Seguimiento remoto de la recaída de hernia después de procesos abiertos de plastia de la pared abdominal– estudio prospectivo que incluye 142 pacientes

ResumenAntecedentesLa hernia incisional sigue siendo una complicación común de las laparotomías. El propósito del estudio es analizar la recidiva de hernia en un año, después de varios métodos abiertos de plastia de la pared abdominal.Material y métodosEstudio longitudinal prospectivo, en el que se incluyó a 142 pacientes. Se analizaron: los datos individuales, el grado de obesidad, las variaciones intraoperatorias de la presión abdominal, la intensidad del dolor postoperatorio, las complicaciones postoperatorias y los tipos de plastias de la pared abdominal: simple y con malla de polipropileno.ResultadosEl análisis del grupo estudiado estableció una tasa general de reincidencia de 16.9% y, en los 4 procesos, del 40.74% en caso de plastias simples, del 16.07% después de plastias onlay, del 6.97% después de plastias retromusculares y del 6.25% después de la sustitución completa de la avería parietal. Mediante el análisis de los datos obtenidos, la recidiva de la hernia fue significativamente correlacionada con: el grado de obesidad, las variaciones de la presión intraabdominal, el dolor postoperatorio y el tipo de procedimiento realizado.ConclusionesLa recurrencia de la hernia fue más frecuente en las plastias simples. Entre los procesos con malla, a la plastia onlay se le asignó una mayor tasa de recaídas y complicaciones postoperatorias. La recurrencia de la hernia fue más frecuente en las variaciones de la presión intraabdominal y con el dolor postoperatorio aumentado. La realización de la ecografía puede aumentar la precisión de la presencia de la hernia.AbstractBackgroundThe incisional hernia continues to be a frequent complication of laparotomies. The purpose of study is the analysis of hernia disease relapse after one year after different open plasties methods of the abdominal wall.Material and methodsA prospective longitudinal study was performed that included 142 patients. An analysis was performed on the individual data, the level of obesity, intra-surgical variations in intra-abdominal pressure, the intensity of post-surgical pain, the post-surgical complications, and the types of plasties of abdominal wall, simple and with polypropylene mesh.ResultsThe analysis of studied group showed a general rate of relapse of 16.9%, and within the 4 procedures, 40.74% in the case of simple plasties, of 16.07% after the only plasties, 6.97% after the retro-muscular plasties, and 6.25% after the full substitution of parietal defect. On analysing the collected, hernia relapse was statistically significantly related to the level of obesity, variations in intra-abdominal pressure, post-surgical pain, and the type of procedure performed.ConclusionsHernia is a frequent complication of laparotomies. Hernia relapse was more frequent in the case of simple plasties. Among the mesh procedures, the onlay plasty showed a higher rate of relapse and post-surgical complications. Hernia relapse was more frequent in the case of variations of intra-abdominal pressure, and with increased post-surgical pain. The use of an echography examination may increase the accuracy of the presence of hernia disease

Rare cause of digestive hemorrhage – synchronous gastrointestinal stromal tumor of jejunum – case report

Clinica Chirurgicală II Tg-Mureş, Departamentul de Anatomie PatologicăTumora gastrointestinală stromală este o neoplazie malignă rară, reprezentând 0,1-3% din neoplaziile gastrointestinale. Tumora interesează cel mai frecvent stomacul (50-70%), intestinul subţire (20-30%) şi colonul – mai puţin de 10%. Descriem cazul unui pacient de sex masculin în vârstă de 61 ani internat cu anemie severă, datorate unei hemoragii digestive grave prin tumoare stromală gastrointestinală sincronă jejunală cu ulceraţie dublă a mucoasei intestinale. Gastroscopia, colonoscopia şi irigografia nu poate preciza sursa hemoragiei. Computer tomografia evidenţiază îngroşarea marcată a peretelui jejunal (21 mm). Se intervine chirurgical constatându-se intraoperator două tumori jejunale, prima la 30 cm de unghiul Treitz aderent de o ansă ileală şi epiplon, iar a doua la 30 de cm distal de prima tumoră. S-a practicat rezecţie segmentară de jejun şi ileon ”en bloc” cu anastomoză jejuno-jejunală şi ileo-ileală. Evoluţia postoperatorie a fost favorabilă, cu externarea pacientului în ziua a 6-a postoperatorie. Rezultatul examinării histopatologice: tumori stromale gastrointestinale maligne, pleomorfe sincrone, CD117 pozitiv. Concluzii: tumorile stromale gastrointestinale pot fi evidenţiate prin explorări imagistice; rezecţia chirurgicală completă ”en bloc” constituie terapia în cazul tumorilor rezecabile.Gastrointestinal stromal tumor is a rare malignant neoplasia, representing 0,1-3% of gastrointestinal cancers. This tumor appeares most frequently in the stomach (50-70%), small bowel (20-30%) and colon – less than 10%. We describe here the case of a 61 years male patient who was admitted in our surgical department for severe digestive hemorrhage by jejunal gastrointestinal stromal tumours with synchronous double ulceration of intestinal mucosa. Gastroscopy, colonoscopy and irigography did not specify the source of bleeding. Computer tomography shows marked wall thickening of jejunum (21 mm). Intraoperatively we found two jejunal tumors, first at 30 cm from the angle of Treitz joint to the ileon and epiplon and the second at 30 cm from the first tumor. We performed “en bloc” segmental jejunal and ileal resection with jejuno-jejunal and ileo-ileal anastomosis. The postoperative outcome was favorable; the patient was discharged on day 6 after surgery. The histopathological examination showes: pleomorfe synchronous malignant gastrointestinal stromal tumors, CD117 positive. Conclusions: gastrointestinal stromal tumors can be revealed by echo and CT ; “en bloc” surgical resection is the therapy of choice for resectable tumors

Subungual squamous cell carcinoma leading to arm amputation

Although rare, subungual carcinoma is the most common malignant nail tumor. The symptomatology is not characteristic, being very similar to that of other nail and periungual diseases. For this reason, early diagnosis is usually established by performing a biopsy. With appropriate treatment, subungual carcinoma usually has a favorable prognosis. Metastatic cases are rarely encountered, but they usually have a poor therapeutic result. This article presents the case of a patient with subungual carcinoma (diagnosed by histopathological exam), initially treated by amputation of the distal and middle phalanges of the fourth finger. Two years after the operation, a recurrence in the epitrochlear nodes was diagnosed, for which epitrochlear lymphadenectomy and postoperative chemotherapy were performed. At 7 months, metastases were detected in the axillary nodes, which were treated with radiotherapy and chemotherapy. The appearance and development of the tumor at the elbow and the lower third of the arm led the patient to accept scapulohumeral disarticulation. The patient finally adapted to the physical infirmity, having a good general condition and an optimistic attitude