ABSTRACT
INTRODUCTION: Intestinal duplication is rarely reported in adulthood and often remains undiagnosed until onset of complications. We describe the case of a 39 year old woman who came to our observation for acute abdomen due to a combination of double intestinal duplication (colon and ileum) and an incidental neuroendocrine tumor of the appendix. MATERIALS AND METHODS: A 39 year old woman who was admitted at with upper abdominal pain. Multisliced spiral CT scan showed a cystic lesion suggestive of an inflammed Meckel's diverticulum.The patient was underwent an urgent explorative laparoscopy. The intraoperative findings revealed a cystic lesion of the anti-mesenteric side of transverse colon, apparently dissectable from the bowel and a second lesion with a strongly adherent and unresectable from the anti-mesenteric aspect of the small bowel. A combined appendectomy was also performed. The histological diagnosis was consistent with a typical intestinal duplication for both intestinal lesionsand an incidental 2mm carcinoid tumor was also found in the appendix. The postoperative course was uneventful and the patient was discharged on p.o. day 5. At the presenttime she is well and following a regular oncologic follow-up. DISCUSSION: The rarity of this case is due to the concomitant presence of an incidental, sincronous, appendiceal NET. The elective treatment is surgical resection. CONCLUSION: Intestinal duplication in the adulthood is extremely rare and may either have an acute presentation as acute abdomen or represents an incidental finding of mass. We suggest that, once the diagnosis is suspected patient must undergo surgery.
ABSTRACT
BACKGROUND: Although in recent years our knowledge of pathogenesis and natural history of thyroid cancer has widely increased, there is not accordance among authors in the field of surgical treatment of well-differentiated tumours. In fact the extension of the tumour resection and modality of cervical lymph-nodes dissection show questions not easy to answer. METHODS: From 1985 to 1994, in our Surgical Institute, 128 cases of well-differentiated thyroid cancer, out of 1346 nodular thyreopathies, were operated on. We have considered some factors as anamnestic thyreopathy, familiarity, symptoms, US and scyntigraphic factors, fine-needle aspiration cytology and surgical option. The surgical treatment consisted of 99 total thyroidectomies (with or without cervical lymph-nodes dissection) and 18 lobus-isthmectomies. Surgical morbidity was 0.7% for permanent vocal cords palsy, 9.3% for transient hypoparathyroidism and 1.4% for permanent hypoparathyroidism. RESULTS: The 5.8-year survival rate was 92.9%. Fifty-four patients were in Stage I, 35 patients in Stage II, 27 in stage III and 4 in Stage IV. Histological patterns showed the prevalence of papillary type (63.3%) over follicular type (36.7%). CONCLUSIONS: The aggressive surgical approach in well-differentiated thyroid tumours, supported by complementary postoperative therapies, leads to a good control of the disease
