RESUMO
Multilocular cystadenoma are benign lesions located most commonly between the rectum and the bladder. Their presence manifests as obstructive or/and irritative lower urinary tract symptoms or transit disorders. Computed tomography scan and magnetic resonance imaging may help to establish the diagnosis. Surgery is the established treatment standard, with a high risk of recurrence in case of incomplete excision of the lesions. Here we report a case of 59-year-old man presenting with an acute urinary retention due to a giant multilocular prostatic cystadenoma treated by complete excision. The diagnosis has never been suspected before surgery and has been confirmed histologically after complete excision.
RESUMO
Tissue adhesives have gained increasing use as a possible method of wound closure. We compared the use of 2-octyl cyanoacrylate (OCA) or subcuticular suture in incisions sutures for the closure of laparoscopic cholecystectomy port incisions. A prospective randomised controlled trial was performed. Patients were randomised to have closure of laparoscopic port sites using either OCA or sutures. Patients were reviewed at 24 hours and returned for follow-up 1 week and 1 month after postoperatively. At these times, different wound characteristics were documented: Two tools were used to measure the cosmetic result using Hollander wound evaluation scale (HWES) and the patient and observer scar assessment scale (POSAS). A total of 70 patients, 35 in each group were enrolled. The wounds were closed significantly faster in the OCA group (mean 229.16 [±43.7] seconds versus 258.82 [±51.7] seconds, P = .01). Statistically significant difference in favour of using OCA was found for dehiscence (17.1% versus none in the suture group, P = .025) after 1 week. However, no difference was found for wound dehiscence after 1 month. OCA and suture groups did not differ significantly on patient satisfaction. There were no differences in the percentage of wounds achieving optimal scores on the HWES (suture 85.7% versus OCA 74.2%, P = .169). Nerveless, wound evolution was judged to be significantly better in the OCA group using POSAS. Patients' median POSAS was 9.45 (6-11) and 11.43 (10-13) in the OCA and suture groups, respectively (P = .005), and surgeon's median POSAS was 9.42 (6-11) and 11.48 (10-13) in the OCA and suture groups, respectively (P = .006). N-butyl-cyanoacrylate tissue adhesive is an acceptable technique for the closure of laparoscopic wounds with less operative time, and cosmetic results are comparable to suturing.
Assuntos
Implantes Absorvíveis , Colecistectomia Laparoscópica/métodos , Cianoacrilatos/farmacologia , Ferida Cirúrgica/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Cicatrização , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Estudos Prospectivos , Adesivos Teciduais/farmacologiaRESUMO
INTRODUCTION: Intussusception through an ileostomy is one of the rarest complications of stomas. In this study we report a case and a brief update of the literature to focus on the clinical level of this pathology and the therapeutic attitudes. PRESENTATION OF CASE: a 44-year-old man who underwent a small bowel resection with double stoma for tuberculosis peritonitis presented with stomatal prolapse. On examination of the stoma, small bowel mucosa appeared to have evident rather than serosa. The patient had an elective reduction of the proximal stoma under anesthesia. CONCLUSION: A review of the literature shows that Intussusception through an ileostomy can occur at any time after the first surgery. The cause is still unclear. Urgent conservative surgical management based on manual reduction should be preferred.