Retroperitoneal and mesenteric cysts.

Retroperitoneal and mesenteric cysts are rare abdominal tumours. This report is a presentation of three cases. One patient had large retroperitoneal cyst which was accidentally discovered, another patient had mesenteric cyst presenting with abdominal pain, and the third patient had emergency admission due to infection of a large mesenteric cyst. The literature on this condition is reviewed.

Postoperative adhesive small bowel obstruction: the resources impacts.

AIM: To assess the resource implications of managing small bowel obstruction, which is common and has diverse causes and outcomes. METHOD: A retrospective study of 332 patients documented to have postoperative, adhesive small bowel obstruction, from 1988 to 1996, was carried out. Complications and resources used were recorded and costs were determined. Results. There were 207 females and 125 males, with a median age of 63 years. There were 374 hospital admissions, in 121 (32.4%) of which no surgical operation was performed. Patients had a median hospital stay of eight days. The overall median cost for a patient who had no operation was NZ$1 039 (minimum $94, maximum $13 262), compared to NZ$7 630 (minimum $2 038, maximum $135 173) for a patient who had an operation. Postoperative adhesive small bowel obstruction accounted for 1.3% of all admissions, 59.2% of all cases of bowel obstruction, 65.2% of all admissions with small bowel conditions, 73.5% of laparotomies for bowel obstruction and 4.1% of all laparotomies. Sixty-eight patients (20.5%) developed a total of 102 complications and there were eight deaths (2.4%). CONCLUSION: Postoperative adhesive small bowel obstruction is a common condition, which is associated with a substantial morbidity and workload. The treatment of these conditions has significant health care costs. Most are emergencies and the costs of their management are very variable.

Acute colonic pseudo-obstruction.

BACKGROUND: Acute colonic pseudo-obstruction is an acute non-mechanical colonic obstruction. Twenty patients with this condition presenting between 1988 and 1996 were retrospectively reviewed to identify the incidence and potential aetiologic factors, and to establish a uniform therapeutic approach. METHODS: Patients who fulfilled the criteria of acute pseudo-obstruction of the colon were reviewed retrospectively from a computerized database, and from a study of the hospital notes. RESULTS: There were 12 men and eight women with a median age of 71 years. Seventeen patients (85%) had various coexisting medical conditions, and none of the cases had a recent surgical operation or trauma. Four patients had previous similar attacks. Patients had a median duration of symptoms and a hospital stay of 3 and 7 days, respectively. Diagnosis was based on the clinical features coupled with the findings on plain abdominal X-rays and contrast enema. Sixteen patients were successfully treated conservatively over a median time of 5 days. Three patients had a laparotomy: two patients had tube caecostomy (followed by complications), and one patient had no further treatment. One patient had colonoscopy with an unsatisfactory result. Two patients (10%) died and three (15%) developed complications. CONCLUSIONS: Acute colonic pseudo-obstruction is an uncommon but serious condition. The majority of our patients (17/20) had associated significant medical problems. Most of the patients were successfully managed conservatively. This was the preferred initial line of treatment in this department during the study period.

Hepatic cryotherapy and subsequent hepatic arterial chemotherapy for colorectal metastases to the liver.

This paper presents an experience of thirty consecutive patients with hepatic colorectal metastases who were treated with hepatic cryotherapy and subsequent hepatic arterial infusion (HAI) chemotherapy using 5 FU. Patients with colorectal metastases confined to the liver but not suitable for resection, and with liver involvement of less than 50% were offered the treatment. Prospective documentation of all patients was undertaken with data being recorded on a computerised database. Patients had a median of 6 (2-15) lesions with sizes ranging from 1-12 cm. There was no 30 day mortality. Postoperative complications developed in 8 patients but were followed by full recovery in all instances. Side effects from chemotherapy occurred in 23% of cycles. Twenty seven patients have died. Median survival from the time of cryotherapy was 18.2 months (7-34), or 23 months (9-44) from diagnosis of liver lesions. Hepatic cryotherapy with subsequent arterial chemotherapy is safe and well tolerated. The results suggest survival of patients with colorectal hepatic metastases can be improved by the use of this modality of treatment.

Primary gastrointestinal non-Hodgkin's lymphoma: a study of 35 patients.

In a retrospective study of 35 patients (29 men, 6 women) with primary non-Hodgkin's lymphomas of the gastrointestinal tract, 13 of the tumours were located in the stomach, 21 in the small bowel and one in the colon. Various radiological findings were detected, and the majority of tumours (23) had high grade histology. Three patients had immunoproliferative small intestinal disease. Only tumours in stages I and II were included in the study, and the majority (25) were in stage IIA. All patients except one had undergone resection of the neoplasm. This was followed by combined chemotherapy in 25 patients, and chemotherapy followed by radiotherapy in three cases. There were two (5.7%) hospital mortalities. Two- and 5-year survival rates were better in those patients with low stage and low grade tumours. The overall 5-year survival rate was 38%.

