RESUMO
A mixed Müllerian mesodermal tumour (MMMT) is a rare aggressive carcinosarcoma. Metastatic progression is uncommon, and occurs via haematological, lymphatic and intraperitoneal spread. Although the latter is seen most frequently, the small intestine seems to be relatively preserved from disease progression with only one reported case of synchronous involvement. We report a case of metachronous MMMT involvement of the small bowel presenting with subacute obstruction that was successfully resected at operation.
Assuntos
Carcinossarcoma , Neoplasias Intestinais , Intestino Delgado/patologia , Tumor Mulleriano Misto , Idoso , Feminino , Humanos , Histerectomia , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologiaRESUMO
A 56-year-old man presented with a delayed mesh infection 8 years following an elective laparoscopic totally extraperitoneal (TEP) bilateral hernia repair. Sterile pus was drained percutaneously as a temporising measure prior to removal of the right-hand mesh; the left-sided mesh was adherent to the femoral vessels and minimally contaminated. Delayed mesh infection is a rare occurrence. This case is the fourth example and the longest following initial operation. Removal of the infected mesh is advocated.
Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Telas Cirúrgicas/efeitos adversos , Herniorrafia/instrumentação , Herniorrafia/métodos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Infecções Relacionadas à Prótese/terapia , Tomografia Computadorizada por Raios XRESUMO
Gastric volvulus is a rare complication of diaphragmatic rupture. We report the case of an 82-year-old man who presented following an out-of-hospital cardiac arrest. Chest radiography and thoracic computed tomography revealed an acute gastric volvulus and a chronic diaphragmatic hernia containing transverse colon and abdominal viscera. He had complained of retching and associated epigastric pain prior to collapse, and had sustained a motorcycle accident approximately 60 years earlier. Insertion of a nasogastric tube was unsuccessful (completing Borchardt's diagnostic triad) and his condition prevented both operative and endoscopic reduction of his volvulus. He died soon afterwards.
Assuntos
Hérnia Diafragmática/diagnóstico , Parada Cardíaca Extra-Hospitalar , Volvo Gástrico/diagnóstico , Doença Aguda , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Evolução Fatal , Hérnia Diafragmática/diagnóstico por imagem , Humanos , Masculino , Radiografia Torácica/métodos , Ruptura Espontânea/diagnóstico , Volvo Gástrico/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
A 66-year-old patient had an incidentally detected caecal neuroendocrine tumour that had metastasised to the liver and left atrium. He was asymptomatic with regard to this tumour and did not have carcinoid syndrome. Resection of the primary tumour and the metastatic deposits (with the ablation of one lesion) is thought to be curative.
Assuntos
Tumor Carcinoide/cirurgia , Neoplasias do Ceco/cirurgia , Neoplasias Cardíacas/cirurgia , Neoplasias Hepáticas/cirurgia , Idoso , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/secundário , Átrios do Coração , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/secundário , Compostos Heterocíclicos com 1 Anel , Humanos , Achados Incidentais , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Imageamento por Ressonância Magnética , Masculino , Peptídeos Cíclicos , Pericárdio , Cuidados Pós-Operatórios , Compostos Radiofarmacêuticos , Somatostatina/análogos & derivados , Tomografia Computadorizada de Emissão de Fóton Único , Imagem Corporal TotalRESUMO
Pancreatic haemangiomas are rare benign tumours that can affect both adults and children. They have an unknown incidence and only 15 adult cases have been reported, all from histological examination. Patients present with vague symptoms relating to tumour mass or they are detected incidentally. Cross-sectional imaging is the mainstay of investigation and may reveal arterially enhancing cystic lesions but in the case presented here, it was non-diagnostic. The use of endoscopic ultrasonography confirmed the nature of the benign lesion, allowing a conservative approach as opposed to operative resection.
