RESUMO
CT images and endoscopic findings in a case of Bouveret's syndrome.
Assuntos
Cálculos Biliares/diagnóstico , Íleus/diagnóstico , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal , Feminino , Cálculos Biliares/patologia , Cálculos Biliares/cirurgia , Gastrostomia , Humanos , Íleus/patologia , Íleus/cirurgiaRESUMO
Obstructive jaundice caused by a pancreaticoduodenal pseudoaneurysm, probably related to a chronic pancreatitis.
Assuntos
Falso Aneurisma/complicações , Duodenopatias/complicações , Icterícia Obstrutiva/etiologia , Pancreatopatias/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/cirurgia , Radiologia Intervencionista , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
INTRODUCTION: Complete resection with clear margins in locally advanced pelvic visceral tumors, primary or recurrent, occasionally requires total pelvic exenteration (TPE). METHODS: We reviewed the results of EFA in 34 consecutive patients operated on between June 2006 and December 2013. RESULTS: Median age was 62 (40-82) years; 24 (70%) were male. The tumor origin most frequent was advanced primary rectal tumor (APRT), with 19 cases (55.9%) and most common type of exenteration was supraelevator (61.8%). R0 resection was achieved in 24 (70.6%) patients and in 16 (85%) of the APRT. Fifteen (79%) patients had pT4 APRT, and 4 (20%) pN +. Reconstruction of the bowel and bladder was performed with two stomas in 17 cases (50%), colorectal anastomosis and Bricker in 11 (32.3%) and wet double barreled colostomy in 6 (17.6%). There was no postoperative mortality; 23 (67,5%) patients had complications, and 5 (14.6%) required a postoperative reoperation to solve them. Median follow-up was 23 (13-45) months. Overall survival (OS) and disease free survival (DFS) at 2 years were 67% and 58% respectively, and the median OS and DFS was 59 months (95% CI 26-110) and 39 months (95% CI 14-64), respectively. The DFS of R0 was significantly better (p=0.003) than R1. CONCLUSIONS: TPE is a potentially curative procedure for advanced pelvic visceral malignancies with similar morbi-mortality than other extended excisional surgery.
Assuntos
Recidiva Local de Neoplasia/cirurgia , Exenteração Pélvica , Neoplasias Pélvicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Neoplasias Pélvicas/mortalidade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
A literature review has been made on the pelvic recurrence of rectal cancer using the MedLine, Ovid, EMBASE, Cochrane and Cinahl data bases. Assessment of the locoregional recurrence must be made using imaging tests in order to rule out the presence of metastasis, as well as for locating its exact location within the pelvis. As the only curative treatment should be complete resection of the recurrence with negative margins, a pre-operative CT, NMR, endorectal ultrasound and PET-CT must be performed to determine its resectability. For a potential cure, radical resections must be made, with the technique varying according to whether the location is central (axial), posterior (presacral) or lateral, as well as treatment directed at the primary tumour. Neoadjuvant treatments, brachiterapy and intra-operative radiotherapy improve the local control results and survival in these patients.
