Our experience does not support the routine use of colonic stenting for extracolonic cancer obstructing the colon. A more realistic approach is necessary including either the acceptance that the obstruction represents a life-ending event or proceeding immediately to a colostomy. Decisions should be individualised and stenting used after recognising its shortcomings.
In our own practice, patients undergoing SEMS as a "bridge to surgery" have the same long-term survival with those undergoing elective surgery. This finding needs to be confirmed in larger scale studies.
We report the case of an 81-year-old man with agenesis of the gall-bladder that presented with choledocholithiasis, obstructive jaundice, and very high CA 19-9 serum level (2765 U/ml). On ultrasound and CT scan, the gallbladder was not visualised and it was assumed shrunken and filled with gall-stones. After repeated unsuccessful endoscopic retrograde cholangiopancreatography, the patient was operated on for common bile duct (CBD) stones. At laparotomy the gall-bladder was not identified but a 3 cm long gall-stone was removed from the CBD. After decompression of the CBD all symptoms disappeared and the CA 19-9 returned to normal. We believe that this is the first report in the literature of gall-bladder agenesis presenting with high serum level of CA 19-9.
Primary gallbladder lymphoma is rare. Perforated cholecystitis due to primary gallbladder lymphoma and not related to chemotherapy has been unreported. We report the case of an 80-year-old woman presenting with an acute abdomen and clinical peritonitis. Her serum amylase was raised to 878 iu/l. Urgent computed tomography revealed generalised free fluid with a normal pancreas and was non-diagnostic as to the underlying pathology. An emergency laparotomy revealed bilious peritonitis with a necrotic patch on a distended gallbladder. A cholecystectomy was carried out and histology of the gallbladder revealed a marginal zone lymphoma.
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