In case of unidentified abdominal pain we have to consider the possibility of the stenosis of the celiac trunk. By our case study we would like to call the attention to the importance of the auscultation over the abdomen, which is a relevant part of the basic physical examinations. When getting to the final diagnosis, apart from the duplex doppler sonography, we also used the results of angiography. The essence of the surgery was to get rid of the outer compression of the artery, which has to be done as soon as possible in order to avoid that compression causes degeneration of the artery itself.
The authors present a case of locally advanced anal squamous cell carcinoma which, due to infiltration of deep structures, caused anal incontinence, serious pain, exulceration, and bleeding. Neoadjuvant radiotherapy made the tumour operable and abdominoperineal extirpation was performed. The large tissue loss of the anal and perineal region was covered by bilateral gluteus maximus myocutaneous flaps, and the loss of the pelvic musculature and the remaining pelvic skin loss were replaced by a right gracilis myocutaneous flap. The patient was discharged on the 36th postoperative day. There was no flap necrosis noted and an incomplete lesion of the proximal urethra healed after direct suturing. The patient was allowed to lye on the flap in the second postoperative month and sitting on the third month. Unfortunately, an inoperable infiltrative lymph node metastasis occurred in the right inguinal region after six months, and the patient died 10 months after the surgery. We believe that in cases of large, ulcerating anal tumours, when direct closure would be impossible due to massive tissue loss after resection, quality of life can be significantly improved by resection and closure with myocutaneous flaps.
No indication has been left for subtotal resection. Even if benign multinodular goitre is present, since the clinical and pathophysiological evidences suggest that multinodular goitre affects the entire gland, any surgery that leaves potentially abnormal thyroid tissue in situ carries a risk of recurrent disease. RLN palpatory method is a useful part of thyroid surgery but it is suitable for rough orientation only.
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