Assuntos
Endossonografia/métodos , Hemangioma/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Doenças Raras/diagnóstico por imagem , Idoso , Feminino , Humanos , Conduta ExpectanteRESUMO
INTRODUCTION: Hepatobiliary cystadenomas are rare cystic tumours that can arise from any portion of the biliary tract but most commonly develop intrahepatically. They typically cause non-specific symptoms and are often detected incidentally. Cystadenomas can be mistaken for simple hepatic cysts on radiological imaging, which leads to inadequate treatment. Hepatobiliary cystadenomas have a malignant predisposition and a high recurrence rate. Complete excision including hepatic resection is therefore generally recommended. METHODS: Three cases of hepatobiliary cystadenoma were identified at one unit over a six-month period. Their clinical details and management are reported. RESULTS: Three female patients are described aged 25, 37 and 73 years. One patient presented because of recurrent infection, one presented because of pressure related symptoms and one lesion was identified incidentally. All patients were investigated by ultrasonography and computed tomography (CT), two additionally had magnetic resonance imaging (MRI) and one had a liver biopsy. The tumours were 4-16cm in size and all lesions were excised by non-anatomical, parenchyma sparing resections. Histology revealed mixed epithelium with underlying ovarian-like stroma. CONCLUSIONS: The management of hepatic cystadenomas as well as operative and pathological findings are discussed. Preoperative ultrasonography, CT and MRI is recommended, and early referral for specialist hepatobiliary review is advised. Operative resection is also recommended and complete excision was achieved in these cases. This strategy is supported by the current literature and recurrence has been shown to be unlikely.
Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Cistadenoma/cirurgia , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos , Cistadenoma/diagnóstico , Feminino , Humanos , Achados Incidentais , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XAssuntos
Sistema Biliar/lesões , Ferimentos e Lesões , Procedimentos Cirúrgicos do Sistema Biliar , Diagnóstico por Imagem , Gerenciamento Clínico , Humanos , Incidência , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapiaRESUMO
Pancreatoduodenal injuries are an uncommon but important source of morbidity and mortality in the trauma patient. They require a multidisciplinary approach, with a pancreatic surgeon involved at the earliest opportunity. The investigation and management of these injuries are discussed along with the role of operative intervention.
Assuntos
Duodeno/lesões , Pâncreas/lesões , Erros de Diagnóstico/prevenção & controle , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Humanos , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Complicações Pós-Operatórias/terapia , Tomografia Computadorizada por Raios X , Índices de Gravidade do TraumaRESUMO
BACKGROUND: Bariatric and metabolic surgery is a recent introduction into mainstream surgical practice. It has been shown to have a beneficial effect on the health of an individual and a positive economic impact for society. Nonetheless, bariatric surgery faces a problem of perception from both the public and healthcare commissioners. The media functions as an interface between the medical community, government and the public. It therefore plays a critical role in shaping public opinion regarding health issues. METHODS: Articles relating to bariatric surgery in the ten most frequently read UK daily newspapers were assessed over a 24-month period (January 2010-December 2011). Each article was rated via a five-point scale from very negative (1) to very positive (5) by two independent assessors to produce an average score. RESULTS: A total of 197 relevant articles were identified and analysed for content. Sixty-four (33 %) of all articles were negatively slanted (mean score 1-2.5), 105 (53 %) were positive (mean score 3.5-5) and 28 (14 %) were neutral (mean score 2.5-3.5). The average score of all articles was 3.3 (neutral, but slightly positive). CONCLUSIONS: The print media will influence public perceptions of bariatric surgery. There is huge variation in how bariatric surgery is reported, but overall the coverage is neutral. We feel that negative reportage distorts the overall awareness of bariatric surgery and may affect both how and when the obese seek medical intervention.
Assuntos
Cirurgia Bariátrica , Jornais como Assunto/estatística & dados numéricos , Obesidade , Opinião Pública , Feminino , Política de Saúde , Humanos , Jornalismo Médico/normas , Masculino , Meios de Comunicação de Massa , Obesidade/cirurgia , Saúde PúblicaRESUMO
Barrett's oesophagus is one of the most common pre-malignant conditions in the world and its incidence is increasing. The management of this disease is currently the subject of research and debate, with medical, endoscopic and operative intervention all having a therapeutic role.
