Carcinoma del uraco / Urachal Carcinoma

Objetivo Revisar la patología tumoral del uraco, haciendo énfasis en su clínica, los métodos diagnósticos empleados y el manejo terapéutico. Métodos Presentamos el caso de un varón de 39 años con carcinoma del uraco que simuló clínicamente un absceso umbilical. Resultados Los hallazgos en la TC fueron sospechosos de patología del uraco. El examen anatomopatológico reveló células atípicas y la PET-TC demostró extensión a pared abdominal y epiplón, requiriéndose la resección completa. Conclusiones El carcinoma del uraco es una neoplasia muy poco frecuente, que tiene su origen en el epitelio que recubre la luz del uraco, un vestigio de la alantoides que conecta la vejiga con el ombligo y normalmente involuciona en la etapa embrionaria. La clínica insidiosa hace que el diagnóstico sea tardío y el pronóstico pobre. Las pruebas de imagen tienen un papel fundamental en su sospecha, así como en la definición de la relación con la pared vesical y posible extensión local o a distancia. Una vez confirmado el diagnóstico histológicamente, está indicada la resección quirúrgica completa.

Objective To review tumoral pathology of urachus, emphasizing its clinical manifestations, diagnostic methods and therapeutic management. Method We present the case of a 39-year-old male with urachal carcinoma who clinically mimicked an umbilical abscess. Result CT findings were suspected of urachus pathology. Histologic analysis of the resected specimen demonstrated atypical cells, and PET-CT showed extension to the abdominal wall and omentum, requiring complete resection. Conclusions Urachal carcinoma is a very rare neoplasm that originates in the epithelium that covers the lumen of the urachus, a vestige of the allantois that connects the bladder with the navel and normally involves in the embryonic stage. The insidious clinic makes late diagnosis and poor prognosis. Imaging tests play a fundamental role in their suspicion, as well as in the definition of the relationship with the bladder wall and possible local or distant extension. Once the diagnosis has been confirmed histologically, complete surgical resection is indicated.

Hartmann's procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery.

INTRODUCTION AND OBJECTIVES: Despite the criticisms from prestigious expert committees, a high percentage of surgeons continue to use, as the technique-of-choice, Hartmann's procedure for acute malignant intestinal obstruction of the distal colon and rectum, without faecal peritonitis. We have reviewed our results with this technique and compared them with other series of patients in the literature undergoing one-stage surgery (resection with primary anastomosis or sub-total colectomy). MATERIAL AND METHODS: A retrospective and descriptive study using clinical histories and, from which, the variables studied were: median hospitalisation stay, morbido-mortality and reconstruction index. RESULTS: Included in the analysis were 44 patients (24 male; 20 female) with an age range between 37 and 87 years (median age: 67.04 years). The median hospitalisation stay was 15.59 days (range: 8-39). In the 10 patients undergoing reconstruction this was 12.8 days (range: 10-17). The overall stay, therefore, was 28.39 days. The median stay in the series of patients having one-stage surgery was 13.9 days. The morbidity using Hartmann's procedure was 43.18% (19/44) and, in the patients with reconstruction, 40% (4/10). The morbidity in the literature series with one-stage surgery was 22.53%. Mortality in our study was 0%. The mortality in the 16 cases from the literature was close to 5%, although in 3 of the studies this was also 0%. The percentage undergoing reconstruction was 22.72% (10 cases). The median age in the non-reconstructed patients was 71.42 years (range: 46-87) compared to a median age of 52.6 (range 37-67) in the group with reconstruction (p < 0.001). The percentages undergoing reconstruction, according to tumour stage, were Dukes B: 36.84%; Dukes C: 23.07%; Dukes D: 0% (p < 0.001). The median waiting-time for a reconstruction was 15.73 months (range: 8-33). CONCLUSIONS: Comparisons of our results with the outcomes in the series of patients in the literature with one-stage surgery indicate that "one-stage surgery" is the more suitable but, however, with two conditions: a sufficient command of the technique so as to minimise complications and a strict patient selection, with the Hartmann's procedure being retained for patients with high anaesthesia risk.