RESUMO
Perianal abscess and fistula are 2 distinct entities that share a common pathology. A horseshoe fistulous abscess, a complex type of these conditions, occurs when the suppurative inflammation spreads through the deep anal space to the bilateral ischiorectal fossae. Following the intersphincteric plane, this infection may extend to the pararectal space, forming a supralevator abscess. We present a very rare case involving a 52-year-old male patient who was admitted to our surgical department with an extraperitoneal purulent inflammation as a complication following multiple drainage procedures for a posterior horseshoe abscess. Emphasis is given to the anatomical and technical considerations of eradication of anorectal sepsis and the management of complex fistula-in-ano along with a concise review of the literature.
RESUMO
Pancreatic adenocarcinoma is the sixth leading cause of cancer-related death in Europe with survival rates remaining unchanged over the last three decades. Early diagnosis and accurate staging are essential due to the difficulty of curing this tumor in its advanced form. Endoscopic or laparoscopic ultrasonography and computed tomography are the preferred imaging and staging modalities for many patients with pancreatic adenocarcinoma. Morbidity and mortality are similar for pylorus-preserving and classic pancreatico-duodenectomy. Extended retroperitoneal lymphadenectomy does not improve survival and increases morbidity compared with standard pancreaticoduodenectomy, while adjuvant chemoradiotherapy prolongs survival in selected groups of patients. This article reviews the causes, risk factors, and clinical features of pancreatic adeno-carcinoma and discusses the methods of optimal diagnosis, staging and treatment.