[Solitary Fibrous Tumor in the Retroperitoneum : A Case Report].
T. ImanakaYoshiyuki YamamotoGo TsujimuraSayaka HoriiDaichi NonomuraHironori NomuraIwao YoshiokaShingo TakadaKenichi YoshidaHironao Yasuoka
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Abstract:
A 55-year-old man was diagnosed with an abdominal tumor and referred to our department. Abdominal contrast-enhanced computed tomography revealed a 15-cm tumor in the retroperitoneum. The inferior vena cava was compressed ventrally, the right ureter laterally, and the right kidney toward the head. Part of the tumor was situated on the dorsal side of the abdominal aorta. A preoperative diagnosis of neurogenic tumor or a type of sarcoma was made. We performed en bloc resection of the tumor. The right kidney was also resected. We exfoliated between the tumor and inferior vena cava without temporary interruption. The final diagnosis was a solitary fibrous tumor. The patient received no adjuvant therapy. Neither recurrence nor metastasis has been detected for 8 months postoperatively.Keywords:
Abdominal aorta
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From 1986 to 1990, 46 patients with blunt liver trauma were hospitalized and operated on in Kuang Tien General Hospital. Included were 33 males and 13 females with a mean age of 31 years (range: 2 to 62). The mean duration of the follow-up was 43 months. We classified the severity of liver injury with the liver injury scale which was published by the Organ Injury Scaling (O. I. S.) Committee of the American Association for the Surgery of Trauma (A. A. S. T.) in 1989. According to the operative findings, the liver injury of the 46 cases were classified as follows: grade I 4 cases, grade II 18 cases, grade III 16 cases, grade IV 2 cases, grade V 4 cases, and grade VI 2 cases. Among the patients, 4 cases were treated with drainage. Four cases underwent simple repair. Twenty-seven cases were treated with repair and drainage. Three cases underwent debridement and selective ligation of bleeding vessels. Four cases underwent partial resection of liver, and 3 cases required repair of the inferior vena cava. One case was packed with gauze for hemostasis. The mortality rate was 15.2%, and the morbidity rate 30.3%. The most frequent postoperative complications related to the hepatic injury in the patients who survived the initial operation were wound infection (8.7%), intra-abdominal abscesses (6.5%), pancreatitis (6.5%), pulmonary infection (4.3%), and small bowel obstruction (4.3%).
Blunt trauma
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Asymptomatic simultaneous thrombosis of abdominal aorta and inferior vena cava is a rare complication in advanced malignancy. We described an incidental finding of this clinical entity in our patient who presented with advance stage of malignant fibrous hystiocytoma of soft tissue and pathological fracture. The radiological evaluation with spiral computed tomography scan of abdominal aorta and inferior vena cava are presented and the subsequent management highlighted.
Abdominal aorta
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BACKGROUND: The management of coexisting intra-abdominal disease in aortic surgery is controversial. A staged repair is preferred by many and, in general, the symptomatic lesion is treated first. Twenty-one years ago this vascular unit elected a policy of treating such lesions synchronously. This was on the theoretical premises that the benefits of a single operation in these patients would outweigh the potential risks of graft infection and increased complication rates from a prolonged procedure. METHODS: The case records of 676 patients undergoing aortic grafting for aneurysmal or occlusive disease between 1978 and 1998 were analysed retrospectively. RESULTS: Fifty-five patients (8 per cent) had coexisting intra-abdominal diseases treated at the time of aortic graft surgery. These included biliary disease (26), and gastric (12), intestinal (13), urological (two), hepatic (one) and splenic (one) pathology. The median age at presentation was 72 (range 46-90) years. There were three hospital deaths and five patients required early reoperation, three for lower limb ischaemia and two for intra-abdominal bleeding. One patient developed a subphrenic abscess and there were three superficial wound infections. There were no graft infections in this group of 55 patients. CONCLUSION: This large single-centre experience with synchronous intra-abdominal surgery and aortic grafting demonstrates that it is safe and does not predispose to an increased risk of graft infection or perioperative haemorrhage.
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Inferior vena cava anomaly is usually asymptomatic. It is rare and commonly detected while performing abdominal imaging for other clinical situations. The anomalies can mimic normal anatomical structures. Thus, the identification of the anomalies is important to avoid complication during abdominal procedures. We report two cases of inferior vena cava anomalies found during Computed Tomography scan of our elective cases.
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We describe a patient with leiomyosarcoma of the inferior vena cava. There has been no previous report of the sonographic diagnosis of this rare entity.
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Objective: To evaluate the clinical efficacy of transperitoneal laparoscopic ureterovesical reimplantation.Methods: Three patients who were diagnosed with simple congenital ureter outlet stricture,underwent transperitoneal laparoscopic ureterovesical reimplantation.Results: All the operations were successful.The intraoperative blood loss was 20-80 mL(mean 45 mL).And the postoperative hospitalization was 7-12 day.No complications were occurred during operation and the follow up period for 3-6 months in 3 cases.Conclusion: Transperitoneal laparoscopic ureterovesical reimplantation has the advantages of minimal invasion,less blood loss and rapid postoperative rehabilitation,which is an effective and practical procedure.
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