Perianal giant condyloma acuminatum (Buschke-Löwenstein tumor). Case report and review of the literature.

UNLABELLED: Giant condyloma acuminatum, also known as Buschke-Löwenstein tumor (BLT) is a very rare sexually transmitted disease that affects the ano-genital region. BLT is a slow growing cauliflower-like tumor, but unlike simple condyloma, it is locally aggressive and destructive, malignant transformation occuring in 40-60% of cases. We present a case of perianal carcinomatous BLT and discuss some controversies about the nature and treatment of this disease. Our aim is to emphasize some basic points in the management of giant perianal condyloma acuminatum. CONCLUSIONS: The patient with BLT must be very carefully clinical and imagistic investigated in order to detect the tumor visceral invasion and to establish the extension of the surgical procedure. Wide perineal excision with histopathological margins control is the best surgical choice if the anal canal is not involved. The radical pelvic surgery is indicated only in patients with provable visceral invasion. Excision is mandatory even in very small condilomas to prevent BLT later development.

[Temporary total fecal diversion--ultimate solution for complex recurrent anal fistula]. / Colostomie terminala temporara--solutie extrema într-un caz de fistula perianala complexa multirecidivata.

Anal fistula is a frequent disease, but complex fistulae are relatively uncommon. The treatment for this pathology remains debated all over the world, and in cases of complex fistulae represents a challenge. We present a 55 years old male, operated more than 40 times in the last 15 years for perianal recurrent fistulas and abscesses. The fistula has had a progressive evolution despite all kind of surgery and has extended finally to entire perineal and gluteal region; more than 30 orifices were founded on skin surface and many internal anorectal orifices as well. The patient is weakened, anemic, in chronic sepsis. As a last resort, we decided to perform a terminal fecal diverting stoma at the level of sigmoid colon, with closure of distal end. There were subsequent operations necessary to resolve perineal and gluteal disease: extensive excisions of altered tissues, various full-thickness skin grafts and covering flaps. After 12 months the perineal region was clean, so remaking of colic continuity was possible. Continuous follow-up until 12 months revealed no sign of recurrence. We conclude that temporary total fecal diversion followed by wide excisions of perianal fistulous tissues represents an ultimate solution to complex recurrent perianal fistula, with good results at least in our case.

[Acute surgical abdomen produced by an abdominalized infected gigantic hydatid cyst]. / Abdomen acut chirurgical produs de un chist hidatic hepatic gigant infectat abdominalizat.

We report the case of a 47 year old female patient, transferred urgently to our clinic with suspicion of a broken liver hydatid cyst, with acute, generalized peritonitis. Intraoperative we found a gigantic liver hydatid cyst, surrounding the liver with a massive abdominal extension till the Douglas's bottom sack, adhesive to the parietal and visceral peritoneum. There are presented particular aspects concerning the uncertainties that happened in positive diagnosis establish, the disease evolution, as well as the difficulties of surgical conduct in this case.