Hydatid cyst disease: optimal management of complex liver involvement.

The most frequent location of hydatid cystic lesions is in the liver (up to 80% of cases), followed by the lung (about 20% of cases), and with lower reported incidence, virtually in any other organ or tissue in the body. Therefore, the case an American medical practitioner would most likely encounter, albeit still rare, is a large, symptomatic liver cyst, similar to the one presented in this report. Current techniques and reasoning concerning optimal treatment of liver hydatid cyst disease are revisited, and recommendations based on available literature regarding ideal management of such cases are presented.

A malignant omental extra-gastrointestinal stromal tumor on a young man: a case report and review of the literature.

BACKGROUND: Gastrointestinal stromal tumors (GIST) are uncommon intra-abdominal tumors. These tumors tend to present with higher frequency in the stomach and small bowel. In fewer than 5% of cases, they originate primarily from the mesentery, omentum, or peritoneum. Furthermore, these extra-gastrointestinal tumors (EGIST) tend to be more common in patients greater than 50 years of age. Rarely do EGIST tumors present in those younger than 40 years of age. CASE PRESENTATION: We report a case of a large EGIST in a 27-year-old male. An abdominal pelvic computerized tomography imaging demonstrated an intra-abdominal mass of 22 cm, without invasion of adjacent viscera or liver lesions. This mass was resected en bloc with its fused omentum and an adherent portion of sigmoid colon. Pathology results demonstrated a malignant gastrointestinal stromal tumor with positive CD117 (c-kit) staining, and negative margins of resection, and no continuity of tumor with the sigmoid colon. Due to the malignant and aggressive nature of this patient's tumor, he was started on STI-571 as adjuvant chemotherapy. CONCLUSION: Stromal tumors of an extra-gastrointestinal origin are rare. Of the reported omental and mesenteric EGISTs in four published series, a total of 99 tumors were studied. Of the 99 patients in these series only 8 were under 40 years of age, none were younger than 30 years old; and only 5 were younger than 35 years old. Our patient's age is at the lower end of the age spectrum for the reported EGISTs. Young patients who present with an extra-gastrointestinal stromal tumor (EGIST), who have complete resection with negative margins, have a good prognosis. There is little data to support the role of STI-571 in adjuvant or neoadjuvant therapy after curative resection. Given the lack of data, the use of STI-571 must be individualized.

Right hemicolectomy in a severely anemic Jehovah's Witness patient with an extremely low preoperative hemoglobin level and the decision to operate.

Severe anemia is associated with high mortality, and patients with this condition are typically treated with packed blood red cells. Patients of Jehovah's Witness faith, however, do not accept blood transfusion therapy. The authors report the case of a Jehovah's Witness patient who presented with lower gastrointestinal bleeding secondary to Clostridium difficile colitis. Because the patient refused blood transfusion therapy, he underwent a right hemicolectomy with a preoperative hemoglobin level of 2.7 g/dL and a postoperative hemoglobin level of 1.8 g/dL. He was neurologically intact and discharged to a skilled care facility on postoperative day 10. The surgical team worked with the patient, his family, the anesthesiologists, and the Jehovah's Witness Hospital Liaison Committee physician members to devise a care plan that fully supported and respected the patient's religious beliefs and allowed him to maintain complete autonomy in his treatment decisions. Health care providers should be aware of how a patient's ethical, cultural, and religious background may impact treatment options.