Management of adhesive small bowel obstruction: the results of a large retrospective study.

BACKGROUND: Postoperative adhesive small bowel obstruction (SBO) is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive SBO can be managed nonoperatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive SBO. Treatment recommendations are still controversial. METHODS: We conducted an observational retrospective monocentric study to test our protocol of management of SBO using Gastrografin®, enrolling 661 patients from January 2008 to December 2021. An emergency surgery was performed in patients with abdominal tenderness, peritonitis, hemodynamic instability, major acute abdominal pain despite gastric decompression, or CT scan findings of small bowel ischemia. Nonoperative management was proposed to patients who did not need emergency surgery. A gastric decompression with a nasogastric tube was immediately performed in the emergency room for four hours, then the nasogastric tube was clamped and 100 ml of nondiluted oral Gastrografin® was administered. The nasogastric tube remained clamped for eight hours and an abdominal plain radiograph was taken after that period. Emergency surgery was then performed in patients who had persistent abdominal pain, onset of abdominal tenderness or vomiting during the clamping test, or if the abdominal plain radiograph did not show contrast product in the colon or the rectum. In other cases, the nasogastric tube was removed and a progressive refeeding was introduced, starting with liquid diet. RESULTS: Seventy-eight percent of patients with SBO were managed nonoperatively, including 183 (36.0%) who finally required surgery. Delayed surgery showed a complete small bowel obstruction in all patients who failed the conservative treatment, and a small bowel resection was necessary in 19 patients (10.0%): among them, only 5 had intestinal ischemia. CONCLUSIONS: Our protocol is safe, and it is a valuable strategy in order to accelerate the decision-making process for management of adhesive SBO, with a percentage of risk of late small bowel resection for ischemia esteemed at 0.9%.

Growing teratoma syndrome of the ovary presenting with liver metastasis: report of a case.

Growing teratoma syndrome (GTS) is a rare condition among patients with non-seminomatous germ cell tumors who present with enlarging metastatic masses during appropriate systemic chemotherapy in the context of normalized serum markers. This is an infrequent event in the progression of testicular tumors, and is even less common in the case of ovarian germ cell tumors. The pathogenesis of GTS is not completely understood and diagnosis can only be made with certainty after complete pathologic examination. Although histologically benign, GTS may present an enveloping growth with aggressive local expansion, which can be related to substantial morbidity and mortality. Surgery is the only recommended treatment and early recognition of this syndrome is essential as it offers hope for curative resection and avoids the use of ineffective chemotherapy. The authors present a brief review of the literature, along with the case report of a 37-year-old woman presenting GTS with liver involvement who was successfully treated by debulking surgery followed by major liver resection. This report demonstrates that complete surgical resection results in excellent disease control. More importantly, it highlights that clinicians need to be aware of the possible development of GTS when monitoring their patients with non-seminomatous germ cell tumors. These patients require coordinated care between oncologist, gynecologists, and general surgeons to obtain the best possible outcomes.

Surgical management of sporadic medullary thyroid cancer.

Inherited and sporadic medullary thyroid cancer (MTC) is a rare carcinoma. Sporadic MTCs represent 70% of cases. Diagnosis is currently made with the routine use of serum calcitonin (CT) measurements to screen patients with nodular thyroid disease. Surgery is the only curative treatment of MTC and since cervical lymph nodes metastases are frequent and can occur at an early stage, a standardized lymph node dissection should be associated to total thyroidectomy. However, the extent of lymphadenectomy remains debated. Prognosis of MTC is related to both the stage of the disease and the extent of initial surgery. When tumor remnants persist after surgery, there are very few therapeutic alternatives, and these are generally of limited curative value.

[Colonic lipoma: case report and literature review]. / Lipome colique : cas clinique et revue de la littérature.

Colonic lipoma is a rare benign tumor infrequently met in clinical practice. We report a case of symptomatic lipoma of the ascending colon in a 61-year-old woman. Diagnosis was suspected on CT scan. Colotomy with lipectomy was performed. The diagnosis was confirmed by histological examination. Reviewing the literature and combining with our experience, we discuss the clinical features, diagnosis and treatment of this uncommon disease.

[Laparoscopic partial splenectomy using the Harmonic Scalpel. Two case reports]. / Splénectomie partielle par laparoscopie et ultracision. A propos de deux cas.

For the extirpation of a benign splenic cyst, partial splenectomy is an appropriate approach, since there is significant long-term morbidity following total splenectomy. We report two cases of laparoscopic partial splenectomy for benign splenic cyst. The use of the harmonic scalpel along with segmental ligation of the splenic pedicle allowed the completion of these interventions with minimal blood loss.

[Minimally invasive esophagectomy: prospective evaluation of laparoscopic gastric mobilization]. / Oesophagectomie mini-invasive: évaluation prospective de la gastrolyse coelioscopique.

OBJECTIVE: Esophagectomy carries high morbidity, mainly due to respiratory complications. In digestive surgery, postoperative outcome is generally improved by minimally invasive surgery. A prospective study was conducted to evaluate feasibility and postoperative outcome of minimally invasive esophagectomy (MIE). METHODS: From July 2001 to June 2004, 20 patients underwent esophagectomy with laparoscopic gastric mobilization (LGM) for squamous cell carcinoma (N=11), adenocarcinoma (N=7), Barrett's esophagus with high-grade dysplasia (N=1), and long peptic stricture (N=1). Tumours (N=19) were located on the cardia (N=5), on the lower third of the oesophagus (N=10), on the median third (N=3), and on the upper third (N=1). Following LGM, transthoracic (N=19) or transhiatal (N=1) oesophagectomy was performed. RESULTS: Complete LGM was achieved in all cases. Mean operative time for LGM was 197+/-48 minutes. In the 19 patients operated for tumours, 18 underwent R0 resection. Eleven patients (55%) developed postoperative complications, mainly (30%) respiratory. Intrathoracic anastomotic leakage occurred in 2 patients, with favourable outcome. Pylorospasm (N=1) was the only intraabdominal complication. One patient died (5%). CONCLUSION: Esophagectomy with LGM is feasible with few specific complications. However, no decrease in morbidity could be observed with this technique. Further studies are required to evaluate if thoracoscopy could improve the postoperative course after LGM and to validate oncologic safety of MIE.

[Emphysematous cholecystitis: a pathologic entity. A case report]. / La cholécystite emphysémateuse : une entité pathologique. A propos d'un cas.

Emphysematous cholecystitis is a rare but real entity, which have to be recognized early in order to quickly start the best treatment. We report a case of acute emphysematous cholecystitis diagnosed with computed tomography. A successful outcome was obtained by antibiotherapy and cholecystectomy in emergency.