C Decanini-Terán | PubMed Health

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[Laparoscopically created stomas].

PURPOSE: The aim of this paper is to present the results obtained in five cases with a stoma created by the laparoscopic approach. PATIENTS AND METHOD: Analysis of five patients who required a stoma as treatment for their diseases or as a complementary management of another medical problem from March 1999 to May 1999. There were three women and two men. Mean age was 43 years (range 20-59 years). Two women had a rectovaginal fistula secondary to radiation proctitis, another woman presented an infected sacral wound, one man suffered a sphincteric lesion that required sphincteroplasty, and the other man had Fournier's gangrene. Surgical technique included the use of two ports, one at the umbilicus for the camera and the other at the site previously chosen for the stoma. RESULTS: Mean surgical time was 30 min (range 20-40 min), transoperative bleeding was meaningless; all stomas began to function during the first 24 h after the procedure. One patient began oral intake on the first day, three patients on the second day, and one patient was intubated in the intensive care unit and for this reason was unable to eat. All stomas achieved the objective sought and there were no complications related to the procedure. CONCLUSIONS: Stoma creation by the laparoscopic approach may offer advantages over the open-surgery technique.

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[Primary melanoma of the esophagus. Unusual case with Barrett's esophagus].

OBJECTIVE: To present a rare entity of difficult preoperative diagnosis. BACKGROUND: Primary malignant melanoma of the esophagus represents 0.1% of all malignant tumors in this organ. It has been described in association with esophageal melanocytosis and melanosis with a clinic behavior similar to other neoplasm in the esophagus, but is more aggressive and fatal. By endoscopy, it usually appears as a vegetant, non-obstructive lesion, with dark pigmentation in the melanotic variant, the sole evidence that suggests the diagnosis prior to microscopic examination. Clinical exclusion of metastasis melanoma as a possibility is obligatory. METHODS: We reviewed clinical, imagenologic, endoscopic, and anatomopathological aspects of an ulcerovegetant neoplasm on the esophago-gastric junction, surgically resected, in a 65 years-old man with progressive dysphagia, who was without tumoral relapse during 18 months after surgery. RESULTS: The tumoral mass was an anaplastic cell tumor with very scant melanic pigmentation and diffuses stain for HMB-45 antigen and S100 protein, considering it to be a primary malignant melanoma. The neighboring mucous membrane showed a typical Barrett's esophagus and melanocytic hyperplasia. CONCLUSIONS: 1) Endoscopy may suggest the possibility of esophagus melanoma when there is a vegetate, non-obstructive, pigmented tumor. 2) Immunohistochemistry confirms the entity if HMB-45 antigen and S100 protein are detected in the tumoral cells, while the negative results for keratin and leukocytic common antigen (LCA) eliminate carcinoma and lymphoma as possible diagnoses. 3) In our case, the presence of Barrett's esophagus is exceptional, because it has not been described previously in the literature reviewed.

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