Retrorectal endometrioid cyst: a case report

<p>Abstract</p> <p>Introduction</p> <p>Developmental cysts are the most common retrorectal cystic lesions in adults, whereas reports of endometrioid cysts in this anatomic location are extremely rare.</p> <p>Case presentation</p> <p>A 21-year-old nulliparous Greek woman presented with chronic noncyclic pelvic pain, and a retrorectal cyst was diagnosed. The lesion was resected through a laparotomy and, on histologic examination, was found to be an endometrioid cyst. The treatment was completed with a six-month course of a gonadotropin-releasing hormone analogue. One year after surgery, the woman remained free of symptoms, and pelvic imaging showed no recurrence of the lesion. Reviewing the literature, we found only three previous reports of an endometrioid cyst in this anatomic location.</p> <p>Conclusion</p> <p>In women of reproductive age, endometriosis must be included in the differential diagnosis of retrorectal cysts.</p

Transanal endoscopic microsurgery: an indispensable component of contemporary coloproctology

Petr Vavra, Petr Andel, Anton Pelikan, Lubomir Martinek, Petra Gunkova, Igor GunkaDepartment of Surgery University Hospital of Ostrava,Ostrava-Poruba, 17. listopadu 1790,708 52 Ostrava, Czech RepublicE-mail: [email protected] Background / objective At many surgical and gastroenterological working places still persists the problem what to do with an adhered tumour in the rectum at an unfavourable distance from the anus. This paper presents the possibilities offered by contemporary coloproctology by means of TEM (transanal endoscopic microsurgery) applied to the lesions that are hardly accessible. Patients and methods At the Department of Surgery of University Hospital Ostrava, the TEM method has been used since August 2002. The technique itself was implemented by Buess in the year 1983. His working place in Tübingen, Germany serves also as a training centre for teaching TEM. In the Czech Republic, the TEM method was used for first time in 1992. In TEM methodology the advantages of mini-invasive endoscopic medical help and the advantages of surgical treatment are combined. Results At the Department of Surgery of University Hospital of Ostrava in the period between 01/2003 and 12/2003 we carried out 37 operations by means of TEM. Of this number, 15 patients were operated on for benign rectum affection, 18 for malign disease, other 4 operations were twice on periproctal fistula, one operation for rectum stenosis, one introduction of a self-expandible stent. In malign rectum lesions we performed CT and endosonography preoperatively and used TEM twice for carcinoma in situ, 6 times for T1NXM0 lesions, 3 times for T2NXM0 lesions and 4 times for T3NXM0 lesions. These patients were then operated on transabdominally on the basis of definite histological findings. For a palliative effect we used TEM twice in patients with metastatic liver affection T3NXMl and once for a patient with T4NXMl. Conclusions The TEM methodology introduced in 2002 has become an inseparable and inevitable component of coloproctological operations at our department. We think the main contribution of this method consists in a safe treatment of wide benign rectum lesions, in treatment of early rectal carcinoma stages, and last but not least, the use of TEM in palliative surgery of rectum while emphasising the quality of life preservation. Keywords: transanal endoscopic microsurgery, TEM unfavourable distance, indication, harmonic scalpe

Tiesiosios žarnos vėžio chirurginis gydymas Ostravos universiteto ligoninėje, Čekijos Respublika

