Stercoral perforation of the sigmoid colon. A case report and brief review of the literature.

Stercoral perforation of the colon due to fecaloma is a rare disease and less than 100 cases have been described in the literature. The disease mainly involves the rectosigmoid colon. The condition is correlated with longstanding decubitus, chronic constipation, abuse of laxatives and/or constipating agents (anticholinergics, neuroleptics, etc). We report a case of 82-year old woman who presented a covered colonic perforation due to fecaloma, related with a history of longstanding decubitus because of senile dementia, chronic constipation and use of anticholinergic drugs.

A prospective comparison of ampullectomy with pancreaticoduodenectomy for the treatment of periampullary cancer.

Local surgical treatment of periampullary neoplasms seems attractive in the context of the reduced morbidity and mortality than the more radical treatment options. The aim of our study was to compare local excision (LE) of the ampulla with standard pancreaticoduodenectomy (PD) for the treatment of periampullary cancer in terms of overall survival. Inclusion criteria were primary tumor < or = 2 cm with no evidence of lymph node involvement or distant metastasis on abdominal computed tomography (CT). Between January 2000 and January 2004, 23 patients were enrolled onto this study (9 in the LE group and 14 in the standard PD group). The two groups were homogeneous with respect to age and gender as well as the size and origin of the primary neoplasm. There was no correlation of the survival with age, gender, presence of lymph node metastasis, size of the primary tumor, type of surgery or histologic grade (x(2), p >0.05). However, the origin of the tumor had major impact on survival, with pancreatic tumors having the worst prognosis. Hospital stay was significantly reduced in the LE treated patients. Our results showed that LE for periampullary tumors is a viable option and is well suited for medically unfit patients or those who refuse more radical treatment options.

Endoscopic transgastric procedures in anesthetized pigs: technical challenges, complications, and survival.

BACKGROUND AND STUDY AIMS: An incisionless endoscopic peroral transgastric approach to the peritoneal cavity has shown promise in animals as a potentially less invasive form of surgery. We present our experience with various endoscopic peroral transgastric procedures, reporting on the technical aspects and challenges that arose. MATERIALS AND METHODS: The following procedures were performed in 10 anesthetized pigs using a double-channel endoscope: peritoneoscopy (10 pigs), liver biopsy (one pig), cholecystectomy (six pigs), fallopian tube excision (one pig), and hysterectomy (one pig). RESULTS: All the procedures were accomplished successfully. There were six minor intraoperative complications. Complete gastric cleansing and elimination of all bacteria was found to be impossible to achieve in the porcine model. Overinflation was a common problem. The lack of adequate endoscope support was a major limitation. Safe closure of the gastrotomy incision was difficult using the available clipping devices. Six pigs made an uncomplicated recovery after a follow-up period of 4-6 weeks. Subsequent pathological examination revealed deep gastric ulceration in one animal and a gastric wall abscess in another. CONCLUSIONS: Peroral transgastric surgery is technically feasible and safe in a porcine model. Although all the procedures were performed successfully, the study highlights some technical difficulties and illustrates the need for major technical innovations and extensive animal studies in order to evaluate the merits of incisionless surgery.