RESUMO
BACKGROUND: Wounds resulting from the closure of temporary stomas have a high risk of developing an incisional hernia (IH) with incidences around 30% in studies designed to investigate this outcome. A temporary diverting ileostomy (TDI) is often used in patients after low anterior resection (LAR) for rectal cancer. METHODS: The OSTRICH study is a retrospective cohort study of rectal cancer patients who had a LAR with a reversed TDI and at least one CT scan during follow-up. Two radiologists independently evaluated all abdominal CT scans to diagnose IH at the ileostomy wound and additionally, IH at the laparotomy site. RESULTS: From the oncological database of rectal cancer patients treated from 2003 till 2012 (n = 317) a cohort of 153 patients that fulfilled the inclusion criteria was identified. Rectal cancer resection was performed by laparoscopy in 53 patients (34.6%) and by laparotomy in 100 patients (65.4%). A total of 17 IH (11.1%) was diagnosed at the former stoma site after a mean follow-up of 2.6 years. Of these, 8 IH were in patients who had a laparoscopic LAR (15.1%) and 9 IH in patients who had an open LAR (9.0%) (Fisher's exact test; p = 0.28). IH on the other abdominal wall incisions was reported in 69 patients (45.1%). Of these, 10 patients underwent laparoscopic rectal surgery (18.9%) and in 59 patients had open rectal surgery (59.0%) (Fisher's exact test; p < 0.0001). CONCLUSION: We found a lower number of incisional hernias (11.1%) after reversal of ileostomies than expected from the literature. In contrast to the findings at the ileostomy site, a very high frequency of IH (59.0%) after LAR by laparotomy was found, which was significantly higher than after laparoscopic LAR.
Assuntos
Ileostomia/efeitos adversos , Hérnia Incisional/diagnóstico por imagem , Neoplasias Retais/cirurgia , Idoso , Feminino , Humanos , Incidência , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estomas Cirúrgicos/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Incisional hernia (IH) is the most frequent complication after colorectal carcinoma (CRC) resection. The incidence depends on the method of follow-up, where ultrasound yields a significant number of additional hernias compared to clinical examination alone. Not many studies have evaluated the value of computed tomography (CT) to diagnose IH. METHODS: The CorreCT study is a retrospective cohort study of IH after CRC surgery by clinical examination and by CT, as reported in the medical files. Additional independent reviewing of all CTs by two radiologists was performed. RESULTS: From the oncological database (2004-2008) of the hospital, 598 patients with CRC were identified. The data of 448 consecutive patients who underwent surgery were analyzed. Tumors were resected by laparotomy in 366 patients (81.7 %), by laparoscopy in 76 patients (17.0 %) and by laparotomy after conversion in 6 patients (1.3 %). A clinical follow-up by the surgeon in 282 patients (62.9 %) with a mean duration of 33 months, yielded 49 patients with IH (17.4 %). The mean time of IH diagnosis (T1) was 19 months. Only 16 patients (33 %) underwent a hernia repair. For 363 patients (81.0 %), CT follow-up was available for a mean period of 30 months. In 84 patients (23.1 %), an IH was diagnosed with a mean T1 of 21 months. The review of all CTs by two independent radiologists yielded additional IH in 19 and 21 patients, respectively, increasing the IH rate to 29.1 and 29.7 %, respectively, and with a decrease in mean T1 to 14 months. The inter-observer agreement between the radiologists had a Kappa-statistic of 0.73 (95 % CI 0.65-0.81). For those patients with disagreement between the radiologists, a final agreement was made during an additional reviewing session of both radiologists, increasing the IH rate to 35.0 %. Comparing clinical follow-up, routine CT follow-up, and reassessed CT follow-up we found a statistically significant difference between the three methods of IH detection (p < 0.0001). CONCLUSION: CT follow-up can identify significantly more IH than clinical examination alone, in particular if the radiologist focuses on IH development. Furthermore, we showed that focused CT evaluation diagnosed IH 7 months earlier than routine CT and 5 months earlier than clinical follow-up alone.
Assuntos
Colectomia , Neoplasias Colorretais/cirurgia , Hérnia Abdominal , Complicações Pós-Operatórias , Idoso , Bélgica , Colectomia/efeitos adversos , Colectomia/métodos , Feminino , Seguimentos , Hérnia Abdominal/diagnóstico por imagem , Hérnia Abdominal/epidemiologia , Hérnia Abdominal/etiologia , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Humanos , Incidência , Laparoscopia , Laparotomia/efeitos adversos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
We report a case of a woman diagnosed with a solitary true cyst of the pancreas. CT and especially MRI guided us in the diagnosis of this benign lesion. The cyst has been surgically removed because of secondary bile-duct obstruction causing painless jaundice. Clinical history, laboratory, imaging, and histological findings are reported.
Assuntos
Diagnóstico por Imagem , Cisto Pancreático/diagnóstico , Colestase/etiologia , Feminino , Humanos , Icterícia/etiologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Cisto Pancreático/complicações , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/cirurgia , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Dor Abdominal/diagnóstico , Cistadenoma Seroso/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Colangiografia , Cistadenoma Seroso/complicações , Cistadenoma Seroso/cirurgia , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
A case of benign multilocular cystic nephroma in a young female is presented. The radiological features (urography, ultrasonography, computed tomography and angiography) are not specific for this diagnosis. The differential diagnosis includes a cystic Wilms' tumor in children and a cystic renal cell carcinoma in adults. The final diagnosis is obtained by histological examination of the resected specimen.