Hepatobiliary cystadenomas are rare tumors that are difficult to diagnose preoperatively. They can reach large sizes that make them real intraoperative "surprises". A 63-year-old woman, presented with a symptomatic huge abdominal cystic mass, underwent complete resection of the mass with safety margins. Histopathological report revealed mucinous hepatic cystadenoma with "ovarian-like" stroma and areas of sclerohyalinization. The differential diagnosis of the large cystic tumors which occupy the right hemiabdomen must include the biliary cystadenoma; the complete resection of the tumor with safety margins avoids local recurrence, and therefore represents the optimal therapy because of the malignant potential of the disease. The postoperative follow-up includes abdominal ultrasound or CT scan and CA 19-9 measurement.
BACKGROUND: For medium and low rectal cancer the most common surgical procedures are: low anterior resection with mechanical or manual colorectal anastomosis and transanal rectosigmiod resection with abdominoendoanal intubation. METHODS: We have conducted an observational, retrospective single-center study on a number of consecutive patients operated between January 1 st and June 31 st , 2011 for malign pathology of the middle and low rectum in The Clinical Emergency Hospital Bucureşti. We included patients with medium and low rectal cancer who had been previously treated by radiotherapy. We practiced rectal resection with mechanical colorectal anastomosis or abdominoendoanal intubation with anal mucous membrane removal. We assessed a number of parameters in relation to surgical procedure, such as: anastomosis dehiscence (AD), anastomotic stenosis (AS), the number of defecations in 24 hours, nocturnal incontinence, delayed bowel movement, flatulence continence, postoperative complications, local tumour recurrence and mortality. RESULTS: The study comprises 53 patients divided into 2 groups: the 1 st group, included 19 patients treated by rectal resection with abdominoendoanal intubation and anal mucous membrane removal, and the 2 nd group, included 34 patients treated by rectal resection with mechanical colorectal anastomosis. AD was found in 5.26% (1/19) in group 1, respectively 20.5% (7/34) in group nr 2. At 6 months follow-up, one patient from the 1 st group experienced AS (5.26%), as for the 2nd group, AS was present in 5 patients (14.7%); at 12 months after the procedure the number of patients with AS increased to 3 in group 1 (15.78%) and to 6 in group 2 (17.64%) respectively. After 12 months, the nocturnal incontinence evaluated between 11.00 pm and 06.00 am: 3 patients from group 1 had 1 night evacuation daily, in all days of the week; 1 patient from group 2 presented 2 night evacuations on week. After 12 months postoperative: 11 patients, (57.89%) from group 1 had complete continence and also 29 patients (85.29%) from group 2. Patients from group 1: 36.36% (4/11) needed evacuation clysters' and also 10.34% (3/29) for the group 2. In the case of group 1 mortality was 5.26% (1/19) and for group 2 was 8.82% (3/34). CONCLUSIONS: The intestinal transit disorders are quite frequent after colonal anastomosis."Achilles heel" of mechanical anastomosis is represented by postanastomotical stenosis.
Due to associated diseases, the function of the spleen may be modified, in turn causing certain complications, such as anaemia, altered coagulation, malnutrition and organ failure. Preoperative management of patients must take these two possibilities into account. In non-traumatic splenectomies, blood samples are necessary to screen for thrombophilia: antithrombin III deficiency, protein C deficiency, protein S deficiency and dysplasminogenemia. Complete blood count, AST, ALT, serum amylase, C-reactive protein, thrombin-AT-III complex and D-dimer also become necessary perioperatively. The preoperative management of anaemia must evaluate the risk and benefits of blood transfusion. Malnutrition increases the risk of postoperative complications. Antibiotics are recommended for patients who are immunosuppressed and in trauma. In the classical form of spleen surgery, pain is a frequent symptom, with variable intensity, mostly due to the pressure applied to the ribs. If the pain is not well managed by specific pills, it is better to make an anaesthetic block of the thoracic nerves. Thrombosis extending into the portal vein is rare; with an overall risk of 3.3%. Infection is the most common postoperative complication. Fever commonly appears between the fourth and seventh day after surgery. The risk of thromboembolic events and pulmonary arterial hypertension varies greatly, depending on the underlying condition for which the splenectomy is performed and its association with intravascular haemolysis. The most serious septic complication after splenectomy is the (OPSI), which brings about a prohibitory mortality rate of 50% to 90%. Prevention of postsplenectomy sepsis has occurred through the use of greater efforts to avoid splenectomies.
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