A complete rectal prolapse or procidentia is a protrusion of the rectum with all its layers through the anus. The incidence ranges between 0.79-6.08 per 100 000 population per year.The diagnosis could be easily established during examination, or in cases with internal rectal prolapse by defecography. Weakness of the anal sphincters is very common with advance disease and approximately 50% to 75% of patients experience some form of fecal incontinence. Symptomatic rectal prolapse is an indication for operation.Over 100 operative procedures have been described for the treatment of rectal prolapse and they all can be categorized as transabdominal and transperineal procedures. Delorme procedure is a transperineal procedure that consists of resection of a cylindrical mucosal flap and plication of the protruded rectal musculature.We are presenting two, senior and debilitated patients with procidentia and complete fecal incontinence, successfully treated with the Delorme procedure. The results of the treatment were remarkable regarding both the prolapse and the fecal incontinence.We are concluding that for the surgeon, who is already familiar with other anorectal procedures, the Delorme procedure is relatively simple and easy to learn, with excellent structural and functional results even in very poor-risk patients with a long-segment rectal prolapse.
Annular pancreas is very rarely presented with a clinical picture of obstructive jaundice, usually due to some biliopancreatic malignancy rather than choledocholithiasis which make our case unique. We are presenting a 60-year-old male patient with a 6 mounts old medical history of right upper quadrant pain and intermittent jaundice. On ultrasonography a common bile duct stone was detected with dilatation of the biliary tree and gallstones with edematous wall of the gallbladder. On gastroscopy narrowing of the duodenum was registered. On ERCP the papilla Vateri could not be cannulated and there was a substantial amount of retained food in the duodenal bulb and antral part of the stomach. MRCP showed extensive dilatation of the whole biliary tree from several stones in the distal part of the common bile duct. At the operation there was a ring of pancreatic tissue about 2 cm wide that surrounded the second portion of the duodenum. The operation proceeded with choledochotomy, choledocholythotomy, L-L choledocho-duodenostomy and partial resection of the pancreatic ring. After three mounts the patient had gain weight, had no pain or any other symptoms and control gastroscopy showed normal finding.
Introduction. Ventral hernia represents a problem for the surgeon and patients alike. eTEP repair is a technique that is minimally invasive, provides lower overall complication rates, decreased wound complications and the recurrence rates and shortens the length of stay in the hospital. Case. We present a case of a 48 year old patient who was admitted to our hospital for elective treatment of recurrent umbilical hernia. The patient had umbilical hernia repair 4 years ago, suture repair without mesh placement was performed according to the information given by the patient. On inspection there is visible supraumbillical scar, 12 cm in length with hernia bulging under the scar which is partially reducible on pressure. Discussion. The eTEP technique is closest to ideal because the abdominal cavity is not penetrated, is lessening the risk of visceral lesions and trocar site hernias, allows local or regional anesthesia, gives unsurpassed views of inguinal region and hernias and reproduces the technique of Rives-Stoppa. In favor to overcome the limitations deriving from the limited surgical field and restricted port set up, this technique has been modified based on the normal anatomy of the abdominal wall naming it dependently of the extension of the dissection and the location of the hernia. Conclusion. The extended-TEP (e-TEP) technique is based on the anatomical principle that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall. It provides the most of the benefits for the patients but also requires great surgical skill and understanding of the anatomy of the anterior abdominal wall.
Introduction. Cystic echinococcosis is a zoonosis caused by the larval stage of Echinococcus granulosus. In most of cases hydatid cysts are found in the liver but in rare cases a migration of the hydatid cyst can occur following rupture of hepatal pericist.Case. A 38 year old female presented with abdominal pain, fatigue, weakness and fever for more than three months. Computed tomography show segment II and IV hepatic per-magna cystic formations with dimensions: No I: 80×60×74 mm and No. II: 70×60×58 mm. Per magna cystic formation in the Douglas space, with dimensions of 93×90×62 mm with clearly expressed mass effect on surrounding organ structures.Discussion. Active hydatid disease may show migration of cysts due to rupture of hepatal pericyst, pressure difference between the anatomic cavities, and by contribution of gravity. Sudden death, anaphylactic shock and dissemination of disease can be seen with cystic content spillage into the peritoneal cavity.Conclusion. Migrated hydatid cysts are very rare parasitic manifestation presenting with symptoms deriving from the neighboring organs. They are diagnosed typically by CT and managed with evacuation of cysts following abdominal exploration. Full abdominal organ ultrasonography, with accent on the liver, should be performed in any case of intraabdominal simple cyst presence.
End-to end colorectal anastomosis with the ColonRing is feasible and safe procedure with fast learning curve. To date, this type of anastomosis is possible in left sided colon lesions where anastomosis is contemplated below the promontory. We find the device easy to use with high level of confidence. Further prospective studies including comparison between the ColonRing device and the conventional staplers evaluating long-term anastomotic complications (i.e., leak or stricture) are needed to evaluate the benefits and limitations of this device.
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