MULTIPLE COLONIC AND GASTRIC METASTASIS OF ENDOMETRIAL ADENOCARCINOMA -CASE REPORT (Abstract): INTRODUCTION:In the gynecological malignancies endometrial adenocarcinoma is the second most common, giving early hematogenous and lymphatic metastasis to the lungs, brain and bones. CASE REPORT: We present the case of a 71 year old patient who underwent surgery two years ago for endometrial adenocarcinoma and followed postoperatively multimodal oncological treatment. The patient was admitted in January 2013 in the First Surgery Clinic of the Emergency Clinical County Hospital Târgu Mureş, Romania, for chronic anemia, consumptive disease signs and subocclusive syndrome. The preoperative exams (upper and lower gastrointestinal endoscopy, thoracoabdominal computed tomography and ultrasound) found a tumor invading right, transverse and sigmoid colon as well as gastric antrum and spleen. A subtotal colectomy with ileo-rectal anastomosis was then performed associated with distal gastrectomy and splenectomy. The histopathological exams revealed gastric and colonic metastasis from the endometrial serous cancer operated two years ago. The postoperative evolution was uneventful. CONCLUSIONS: Endometrial cancer can metastasize to the colon and stomach even without the presence of endometriosis. Multivisceral resections and preoperative exams of the digestive tract are justified in terms of subjective complaints of an occlusive simptomatology.
Background: In the literature there are a number of studies that suggest a possible correlation between cholelithiasis/cholecystectomy and colorectal cancer. The exposure of the colon mucosa to the action of bile acids that potentially have a carcinogenic effect due to the change in anatomy after cholecystectomy, seems to be the explanation of this association. The purpose of this paper was to search for such a correlation in our study group. Methods: We performed a retrospective cross-sectional study, analyzing the patients admitted to the First Surgical Clinic of the County Emergency Clinical Hospital Tîrgu Mureș, between January 1 st , 2005 -December 31 st , 2010. Analyzing the medical records, operation protocols and histopathological results, we paid attention to demographics, location of neoplasia, the time elapsed since the cholecystectomy to the discovery of neoplasia, histological types, trying to perform correlations between these parameters and the lithiasic factor. Results: Out of the 534 patients admitted and operated with the diagnosis of colorectal cancer, 15.6% (n = 83) showed a history of gallbladder stone affection. Most patients came from urban areas, the average age was 67.2 (range 39-88 years), females were more affected. The most common locations were: the sigmoid colon (26.5%), rectum (36.3%) and the most common histological form was moderately differentiated adenocarcinoma. Conclusions: Similar to other studies, our work suggests a slight increase in the incidence of colorectal cancer in patients that underwent a cholecystectomy, without drawing a fi rm conclusion. We deem it necessary to see if diet changes of the Romanian population affect this relationship.
Background: Incisional hernias are important complications of abdominal surgery. Normally they are followed by the growth of the hernia sac and an increase of the abdominal wall defect with loss of domain of the herniated organs. Case report: We report a case of a 51 year old female, admitted in the 1 st Surgical Clinic of the County Emergency Clinical Hospital of Tîrgu Mureș with a large median reducible incisional hernia and a wall defect of 10/12 cm. The abdominoplasty was performed using the Oscar Ramirez technique, which consists of a longitudinal incision along the aponeurosis of the external oblique muscle, at approximately 1-2 cm from the external edge of the rectus abdominis. This procedure allows the abdominal wall closure. This case is part of a lot of 4 patients who received this treatment using the aforementioned procedure in the past 2 months. Postoperative recovery was favorable, bowel movements were present on the second day after the surgery, the subcutaneous drains were shortened on the fi fth day and removed on the sixth. There were no immediate postoperative complications or up to a month after the surgery. The patient was discharged on the seventh day. Conclusions: This technique can be used alone in case of large abdominal wall defects, or prequeling an on-lay mesh procedure addressed to a weak abdominal wall, case in which the functional result is superior to a substitutional mesh.
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