Secondary Iliac-Enteric Fistula to the Sigmoid Colon Complicated with Entero-Grafto-Cutaneous Fistula

We report the case of a 67-year-old man who was admitted to our department with acute rectal bleeding. The patient had had previous aortoiliac surgery with the utilization of an aortobifemoral vascular prosthesis. Diagnosis of aortoenteric fistula was made between the distal suture line of the right graft leg and the sigmoid colon. This fistula had an enterocutaneous component. After exploratory laparotomy, primary resection of the sigmoid colon, exstirpation of the enterocutaneous fistula, excision of the right graft leg and extraanatomical crossover bypass were successfully performed. This study reports a rare type of aorto/ilac-enteric fistula to the left colon complicated with an entero-grafto-cutaneous component and describes an unusual and successful surgical treatment method

Jejunalis polyposisból származó heveny gastrointestinalis vérzés diagnosztikája és eredményes kezelése

The authors present an interesting case of massive gastrointestinal bleeding which is caused by extended jejunal polyposis. They discuss the diagnostic challenges and the way of successful treatment of this case. The authors also summarize their experience and review the relevant literature regarding acute gastrointestinal bleeding from the small bowel

"Fast track" vastagbélsebészet

A vastagbélműtéteket követ őgyors felépüléshez sok tényező járul hozzá. A műtéthez kapcsolódó folyamatok optimálissá tételéhez nemcsak az operációs technika, hanem ezen túl a műtét előtti és utáni tényezők is nagyban hozzájárulnak. A Medline elektronikus adatbázisból kulcsszavakra való kereséssel gyűjtöttük ki a megfelelő cikkeket, majd az oxfordi Evidence Based Medicine beosztása alapján rangsoroltuk őket és a legrelevánsabbakat használtuk fel. Randomizált, multicentrikus tanulmányok igazolták, hogy a vastagbélműtéteket megelőző hashajtás nem csökkenti az anastomosis insufficientiák és sebszövődmények számát; a hasi drének rutinszerű használata nem szükséges; a körültekintő, korai táplálás a vastagbélsebészetben is biztonságos és jól tolerálható, és a laparoszkópos vastagbélműtétek a nyílt műtétekkel egyenértékűek. A kapott evidenciákat jelenleg nem teljes mértékben alkalmazzuk. A laparoszkópos műtéti technika előnyeit a fast track perioperatív ellátás nagyban fokozza. Ahhoz, hogy a vastagbélsebészet perioperatív folyamataiban szerepet játszó faktorok előnyeit a legjobban kihasználhassuk, ezek kellő ismerete szükséges. Many factors have effect on the enhanced recovery after colon surgery. Not only the technical skill but the perioperative events needed to be optimized by the pre- and postoperative issues. Articles were obtained with search for keywords in Medline electronic database and evidences have been ranked according to the recommendation of the Oxford Evidence Based Medicine Centre. Multicentric, randomised studies have proved that preoperative bowel emptying could not decrease the number of anastomotic insufficiency and wound infection rate; the use of abdominal drains is not necessary in every case; the proper, early oral intake is safe and well tolerated in colo-rectal surgery, and with laparoscopic surgery the same results can be achieved as with open ones. The evidences found even are not used completely. The advantage of laparoscopic surgery can be improved with fast track methods. To use correctly the affecting factors it is essential to know the current literature

Colon- és csepleszmetastasis okozta ileus mint a ductalis emlőrák első klinikai jele

Distant spread from breast cancer is commonly found in bones, lungs, liver and central nervous system. Metastatic involvement of peritoneum, omentum or/and gastro-intestinal tract is unusual and unexpected. We present the case of a 48 year-old woman who presented with gastro-intestinal symptoms as signs of omental and colonic metastasis of an invasive ductal breast cancer, which was not diagnosed before her admission. Ileus was diagnosed and urgent surgery was performed. Histology revealed metastatic ductal breast carcinoma. Mastectomy and axillary lymphadenectomy were performed therefore. Reviewing the literature--to the best of our knowledge--such a case has never been published before

Detection of human papillomavirus type 16 in squamous cell carcinoma of the colon and its lymph node metastases with PCR and southern blot hybridization

The etiological role of human papillomavirus (HPV) in a number of squamous malignant tumors is well known. Squamous cell carcinoma (SCC) of colon is a rare disease with uncertain etiology. Our objective was to detect possible HPV infection in a colon SCC patient. The 94-year-old female patient was operated due to colon tumor causing passage disturbances. Histology confirmed SCC. Tumor tissue and the removed lymph nodes were examined with polymerase chain reaction and Southern blot hybridization techniques. Of HPV types most often occurring in malignant tumors (16, 18) the presence of HPV type 16 could be confirmed in the primary tumor and in four out of the nine surrounding lymph nodes, of which two were metastatic. HPV-16 infection could be detected in an SCC patient in the primary tumor and in surrounding lymph nodes. According to our knowledge, no similar study has been published yet. © 2008 Arányi Lajos Foundation

Kizárt combsérv klinikai képét mutató recidív retroperitonealis liposarcoma

56-year-old man was admitted to our hospital 18 month after extirpation of retroperitoneal liposarcoma. We diagnosed recurrent tumor in the inguinal fossa. The tumor situated along the femoral artery and propagated to the thigh among the muscles, mimicking incarcerated femoral hernia. We performed resection with synchronous abdominal and femoral exploration. By our knowledge this is the first case report about recurrent retroperitoneal liposarcoma presenting as an incarcerated femoral hernia

A pancreas praecancerosisai: intraepithelialis neoplasia (PanIN) és intraductalis papillaris mucinosus neoplasia (IPMN)

Pancreatic Intraepithelial Neoplasia (PanIN1-3) and Intraductal Papillary Mucinous Neoplasms (IPMN) putative precursors of and associated to pancreatic cancer represent a distinct, however pathologically heterogenous entity. Recently a new classification and nomenclature was established. We review the clinicopathologic and cytogenetic characteristics of PanIN and IPMN highlighting the nonaggressive biological behavior of intraepithelial and intraductal neoplasms which, in part explain their favorable prognosis

Aortoenteralis fistula ritka formája – sigmoideo-grafto-cutan fistula

We report a case of a 62-year-old man who presented to the emergency department with acute rectal bleeding. The patient had previous aortoiliac surgery with the utilization of an aorto-bifemoral vascular graft. Diagnosis of secondary aortoenteric fistula was made between the aortoiliac graft and sigmoid colon. This fistula had an entero-cutaneous component. After exploratory laparotomy resection of the sigma, extirpation of the entero-cutaneous fistula, excision of the graft, oversewing of the aortic stump, and extra-anatomical crossover bypass were successfully performed. This study reports a rare type of secondary aortoenteric fistula to the sigmoid colon complicated with an entero-grafto-cutaneous component and it describes an unusual and successful surgical treatment