Adrenal metastasis as first presentation of hepatocellular carcinoma

BACKGROUND: Metastases from hepatocellular carcinoma (HCC) can be found in the lung and adrenal gland. We report case of a patient who presented with adrenal metastasis as the first clinical manifestation of HCC. CASE PRESENTATION: A patient was referred for surgical treatment for a tumor in retro-peritoneal space. The computerized tomography (CT) scan revealed a mass originating from the left adrenal gland. The patient underwent left adrenalectomy and the exploration of abdominal cavity did not reveal any other palpable lesions. Histologically, the resected lesion was a poorly differentiated metastatic tumor from HCC. Seven months later patient was readmitted complaining of cachexia, icterus, and significant weight loss. CT scan revealed hyperdense lesions of the liver CONCLUSION: HCC may have atypical presentations like in present case. Fine needle aspiration/tru-cut(® )biopsy might be useful in the investigation of an accidentally discovered adrenal mass regardless of the size and can lead to the detection of a primary tumor

Our local experience with the surgical treatment of ampullary cancer

BACKGROUND: The aim of this study is to report the outcome after surgical treatment of 32 patients with ampullary cancers from 1990 to 1999. METHODS: Twenty-one of them underwent pancreaticoduodenectomy and 9 local excision of the ampullary lesion. The remaining 2 patients underwent palliative surgery. RESULTS: When the final histological diagnosis was compared with the preoperative histological finding on biopsy, accurate diagnosis was preoperatively established in 24 patients. The hospital morbidity was 18.8% as 9 complications occurred in 6 patients. Following local excision of the ampullary cancer, the survival rate at 3 and 5 years was 77.7% and 33.3% respectively. Among the patients that underwent Whipple's procedure, the 3-year survival rate was 76.2% and the 5-year survival rate 62%. CONCLUSION: In this series, local resection was a safe option in patients with significant co-morbidity or small ampullary tumors less than 2 cm in size, and was associated with satisfactory long-term survival rates

Weil's disease and abdominal compartment syndrome

Purpose: To report a rare complication of Weil’s disease.Report of case: A 47-years-old man was referred to ICU of our hospital in shock. The clinical findings and the serological tests established the diagnosis of Weil’s disease. After the patient became haemodynamic stable, underwent a cholecystectomy for acute acalculous cholecystitis, while ten days later he developed abdominal compartment syndrome (ACS). The later, was successfully managed surgically, with decompression laparotomy, placement of a 3 lit TPN (Total Parenteral Nutrition) bag to cover the viscera and gradual closure of the abdomen by tying the tension sutures each time more tight. The patient returned home after two months of hospitalization, in a good general condition.Conclusion: Patients with Weil’s disease seem to be susceptible to the development of ACS. The clinicians must be always suspicious for the possibility of its occurrence, in order to have an early diagnosis and a therapeutic surgical intervention