Assuntos
Esôfago de Barrett/terapia , Lesões Pré-Cancerosas/terapia , Esôfago de Barrett/complicações , Esôfago de Barrett/cirurgia , Ablação por Cateter , Comorbidade , Neoplasias Esofágicas/etiologia , Esofagectomia , Esofagoscopia , Refluxo Gastroesofágico/complicações , Fármacos Gastrointestinais/uso terapêutico , Humanos , Incidência , Estilo de Vida , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/cirurgiaRESUMO
A 25-year-old woman underwent routine day-case endoscopic mucosal resection (EMR) of two ascending colonic polyps. Six hours later she re-presented with severe abdominal pain. On examination she was tachycardic with tenderness and peritonism in the right lower quadrant. Urgent abdominal computed tomography (CT) did not reveal any signs of free intra-abdominal gas or fluid but did detect transmural thickening and oedema in the ascending colon and caecum. As there was no radiological evidence of perforation, the patient was managed conservatively and made a full recovery. The exact aetiology of this patient's symptoms is not known. She may have developed post-polypectomy electrocoagulation (a transmural diathermy injury), localised ischaemia of the colonic wall (secondary to the adrenaline used during EMR) or an allergic reaction to the dye used during EMR. As EMR is an increasingly used treatment modality in the management of colonic polyps, clinicians should have an awareness of the complications of treatment. We would advocate a low threshold for prompt CT investigation in any patient presenting with abdominal pain after EMR to detect any evidence of free intraperitoneal air. Patients without signs of perforation may be managed conservatively, as in this case.
Assuntos
Dor Abdominal/etiologia , Doenças do Ceco/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Pólipos do Colo/cirurgia , Colonoscopia/efeitos adversos , Perfuração Intestinal/diagnóstico por imagem , Adulto , Doenças do Ceco/etiologia , Colo Ascendente/cirurgia , Doenças do Colo/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Mucosa Intestinal/cirurgia , Perfuração Intestinal/etiologia , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Gastric schwannomas are rare mesenchymal tumours that arise from the nerve plexus of the gut wall. They present with non-specific symptoms and are often detected incidentally. Pre-operative investigation is not pathognomonic and many are therefore diagnosed as gastrointestinal stromal tumours (GISTs). Operative resection is usually curative as they are almost always benign, underpinning the importance of differentiating them from GISTs. METHODS: Three cases of gastric schwannomas were identified over a seven-year period. The clinical details and management were reviewed retrospectively. RESULTS: There were two women and one man with a mean age of 62 years (range: 51-69 years). Two patients presented with bleeding and one with abdominal pain. The mean tumour size was 5.2 cm (range: 2-10 cm) and the tumours were resected completely following total or wedge gastrectomies. Histology in all cases showed spindle cells with a cuff of lymphoid tissue. Immunohistochemistry confirmed positive S100 staining and negative CD117 and DOG-1 staining in all cases. CONCLUSIONS: We report our experience with these unusual primary stromal tumours of the gut and their presentations, pre-operative investigations, operative findings and pathological findings are discussed. Operative resection in all cases has been considered curative, which is supported by previous series confirming the excellent prognosis of gastric schwannomas.
Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Idoso , Diagnóstico Diferencial , Feminino , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Gastroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/patologia , Neurilemoma/cirurgia , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
AIM: To date there has been no assessment of the educational content of colorectal newspaper articles. We aimed to analyse articles in the print media concerning colorectal cancer for their public health content. METHOD: Articles mentioning colorectal cancer in the top 10 UK newspapers were analysed over a 1-year period for their educational content. The number of articles mentioning 'red flag' symptoms, celebrity connections or specific cancer charities was recorded. RESULTS: Of the 349 articles identified, 146 were not relevant. Of the remaining 203 articles, 62 (30%) were concerned with celebrities with colon cancer, 13 (6.4%) made reference to red flag symptoms and 14 (6.9%) mentioned cancer charities by name. CONCLUSION: About 13% of newspaper articles have any educational content. If this increased, the general public might benefit.
Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Informação de Saúde ao Consumidor , Jornais como Assunto , Instituições de Caridade , Pessoas Famosas , Humanos , Educação de Pacientes como Assunto , Reino UnidoRESUMO
Case Summary. An 18-year old man presented with a three-week history of abdominal pain, weight loss and bloody diarrhoea. He was profoundly septic, with generalised abdominal tenderness. CT and flexible sigmoidosopy confirmed colitis of the colon with rectal sparing. Laparotomy was performed when conservative management failed to improve his condition. Subtotal colectomy, with end ileostomy and mucus fistula formation, was performed in light of active colitis. Despite successful operative intervention the patient acute left ventricular failure, raising the possibility of giant cell myocarditis, which fully resolved before a definitive diagnosis could be reached. Discussion. It is possible that the transient cardiac failure in this case may represent an overwhelming inflammatory response or myocarditis. Inflammatory bowel disease is rarely associated with giant cell myocarditis (GCM). GCM usually affects a young population and its prognosis is variable, ranging from complete recovery, remission with recurrence and fatality. The management of this group of patients is still relatively experimental. Conclusion. Fulminant colitis can be associated with a rapid deterioration in cardiac function. Causes include sepsis, systemic inflammatory response syndrome or myocarditis. GCM should be considered in patients with new onset of left ventricular failure that decline rapidly.
RESUMO
INTRODUCTION: Pancreaticoduodenal (PD) artery aneurysms account for less than 2% of all splanchnic aneurysms. A mycotic aetiology is extremely uncommon. INTRODUCTION: Two weeks following an episode of sepsis related to a prostatic biopsy, a 59-year-old man presented with abdominal pain and anaemia. Ultrasonography and computed tomography revealed an inferior PD artery pseudoaneurysm with an associated mesenteric root haematoma. This was treated successfully by transcatheter embolisation. INTRODUCTION: Infective pseudoaneurysms of the PD artery are rare but can be associated with rupture into the gastrointestinal tract or retroperitoneum. Transcatheter embolisation remains the most effective therapy as it is associated with low morbidity and mortality rates and recurrence is very unlikely provided the aneurysm is completely excluded from the circulation.
Assuntos
Falso Aneurisma/terapia , Aneurisma Infectado/terapia , Infecções por Clostridium/terapia , Duodeno/irrigação sanguínea , Embolização Terapêutica/métodos , Pâncreas/irrigação sanguínea , Dor Abdominal/etiologia , Artérias , Clostridioides difficile , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Somatostatinomas are rare neuroendocrine tumours with an annual incidence of 1 in 40 million. They arise in the pancreas or periampullary duodenum. Most are clinically non-secretory and do not cause the somatostatinoma syndrome. Many are metastatic at presentation and their management is typically multimodal. CASE HISTORIES: Four cases of somatostatinoma are described. Two patients with periampullary disease presented with biliary obstruction, one with frank jaundice and one with incidental bile duct obstruction on investigation of hepatitis B. Each patient had type 1 neurofibromatosis and resection of the somatostatinoma by means of a pylorus-preserving proximal pancreaticoduodenectomy has resulted in long-term survival. Another two patients with metastatic pancreatic somatostatinomas presented with abdominal pain. Contrasting management illustrates current treatment strategies that are dependent in part on the distribution of the disease. DISCUSSION: The pathophysiology, presentation, clinical associations and role of diagnostic imaging are discussed for periampullary and pancreatic neuroendocrine tumours. Operative treatment has an important role in both the curative and palliative settings in conjunction with appropriate medical treatments and these are described. Management options depend on the extent of the disease and the cases are used to illustrate the rationale of such strategies.