Preoperative staging of colon cancer patients: ultrasound can be a valuable alternative to computed tomography.

OBJECTIVE: The aim of this study was to compare the results of ultrasound and CT assessment in preoperative staging of colonic cancer, and to determine whether CT offers any benefits beyond ultrasound. PATIENTS AND METHODS: Sixty-one cases of intraperitoneal colon cancer were assessed by preoperative abdominal ultrasound and CT. The ultrasound and CT findings were assessed for ascites, hepatic and peritoneal metastases, invasion of adjacent organs, and findings of other diseases. RESULTS: The sensitivity rates of CT for liver metastases, adjacent organ invasion, ascites and peritoneal metastases were 81 %, 25 %, 29 % and 20 % respectively, while those of ultrasound were 69 %, 6 %, 43 % and 0%, respectively. Both methods had similar sensitivity, specificity and accuracy rates regarding the detection of all criteria. Ultrasound was more sensitive for detecting ascites and liver metastasis when compared to peritoneal metastasis and invasion (p<0.05). CT allowed the detection of liver metastasis to be more sensitive when compared to the other three criteria (p<0.05). In addition to ultrasound, CT gave no more additional knowledge indicating the necessity of altering the clinical management in patients. CONCLUSION: The first-line scanning technique should be the ultrasound and there is no need for CT scan, should no abnormalities be found upon ultrasound examination. CT investigation plays a role in cases where the ultrasound findings are suspicious (Tab. 1, Ref. 16). Full Text in free PDF www.bmj.sk.

Right liver necrosis: complication of laparoscopic cholecystectomy.

Although bile duct injuries are common among the complications of laparoscopic cholecystectomy, hepatic vascular injuries are not well described. Between January 1990 to December 1999, 83 patients with bile duct injuries have been referred to our clinic. Two of them had liver necrosis due to hepatic arterial occlusion. These two women had laparoscopic cholecystectomy for symptomatic cholelithiasis in district hospitals 4 and 15 days prior to their referral to our clinic. Serum aspartate aminotransferase and alanine aminotransferase levels were found to be 30 to 40-fold higher than normal levels. Ultrasonography, computed tomography and Doppler sonography showed necrosis in the right liver lobe and no flow in the right hepatic artery. Patients were also complicated with liver abscess and biliary peritonitis, respectively. Emergency right hepatectomy was performed in both cases and one of them needed Roux-Y-hepaticojejunostomy (to the left hepatic duct). One patient died of peritonitis in the postoperative period. The other one has no problem in her third postoperative year. The earliest and the simplest method for diagnosis or ruling out hepatic arterial occlusion is detecting the blood biochemistry and Doppler ultrasonography. In some cases emergency hepatectomy can be necessary. Postoperative complications should be expected higher than elective cases.

Is endorectal ultrasound still useful for staging rectal cancer?

OBJECTIVE: Staging in rectal carcinoma is important for planning treatment. Preoperative staging and treatment strategies have changed along with improvements in imaging techniques. The aim of this work is to evaluate the accuracy of endorectal ultrasound (ERUS) in rectal cancers, especially in low rectal cancers and stenotic cases. PATIENTS AND METHODS: From January 2011 to December 2011, patients diagnosed with rectal cancer who were admitted to our endosonography unit for staging and who were operated on in our hospital were evaluated retrospectively. Patients who received neoadjuvant chemotherapy were excluded. Endosonographic staging was compared to postoperative pathological staging. RESULTS: In total, 38 patients (28 males, 10 females) were included. Their mean age was 57.6±11.3 years (27-75 years). Thirteen (34.2%) had stenotic lesions. The accuracy of ERUS for staging of lesions was evaluated according to pathology and was 73.7% overall (kappa coefficient = 0.317; p = 0.002). When patients were split into stenotic and non stenotic groups, the accuracy was 68% (kappa coefficient = 0.170; p = 0.125) for stenotic lesions and 84.6% (kappa coefficient = 0.606; p = 0.001) for non-stenotic lesions. Internal and external sphincter involvement were significantly correlated with the postoperative pathological evaluation in both groups. CONCLUSIONS: Technological improvements in imaging methods have made the diagnosis and management of malignancies more precise. Low rectal tumours, have difficult characteristics for evaluation because of their unique location. Although ERUS has some disadvantages, it is still useful for T staging, evaluating sphincter involvement, and defining tumour size and distance from the anal verge. ERUS was less accurate for T staging of stenotic tumours, but the accuracy may still be within acceptable limits.

Ischemic necrosis of the right colon in a patient with a ventricular assist device system.

Despite improvements in medical therapy, the annual high mortality rate from end-stage heart failure continues. Although cardiac transplantation is a successful treatment for these patients, the shortage of donor hearts has led surgeons to seek other options. Ventricular assist device (VAD) technology is applied to a broader population of heart failure patients, and clinicians are confronted with the specialized perioperative and chronic care of patients who receive these devices. VAD implantation is now an acceptable means of bridging to heart transplantation. We report a case of isolated right colon necrosis in a patient with VAD, who was successfully treated with right hemicolectomy and ileocolostomy.

Evolving technique for continent ileostomy: valveless pouch design.

A continent ileostomy, or Kock pouch, is a useful option for patients with inflammatory bowel disease whose only alternative is an end ileostomy. This technique has a high morbidity rate. Nipple valve slippage is the most common complication, causing incontinence or intubation problems. A novel, valveless continent ileostomy technique is described here. A porcine model was used to create the continent ileostomy. Two pouches were created and tested for integrity and continence using lactated Ringer's solution. Pouch pressure and volume were recorded in one pouch. The valveless continent ileostomy was successfully created twice, and both pouches were continent. An intraluminal pressure of 30 mmHg and a volume of 225 ml were measured in one pouch. In this preliminary report of a valveless continent ileostomy, we had promising results. The future of this technique in clinical practice needs to be addressed with further studies.