Background: Anastomotic leakage is a fearsome complication in rectal surgery. Surgeons perform the classic air-leak test, although its real effectiveness is still debated. The aim of this study was to describe a personal technique of reverse air leak test in which low colorectal anastomosis were assessed transanally through the intra-rectal irrigation of a few mL of saline solution. Methods: From October 2014 to November 2019 eleven patients with low rectal cancer (Type 1 in Roullier classification) were included in this study. At the beginning of the procedure, a circular anal dilator (CAD) was inserted into the anus. A side-to-end colorectal anastomosis was performed. A few mL of saline solution were injected into the rectum and the entire anastomotic line was directly explored. The appearance of bubbles was considered as an anastomotic defect and repaired with an interrupted suture. A fluorescence angiography after intravenous injection of Indocyanine green was performed in order to evaluate the perfusion of the anastomosis. Results: In 4 cases (36.3%) the reverse air-leak test was positive. The defect was repaired and a confirmation test was performed. In all patients, near-infrared evaluation showed not perfusion defect (grade 0) in low colorectal anastomosis. No post-operative fistula was detected in cohort study. A protective stoma was performed in 10 patients. At 90-days there were no complications and stoma closure was performed as planned. Conclusion: The reverse air-leak test is a simple, feasible and effective procedure to identify anastomotic leak in low colorectal anastomoses.
HighlightsEctopic thyroid is thyroidal tissue located far from its anatomic place.A patient under our observation displayed left submandibular swelling.The FNAC test report described a follicular adenoma.Based on the FNAC diagnosis, we surgically removed the mass.The post-operative follow-up was uneventful.
HighlightsThis is a rare case of WS after surgery in patients with small AML.Renal Angiomyolipoma (AML), a benign mesenchymal tumor, is the most frequent cause of WS.Ten million people worldwide have such lesion.We have reported a rare case of WS due to rupture of small AML after five days from colorectal surgery.We suppose that the breaking of the lesion was favored by bridging therapy with low-molecular weight heparin.
HighlightsThere are rare reports of small intestinal intussusceptions caused by metastatic lung carcinosarcoma.Medical treatment, chemotherapy, and radiotherapy are not active in this kind of tumor, so surgery is the treatment of choice.Surgical treatment plays an important role in lung cancer patients with GI metastasis that cause bowel obstruction, perforation, or massive hemorrhage.This presentation shows the third case in literature.
The nephron-sparing techniques allow the excision of kidney tumors preserving renal function and ensuring adequate oncological results. We describe a case of a 77-year-old patient who underwent an ex vivo partial nephrectomy with orthotopic autotransplantation for kidney cancer. The postoperative course was marked by bleeding which required radiological embolization. Postoperative dialysis was required for about 1 month. The anatomopathological examination showed a clear cell carcinoma staged pT1b, pNX, R0. At 2 years follow-up, no recurrence was detected with a complete renal function restoration. Our experience shows that ex vivo nephron-sparing surgery with autotransplantation is a good alternative to total nephrectomy in the case of voluminous or perihilar tumors. Considering the high morbidity of this procedure, it should be only performed in specialized centers.
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