Petr Vavra1, Marie Rydlova3, Anton Pelikan1, Lubomir Martinek1, Petra Gunkova1, Michaela Vavrova2, Igor Gunka11 Department of Surgery and 2 Department of Radiology,University Hospital of Ostrava,3 Department of Pathology, Medical-Social Facultyof University of Ostrava,17 listopadu 1790, 708 52 Ostrava Poruba,Czech RepublicE-mail: [email protected] Background / objective Czech Republic is among the countries with the highest incidence of rectal cancer. The aim of the prospective study was to monitor the surgical treatment of patients with the diagnosis of rectal cancer. Patients and methods 188 patients (121 males and 67 females) with rectal cancer were operated on within the period of three years (2000–2002). The definitive analysis encompassed 171 patients. The following aspects were observed: the types of operations carried out, the safety distance of the lower resection line during the operation of rectal cancer mainly, the amount of lymphatic nodes spotted in the mesorectum and the possibility of their laparoscopic treatment. Results 129 patients were operated on by conventional methods and 42 patients (24.6%) by laparoscopical methods (25 anterior resections, 6 abdominoperineal amputations, 10 colostomies, 1 proctocolectomy). At a distance of 2 mm from the aboral edge of the tumour, the distal intramural spread of cancer was detected in 8 (11.8%), at 5 mm in 6 (9%), at 1 cm in 2 (2.6%), at 2 cm in 4 patients (5.8 %) and at 5 cm from the macroscopical edge no distal intramural spread was recorded. Enlarged lymphatic nodes were discovered in 128 patients. In total, there were 1383 lymphatic nodes, i.e. 10.8 lymphatic nodes per patient. 271 lymphatic nodes (19.5%) affected by a tumour process, i.e. 2.1 affected lymphatic nodes per patient were found. The number of the affected lymphatic nodes in the mesorectum was compared in connection with the usage of conventional or laparascopical operation. There was no difference in oncological radicality as far as these types of operations are concerned. Conclusions There is no evidence of the spread of well differentiated adenocarcinoma from the aboral edge of the tumour. All positive findings of distal intramural spread were found in the medium and lower differentiated adenocarcinomas. The distal intramural spread of the tumour is quite rare, but when present it signifies a very advanced and aggressive progress of the illness with a bad prognosis. It is too early to formulate the conclusions comparing the conventional and the laparoscopic approaches to rectal cancer

IMPROVING THE ECOLOGICALAND ECONOMIC INDICES OFTHE COMPANY ON THE BASIS OFTHE BESTAVAILABLE TECHNIQUES

It is shown that the modern society pays much attention to the issue of environmental security. On the basis of literary sources it is noted that there is a trend to strengthening the role of environmentally oriented management methods, guidelines for the modernization of production, implementation of environmental management systems and environmental certification. Environmental certification helps the company to properly allocate resources for environmental protection and provides the state with the accurate data and the receipt of payments in budgets of all levels for negative impact on the environment. The structural changes are based on the requirements of the environmental legislation, new requirements to ecological regulation. The authors confirm the need for transition to the Best available techniques (BAT), which significantly improve environmental and economic performance of the enterprise. Implementation of BAT requires the effective replacement of obsolete resource-intensive production and modern technology. Such transitions affect the size of payments for negative impact on the environment and the volume of economic incentives from the state. It is noted that Russia applies the European experience as a basis of creating guidebooks on the best available techniques. The definition of technology as the best available techniques is determined by the resolution of the Government of the Russian Federation. Indicators and information generated in the BREF are also required in carrying out the environmental monitoring and control. Changes in these indicators reflect the quality of the technology used. Implementation of BAT requires significant investments, the priority should be conservation projects that eliminate the most acute environmental problems and maximize environmental benefits. The increased interest of enterprises in the application of environmental technologies is not only based on obtaining favorable conditions for state support, but are also aimed at improving the company’s image, increasing economic capacity and competitiveness

Laparoscopic approach to retrorectal cyst

Retrorectal cysts are rare benign lesions in the presacral space which are frequently diagnosed in middle-aged females. We report here our experience with two symptomatic female patients who were diagnosed as having a retrorectal cyst and managed using a laparoscopic approach. The two patients were misdiagnosed as having an ovarian cystic lesion after abdominal ultrasonography. Computer tomography (CT) scan was mandatory to establish the diagnosis. The trocar port site was the same in both patients. An additional left oophorectomy was done for a coexisting ovarian cystic lesion in one patient in the same setting. There was no postoperative morbidity or mortality and the two patients were discharged on the 5th and 6th post operative days, respectively. Our cases show that laparoscopic management of retrorectal cysts is a safe approach. It reduces surgical trauma and offers an excellent tool for perfect visualization of the deep structures in the presacral space

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doi:10.3748/wjg.14.658