A Rare Case of Primary Gastric Melanoma

Abstract Primary melanomas in the gastrointestinal tract are extremely rare, with an estimated prevalence of 0.5 to 1 case per million. Primary mucosal melanomas of gastric origin account for approximately 1–3% of all primary melanomas in the gastrointestinal tract. We present the case of a patient who underwent surgery due to primary gastric melanoma

Polyp of jejunum detected by endoscopy as a reason of chronic anemia in a patient with polyps of stomach. A case report

Wstęp: Polipy jelita cienkiego stanowią bardzo rzadką patologię i równie rzadko są przyczyną krwawienia w obrębie przewodu pokarmowego. Opis przypadku: Przedstawiono przypadek chorego z przewlekłą niedokrwistością, okresowo zaostrzającą się, wymagającą wielokrotnych przetoczeń masy erytrocytarnej i suplementacji żelaza, u którego rozpoznano endoskopowo dużego polipa hiperplastycznego w jelicie czczym jako źródło przewlekłego krwawienia do przewodu pokarmowego. Wnioski: Polipy w jelicie czczym mogą być rzadką przyczyną przewlekłych krwawień do przewodu pokarmowego. Aby znaleźć miejsce krwawienia, wykonuje się badanie endoskopowe górnego odcinka przewodu pokarmowego. W badaniu tym należy także ocenić jelito znajdujące się poza częścią zstępującą dwunastnicy, najdalej jak tylko jest to możliwe w zasięgu endoskopu.Background: Polyps of the small intestine are a very rare pathology and they are also a reason for rare gastrointestinal bleeding. Case report: A case of a patient with chronic anemia, periodically becoming aggravated requiring multiple blood transfusions and iron supplementation, with a large hyperplastic polyp of jejunum detected by endoscopy as a source of chronic gastrointestinal bleeding, is described. Conclusions: Polyps of the small intestine can be a rare reason for gastrointestinal bleeding. A gastrointestinal upper endoscopy should be performed in every case of searching for gastrointestinal bleeding, with an attempt to estimate the small intestine beside the descendent part of the duodenum as far as possible

The mask of duodenal tumor in the course of colon cancer

Rak dwunastnicy należy do najrzadszych nowotworów przewodu pokarmowego. W każdym przypadku podejrzenia pierwotnego nowotworu dwunastnicy należy rozważyć możliwość, czy jest to nowotwór wychodzący z innego narządu, z wtórnym zajęciem dwunastnicy. Autorzy niniejszej pracy przedstawiają przypadek raka zagięcia wątrobowego jelita grubego z przetoką okrężniczo-dwunastniczą i naciekaniem dwunastnicy, przebiegającego pod maską raka dwunastnicy.Duodenal cancers are the most rare neoplasms of the digestive duct. Every time when we suspect primary duodenal neoplasm, we should consider the possibility, that in fact it is a neoplasm of a different origin site, secondarily infiltrating the duodenum. We present a case of cancer of the hepatic flexure of the colon, accompanied by a colo-duodenal fistula, infiltrating the duodenum, which could be misdiagnosed as duodenal cancer

Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated in animal models that selective intra-arterial ICG staining can be used to define and visualize resection margins in rectal cancer. In this animal study, we investigate if laparoscopic intra-arterial catheterization is feasible and the staining of resection margins when performing total mesorectal excision with a laparoscopic medial to lateral approach is possible. In 4 pigs, laparoscopic catheterization of the inferior mesenteric artery (IMA) is performed using a seldinger technique. After a bolus injection of 10~ml ICG with a concentration of 0.25~mg/ml, a continuous intra-arterial perfusion was established at a rate of 2~ml/min. The quality of the staining was evaluated qualitatively. Laparoscopic catheterization was possible in all cases, and the average time for this was 30.25 ± 3.54~min. We observed a significant fluorescent signal in all areas of the IMA supplied, but not in other parts of the abdominal cavity or organs. In addition, the mesorectum showed a sharp border between stained and unstained tissue. Intraoperative isolated fluorescence augmentation of the rectum, including the mesorectum by laparoscopic catheterization, is feasible. Inferior mesenteric artery catheterization and ICG perfusion can provide a fluorescence-guided roadmap to identify the correct plane in total mesorectal excision, which should be investigated in further studies

Effectiveness and safety of sleeve gastrectomy and adjustable gastric banding in morbidly obese patients single centre study

