity for c-kit (CD-117) and CD-34, but without myogenic or neural differentiation. We consider this case unusual because of its huge size, its gastric serosal location and its extremely rare histological pattern.