[Hepatocellular carcinoma complicated with echinococcal cyst of the liver].

AIM: We present a rare case of concomitant echinococcus and hepatocellular carcinoma in a single lesion, and discuss the possible pathogenesis. MATERIAL AND METHODS: A 64-year-old woman was admitted to the hospital with a few months' history of weakness, weight loss and abdominal discomfort. Ultrasonography and computed tomography showed a cystic lesion measuring 10 cm in diameter in the segments 2 and 3 and multiple well-enhanced nodules adjacent to the cystic portion in the segments 4,5,8. RESULTS: The diagnosis was confirmed intraoperativelly--a hepatocellular carcinoma complicated with echinococcal cyst of the liver. A left trisectionectomy was performed. Mebendazole treatment was begun. CONCLUSION: The simultaneous occurrence of echinococcosis disease and hepatocellular carcinoma is quite rare. Both of these diseases are chronic processes, and this further raises the possibility that echinococcosis could have had a role in the development of the liver cancer.

[A rare case of short bowel syndrome].

A rare case of short bowel syndrome combined with mechanical ileus due to numerous strictures of duodenum, a large part of the small and a half of the large bowel complicating radiotherapy after radical right nephrectomy for Wilms tumor 31 years ago was reported. The proximal 60cm of the jejunum were preserved only. A by-pass latero-lateral isoperistaltic retro-colonic gastrojejunoanal anastomosis was performed in combination with antiperistaltic interposition of 15cm of intact large bowel between the first proximal 40cm and the distal 20cm of the intact jejunum. The distal part of the intact jejunum was included in an isoperistaltic latero-lateral anastomosis with a normal colon segment. The success of the operative intervention depends on patient's age, intestinal residual, the presence of pre-stenosis dilatation, intestinal function and correctly selected surgical method to maintain the energy balance in the organism with oral feeding only.

[Operative-technical special features of the left lobectomy in colorectal cancer liver metastases].

The indications of the liver resection are the primary and secondary malignant neoplasms of the liver, the benign liver tumors and some inflammatory diseases. Approximately 10-30% of the patients with colorectal cancer liver metastases are suitable to a curative liver resection. The aim of the study is to presenti of the operative-technical special features of the anatomical left lobectomy of patients with colorectal cancer liver metastases. In the course of 24 months we carried out 9 anatomical left liver resections. The indications of the operation of eight of them were solitary metastases, which had appeared after an operation on colorectal cancer and at one of them the resection was performed due to an angiosarcoma of the liver. The operative blood loss was in the order of 100 ml. The operative mortality and postoperative morbidity were 0%. The anatomical knowledge of the Rex's recessus is a key of utmost importance for the performance of a left lobectomy. The Rex's recessus is a physiological enlargement of the left branch of v.porta in the region of the clamping of ligamentum teres. The liver resection highly improves the prognosis on the following conditions: a radical treatment of the primary tumor, an absence of local recurrence, an absence of an extrahepatic incidence of the primary tumor and a preservation of a sufficient capacity of the liver.

[Duct-mucosa pancreaticojejunostomy].

The subject of the study is operative-technical special features by fashioned a duct-mucosa pancreaticojejunostomy, which has been done by 15 patients. Three of the patients have been operated on a multivisceral caustic injury of an alimentary system and the rest twelve patients on a carcinoma of the pancreatic head or chronic pancreatitis. A subtotal duodenopancreatic resection has been performed on the cases with a carcinoma of the pancreatic head and chronic pancreatitis. A duodenopancreatic resection (n=3) have been done by the patients with caustic injure after a removal of an esophagus, a stomach and a part of the proximal jejunum. The operative-technical special features of the duct-mucosa pancreaticojejunostomy have been described. The postoperative mortality was 18% (n=2). The postoperative morbidity was 36% (n=4) and an anastomotic failure of the duct-mucosa pancreaticojejunostomy has been reported on two patients (18%). The consistence of the pancreas and the width of the pancreatic duct don't exert substantial influence on the leak tightness of the duct-mucosa pancreaticojejunostomy, which is an alternative operative method. A stenting of the anastomosis saves a lumen of the pancreatic duct, decreases a pressure in the jejunum and prevents an activation of the pancreatic secretion near the anastomosis.