Acute lower gastrointestinal bleeding is a significant problem, a rare and life threatening situation, that has a mortality rate situated between 2 and 4% (1). According to recent studies up to 15% of them present as massive bleeding and 5% require surgery (2). Acute lower gastrointestinal bleeding can be divided according to their location in the small or large bowel. The small intestine is less interested and is known to be the commonest cause of obscure bleeding. About 5% of total lower gastrointestinal bleeding comes from the small intestine (3). When conservative medical treatment associated with interventional endoscopy can not handle the bleeding, endovascular therapy can be salutary. Also in some rare cases of acute lower gastrointestinal bleeding with hemodynamic instability the last therapeutic resource remains surgery. Thus, we will present two cases of acute lower gastrointestinal bleeding which were managed different, we will then summarize the different variants of available treatment and finally, in the conclusions, we will underscore the most important steps of the management algorithm and highlight the crossing point in acute lower gastrointestinal bleeding.
RezumatVã prezentãm cazul unui pacient în vârstã de 93 de ani cu ocluzie intestinalã datorate unei tumori de colon descendent, cu ascitã carcinomatoasã şi determinãri secundare hepatice şi pulmonare. Având în vedere riscurile asociate unui act chirurgical la un astfel de bolnav cât şi imposibilitatea efectuãrii unei intervenţii curative, a fost montat un stent colonic metalic auto-expandabil. Evoluţia post-intervenţie a fost favorabilã, pacientul fiind externat 48 de ore mai târziu. Cancerul de colon stâng se diagnosticheazã în fazã ocluzivã în 8 pânã la 26 % din cazuri (1). Acesta, necesitã de cele mai multe ori o rezolvare imediatã chirurgicalã datoritã potenţialului risc de deces. Procedurile chirurgicale efectuate în regim de urgenţã asociazã rate crescute de morbiditate şi mortalitate (2). Astfel au fost dezvoltate alte modalitãţi de rezolvare ale acestor urgenţe chirurgicale. Stenturile colonice au fost raportate prima datã în literaturã de cãtre Dohmoto (3). Iniţial, folosirea stenturilor a fost gandita ca şi metoda finala de paleaţie (4). Ulterior sau folosit ca punte catre chirurgia programata minim invaziva (5).Cuvinte cheie: tumora de colon descendent, ocluzie intestinalã, stent colonic metalic auto-expandabil AbstractWe present the case of a 93-year-old patient with intestinal occlusion due to a descending colon tumor, with carcinomatous ascites and secondary liver and lung determinations. Considering the risks associated with a surgical act in such a patient and the impossibility of performing a curative intervention, a self-expanding metallic colonic stent was mounted. The post-intervention evolution was favorable, the patient being discharged 48 hours later. Left colon cancer is diagnosed in the occlusive phase in 8 to 26% of cases (1). It often requires an immediate surgical resolution due to the potential risk of death. Emergency surgery involves increased rates of morbidity and mortality (2). Thus, other ways of resolving these surgical emergencies have been developed. Colonic stents were first reported in the literature by Dohmoto (3). Initially, the use of stents was as the final method of palletising (4). Later, they were used as a bridge to minimally invasive programmed surgery (5).
Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious complications, anastomotic leaks and secondary peritoneal abscesses, pancreatic complications after multivisceral resection and length of hospital stay. Conclusions. Preoperative anemia is a risk factor that exposes the cancer patient to an increased incidence of life-threatening postoperative complications. In addition, it also extends the length of hospital stay and costs. Therefore, special attention should be paid to the identification and reduction of anemia before extensive gastric surgery in order to obtain the best possible therapeutic result.
We present a preliminary report of an observational retrospective study of clinical and pathological features of emergency colorectal cancer (CCR) aiming to identify specific profiles of patients according to gender, age, and residence. This analysis would contribute to better understanding surgical emergency presentation and for identification of those characteristics that are essential for both reducing emergency CCR incidence and for improving the management of such cases. A number of 159 patients that underwent surgery for obstructive, bleeding and perforated colorectal cancer between January 2015 and September 2017 were selected to be included in the study. The results obtained by analyzing available data collected from the observation charts, surgery protocols, histopathological protocols were then compared with those in the literature.
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