[A rare cause of peritoneal fistula]. / Fistula abdominala de cauza neobisnuita.

The abdominal pregnancy is an extremely rare variety of the ectopic pregnancy. The symptoms are atypical, which causes a delay in putting the diagnosis, which is established most of the times when complications appear, which are always severe, and endanger the patients lives. This paper presents a rare complication of the abdominal pregnancy, at about 6 months old, stopped in evolution, complicated by an abscess, generalised peritonitis and peritoneal fistula. The diagnosis and treatment of the abdominal ectopic pregnancy are discussed.

[Gastric volvulus--complication of a large paraesophageal hiatal hernia]. / Volvulusul gastric--complicatie posibila in herniile hiatale paraesofagiene mari.

The authors present the case of a patient with a large paraesophageal hiatal hernia complicated with organo-axial gastric volvulus. We discuss problems of diagnosis and therapeutical options.

[Gastrointestinal stromal tumor (GIST) with jejunum localisation, unusual source of digestive bleeding. Considerations about two cases]. / Tumora stromala gastrointestinala (GIST) cu localizare jejunala, sursa rara de hemoragie digestiva. consideratii pe marginea a doua cazuri.

Gastrointestinal stromal tumors are those gastrointestinal tumors , which expression antigens for CD 117 and CD 34. GIST arise from c - kit gene mutation through inadequate function of KIT enzyme (thyroxine kinase). However, the name is gastrointestinal stromal tumor, their localisation maybe under esophagus, stomach, duodenum, small bowel or colorectal.. CT scanning shows tumoral mass with nonspecific affiliation thanks to this development extraluminal and exophytic. Digestive hemorrhage, through GIST with small bowel localisation was called "obscure" because of impossibility to detect preoperative a bleeding source. We present, two cases of hemorrhage through GIST with jejunal localisation, male 70 years old with 10 cm tumor, discovered through CT scanning such as tumoral mass in left hypochondrium and female 55 years old, with 3 m tumor, discovered through emergency laparotomy for severe digestive bleeding. Also, it is discussed the possibility of intraoperative diagnosis, criterion to appreciate benign and malign features of the tumors and to determine their mitotic index for the supervision of these two cases.

[Severe nosocomial infection of soft tissue in general surgery]. / Infectiile nosocomiale severe ale partilor moi în chirurgia generala.

This paper aim is to emphasize the severity of soft tissue nosocomial infections, determined by anaerobic bacteria associated with Gram-negative aerobic bacteria: 50% mortality, higher economic costs, disabling morphologic and functional sequels. We present the pathogenic, clinical and therapeutically problems which characterize this type of postoperative infections.

The esophagogastric junction cancer: diagnosis and surgical treatment challenges.

AIM: To present our experience in esophagogastric cancer. MATERIAL AND METHOD: Fifty nine subjects with esophagogastric junction cancer (52 men and 7 women, aged between 41 and 74 years), selected from 79 esophageal cancer patients admitted in the last 20 years (1982-2002) were analysed. The diagnosis was established on the clinical picture (esophageal syndrome 54 cases, weight loss 51 cases, anemia 49 cases), on the imaging tests (chest X-ray, barium swallow and CT scan) and endoscopy. The delay of the diagnosis was more than 1 year in 71.5% of cases. 47 (79.7%) cases were operated on; we performed 18 resections (14 total esophagogastrectomies with end-to side esophagojejunostomy and 4 partial esophagogastrectomies with intrathoracic esophagogastrostomy), 24 gastrostomies and 5 exploratory laparotomies. The surgical approach was left thoracotomy with frenotomy in all 18 resectable cases. All resected cases were adenocarcinomas, belonging to the II B and III pTNM stages. RESULTS: refer only to the resected cases. We registered: fair evolution in 13 cases (72.2%), postoperative morbidity rate of 27.8% (5 cases) and postoperative mortality rate of 5.5% (1 case). We also registered the following long term survival: 7 cases less than 6 months, 6 cases between 6 months and 1 year, 3 cases between 1 and 3 years and 2 cases over 5 years. CONCLUSIONS: 1. preoperative assessment of the local invasion and lymphatic spread is very difficult; 2. surgical exploration is the only certain method for the assessment of resectability; 3. left thoracotomy with VII or VIII rib resection and frenotomy is the best surgical approach; 4. total esophagogastrectomy with end-to side esophago-jejunostomy is the main surgical procedure in the esophagogastric junction cancers.

Cystic tumors of the pancreas. Considerations upon 34 operated cases.

AIM: To point out the morphologic, clinic and therapeutic aspects of pancreatic cystic tumors. MATERIAL AND METHOD: 34 pancreatic cystic tumors (21 males and 13 females, aged between 21 and 68 years), admitted in the last 15 years were analyzed. They were true cysts in 3 cases (9.9%) and pseudocysts in 31 cases (91.1%), located on the head of the pancreas in 8 cases, on the body in 19, on the tail in 6 and on the body and tail in 1 case. We noticed in the past medical history of the patients with pseudocysts a recent acute pancreatitis attack (26 cases), chronic pancreatitis (4 cases) or a recent abdominal trauma (1 case). The delay between the acute pancreatitis attack and the onset of the pseudocyst varied between 18 days and 2 months. The diagnosis was established by clinical picture (Shefer-Silvis triad), laboratory findings and imaging tests (barium meals, ultrasound test and/or CT test). Thirty cases (27 pseudocysts and 3 true cystic tumors) were operated on: the main surgical procedures were cystogastrostomy (12 cases), cystojejunostomy (6 cases) or cystoduodenostomy (3 cases); we also performed distal pancreatectomy (3 cases), laparostomy or external drainage in 5 cases. RESULTS: We registered 1 death (mortality rate of 3.3%), 2 pancreatic fistulae, 1 pancreatic abscess and 2 recurrences. CONCLUSIONS: 1. The pseudocyst, as an evolutionary complication of acute or chronic pancreatitis, is the most frequent cystic tumor of the pancreas, true pancreatic cysts being extremely rare. 2. The diagnosis is established by clinical pictures, laboratory findings and imaging tests. 3. The treatment is surgical, cystogastrostomy or cystojejunostomy being the main surgical procedures.