HIIC may be applied to select patients with peritoneal carcinomatosis from gastrointestinal malignancies with 27.0% major morbidity and 1.5% treatment-related mortality. The frequency of complications was associated with the extent of the surgical procedure and not with variables associated with the delivery of heated intraoperative intraperitoneal chemotherapy. The technique has shown an acceptable frequency of adverse events to be tested in phase III adjuvant trials.
Background. Radiologic tests to determine the size and location of cancer on peritoneal surfaces are needed for patient management and for clinical research activity.
Methods. Computed tomography (CT) of the abdomen and pelvis were obtained on 45 patients with a diagnosis of peritoneal carcinomatosis before implementation of a complete exploratory laparotomy with biopsy or resection of all tissues suspicious of malignancy. CT findings and surgical findings were recorded and the data analyzed by dividing the abdomen into 9 regions or into 15 anatomic sites.
Results. In an overall patient analysis, the sensitivity was 79%. In the nine different abdominal regions, sensitivity was greater than 80% in the right flank, left flank, and right lower and left lower abdominal regions. Sensitivity was lowest in the pelvis (60%). Negative predictive value in the pelvis was 20%. The volume of tumor present within an abdominal region or anatomic site greatly influenced the sensitivity. A sensitivity of only 28% was recorded when tumor nodules were less than 0.5 cm in thickness. This increased to 90% when nodule thickness was greater than 5 cm.
Conclusions. CT is not a reliable diagnostic test for low volume tumor on peritoneal surfaces, and the greatest inaccuracies were recorded in the pelvis. Its diagnostic value increased as tumor volume increased.
Highlights
Diverticuli are found throughout the gastrointestinal tract from esophagus to rectum.
In the jejunum diverticuli are most commonly proximal, multiple and asymptomatic.
A large solitary jejunal diverticulum caused life endangering midgut volvulus.
In the absence of timely surgical intervention the condition would have been fatal.
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