Results of emergency Hartmann's operation for obstructive or perforated left-sided colorectal cancer

<p>Abstract</p> <p>Background</p> <p>Up to 15% of colorectal cancer (CRC) patients present with obstructive or perforated tumours, and require emergency surgery. The Hartmann's procedure (HP) provides the opportunity to achieve a potentially curative (R0) resection, while minimizing surgical trauma in poor-risk patients. The aim of this study was to assess the surgical (operative mortality), and oncological (long-term survival after curative resection) results of emergency HP for obstructive or perforated left-sided CRC.</p> <p>Methods</p> <p>A retrospective review of 50 patients who underwent emergency HP for perforated/obstructive CRC in our institution between 1995 and 2006.</p> <p>Results</p> <p>Median age of patients was 75 (range 22–95) years and the indications for HP were obstruction (32) and perforation (18 patients). Operative mortality and morbidity were 8% and 26% respectively. 35 patients (70%) were operated with a curative intent; in this group, overall 1-, 3- and 5-year survival rates were 80%, 54% and 40%. In univariate analysis, the presence of lymph node metastases was associated with poor 5-year survival (62% [Stage II] vs. 27% [Stage III], log-rank test, p = 0.02). Eleven patients (22%) had their operation reversed with a median delay of 225 (range 94–390) days. In this subgroup, two patients died from distant metastases, but there were no instances of loco-regional recurrence.</p> <p>Conclusion</p> <p>Hartmann's operation remains a good option to palliate symptoms in 30% of patients with left-sided CRC who are not candidates to a curative resection. For those who have a curative resection, the oncological outcome is acceptable, especially stage II patients, who appear to benefit the most from this surgical strategy.</p

Traitement de la diverticulite sigmoïdienne

While a majority of patients with diverticular disease remain asymptomatic, a subset will develop complications such as diverticulitis or bleeding. Simple diverticulitis is successfully managed with oral or intravenous antibiotics. Complicated diverticulitis is defined by the presence of abscess, fistula, stenosis or peritonitis. The severity of infectious complications is assessed by the Hinchey classification. Hinchey I stage is a small (<4 cm) pericolic abscess and is treated with intravenous antibiotics. Hinchey II stage is a larger (<4 cm) pelvic abscess, which usually requires percutaneous CT scan-guided drainage in addition to antibiotics. Hinchey III stage refers to purulent peritonitis and Hinchey IV to fecal peritonitis. Both stages require an emergent laparotomy. Indications for an elective sigmoidectomy are: a) two or more previous episodes of simple diverticulitis; and b) one episode of complicated diverticulitis

Paediatric living related intestinal transplantation between two monozygotic twins: a 1-year follow-up

We report on a syngeneic living related intestinal transplant in a paediatric setting with a 1-year follow-up. This procedure has allowed progressive growth and weight gain of a recipient patient and a resumption of normal activities with full social and familial reintegration

Chirurgie ambulatoire: une voie incontournable

The trend is to definitely shorten hospital stays. It follows in the footsteps of a broader range of surgeries that can be managed in an ambulatory care setting. The expected benefits are: a reduction in costs, a shorter preoperative delay, a shorter absence for the work place and a lessened risk of hospital-borne infections. A multidisciplinary approach is essential for the success of such a program. Surgeons, anaesthetists and nursing staff must be prepared to modify and adapt their skills. The criterion of success for such an endeavour is a low level of readmissions and hospitalisations. If day surgery tends to keep the patient away for the hospital settings, it certainly places him in the centre of his medical management

Spontaneous dissection of the superior mesenteric artery and the right hepatic artery: a case report

INTRODUCTION: Isolated spontaneous dissection of the superior mesenteric artery is a very rare condition. Endovascular stent placement has been proposed recently for selected cases, which has led to some good clinical results. CASE PRESENTATION: We report a case of spontaneous dissection of the superior mesenteric artery spreading to the origin of a right hepatic artery in a 48-year-old Chinese man. He benefited from the placement of an endovascular stent that yielded excellent results. CONCLUSION: Endovascular stent placement is a good alternative treatment for dissection of the superior mesenteric artery. We propose an algorithm for the management of this rare condition

Devenir à long terme des malades opérés et traités pour échinococcose alvéolaire

Alveolar Echinicoccosis is a severe parasitic disease: its natural evolution is comparable to a slowly progressive malignant liver tumour. There is no definitive medical therapy. Surgery remains the only option to assure a cure. This report is our surgical experience for the care of this affection

Spontaneous dissection of the superior mesenteric artery and the right hepatic artery: a case report

Abstract Introduction Isolated spontaneous dissection of the superior mesenteric artery is a very rare condition. Endovascular stent placement has been proposed recently for selected cases, which has led to some good clinical results. Case presentation We report a case of spontaneous dissection of the superior mesenteric artery spreading to the origin of a right hepatic artery in a 48-year-old Chinese man. He benefited from the placement of an endovascular stent that yielded excellent results. Conclusion Endovascular stent placement is a good alternative treatment for dissection of the superior mesenteric artery. We propose an algorithm for the management of this rare condition.</p