Appendiceal-sigmoid fistula presenting in a man with ulcerative colitis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ulcerative colitis is a chronic disease characterized by diffuse mucosal inflammation limited to the colon. It mostly affects young adults, yet a large number of middle-aged and older patients with ulcerative colitis have also been reported.</p> <p>Case presentation</p> <p>A 58-year-old Caucasian man presented to our hospital in August 2006 with continuous and diffuse abdominal pain, meteorism, fever and bloody diarrhea. He had a two-year history of ulcerative colitis. Our patient was treated with intravenous medical therapy. As his condition worsened, he underwent surgery. An explorative laparotomy revealed that the entire colon was distended and pus was found around an appendiceal-sigmoid fistula.</p> <p>Conclusions</p> <p>Therapy for ulcerative colitis <b/>is a rapidly evolving field, with many new biological agents under investigation that are likely to change therapeutic strategies radically in the next decade. Indications for surgery are intractability (49%), stricture, dysplasia, toxic colitis, hemorrhage and perforation. To the best of our knowledge, this is the first case of an appendiceal-sigmoid fistula in a patient affected by ulcerative colitis reported in the literature. Fistulae between the appendix and the sigmoid tract are rarely reported in cases of diverticular disease and appendicitis.</p

One Time Surgery in Contemporary Diseases of the Abdominal Wall and Pelvis in the Elderly

Introduction: The diseases most frequently found in the elderly are E.I. (inguinal hernia)* and BPH. (Prostatic hypertrophy non-neoplastic)*. The latter causes an effect on the abdominal wall to the increase in abdominal pressure from cervical-urethral obstruction, leading to the onset of the inguinal hernia pathology due to abdominal pressure which is higher, the greater as the residual bladder urine. The purpose of the study is to provide information on the surgical strategy and on timing in the presence of the simultaneous two diseases.Material and Method: Patients observed and joint treated were divided into two subgroups A (patients without) and B (patients with prosthetic implantation), with a mean age of 74 years. These patients accounted for 23% of the cases handled by hernioplasty and 49% of treated cases of BPH. The surgical treatment performed for joint pathologies in the two groups was that of a Pfannestiel single super-pubic incision extending on the projection of the inguinal ligament. In a first stage is performed a prostatic adeno-myomectomy sec Frayer, and subsequently an hernioplasty (prosthetic and do not).Results: The complications (seroma, hematoma) represented 10.6% of group A patients. In group B patients’ complications attested to only 6% of cases, without a significant increase in complications or therapeutic failure, or a prolongation of hospital stay which was an average of 4 days and of 2 days in group A and B respectively. Early recurrent hernia, episodes that usually occur in the immediate postoperative period (prosthesis mobilization, throttling of the spermatic cord, etc.), we observe only 1% in group B, while present in 3% of patients in group A without affixing the prosthetic material. Finally the follow-up, implemented for a period of 24 -36 months to two groups, was sufficiently adequate for the purposes of a detection of possible late complications or relapses.Discussion: The affixing of the prosthesis thanks to the continuous evolution of materials and improved surgical technique favors the consolidation of early hernioplasty and the further reduction of the relapse rate. The simultaneous treatment of the two diseases in terms of satisfaction in patients treated has produced excellent results. Patients with only one operating session are not exposed to additional risks both anesthesia, and surgical, still burdened by complicationsConclusions: The treatment of joint diseases EI ((inguinal hernia) and BPH (prostatic hypertrophy non-neoplastic) meets a great liking to the patient, for the adoption of a single analgesia to allow the implementation of both interventions in same day. Anatomical incision detects any non-clinically significant hernias, or unmask.</p

Markers of bile duct tumors

Biliary tract carcinomas are relatively rare, representing less than 1% of cancers. However, their incidence has increased in Japan and in industrialized countries like the USA. Biliary tract tumors have a poor prognosis and a high mortality rate because they are usually detected late in the course of the disease; therapeutic treatment options are often limited and of minimal utility. Recent studies have shown the importance of serum and molecular markers in the diagnosis and follow up of biliary tract tumors. This review aims to introduce the main features of the most important serum and molecular markers of biliary tree tumors. Some considerable tumor markers are cancer antigen 125, carbohydrate antigen 19-9, carcinoembryonic antigen, chromogranin A, mucin 1, mucin 5, alpha-fetoprotein, claudins and cytokeratins