[Iliac venous aneurysm: a case report and review of literature]. / Anevrism al venei iliace comune drepte: prezentare de caz si revista literaturii.

Primary iliac vein aneurisms are extremely rare being described as anomaly, without any history of trauma, cardiovascular pathology or arteriovenous fistula. This clinical condition has a high rate of potentially fatal complications: pulmonary embolism; ruptured aneurism; deep vein thrombosis. There are only 7 cases of iliac vein aneurism described in the literature. We describe an additional case of a 59-year old patient presented with abdominal pain, right lower limb edema and palpable mass in the right iliac area. Ultrasound (US) revealed a liquid formation, confirmed by computed tomography (CT). Surgical removal of the aneurism with lateral venorrhaphy was performed. Postoperative evolution was uneventful. The patient is asymptomatic during 36 month follow-up.

[Bleeding gastric inflammatory fibroid polyp (Vanek's tumor)]. / Polip inflamator fibroid gastric (tumoare Vanek) cu hemoragie.

Inflammatory fibroid polyp's (IFP) or Vanek tumor of the gastrointestinal tract represents a relatively unusual entity. IFP is an extremely rare cause of upper gastrointestinal bleeding. We report herein a case of a 30-year-old woman who had a gastric IFP complicated by gastrointestinal bleeding and obstructive symptoms. The lesion was mistaken on endoscopic, radiologic examination and in the operating room for a gastrointestinal stromal tumor (GIST). Preoperative endoscopic examination revealed a protruding oval-shaped submucosal lesion (approximately 7 cm in size) of the gastric antrum, with ulceration of the mucosal surface. Multiple endoscopic biopsies were negative for neoplastic changes. Barium meal study disclosed a large tumor in the prepyloric area of the stomach. Presumptive preoperative diagnosis was GIST. Subtotal Bilroth II gastrectomy en bloc with the mass and lymphadenectomy was performed. Surprisingly, the final histological diagnosis was IFP. Postoperative course was uneventful and no recurrences were observed during 4 years follow-up. With reference to case report, the etiology, diagnosis and treatment strategy of IFP will be discussed. This case highlights an unusual presentation of IFP. Although bleeding may represent a rare complication due IFP, it should be considered in the differential diagnosis of upper gastrointestinal hemorrhage of uncertain etiology.

[Mesenteric cyst in the descending colon: a case report]. / Chist al mezocolonului descendent.

Mesenteric cysts are rare abdominal findings. The majority are asymptomatic and if found are discovered incidentally during ultrasonography and/or CT scanning. The optimal surgical treatment requires complete excision of the cyst. We report a case of 36-year-old woman with mesenteric cyst in the descending colon. Laboratory tests indicated no abnormality. Abdominal CT revealed a cystic mass in the retropreritneal space measuring 14.0 x 8.3 x 9.4 cm, density 26-29 HU. We found a cystic mass at the mesentery of the descending colon that was removed in toto. The authors discuss the symptoms and complications, classification, and treatment of mesenteric cysts with review of literature.

[Carcinoid of the minor duodenal papilla associated with multiple jejunal leiomyomas in type 1 neurofibromatosis]. / Carcinoidul papilei duodenale mici asociat cu leiomioame jejunale multiple si neurofibromatoza tip 1.

Duodenal endocrine tumors are rare and represent 2% of all gastrointestinal endocrine neoplasms. Carcinoids of the ampulla of Vater are the most rare primary ampullary tumors. There was noted a frequent association of the endocrine tumors with type 1 neurofibromatosis also known as von Recklinghausen disease. To the best of our knowledge there are only 8 cases of papilla duodenalis minor carcinoids described in the literature. Authors describe herein the first carcinoid of papilla duodenalis minor case associated with multiple synchronic jejunal leiomyomas and von Recklinghausen disease, manifested with proximal intestinal obstruction and resolved by pancreatoduodenectomy (Kausch-Whipple procedure).

Endoscopic papillectomy into the treatment of neoplastic lesions of vater papilla.

UNLABELLED: Adenomas of the duodenal papilla are rare. The frequency of malignant adenomas is 15-30%. Villous adenoma is a premalignant lesion with the highest rate of transformation. Options for surgical treatment include endoscopic and ablation resection, transduodenal ampullectomy, duodeno-pancreatectomy. AIM: Evaluation of the efficacy and safety of endoscopic papillectomy for ampullary adenomas. MATERIAL AND METHOD: 12 patients were selected (F:M, 5:7, age range 37 - 68 years) with ampullary adenoma, treated by endoscopic papillectomy. Biliary sphincterotomy was performed in 6 cases; and pancreatic sphincterotomy was performed in 3 cases. Biliary stenting was performed in 2 cases; pancreatic stent was placed in 11 cases. RESULTS: En bloc resection was performed in 8 cases, and piecemeal resection in 4 cases. Complete resection R0 was noted in 10 cases. Pathology examination has show: tubulo-villous adenoma (5 patients); villous adenoma (4 patients), tubular adenoma (2 cases), adenocarcinoma (one case). Complications were immediate: bleeding (2 cases) and pancreatitis (1 case). Follow-up endoscopy reveals no ductal stenosis or recurrence. CONCLUSION: Endoscopic papillectomy is a safe and well-tolerated alternative to surgical treatment of ampullary adenoma.

[Recurrent Crohn's disease in the ileocolonic anastomosis complicated with duodenal fistula]. / Boala Crohn recidivanta în anastomoza ileo-colica complicata cu fistula duodenala.

