Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Surgery with complete removal of the tumor is the primary treatment for resectable GIST and the only chance of cure. However, recurrence after surgery is common. The 2 main prognostic factors are the mitotic activity and the size of the tumor. Tumor rupture is also a risk factor for postoperative recurrence, and extra care should be taken while manipulating this soft and friable tumor. Imatinib mesylate (IM, Gleevec®, Novartis, Basel, Switzerland) is a tyrosine kinase inhibitor and was first studied in the palliative setting for metastatic GIST patients in the year 2000. It is now the cornerstone of metastatic GIST treatment. IM also plays an important role as an adjuvant treatment for resectable GIST and has been shown to increase the recurrence-free survival in phase III studies. However, some points remain to be clarified. Notably, the ideal duration of adjuvant IM after surgery is still unclear. It is also difficult to determine the exact place of surgery in metastatic or recurrent GIST patients in the IM era. A multidisciplinary approach is, therefore, mandatory to offer GIST patients the best treatment available.
A rare cause of intestinal obstruction after laparoscopic Roux-en-Y gastric bypass (RYGBP) is reported. A 42-year-old woman developed nausea, vomiting and dilated loops of small bowel upon commencing oral intake the day after RYGBP surgery. A CT scan demonstrated a loop of bowel twisting around the abdominal drainage catheter. After removal of the catheter, the patient's symptoms immediately resolved and her subsequent course was uneventful. We suggest avoidance of drainage catheters after uncomplicated laparoscopic RYGBP.
Pancreatic infection is associated with high morbidity and mortality. Drainage of the infection is the usual therapeutic approach. Clostridium perfringens infection can cause fulminant sepsis, but it rarely occurs within the pancreas. The case of a 76-year-old man with cystic pancreatic lesions in which sepsis developed after endoscopic ultrasound with fine-needle aspiration biopsy is described. The sepsis was managed with pancreatic resection and antibiotics. Clostridium perfringens was isolated from blood cultures and microbiologic smears from the pancreas. Invasive intraductal papillary mucinous neoplasm with lymph node involvement was identified on histologic examination. The patient made a complete recovery from surgery without complications.
Rectal cancer typically arises from the epithelial cells lining the lumen of the rectum. Extra-luminal primary rectal cancers are rare and differ histologically from retrorectal and sacral tumors. The current report presents the case of a 44 year-old male who developed adenocarcinoma outside of the lumen of the rectum 38 years after he underwent a pull-through procedure for Hirschsprung's disease. We hypothesize that the tumor emerged from an excluded, entrapped segment of rectal mucosa at the time of the patient's childhood procedure.
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