Pelvic Exenteration for the Management of Pelvic Malignancies

Pelvic exenteration is a surgical procedure first described by Brunschwig in 1948 as a curative or palliative treatment for pelvic and perineal tumors. It is actually a radical operation, involving en bloc resection of pelvic organs, including reproductive structures, bladder, and rectosigmoid. In patients with recurrent cervical and vaginal malignancy, it is associated with a 5-year survival of more than 50%. In spite of advances in surgical management, consequences such as stomas, are still frequently unavoidable for radical tumor excision. Most candidates for this procedure have been diagnosed with recurrent cervical cancer that has previously been treated with surgery and radiation, or radiation alone. Complications of pelvic exenteration are more severe than those of standard resection of a colorectal carcinoma, so it is not commonly performed, including wound infection, wound dehiscence (also described as burst abdomen) the creation of fistulae (perineal-fecal, uretero-vaginal, between conduit and perineal wound), urinary tract infections, perineal hernias and intestinal obstruction. Patients need to be carefully selected and counseled about risks and long-term issues related to the surgery. A comprehensive evaluation is required in order to exclude unresectable or metastatic disease. Evolution of the technique through laparoscopy and minimally invasive surgery may result in a reduction of morbidity and mortality

Diagnostic Colonoscopy Leading to Perforated Appendicitis: A Case Report and Systematic Literature Review

Introduction. Intestinal perforation is a known complication after colonoscopy. However, appendiceal involvement with inflammation and perforation is extremely rare and only 37 cases of postcolonoscopy appendicitis have been reported so far. We describe a case of perforated appendicitis 24 hours after colonoscopy that was treated successfully in our Department. Case Report. A 60-year-old female patient underwent a colonoscopy during the investigation of nontypical abdominal pain without pathologic findings. 24 hours after the examination she presented gradually increased right lower quadrant abdominal pain and a CT scan was performed, showing an inflammation of the appendiceal area with free peritoneal air. Through laparotomy, perforated appendicitis was diagnosed and an appendectomy was performed. The patient was discharged on the tenth postoperative day in good health condition. Discussion. The characteristics of all cases reported in the literature are described, including our case. Perforated appendicitis soon after a colonoscopy is a rare, but serious complication; therefore, it is crucial to be included in the differential diagnosis of postcolonoscopy acute abdominal pain

Simultaneous Hepatic and Mesenteric Hydatid Disease—A Case Report

IntroductionHydatid cysts most commonly present in the liver and the lungs; however, they can appear more rarely in other locations, such as the mesentery, with a rather unclear mechanism of manifestation. Herein, we present a case of simultaneous presence of hydatid cysts in the liver and the mesentery of a young man.Case reportA 39-year-old man was referred to our Department for further investigation of intermittent abdominal pain, especially in the right upper quadrant, and abdominal distension. Abdominal CT imaging revealed three calcified lesions, one in the liver, a similar adjacent to an ileal loop and one close to the urinary bladder, while antibody control was positive for echinococcal infection. The lesions were excised and the patient was discharged on the seventh post-operative day in good general condition. Post-operative control after 6 months did not show any signs of recurrence.ConclusionSimultaneous presence of hydatid cysts in two organs occurs in 5–13% of cases. Presence in the mesentery is extremely rare, although, should be included in the classic differential diagnosis, especially in endemic areas