Introduction: This retrospective study aimed to compare short- and long-term outcomes between laparoscopicsleeve gastrectomy (SG) and laparoscopic adjustable gastric banding (LAGB). Material and methods: This retrospective one-centre study included patients who underwent bariatricsurgery in the form of LAGB and SG. Results: %BMIL was significantly higher in the SG group than in the LAGB group during postoperativefollow-up months (p < 0.001). LAGB patients had a lower %EWL compared to SG at each postoperativefollow-up month (p < 0.05). After LAGB, 25.0% patients had %EW ≥ 50%; in the LSG group, 44.8% patients achieved %EWL ≥ 50% (p < 0.0001). The LAGB group’s %EWL ≥ 50 was dependent on BMI before operation (p = 0.049). There are no postoperative complications after LAGB. A total of 221 patients in the SG group 6 (2.7%) had postoperative surgical complications within 30 days after surgery. Postoperative complications in the long term were significantly higher for LAGB than for LSG (p = 0.0062). Reoperation was performed in 16 (7%) patients after LAGB compared to 2 (0.9%) patients after LSG. Conclusions: LSG is a more effective procedure than LAGB, contributing to greater improvement of weightloss. LAGB is associated with lower surgery-related complications in the early postoperative period,but long-term outcomes contributing to a higher late complication rate led to a higher reoperation ratethan SG procedure

Impact of Weight Loss Due to Sleeve Gastrectomy on Shear Stress of the Femoral Vein in Morbid Obesity

BACKGROUND: Studies have shown that obesity is associated with venous flow disturbances that lead to changes of the biomechanical forces on the venous wall known as shear stress. We hypothesized that weight loss due to bariatric surgery affects the venous hemodynamics and biomechanical forces on the venous wall. The aim of this study was to evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on the wall shear stress (WSS) and the venous hemodynamics of the femoral vein. METHODS: We studied ten morbidly obese patients who underwent LSG. We investigated venous hemodynamics before, 6 and 12 months after LSG. The femoral vein diameter, cross-sectional area, peak (PeakV) and maximum (TA(max)) velocities, WSS, and shear rate (SR) were assessed. RESULTS: PeakV and TA(max) were significantly lower in the obese patients compared with the control group. WSS and SR were significantly lower in the obese patients compared with the control subjects. Venous hemodynamic parameters increased in the postoperative period at baseline compared with 12 months after surgery: PeakV increased from 17.53 (14.25–20.01) cm/s to 25.1 (20.9–30.1) cm/s (P = 0.04) and the TA(max) from 12.97 (11.51–14.6) cm/s to 18.46 (13.24–24.13) cm/s (P = 0.057). WSS significantly increased from 0.21 (0.19–0.23) Pa at baseline to 0.31 (0.23–0.52) Pa 12 months after surgery (P = 0.031). SR also significantly increased from 47.92 (43.93–58.55) s(−1) at baseline to 76.81 (54.04–109.5) s(−1) 12 months after surgery (P = 0.02). CONCLUSIONS: This study showed that weight loss due to LSG significantly changes the biomechanical forces on the femoral vein generated by blood flow

Influence of Obesity on Anastomotic Leakage After Anterior Rectal Resectionperformed Due to Cancer

Anterior resection for rectal cancer carries the risk of serious complications, especially fistulas at the site of anastomosis. Numerous factors have been shown to impact anastomotic leakage. The results of studies on the influence of obesity on the frequency of anastomotic leakage after rectal resection performed due to cancer have been contradictory. The aim of the study was to evaluate the relationship between body mass index (BMI) and frequency of anastomotic leakage after anterior rectal resection performed due to cancer. Material and methods. This retrospective analysis included 222 subsequent patients who had undergone anterior resection due to cancer with an anastomosis formed with a mechanical suture. The patients were divided into 3 groups depending on their BMI quartile as follows: Group I, BMI 29.38 kg/m2 (upper quartile). Results. Anastomotic leakage occurred in 8 (3.6%) patients. Fistulas occurred in 4 out of 61 patients (6.56%) in group I, which was the highest incidence of fistulas for all 3 groups. In group II, fistulas occurred in 2 out of 55 patients (3.63%), and similarly, in group III, they occurred in 2 out of 106 patients (1.87%). The differences found in the frequency of fistulas between groups were not statistically significant (p=0.31). The logistic regression analysis did not show any relationship between leakage and age (p = 0.55; OR = 1.02; 95% CI: 0.95 - 1.1), sex (p = 0.97; OR = 0.97; 95% CI: 0.22 - 4.25) or BMI (p = 0.27; OR = 0.58; 95% CI: 0.22 - 1.53). Conclusions. The results of our study show that BMI did not have any influence on the frequency of anastomotic leakage after anterior rectal resection performed due to cancer