Malone appendicostomy: an unexpected complication.

The Malone appendicostomy is a novel option for surgical management of faecal incontinence and chronic constipation, by permitting the administration of antegrade colonic enemas for colonic evacuation. We report the case of a 54-year-old female who had undergone abdomino perineal resection for low rectal cancer followed by total perineal reconstruction with perineal colostomy, dynamic double graciloplasty and Malone appendicostomy. After 7-year follow-up, functional results and quality of life scores were satisfactory. Suddenly the patient described increasing difficulty with intubation of her appendicostomy and complete reflux of the enema liquid, which radiology referred to a calcified body of 35 mm within the Malone appendicostomy causing nearly complete obstruction of the conduit. A surgical exploration was necessary to extract the fecolith allowing full recovery with return to satisfactory Malone appendicostomy function. To our knowledge, this is the first report of a fecolith causing obstruction within a Malone appendicostomy.

Solitary fibrous tumor of the pleura: a report of five cases diagnosed by transthoracic cutting needle biopsy.

Five patients had a solitary fibrous tumor of the pleura; a well-known but rare entity. In all cases, biopsy by a transthoracic cutting needle (Tru-Cut; Travenol; Deerfield, IL) yielded specimens adequate for histologic analysis and gave the clue to the diagnosis. In four patients, surgical resection confirmed the diagnosis. The opportunity for and interest in diagnosing these tumors by transthoracic cutting needle biopsy before surgery are discussed. An accurate diagnosis of solitary fibrous tumors of the pleura can be made by a minimally invasive procedure; this allows for a more informed allocation of surgical resources.

Spontaneous favorable outcome of tracheal laceration.

We present the case of a 57-year-old woman with a huge tracheal laceration after intubation. With simple supportive therapy, the laceration healed in ten days, and the patient made an uneventful recovery. At the three-month follow-up, no sequelae were observed.

Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy.

BACKGROUND: The classic manual end-to-side technique of esophagogastrostomy after gastric pull-up to the neck carries a rather high risk of fistula and stricture. METHODS: A terminalized semimechanical side-to-side technique of cervical esophagogastrostomy was performed in 16 patients by the application of an Endo-GIA stapler across the gastric and esophageal walls placed side by side, so as to create a V-shaped posterior opening between the two lumina. The anterior aspect of the anastomosis was hand-sewn using a classic running suture. The cross-sectional area of the semimechanical anastomoses was estimated by barium swallow study 2 months after operation and compared with that of 24 manual end-to-side esophagogastrostomies. RESULTS: The cross-sectional area was 225 +/- 15.7 mm2 (mean +/- standard error of the mean) for the 16 semimechanical anastomoses versus 136 +/- 15 mm2 for the 24 manual anastomoses (p = 0.0001). The anastomotic area decreased from 206.6 +/- 13.5 mm2 in 29 patients without dysphagia to 107.5 +/- 4.7 mm2 in 7 patients with moderate dysphagia for solids that did not require endoscopic dilation and to 55.7 +/- 16 mm2 in 4 patients with severe dysphagia that required dilation (p = 0). The anastomotic area in 6 of the 7 patients with initial moderate dysphagia for solids increased spontaneously with time from 107.3 +/- 5.5 mm2 to 174.6 +/- 8.1 mm2, with concomitant symptomatic relief (p = 0.0277). CONCLUSIONS: The terminalized semimechanical side-to-side suture technique produces a larger anastomosis than the classic end-to-side esophagogastrostomy technique. Inflammatory changes related to the operation may cause transient narrowing of a cervical esophagogastrostomy.

Radiologic findings of normal and compromised thoracic venous catheters.

We review the radiologic findings of normal positioning, malpositioning, and complications related to the more commonly used thoracic venous catheters. These include central venous catheters, long-term central venous access catheters, and pulmonary artery catheters. The radiologist plays an important role in the early recognition of the complications of these catheters. The daily practice of chest radiology is intimately related to the evaluation of the integrity and correct placement of thoracic venous catheters. The purpose of this pictorial essay is to review radiologic findings of normal positioning, malpositioning, and complications related to the more common devices used, including central venous catheters, long-term central venous access catheters, and pulmonary artery catheters. Many of the complications described are serious and may remain unrecognized for a long time; this may cause incorrect diagnosis and delayed treatment. The radiologist plays an important role in the early recognition of these complications. Malpositioning and complications often are more easily diagnosed with contrast-enhanced studies and computed tomography.

Clinical, radiological and functional results of remedial antireflux operations.

Fifty-five patients were reoperated on for an unsatisfactory outcome after antireflux surgery. Presenting symptoms were heartburn alone (27), heartburn and dysphagia (10), dysphagia alone (9), chest pain (4), left shoulder pain (1), left shoulder pain and fever (1), and signs of anemia (3). The symptom of dysphagia was usually of immediate onset whereas heartburn reoccurred after a symptom-free period (p = 0.014). The most common failed antireflux procedure was a Nissen fundoplication (37). The incompleteness of the residual wrap, its location around the stomach and the irreducibility of the gastro-oesophageal junction below the diaphragm were accurately predicted by barium swallow study in 70, 83 and 92% of the patients, respectively. Abnormal oesophageal body motility was related to oesophagitis, herniation of the residual repair into the chest or both (16/20), and it normalized in 6 of the 11 patients evaluated at follow-up. Oesophageal acid exposure and prevalence of oesophagitis were higher in patients with heartburn than in those with other symptoms (p < 0.02). Intraoperative findings were breakdown of the repair, its location around the stomach, its herniation into the chest, its too excessive tightness, a gastric fistula, or any combination. Remedial surgery consisted of a new antireflux procedure (42), a new antireflux procedure combined with closure of a gastric fistula (3), a closure of a gastric fistula alone (1), a closure of the crura (4), an oesophageal resection (3), a total gastrectomy (1), and a duodenal diversion (1).(ABSTRACT TRUNCATED AT 250 WORDS)

[Plain film findings and contrast enema in colon ischemia (author's transl)]. / Abdomen sans préparation et lavement opaque dans l'ischémie du côlon.

