Managing Malignant Colorectal Obstruction with Self-Expanding Stents. A Closer Look at Bowel Perforations and Failed Procedures.

Stent treatment of large bowel obstruction is still controversial. There are concerns regarding complications, particularly bowel perforation, as well as long-term outcome in curable patients. Through a 10-year retrospective study, we have evaluated efficacy, complications, delay in surgical interventions and stent patency in cases of palliative treatment. We treated 183 patients, 85 as bridge to surgery and 98 as definitive, palliative treatment. At presentation, 58 % of patients had advanced local or metastatic disease. Seventeen patients required more than one stent insertion. The total number of procedures was 213. We recorded technical and clinical success or failure, complications, necessity of restenting or surgical intervention, mortality and stent patency in the palliation group. Stenting was clinically successful in 89 % of the bridge to surgery group and 86 % of the palliative group. Complications occurred in 7 %, including 12 perforations. Six patients suffered an early perforation, of which two died. Half of the six late perforations were silent. Procedure related mortality was 1 %. The clinical success rate was high in both the palliative and bridge to surgery setting. The complication rate was low, and the sum of early and late perforations was 5.6 %. Procedure related mortality was low.

[Sphincteroplasty in traumatic anal incontinence]. / Sfinkterplastikk ved traumatisk betinget anal inkontinens.

BACKGROUND: Anal incontinence in young women is often caused by sphincter rupture from obstetric injury or anal fistula surgery. MATERIAL AND METHODS: From 1992 to 1997, 17 women were operated for anal sphincter injury at Aker University Hospital, Oslo, Norway. Data were obtained retrospectively from patient files. RESULTS: In 13 patients, the anal incontinence was caused by obstetric injury and in four by anal fistula surgery. In all patients the external anal sphincter was repaired with overlap technique. In addition, plication of the puborectalis muscle was performed in 15 patients, perineoplasty in eight, vaginoplasty in one and operation for genital prolapse in one. Nine patients had a temporary loop sigmoidostomy. 12 of 16 patients for whom postoperative symptoms had been recorded, reported improved anal continence. Eight of these had complete anal continence, whereas four still experienced some incontinence for gas and loose stools. On clinical examination, 11 patients had normal resting sphincter pressure and voluntary sphincter contraction. Six had weak voluntary contraction; two of these had normal resting sphincter pressure. INTERPRETATION: Traumatic anal sphincter injuries in young patients can seriously impair anal function. Results of surgical treatment are satisfactory in most patients.

[Pulmonary plasma cell granuloma. Inflammatory pseudotumor in the lung]. / Pulmonalt plasmacellegranulom. Inflammatorisk pseudotumor i lunge.

A 62-year-old woman developed minor symptoms of subacute respiratory infection simulating bronchitis. Six weeks later, X-ray of the chest revealed a solitary round infiltration ("coin lesion") in the basal part of the left lung. No diagnosis could be made preoperatively. Thoracotomy demonstrated a plasma cell granuloma. The affected pulmonary segment of the basal part of the upper lobe was resected. There were no clinical nor radiological signs of recurrence five years after the operation.