Schistosomiasis and sarcoma of the urinary bladder.

A young male patient with schistosomiasis and sarcoma of the urinary bladder is presented. Total cystectomy followed by radiotherapy was performed. The gross appearance, microscopic findings of the tumor and an outline of the disease are discussed.

[Ureteral strictures caused by bilharziasis]. / Harnleiterstrikturen durch Bilharziose.

In 512 patients with bilharziosis in the urosystem altogether 804 strictures of the ureter were proved. 326 patients had bilateral changes of the ureter (63.7%). With 737 stricture (91.7%) the lower third of the ureter was most frequently affected. Strictures of the medium and upper third were by far more infrequent (67 = 8.3%). The main operation techniques were passage ureteroneocystostomy (40.7%), neoimplantation of the ureter at the roof of the bladder (25.1%) and nipple-ureteroneocystostomy (19.2%). 31 patients (6.1%) had postoperative complications, there was no operation mortality. The best results were obtained by selection of the operation technique suitable for the adequate case and by prevention of a repeated affection with bilharziosis.

Bilharziasis in malignant tumours of the urinary bladder.

In a review of 2248 cystoscopic examinations conducted over 10 years, malignant tumours of the urinary bladder were found in 172 patients. In 128 of these the condition was associated with bilharziasis. The lateral wall of the bladder was the commonest site (52.3%). Squamous cell carcinoma occurred in 78.1%. Forty-nine patients refused surgery and eight were found to have advanced inoperable tumours. Seventy-one patients had a total cystectomy. There were no operative deaths but post-operative complications occurred in nine cases. Eight patients died within 2 years but 21 were well and tumour-free at 5 years. It was concluded that there is a marked association between bilharziasis and bladder cancer. When the tumour is operable, cystectomy is the treatment of choice.

Bacteroides fragilis is a silent pathogen in acute appendicitis.

The role of Bacteroides fragilis in the pathogenesis of acute appendicitis was studied in 135 patients in four patient groups: normal (17); phlegmonous appendicitis (17); gangrenous appendicitis (75); and septic complications of appendicitis (26). Aerobic and anaerobic bacteria were isolated from all groups and members of the 'B. fragilis group' were the most common anaerobic isolates. The rate of isolation of B. fragilis was similar from normal and inflamed appendices but was significantly higher from those with septic complications (p less than 0.01). Antibodies against B. fragilis were demonstrated in patients of all groups and occurred with similar frequencies in patients with normal and inflamed appendices but at a significantly higher rate in those with septic complications (p less than 0.01). Whereas patients in this latter group showed IgM-antibody responses to B. fragilis only, those with acute appendicitis had IgM antibodies against a wide range of organisms of the 'B. fragilis group' which suggests that B. fragilis does not play a significant role in acute appendicitis but may be a major cause of its septic complications.

Bilharzial strictures of the lower third of the ureter: a critical review of 560 strictures.

In a series of 329 patients with urinary bilharziasis, 560 strictures occurred in the lower third of the ureter. Bilateral ureteric involvement was seen in 231 patients (70.2%). Two hundred and fifty-two strictures (45%) were juxtavesical, 210 (37.5%) intramural, 50 (8.9%) were combined juxtavesical and intramural, 43 (7.7%) were pelvic and 5 (0.9%) were ureteric meatal strictures. The main operative procedures were pull-through ureteroneocystostomy (47.1%), ureteric reimplantation into the dome of the bladder (28.8%) and nipple ureteroneocystostomy (20.3%). Post-operative complications occurred in 17 patients (5.2%) and the operative mortality was nil. It is concluded that the best results are achieved through selection of the appropriate operative procedure and prevention of reinfestation.

Internal drainage in the treatment of intrabiliary communication of hydatid cyst of the liver.

In a series of 38 cases of liver hydatid disease, intrabiliary communication occurred in 19 patients (50%), five (13.2%) of whom had frank communication (with main bile duct) and 14 (36.8%) occult communication (with minor bile duct). While various operative procedures were adopted in dealing with the cyst, all 14 patients with the occult communication had evacuation of the cyst contents. In four of them, this was followed by external drainage, where bile continued to be drained for a period of 3 to 8 months. And in the other ten patients, internal drainage using cystojejunostomy was carried out. This procedure proved to be satisfactory, useful and safe. Five (35.7%) of 14 patients developed postoperative complications; there were no operative mortalities.