We describe our observations on abdominal roentgenograms without preparation in two cases of segmental colon infarct and eighteen cases of ischemic colitis. In both infarct cases a colic ileus was noted. In one patient the infarcted loop appeared as gas contrasted. In the ischemic cases there were, in addition to the bowel ileus: a colectasis in two patients, a collapsed segment in thirteen and a gas-filled segment in three. When associated to a significant clinical situation the two latter images have some diagnostic value. In the majority of patients, the contrast enema made possible a diagnosis of ischemic colitis; in three it shaved the sigmoid narrowing responsible for the ischemia.

[Value of echography in the diagnosis of acute intestinal occlusion]. / Intérêt de l'échographie dans le diagnostic de l'occlusion intestinale aiguë.

OBJECTIVE: The aim of our study was to assess the value of sonography in the diagnosis of acute intestinal occlusion. MATERIAL AND METHODS: Sonographic findings were reviewed in 50 cases of intestinal occlusion (39 small bowel and 11 colonic occlusions). The final diagnosis was based on surgical findings (n = 40) or clinical course and further imaging findings (n = 10). RESULTS: Occlusion was correctly detected with sonography in 48 cases (96%). The location was correctly established with sonography in 43 cases (86%). The precise cause was suggested with sonography in 21 cases (42%). COMMENTARY: These results confirm the value of sonography for the diagnosis of intestinal occlusion and the identification of its level and its cause.

[Colonic complications of pancreatitis. A report on 39 cases (author's transl)]. / Le retentissement colique des pancréatites. A propos de 39 observations.

Colonic complications of pancreatitis are not infrequent occurrences, as illustrated by the fact that the authors have personally treated 39 such cases. Lesions are found in the colon at sites which correspond perfectly to diffusion of pancreatic necrotic lesions along mesenteric pathways as described by Meyers. They occur mainly in the left colic flexure (17 cases) and transverse colon (10 cases) but may affect the ascending (6 cases) and descending (4 cases) colon by diffusion of the pancreatitis into the anterior extrarenal space. These topographical characteristics, associated with the extrinsic and inflammatory nature of the lesions, produce a very specific and typical radiological syndrome which should assist diagnosis.

[Plasma cell granuloma of the lung. Apropos of a case and review of the literature]. / Le granulome plasmocytaire du poumon. A propos d'un cas et revue de la littérature.

A case of plasma cell granuloma of the lung is presented, and the clinical, radiological, histological, diagnostic and therapeutic data obtained from 97 published cases are reviewed. Since the disease is usually peripheral, the diagnosis rests on surgical biopsy and histological examination. In the case presented here, it was established on intrabronchial biopsy obtained by fibroscopy.

[Recurrent lithiasis following cholecystectomy imaged with ultrasonography, tomodensitometry and cholangiography]. / Récidive de lithiase après cholécystectomie, imagée par ultrasonographie, tomodensitométrie et cholangiographie.

It is generally admitted, that after cholecystectomy, the cystic duct and the gallbladder remnant may cause symptoms, by being the site of inflammation. Recurrence of stones in a reformed gallbladder is avoided when cholecystectomy is complete. We report the case of a 43-year-old woman, presenting 19 years after cholecystectomy with a reformed gallbladder containing stones demonstrated by US, CT and cholangiography.

[Spiral CT in pulmonary embolism]. / CT scanner spirage dans l'embolie pulmonaire.

Pulmonary embolism is a leading cause of morbidity and mortality that can occur in many clinical situations. For several years, spiral CT has represented a relatively non invasive modality for diagnosing this common disease. The present article is reviewing the CT features of acute and chronic pulmonary embolism, the technical aspects of spiral CT acquisition, the diagnostic accuracy and major limitations and pitfalls of the technique.

[Unilateral peripheral pulmonary nodules: initial symptoms of a limited form of Wegener's disease]. / Nodules pulmonaires periphériques unilatéraux: premiers signes d'une forme limitée de la maladie de Wegener.

The X-ray and CT follow-up features of unilateral peripheral pulmonary masses spontaneously varying in size and amount in a patient with limited Wegener disease are reported. Diagnosis was established by nasal biopsy and dosage of the neutrophils anti-cytoplasmic autoantibodies. The current literature over the condition is reviewed.

Giant idiopathic ulcer of esophagus in the context of acquired immunodeficiency syndrome (AIDS).

The giant ulcer of esophagus is a rare entity in the context of human immunodeficiency syndrome. In front of this type of ulceration the radiologist must to distinguish between two types of ulcers HIV, cytomegalovirus (CMV). The differential diagnosis is necessary for orientation of the therapy and is the result of association between radiological, endoscopic and pathological findings.