Benign stenosis of common bile duct after Roux Y gastrectomy.

We present the case of a 60-year-old patient with the history of subtotal gastric resection and reconstruction of passage using the Roux-Y loop, five years later diagnosed with benign stenosis of the common bile duct. The possibilities of using endoscopy and interventional radiology for the bile duct treatment in the postoperatively altered terrain of the proximal digestive tract were limited. After failure of these methods the patient was indicated for surgery - biliodigestive anastomosis. The postoperative course was significantly complicated by bleeding and formation of bile and colic fistulas. Over time, a migrated stent was found in the small intestine, which was the cause of inflammatory changes and incomplete small bowel obstruction. Increased intraluminal pressure in the intestinal loops inhibited healing of the anastomosis and was a major cause of the complications.

Synchronous tumor duplicity of a neuroendocrine tumor of Meckels diverticulum with liver metastases and colorectal carcinoma.

INTRODUCTION: Meckels diverticulum (MD) is a developmental abnormality and a true diverticulum of the small intestine which can give rise to a malignant tumor. Neuroendocrine tumors (NETs) are the most common tumors arising in MD, but due to the prevalence of MD and its malignancy rate, there is no uniform guideline regarding these tumors. Recent knowledge shows that their biological behavior is aggressive and unrelated to size. Their behavior resembles that of an ileal NET. CASE REPORT: A 62-year-old male was examined for enterorrhagia, and an adenocarcinoma of the ascending colon was diagnosed along with multiple liver lesions that resembled metastases. Needle biopsy of a liver lesion was performed and showed the lesions to be NET metastases of unknown origin. Treatment with somatostatin analogs was commenced, and because of the patients anemization a right hemicolectomy was indicated, during which a normal Meckels diverticulum was found and resected. Histological evaluation of MD confirmed a moderately differentiated NET. CONCLUSION: Surgery is the primary modality for treating MD, including cases in which MD is asymptomatic and found incidentally during surgery for other causes. In the case of NET of MD, a radical surgical treatment is needed because of the risk of early metastatic dissemination. When liver metastases are present, an aggressive approach combining surgical and systemic treatment is recommended to improve the prognosis of the disease.