Duodenal fistulas in patients with Crohn's disease are rare, and up to one hundred cases were described in the medical literature. We report an additional case of a 40-year-old male who underwent an ileo-ascending colectomy 13 years ago for Crohn's disease and was admitted to our unit with palpable abdominal mass and persistent cutaneous fistula. Preoperative fistulography and barium enema demonstrated Crohn's disease recurrence in the site of the ileocolonic anastomosis and external fistula communicating with the pre-anastomotic ileum. At surgery, Crohn's disease recurrence in the site of ileocolonic anastomosis with ileo-cutaneous fistula was confirmed and an additional ileo-duodenal fistula was detected incidentally. The patient underwent resection of the affected bowel and simple closure of the duodenal fistula with omental pedicle graft transposition between the duodenum and the ileocolonic anastomosis. Postoperative period was uneventful. We review the literature and discuss the incidence and treatment strategy of duodenal fistulas complicating recurrent Crohn's disease in the site of the ileocolonic anastomosis. The authors highlight that simple closure of the duodenal defects is appropriate only for small duodenal fistulas and omental transposition between ileo-colonic anastomosis and duodenum during the primary and repeated resection should be considered as an effective prevention method of duodenal fistulas formation.

[Splenic abscess--etiologic, clinical and diagnostic features]. / Abcesul lienal--aspecte etiologice, clinice si diagnostice.

The aim of the study is to elucidate premorbid grounds, diagnostic and clinical peculiarities, as well as medical and surgical management of non-parasitic spleen abscess. We study 6 cases, with median age 56.7 years, men/women ratio--2:1. Onset-diagnosis period was of median 20 days. In 5 cases (83.3%) spleen abscess developed in immune compromised patients (diabetes mellitus, liver cirrhosis, pancreatitis) and in one case (16.7%) subsequent to blunt abdominal trauma. Clinically, patients presented fever, weight loss and pain in the left upper quadrant of the abdomen. The imaging data (USG, CT, and Rx-thoracic) performed prior to surgery confirmed the diagnosis. USG revealed splenic injury in 80%, CT had a 100% sensibility and thoracic Rx revealed left-side pleuro-pulmonary reaction in 83% of cases. Bacteriological test was positive in 50% of cases. One death was recorded in first 24 hours after surgery. The rest of the cases had a favorable evolution, although, in 2 cases a left subphrenic abscess was noticed, one requiring drainage; in one case--colonic fistula, which closed spontaneously. Although, it's a rare pathology, an early diagnosis is as important, as impossible, and it's delay exhausts the organism and increases the postoperative morbidity rate, splenectomy remaining the safest method of treatment.

[Mucinous cystadenocarcinoma of the appendix complicated with spontaneous cutaneous fistula]. / Chistadenocarcinom mucinos apendicular complicat cu fistula cutanata spontana.

Mucocele of the appendix is a relatively rare disease characterized by a cystic dilatation of the appendiceal lumen with stasis of mucus inside. Appendiceal mucocele with a cutaneous fistula is an extremely rare clinical entity, only four such cases being described in the medical literature. We report an additional case of cystadenocarcinoma of the appendix with spontaneous cutaneous fistula. The patient is an 80-year old woman, who originally presented with a skin ulcer in the right lower abdominal quadrant with mucus discharge during the last month. Abdominal ultrasonography and computed tomography demonstrated cystic mass with mixed echogenity and density originating from the appendix, involving the abdominal wall, without signs of ascites or metastasis. A right hemi-colectomy, lymphadenectomy and resection of the skin fistula was performed. The histological findings revealed moderately differentiated mucinous cystadenocarcinoma of the appendix. The postoperative period was uneventful and the patient discharged on the 11th POD. During 12 month follow-up period the patient is free of disease recurrence. The authors present the literature review, diagnostic features and the treatment policy of this extremely rare condition.

[Intrabiliary rupture of the hydatic cyst complicated with acute pancreatitis]. / Erupere intrabiliara a chistului hidatic hepatic complicata cu pancreatita acuta.

Acute pancreatitis is a rare complication of hydatidosis, and only few reports were published previously. We report a case of a 17-year-old man, with recurrent liver hydatid cyst, who presented with severe upper abdominal pain, vomiting, jaundice. Amylase and bilirubin were elevated. Abdominal CT scan showed a cystic lesion in the dome of the liver and a diffusely swollen pancreas. At endoscopic retrograde cholangiopancreatography (ERCP) the common bile duct was dilated with fragments of hydatid membrane. A sphincterotomy was performed and hydatid membranes were extracted, after which the patient made an uneventful recovery and the level of amylase and bilirubin normalized. After two weeks a new episode of hydatid rupture occurred with clinical presentation of cholangitis. Emergency surgery was performed, which consisted of cystectomy, suture of intracavitary bile fistula, omentoplasty, choledochotomy with extraction of the hydatid membranes and common bile duct drainage. There were no relapses during 5 years follow-up. This case report highlights that ERCP and sphincterotomy are considered the procedures of choice in acute pancreatitis induced by biliary rupture of the hydatid cyst and surgical treatment is considered to be the only definitive treatment of the hydatic cystic lesion of the liver with intrabiliary rupture.

[Organized pancreatic necrosis resembling retroperitoneal tumor]. / Necroza pancreatica organizata simulând tumoare retroperitoneala.

This paper presents the case of a 29 years old patient who has an organized pancreatic necrosis, presenting preoperative differential diagnosis problems and surgical technique difficulties, revealing the fact that, in this particular case, paraclinical investigations have an orientative value, and are not offering information regarding etiology, and do not allow to establish a preoperative strategy. Tumor resection was performed; final diagnosis was established by histological examination. The follow-up period was uneventful.