Left-sided inferior vena cava (IVC) is a rare congenital malformation, as is persistent descending mesocolon, a developmental anomaly in which the colonic mesentery does not fuse with the dorsal abdominal wall. Although these anomalies are mostly asymptomatic, they should be identified preoperatively to avoid iatrogenic injury. We report a case of sigmoid colon cancer in a patient with both anomalies. The patient was an 80-year-old man whose preoperative computed tomography (CT) scan showed that the IVC ascended vertically along the left side of the abdominal aorta, and the descending colon was at the abdominal midline. Coronal CT was particularly useful for visualizing these anomalies. With this better understanding of the malpositioned anatomy, we successfully performed laparoscopic sigmoidectomy with lymph node dissection. Careful evaluation of preoperative CT imaging based on a clear understanding of such anatomical anomalies is particularly important for performing safe laparoscopic surgery.
Background
Tracheoesophageal fistula is a one of the most severe adverse events of chemoradiotherapy (CRT) for esophageal carcinoma.
Methods
Case
The patient was an 84-year-old man who was referred to our hospital due to dysphasia, which had persisted for 2 months. Upper gastrointestinal endoscopy demonstrated a semicircular esophageal tumor. Biopsy revealed squamous cell carcinoma. Further examination revealed regional lymph-node metastasis but no distant metastasis. The clinical classification, according to the TNM 7th edition was T4b(trachea)N1M0 Stage IIIC. CRT (using cisplatin (CDDP)/5-fluorouracil (5-FU) infusion with concurrent radiotherapy) was performed. At two weeks after the initiation of CRT, the patient developed pneumonia due to tracheoesophageal fistula. The respiratory infection was controllable and the tumor remained after CRT. Tracheal stent insertion and esophageal stent insertion were performed sequentially as palliative treatments.
Results
There were no specific complications in association with stent insertion and the patient was successfully discharged from the hospital.
Conclusion
Tracheal and esophageal stent insertion are considered to be safe and feasible palliative treatments for tracheoesophageal fistula.
Disclosure
All authors have declared no conflicts of interest.
Introduction: Acute cholecystitis is one of the most common diseases in patient with acute abdomen. Current management of acute cholecystitis is based on Tokyo guideline suggestion. In current studies, there's not much discussion about the cost and outcome for acute cholecystitis with different severity. In our study, we would like to analyze and discuss the cost-effectiveness and outcome for the treatment of acute cholecystitis based on TG18. Method: From October, 2015 to December, 2016, patients S18 years old with a diagnosis of acute cholecystitis in Linkou Chang Gung Memorial Hospital and those who were operated were included. Patient demographics, length of hospital stay, operation details, medical costs, morbidity and in-hospital mortality are recorded. Patients were divided into 3 groups according to their severity, and were further divided into two subgroups according their treatment modality (follow or deviate TG18). Result: In our study, ratio of follow or deviated from TG18 were listed. Grade I and grade II (should be operated early according to TG18) patients with higher age, higher CCI, higher CRP, tended to had a delayed operation. Compared to those who had a early operation, delayed operation had higher medical cost (follow/diviate, p<0.005) and longer length of total hospital stay (follow/deviated,p<0.001).In contrast, for those grade II and III patients that delayed operation were recommended, higher conversion rate, more blood loss, higher morbidity, and higher ICU admission were noted if these patients were treated against TG 18 recommendation. Conclusion: According to our study, TG18 treatment suggestion is cost-effective and has good clinical outcome.
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