Transanal resection: a novel approach.

Due to the increase in screening programs, more rectal polyps and early rectal cancers are detected. Transanal resection of these lesions is less invasive than a transabdominal approach. Transanal endoscopic microsurgery (TEM) has gained a lot of interest, but the technique has several drawbacks such as the expensive instrumentation and considerable learning curve. With the evolution of single incision laparoscopic surgery (SILS), laparo-endoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), new devices have become available. This led to the development of a hybrid technique of transanal surgery. The technique combines a transanal approach, a SILS port and standard laparoscopic instruments. We used this technique in 2 cases.

Primary angioleiomyosarcoma of the lesser omentum.

Primary omental leiomyosarcomas are rare intra-abdominal tumours. A few cases only have been reported in the literature. We present a case of a 79-year old woman, whose tumour was surgically removed. We include a hort review of the literature.

Intra-abdominal metastases from primary carcinoma of the lung.

The case of a 56-year old male with an intra-abdominal metastasis from a primary lung cancer is presented. He was admitted for abdominal obstruction, toxic syndrome and paraumbilical pain. He had a previous history of squamous cell carcinoma of the right lung, for which he had undergone a right upper lobectomy in 1995, four years prior to the development of the abdominal obstruction. A debulking operation and bowel resection for the intestinal metastasis was performed. Eleven months after this operation the patient developed a recurrence: he underwent another debulking operation with resection of the sigmoid colon, jejunal segment and a small part of the bladder. The patient is alive and well 13 months after the initial operation. Intra-abdominal metastases of bronchial carcinoma may be observed with greater frequency, because of the improved survival of the patients with lung cancer. Metastatic small bowel carcinomas are rare and should be considered in the differential diagnosis of acute abdominal syndromes of patients with known history of the lung cancer. Bowel resection and debulking of the metastatic tumour mass give the best palliation and improve short-term survival.

Intramural duodenal hematoma of pancreatic origin.

Non-traumatic intramural hematoma of the duodenum is an unusual clinical entity. Indeed, in a majority of 70% of patients intramural hematoma of the duodenum is caused by a blunt, frequently minor abdominal trauma. The main etiology of non-traumatic intramural hematoma of the duodenum in the adult is overdose anticoagulant therapy. Rarer causes include pancreatic disease, blood dyscrasia or vascular collagen disease. In this presentation a case of pancreatitis-induced intramural duodenal hematoma is discussed and compared with corresponding data in the literature.

Rectourethral fistula due to Crohn's disease.

Fistulas between the large bowel and the prostatic urethra, due to Crohn's disease, are very uncommon. Pneumaturia and an abnormal urethral discharge are the most common symptoms. Diagnosis is made by a voiding cystourethrogram or a retrograde urethrography. Treatment is usually difficult with a high percentage of recurrence. A well documented case is presented.

Hepatoblastoma: actual therapeutic strategies. A case report.

Starting from a case report of a six-month-old boy with a hepatoblastoma, we discuss this topic. New virologic and cytogenetic findings in hepatoma are mentioned in the chapter "epidemiology". In "diagnosis" we focus on history, physical examination, echography, conventional RX, the role of CT-scan of abdomen and thorax, of fine needle aspiration, arteriography and magnetic resonance. In "therapy" we emphasize the new therapeutical means: chemotherapy, orthotopic liver transplantation, resection of pulmonary metastases, as well as radiotherapy and immunotargeting chemotherapy. We conclude that surgery still is the cornerstone of treatment, but the new therapeutical means create hopeful perspectives in outcome.

[Abscess of the liver (author's transl)]. / Het pyogene leverabces.

A case of liver abscess is analysed in the light of recent data from the literature. The attention is drawn on the increase in frequency of this disease over the last 10 years. The diagnosis is difficult to set on clinical and biological grounds but can be established with certainty by means of scintigraphy and hepatic angiography. Identification of the micro-organism is difficult and impossible in more than half of the cases. Treatment which is essentially surgical, in association with antibiotherapy specific of the anaerobic and gram negative micro-organisms, can reduce total mortality to 10%.