Peritoneal tuberculosis with an atypical presentation. Surgical case report.

INTRODUCTION AND IMPORTANCE: 1-3% of tuberculosis cases are extrapulmonary, which 11-16% are abdominal. In recent years, a progressive increase in the number of peritoneal tuberculosis cases has been observed. Peritoneal tuberculosis accounts for only 1-2% of all cases of peritonitis. Historically it is known as "the great mimicker" since it can resemble a neoplastic, infectious or inflammatory intestinal disease. The most common triad of presentation is fever, weight loss and abdominal pain; ascites is also usually present. For diagnosis, computed tomography is the most sensitive technique and is complemented by elevation of CA 125 and Adenosine deaminase (ADA) but is confirmed by pathology study. Treatment is the same as the pulmonary presentation. CASE PRESENTATION: A 33-year-old man presented with acute complication appendicitis. A limited right hemicolectomy was performed due to the nature of the patient advanced disease. Multiple small tumor resembling peritoneal implant and a granuloma were identified has sampled during the patient's surgical procedure. Pathologic examination revealed peritoneal tuberculosis and medical therapy was initiated. Laboratory assays including CA 125 and adenosine deaminase (ADA) can be useful serum markers to follow during treatment if they are positive. DISCUSSION: The most common presentation of peritoneal tuberculosis is fever, weight loss and abdominal pain. Our patient did not have any of these symptoms, we founded granulomas in surgery of intestinal restitution. METHODS: The work has been reported in line with the SCARE criteria. CONCLUSIONS: This pathology should always be kept in mind as a differential diagnosis when faced with unexpected findings in surgery.

Packed red blood cell donor age affects overall survival in transfused patients undergoing hepatectomy for non-hepatocellular malignancy.

BACKGROUND: Patients undergoing hepatectomy often require packed red blood cell (PRBC) transfusion, which has been associated with worse oncologic outcomes. However, limited data exist regarding the impact of PRBC donor factors. We hypothesized that PRBC donor age impacts survival after hepatectomy for non-hepatocellular malignancies. METHODS: Patients who underwent hepatectomy for non-hepatocellular malignancy from 2005 to 2014 were retrospectively evaluated. Impact of clinicopathologic and PRBC factors on oncologic outcomes were assessed. RESULTS: Of 149 identified patients, 76 received a perioperative PRBC transfusion (median 2 units). Transfusion was associated with increased median length of stay (8 vs. 6 days; p < 0.01) and median operative blood loss (700 vs. 350 mL; p < 0.01) versus non-transfused, respectively. In transfused patients, receipt of PRBC from older donors compared to younger resulted in decreased RFS (0.94 vs. 2.63 years, respectively; p = 0.02) and OS (1.94 vs. 3.44 years, respectively; p = 0.6). The PRBC donor age was an independent predictor of decreased recurrence free survival on multivariate analysis (HR 2.5, p = 0.04). CONCLUSIONS: In patients undergoing hepatectomy for non-hepatocellular malignancies and receiving perioperative transfusion, PRBC donor age may impact survival and warrants further investigation.

Preoperative enteral access is not necessary prior to multimodality treatment of esophageal cancer.

BACKGROUND: Surgical enteral access prior to multimodality treatment for esophageal cancer is controversial as dysphagia is often used for feeding tube referral. We hypothesized that enteral access before neoadjuvant chemoradiation for esophageal cancer provides no benefit compared to that placed during definitive esophagectomy. METHODS: Patients undergoing esophagectomy for esophageal malignancy from 2007 - 2014 were retrospectively identified. Clinicopathologic factors were recorded including preoperative enteral access, weight change, nutritional laboratory works, and perioperative complications. RESULTS: Of 156 identified patients, 99 (63.5%) received neoadjuvant chemoradiation and comprised the study cohort. Fifty (50.5%) underwent enteral access (gastrostomy [14], jejunostomy [32], other [4]; "Access Group") prior to chemoradiation followed by esophagectomy and were compared to 49 "No-Access" patients who underwent enteral access during esophagectomy. Clinicopathologic variables were similar between cohorts. The Access and No-Access cohorts had similar reported dysphagia (86% vs 75.5%, respectively; P = .2) and mean preesophagectomy serum albumin (3.9 vs 4 gm/dL, respectively; P = .2). Weight loss ± 6-month periesophagectomy was similar between access versus No-Access cohorts (-11.2% vs -15.4%, respectively; P = .1). Weight loss during this period was likewise similar for patients with dysphagia in the Access (-11%) versus No-Access group (-15.2%, P = .1). No difference in complication rates was noted between Access (64%) and No-Access groups (51%, P = .2). CONCLUSION: Despite healthcare provider bias, there seems to be no nutritional or perioperative benefit for enteral access before neoadjuvant chemoradiation for esophageal malignancy. Patients with esophageal malignancy should therefore proceed to appropriate neoadjuvant and surgical therapy with enteral access performed during definitive resection or reserved for those with frank obstruction on endoscopy.