[Esophago-digestive anastomosis dehiscence]. / Dehiscenta anastomozelor esofagodigestive.

This paper aim is to discuss the main etiopathogenic aspects responsible for eso-digestive anastomotic leakage, as well as prophylactic and therapeutic measures of this postoperative complication. There were studied 173 consecutive eso-digestive anastomosis: 103 anastomosis performed for malignancy and 70 anastomosis for benign conditions. Surgical operations followed by an eso-digestive anastomosis were: esophageal reconstruction for benign esophageal caustic strictures (n=67); total gastrectomy (n=55); total esophagectomy (n=13); total esophagectomy plus total gastrectomy (one case); eso-gastrectomies (n=34); upper gastric pole resection (n=2); distal esophageal resection (n=1). Eso-digestive anastomosis topography were cervical (n=81), intrathoracic (n=37) and abdominal (n=57). There were 30 eso-gastrostomies, 81 eso-jejunostomies, and 62 eso-colostomies. There were recorded 24 eso-digestive anastomotic dehiscences (13.8%): 14 in the cervical region (17.2% out of 81 cervical anastomosis); 5 intrathoracic leakages (14.2% out of 35 anastomosis); 5 intraabdominal anastomotic dehiscences (8.7% out of 57 intraabdominal anastomosis). Four patients died as an anastomotic leakage consequence: two patients died after cervical eso-gastrostomy dehiscences, one patient died after an intrathoracic eso-jejunostomy leakage, and one patient died after intraabdominal eso-gastrostomy leakage. In conclusion, we analyze postoperative results, emphasizing the role of discovering and removal of predisposing factors which may lead to an eso-digestive anastomotic leakage.

Loco-regional advanced colorectal cancer: diagnostic and therapeutic features.

The objective of this study is to analyze the main diagnostic and therapeutic aspects in locally advanced colorectal cancers, related to recent advances published in the medical literature. The paper analyzes 2nd Surgical Clinic cases of advanced colorectal cancers over a five year period: 224 such patients operated on, with 79.9% tumor resectability (64.4% with radical intent); in 12.94% extended resections were necessary in order to achieve primary tumor removal. Overall morbidity and mortality rate were 52.23% and 7.14%, respectively. In conclusion it has been emphasized that improvements are necessary to be made in order to achieve a good staging of disease and, as therapeutic feature, in locally advanced cases extended resections may be perform with acceptable risks for the patients.

[Hemorrhagic intestinal lymphangioma --report of a case]. / Limfangiomul intestinal hemoragic--prezentare de caz.

This paper presents the case of a male patient, 57 years old, admitted to the hospital for upper digestive bleeding revealed by melena stools. The upper digestive endoscopy has not discovered the source of bleeding. Conventional medical therapy, with hemostatics, proton pump blockers and transfusion, failed to stop the bleeding, requiring emergency surgery for stopping the bleeding. The intraoperative exploration discovered three submucosal formations with dimensions between 0,5 and 0,75 cm, who ulcerated the jejunal mucosa, situated at 20-25cm from the duodeno-jejunal angle. The pathologic report described haemorrhagic intestinal lymphangioma. The excision of the sub-mucosal haemangioma stopped the bleeding.

[A rare cause of peritoneal fistula]. / Fistula abdominala de cauza neobisnuita.

The abdominal pregnancy is an extremely rare variety of the ectopic pregnancy. The symptoms are atypical, which causes a delay in putting the diagnosis, which is established most of the times when complications appear, which are always severe, and endanger the patients lives. This paper presents a rare complication of the abdominal pregnancy, at about 6 months old, stopped in evolution, complicated by an abscess, generalised peritonitis and peritoneal fistula. The diagnosis and treatment of the abdominal ectopic pregnancy are discussed.

[Unusual late complication after esophagoplasty type Gavriliu II for esophageal stenosis from chemical burns--cancer of the esophagoplasty tube]. / Complicatie tardiva rara dupa esofagoplastie tip Gavriliu II pentru stenoza esofagiana postcaustica--cancerul tubului de esofagoplastie.

We present the case of a 56 year old female, who in 23 years after esophagoplasty type Gavriliu II, with pre-sternal tube for esophageal chemical burn stenosis, develops a cancer in the upper third of the gastric tube, with a fast evolution to malnutrition, through lumen obturation. The evolution post-esophagoplasty was marked by malfunction of the neo-esophagus, characterized through dysphagia and distal dilatation, requiring many abdominal and pre-sternal reinterventions. The objective of the present surgical intervention was to assure a way for enteral nutrition (gastrostomy for feeding) and to extirpate the gastro-esophagoplasty tube. It is discussed the characteristic feature of the case: the difficulty of the stage-evolutive integration of this malignant disease location, the etiopathogenic factors that contributed to the malignant evolution of the antral portion of the gastro-esophagoplasty tube, the limits of the surgical treatment.

[Crohn's disease. Clinical and therapeutical considerations]. / Boala Crohn. Consideratii clinicoterapeutice.

Crohn's disease is a chronic granulomatous inflammatory condition of the intestinal tract of unknown etiology. Most commonly the disease affects the small bowel, the colon and the rectum. The acute and aggressive forms can evolve fast, mimicking an acute surgical illness, requiring surgical intervention in emergency. Surgical therapeutical option, in this condition, must be determined strictly by establishing a correct intraoperative diagnosis, through macroscopic features and histologic evidence. Because it is an incurable disease with variable evolution, marked by recurrence, that involves repeated surgical intervention, the surgical treatment (often resection), must be most conservative from the small bowel. We present 3 cases of surgical interventions with emergency characteristics (bowel obstruction through fitobezoar, colonic tumors obstruction of colon splenic angle, urachal infected tumors). In these cases the diagnosis was established intraoperatively and the surgical intervention was adapted to the particular cases.

[Coloesophagoplasty, a choice operation for postcaustic esophageal stenosis]. / Coloesofagoplastia, interventie de electie pentru tratamentul chirurgical al stenozelor esofagiene postcaustice.

OBJECTIVE: To evaluate the problems of approach, of technique and of care as a 20 years experience demonstrates. MATERIAL AND METHOD: a retrospective study including 45 operated cases where the large-bowel served as reconstructive material (in 33 cases the transverse colon and in 12 cases right ileocolon). RESULTS: Healing was obtained in 42 patients. Early postoperative evolution presented: peritonitis caused by anastomotic leakages--2 cases, hemoperitoneum--2 cases, cervical fistula --1 case, wound infection--6 cases, evisceration--1 case, acute respiratory failure--6 cases. Cervical anastomosis reconstruction for late stenosis--1 case. There were 2 postoperative deaths by haemorrhagic shock and peritonitis--mortality 4.4. DISCUSSIONS: Reconstruction by using the large-bowel was justified through anatomic argumentation (sufficient vascular supply), technic argumentation (easy anastomosis, tension free, short time of execution), functional argumentation (good compliance of large-bowel to the new function). CONCLUSION: Coloesophagoplasty is an efficient method on the condition of a strict planning: continent gastrostomy and evolvement of vascular arcades due to previous vascular "carving".

Invasive papillary carcinoma of the mammary gland: histopathologic and immunohistochemical aspects.

Papillary lesions of the breast, both being and malignant, can prove to be a very challenging diagnosis in histological preparations. This study emphasizes on the importance of immunohistochemistry and in particular, the identification of myoepithelial cells for the correct evaluation of these lesions.