Intraoperative ultrasonography in detecting and assessment of colorectal liver metastases.

OBJECTIVE: to assess the clinical value of intraoperative ultrasonography (IOUS) in detecting and assessment of liver metastatic tumours in colorectal cancer patients. METHODS: a study is a retrospective analysis of 388 patients operated on for colorectal carcinoma between 1997 and 2004. In all the patients intraoperative ultrasound was performed. The authors analyzed of sensitivity, specificity, PPV, NPV and accuracy of pre- and intraoperative ultrasonography in detecting and staging of colorectal metastatic lesions. RESULTS: Intraoperative ultrasonography showed the highest sensitivity, specificity and accuracy in both, tumor detection (99.1, 98.5 and 98.9%, respectively) and assessment (95.4, 99.5 and 99.1%, respectively). Overall sensitivity of IOUS was significantly better in detection and staging compared with preoperative ultrasonography 91.1 and 72.2%, respectively). CONCLUSIONS: IOUS should be used as routine diagnostic modality in colorectal cancer patients with hepatic metastases or suspected metastases. Transabdominal ultrasonography cannot be used as the only diagnostic tool in the evaluation of liver lesions, but may be helpful in preoperative screening.

Amyand's hernia: a report of two cases.

In 2000-2001 two patients with acute appendicitis in the right inguinal hernia (Amyand's hernia) and the symptoms of incarcerated hernia were operated on in emergency. One patient with the symptoms of local peritonitis was subjected to hernioplasty and appendectomy. The second underwent midline inferior laparotomy, because of diffuse peritonitis with appendectomy and hernioplasty. Both patients were operated by Shouldice's method. None of the patients developed recurrent disease. The presented cases point to the necessity of considering acute appendicitis in the differential diagnosis of incarcerated right inguinal hernia.