Controversias en el tratamiento quirúrgico del tumor carcinoide rectal / Controversy in the surgical treatment of the rectal carcinoid tumor

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Fistulectomía tipo core out modificada. Abordaje personal / Modified core fistulectomy. A personal approach

Objetivo. Presentar los resultados de una técnica de fistulectomía modificada con preservación del esfínter interno y cierre de los orificios esfinterianos por planos en fístulas transesfinterianas altas y en las bajas anteriores de mujeres. Pacientes y método. Estudio prospectivo de esta técnica en 9 pacientes. Ninguno fue operado previamente de fístula y todos presentaron fístulas transesfinterianas según la clasificación de Parks. Se realizó un cuestionario de incontinencia según la escala de Pescatori en el preoperatorio y en el postoperatorio, así como a los 3 y 6 meses y anualmente. Además, se realizó ecografía postoperatoria. La técnica quirúrgica consiste en una disección del tracto fistuloso desde el orificio externo hasta el interno atravesando los planos esfinterianos. Tras la exéresis se cierra primero el esfínter interno con sutura reabsorbible y después el externo con el mismo material. Si la mucosa anal no queda tensa se opta por un cierre vertical (n = 5) hasta el margen anal; en caso contrario se emplea un colgajo mucoso/ submucoso de avance (n = 4) que se fija sobre el esfínter interno íntegro. Resultados. Se han intervenido 9 pacientes (6 varones y 3 mujeres) con una edad media de 39 años (rango, 24-55). El tiempo medio de cicatrización de las heridas fue de 28-50 días. Hubo una dehiscencia de sutura con el colgajo de avance (sin consecuencias) y dos con el cierre vertical, que se manifestaron en un caso por rectorragias defecatorias (n = 1) que cedieron espontáneamente tras cicatrizar la herida. En el otro caso se evidenció una cicatrización tórpida que obligó a una esfinterotomía superficial. El control postoperatorio mínimo de 3 meses y máximo de 24 meses no ha evidenciado recidivas fistulosas ni ningún caso de incontinencia. En 3 casos se realizó una ecografía endoanal de control en el postoperatorio que puso de manifiesto en dos casos una imagen de esfinterotomía superficial. Conclusiones. La fistulectomía tipo core out modificada permite extirpar el trayecto fistuloso entero respetando al máximo la integridad del aparato esfinteriano, y puede ser una técnica alternativa frente al uso tradicional del Seton en las fístulas transesfinterianas altas (AU)

Multiple colon tumors. Diagnosis and follow-up of 450 patients with colorectal carcinoma.

OBJECTIVE: Failure to diagnose synchronous tumors leads to errors in patient treatment and prognosis. The existence of metachronous tumors requires strict patient follow-up to ensure early identification of the second tumor. The present study evaluates the results obtained in the application of a structured procedure for the diagnosis and follow-up of multiple colorectal carcinoma. MATERIALS AND METHODS: A structured procedure was used to follow for 5 years a group of 12 patients with multiple colorectal tumors (7 synchronous and 5 metachronous) of a series of 450 colorectal neoplasms. RESULTS: Six synchronous tumors were diagnosed preoperatively and one intraoperative. Of the 5 metachronous neoplasms, 4 strictly adhered to the follow-up protocol, as a result of which the second tumor was detected at an early stage. The remaining case involved no follow-up, and the second tumor was diagnosed in an advanced stage as a result of bowel occlusion. The left colon was predominantly involved; polyps were detected in 9 cases, while two patients had 3 malignancies detected by histopathological study. COMMENTS: We emphasize the need for a full evaluation of the colon in all patients with colorectal carcinoma. In the case of incomplete preoperative evaluation, intraoperative colonoscopy is to be considered; if this is not feasible it should be performed one month after surgery. A structured follow-up procedure permits the early detection of these tumors, there by improving patient prognosis.

Hourglass thoracic lipoma of infancy: case report and review of the literature.

The authors present a case of lipoma in infancy. A 12-year-old boy was referred for an asymptomatic fast-growing thoracic tumor of 1-month evolution. A simple chest x-ray showed an intra- and extrathoracic mass of extrapleural localization. Ultrasound scan and computed tomography studies were performed, and the diagnosis of an hourglass lipoma was confirmed by a fine-needle aspiration biopsy. Surgical excision of the tumor was performed and the pathological study reassessed the initial diagnosis of lipoma. The thoracic lipoma is a benign disease and has a good evolution after surgery.

[Fetus in fetu: a case report of an extremely rare cause of abdominal tumors in the infant]. / Fetus in Fetu: Ein Fallbericht einer extrem seltenen Ursache von Bauchtumoren beim Säugling.

Fetus in fetu is an extremely uncommon cause of an abdominal mass in the neonate. A 6-week-old female was brought to our hospital because of an upper abdominal mass. A plain x-ray demonstrated a mass of structured bones that suggested a teratoma or fetus in fetu. At operation a 20 cm mass was found in the mesocolon covered by a membrane. The mass corresponded to a fetus in fetu connected by an umbilical-like cord to the host in the depth of the radix mesocoli. The fetus in fetu weighed 150 g and had severe malformations, such as internal hydrocephalus, a left side anotia, a descended right ear, anophthalmia, a right-sided amelia, a micromelia on the left side with 4 fingers, a sympus with 5 and 7 toes on the left and right side, respectively. There was also an almost complete aplasia of the internal organs with some remnants of intestine near the umbilical cord.

[Surgical treatment of Zenker's diverticulum. Apropos of 14 cases]. / Tratamiento quirúrgico del divertículo de Zenker. A propósito de 14 casos.

We present our experience in the surgical treatment of 14 cases of Zenker's diverticulum, diagnosed from January, 1969 to December, 1988. In 11 cases we performed one stage diverticulectomy; in 4 cases, manometric findings required cricopharyngeal myotomy. In 3 cases surgical treatment was not indicated; 2 patients had liver cirrhosis and high surgical risk and the third patient declined the treatment. Current treatment is discussed.

[Presentation of 6 cases of cystadenocarcinoma of the pancreas]. / Aportación de seis casos de cistoadenocarcinomas de páncreas.

Cystadenocarcinomas represent approximately 1% of the pancreatic tumors and are difficult to diagnose clinically and by pathology. Due to their rarity, published series are small. We present 6 cases of pancreatic cystadenocarcinoma collected over a period of 15 years at the Visceral Surgery Service of the Valencia University Hospital. The better evolution and prognosis of these tumors in comparison with pancreatic adenocarcinomas is noteworthy.