RezumatIntroducere: Actinomicoza abdominală este o afecţiune inflamatorie granulomatoasă rară produsă de o bacterie anaerobă Gram pozitivă Actinomyces israelii, care se manifestă ca tumori inflamatorii sau formează abcese. Evoluţia este lentã şi constã în extensie inflamatorie de contiguitate, fãrã limitã de organ, ce pretează la confuzia cu leziuni maligne abdominale. Material şi metodă: Am efectuat un studiu retrospectiv a pacienţilor cu actinomicoză abdominală operaţi în Clinica I Chirurgie Spitalul Universitar " Sf. Spiridon" din Iaşi, între 1980 şi 2018. Au fost înregistrate 13 cazuri (4 bărbaţi şi 9 femei) cu vârsta medie de 44,07 ani care s-au internat cu tumori abdominale (7 cazuri) şi boala inflamatorie pelvină (6 cazuri). Rezultate: Am identificat ca factori predispozanţi: dispositive intrauterine menţinute timp de 10 ani (6 cazuri), corpuri străine -2 cazuri (o scobitoare de lemn care probabil a perforat colonul, calculi biliari pierdut în peritoneu), diabet (3 cazuri), imunodepresia. Pacienţii au fost operaţi prin laparotomie (9 cazuri) sau laparoscopic (4 cazuri). Descriem cinci dintre aceste cazuri de actinomicoză care au mimat un cancer de colon: localizare ileo -cecală -3 cazuri, colon transvers -un caz şi mare epiploon -un caz, care au urmat tratament specific cu penicilină, având o evoluţie bună. Concluzii: Actinomicoza abdominală trebuie întotdeauna inclusă în diagnosticul diferenţial al tumorilor abdominale. Diagnosticul preoperator, dificil, dar posibil, poate evita intervenţia chirurgicală. Tratamentul cu antibiotice este necesar pentru vindecarea bolii. Controlul postoperator este obligatoriu, cu recidive posibile. AbstractIntroduction: Abdominal actinomycosis is a rare granulomatous inflammatory disease caused by a Gram-positive anaerobic bacterium Actinomyces israelii, manifesting as inflammatory mass, or abscess formation. Evolution is slow and steady in inflammatory contiguous extension without limit organ that lends itself to confusion with abdominal malignancies. Methods: We performed a retrospective study on the patients with abdominal actinomycosis operated in the First Surgical Clinic, "St. Spiridon" University Hospital Iasi; between 1980 -2018 there have been 13 cases (4 men and 9 women) with a mean age 44.07 years admitted for abdominal tumors (7 cases) or pelvic inflammatory disease (6 cases). Results: We identified as predisposing factors: IUD maintained over 10 years (6 cases), foreign bodies -2 cases (a toothpick probably perforated colon, gallstones lost in peritoneum), diabetes (3 cases), immunodepression. All cases were operated by laparotomy (9 cases) or laparoscopic approach (4 cases). We describe five of these cases of actinomycosis that had been mimicking a colon cancer: ileo -cecal -3 cases, transverse colon -one case and on the greater omentum -one case, followed by specific treatment with penicillin, with good evolution. Conclusions: Abdominal actinomycosis should always be included in the differential diagnosis of abdominal tumors. Preoperative diagnosis, difficult...
Morgagni hernia occurs after a congenital retrosternal diaphragmatic defect; it is a rare form of diaphragmatic hernia (1-3% of cases). In general, this pathology is diagnosed in children; in adults it is frequently discovered in emergency or incidentally. We prospectively evaluated a series of 8 patients admitted to First Surgical Clinic, St. Spiridon Hospital, Iasi during the period 2011-2017. Out of 8 patients, 6 were operated on, one patient refusing surgery (followed periodically); the patient who was 91 years old had serious associated diseases that made surgery contraindicated. Symptomatology was nonspecific: in 5 cases Morgagni hernia was discovered during the exploration of an associated pathology, either with cardiopulmonary symptoms of dyspnea or palpitations. In 2 cases, the clinical aspect suggested an occlusive syndrome (the herniated organ is usually the transverse colon). The laparoscopic approach was used in all cases: two conversions were recorded due to the tight adherences of the herniated viscera (gastric, colon, epiplon). In 4 cases, the surgical cure of hernia was performed by suture and in 2 cases with prosthesis: dual mesh in one case and polypropylene mesh in another case. We did not register morbidity and the mean postoperative stay was 4 days (range 2-6 days). Hernia Morgagni betrays a rare pathology. The most common is asymptomatic but in complicated cases it is a cause of acute surgical abdomen. Surgical treatment is indicated even for asymptomatic cases due to serious complications Morgagni hernia may develop. The laparoscopic approach is ideal, as reduction of viscera in the abdomen is easy and the defect will be repaired by suturing or using a prosthesis, depending on its size.
Establishing the treatment strategy for patients diagnosed with colorectal cancer is based on their imaging and immunohistochemical evaluation. Depending on the stage of tumor invasion and its aggressiveness, is individualized, surgical, oncological, or both treatment. The most important factor for establishing these protocols is the impact of the tumor on intra- and perilesional colorectal vasculature and implicitly on the process of vascular neoformation in the paraneoplastic syndrome. In this regard, we studied a group of patients, colonoscopically diagnosed with colorectal cancer. The study method was to compare the expression of CD34 tumor marker with EMVI (extramural vascular invasion) staging criteria. The results of our study were compared with the intraoperative aspects. In all cases studied tumor extension reached to at least intestinal muscle layer. We conclude that expression of the CD34 marker has always been increased in correlation with EMVI 3-4 stages. In 2 patients with EMVI score 2, the immunohistochemical marker expression was 6% above the maximum threshold. The expression of vascular endothelial proliferation marker is closely correlated with the EMVI score - these values increase proportionally. The use of both criteria for establishing neovasculogenesis, significantly increases the predictability of postoperative progression and long-term survival.
A single-port laparoscopic approach may be feasible and safe for the removal of a foreign body in the peritoneal cavity.
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